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Healthcare in Lebanon

Guiding Principle

This Articleprovides an overview on the general healthcare situation inLebanon.

The healthcare system in Lebanon is much diversified; there are public and private healthcareproviders, public and private financiers, political agendas and different laws and regulations.

Officially the governmental bodies are the regulators, but the private healthcareproviders are the real influential forces in the market.

I.    Rules and Regulations related to Healthcare

1.   Labour Law and Social Security Law

In contrast to employment laws of other countries in the Middle East, the Lebanese system features a particular care for work of women and children as well as a social security system. The basic Lebanese Labour Law (abbrev. LE-LL) is quite old; it was issued on September 23rd 1946 and amended continuously (the latest amendment took place in May 2000).

In addition to the Lebanese Labour Law, the Social Security Law (abbrev. LE-SocSecL) also regulates rights of the employee and his dependants with regard to health and sickness, which came into effect on July 25, 2006. It includesprovisions such as an end of service gratuity, regulations for sickness, maternity and compensation for work related accidents, illnesses and casualties.

As per Art.40 LE-LL, every employee or worker shall be entitled to the following sick leave:

  • Half a month with full pay, and half a month with half pay for employees or workers , who have spent three between (3) months and two (2) years in service;
  • 1 month with full pay and 1 month with half pay for employees or workers, who have spent between two (2) and four (4) years in service;
  • 1 month and a half with full pay and 1 month and a half with half pay for employees or workers, who have spent between four (4) and six (6) years in service;
  • 2 months with full pay and 2 months with half pay for employees or workers, who have spent six (6) years up to ten (10) years in service;
  • 2 months and a half with full pay and 2 months and a half with half pay for employees or workers  who have spent more than ten 10 years in service.

Sick leaves shall be granted on the basis of a medical report. The employer may reduce the annual leave to eight days in case the sick leave exceeds one (1) month (Art.41 LE-LL). Dismissal cannot occur during sick leave.

Art. 13 to 27 LE-SocSecL guarantee the right of the working persons to keep good health, and safeguard the right of pregnant women to care and support. Benefits in case of maternity and sickness include medical care and cash payments. Any employee or labourer from any sector is eligible to enrol in theprogram.

2.   Healthcare Insurance Law (Public)

a)   National Social Security Fund (NSSF)

The NSSF was established in 1963 by a decree. Itprovides employees and their dependants with a national insurance coverage for sickness, maternity care and work related accidents and diseases. The insured is, however, required to cover 10% of the hospitalizations costs and 20% of the medication and examination expenses. Also the dependants of the members of the NSSF are not fully covered. The only full coverage is given to the terminal ill.

According to the decree, all employees must contribute to the NSSF. Small companies with less than 10 employees must submit a report every three months, larger companies monthly. There are 75 inspectors country wide. Hence, the likelihood to be caught if a company does not comply with this rule is minimal. Therefore, only 38,890 companies with 355,646 employees are registered, whereas it is estimated that there are 116,000 companies with 1.3 million employees.

Social security contributions are calculated as a percentage of monthly salaries, including overtime, gifts, or fringe benefits.

As far as foreigners are concerned, who are working in Lebanon(holders of work permits), they are entitled to social security benefits, provided their countries of origin offer equal treatment to Lebanese workers (i.e. France, Italy, UK, Syria, and Belgium).

Non-resident foreigners and Lebanese are exempted from social security contributions if they are working inLebanonpursuant to an employment contract concluded abroad with foreign companies and if their employerproduces evidence that the employees are entitled to social security benefits in their country of residence at least equivalent to those offered inLebanon.

b)   Civil Service Cooperative (CSC)

The civil service cooperative covers the regular governmental staff. The CSC covers government employees and their families and does not require any contribution from the employees except a 1 % deduction of the salary as a part of the government budget. It covers 75 % of ambulatory services for employees and 50 % of their family members, hospitalization services are covered 90 % for employees and 75 % for family members.

c)   Funds for the Military and the Security Forces

There are four more funds for the members of the military and the security forces. Different than the NSSF, the members of the security forces are fully covered for hospitalization and ambulatory services. Their dependents benefit from the insurance schemes according to the degree of the relationship to the member of the insurance.

d)   Ministry of Health Financing Scheme

The Ministry of Health’s Financing Scheme is the insurer of the uninsured, even though it is by itself not a social insurance scheme. Its potential beneficiaries are the majority of the population (42.7 %). It is funded by the government budget and covers 80 % of the hospital bills as direct payment, with full coverage of expensive intervention.

3.   Healthcare Insurances Law (Private)

The Lebanese insurance market is in line with the free Lebanese economy, open and liberal. Insurance companies take advantage of the system and select only the young, healthy and financially well situated clientele. Expensive treatments are usually excluded from the insurance schemes.

II.  Healthcare in the in Day to Day Life

Before 1975Lebanonboasted advanced health services and medical institutions that madeBeiruta healthcare centre for the entire Middle Eastregion. The war, however, caused enormousproblems. Emergency medicine and the treatment of traumatic injury overwhelmed the healthcare sector during the 1975 Civil War. During the war inLebanon, the public healthcare sector declined and was taken over by private enterprises and by non governmental organizations (NGOs).

Indeed, the problems in healthcare continued into the 1980s. A World Health Organization (WHO) study, conducted in 1983, found that the private sector dominated healthcare services and that public sector health organizations were in chaos.

By now, the private sector is delivering 90% of the health services. That comes at quite a high price tag. The overall expenditure per person in a year is US$ 499.—and thus in line with the expenditure in Europe and North America. However, the health indicators in Lebanonare in line with those in the region. For instance the life expectancy is 69 for men and 72 for women; the infant mortality rate is at 27 per 1000 births.

The regional distribution of healthcare is very uneven, with an agglomeration in Mount Lebanon and Beirut. On the other hand, Lebanonboasts the highest rate of physicians per capita in the Middle East, and treatment in every specialty is available in the country. Universities train very skilled physicians and investments have been made in order to lower the healthcare price level.

III. Healthcare in the Private Sector

Healthcare in the private sector is provided through hospitals, clinics, private laboratories and NGO-owned public healthcare centres. Since the health sector is growing in an unregulated milieu, investments are uncontrolled and the demand supplier induced. Consequently, there is an oversupply of beds, high-tech equipment and specialized doctors, but an undersupply of nurses due to a poorly perceived personal status.

Private hospitals do not offer the same quality of services to the rich as well as the poor. Occasionally, private hospitals collect extra fees from patients that are admitted under a contract with the Ministry of Health or under other public funds.

IV. Healthcare in the Public Sector

Healthcare in the public sector isprovided by public Primary Healthcare centers and dispensaries, in addition to non-individual preventive care through health education and screening campaigns. Public hospitals are overstaffed and operate under rigid administration, and are not able to compete in the market.

A Public Hospitals Autonomy Law has been introduced in 1996, which seems to have created an increase in admission and patient satisfaction

January, 2010 Sabine Reindel and Marco Zucco
Meyer-Reumann & Partners – Abu Dhabi Office
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