A prescription of order
Injecting hope into a virulent healthcare setting
When word broke earlier this year that physicians and pharmacists have been treated to new prescription forms by order of Health Minister Wael Abou Faour, the matter seemed pale — perhaps even byzantine — when compared with the minister’s flashier preoccupations. Who wants to bother with discussing some bureaucratic, procedural reform when there are so many daring indictments of food villains and patient-rejecting hospitals to drum up, replete with photo ops?
Even with the prospect that the new prescription regime might save citizens and the state some pretty pennies on drug expenditures — 30 percent ought to be possible, according to officials (see story page 18) — and at the same time stimulate local production of generic pharmaceuticals, almost everyone ignored examining the new measure and its significant, albeit not short term, implications.
Everyone except Executive, that is. Even more shocking than the malnourished attention given to pharmaceutical issues that each year represent, give or take, 5 percent of our painfully high total imports bill, is another healthcare cost problem. Lebanon may spend much more than it needs to on branded pills but as a society we spend far too little on health overall, it appears, whether on primary healthcare or on preventive medicine.
Data shows that Lebanon spent a mere 7.2 percent of its GDP on health in 2012. This sounds good when compared with an exorbitant expenditure of 12.4 percent of GDP back in 1998 but when compared with the average of 9.3 percent share of healthcare in the GDP of the developed nations in the Organization for Economic Cooperation and Development (OECD), this is far from enough. It means we and especially our younger generations may be sitting on a medical time bomb.
This explosive potential has two components. The first is underfunding and under-investment. According to the Economist Intelligence Unit’s Healthcare outcomes index 2014, the Lebanese currently get good value on money spent on healthcare, as spending per individual amounts to $684 and ranks higher in outcomes than for spending.
However, the index unsurprisingly shows a correlation between healthcare expenditures and outcomes. Maintaining a developed healthcare system typically requires total expenditures to hover around or above 10 percent of national GDP and countries that do so demonstrate advanced efficiency in health outcomes. Not investing sufficiently in the universal provision of advanced healthcare — and such underspending is implied by the sinking share in GDP — means that the national bill is in danger of blowing up from an eruption of accumulated health risks.
The second component of Lebanon’s health gamble is the combination of an aging population and a general increase in lifestyle diseases.
The evidence for this is as strong as it is shocking, even when examining just one massive lifestyle risk. More than one third of Lebanese adults smoke cigarettes, according to a 2008 survey. The survey cautions that “11.3 percent of the adult Lebanese population suffers from smoking-related heart disease [while] smokers with heart disease make up 6.6 percent of the total population.”
Aging and correlated demographic change is also an established fact. A Lebanese male born between 2005 and 2010 can expect to live 76 years, while a female can expect to reach 80. While longer lifespans are not at all a bad thing, experience from developed economies such as Japan shows that population aging has massive implications for healthcare and state spending needs.
If the inevitable rise of lifestyle diseases and the increasing needs of an older populace come to a point of confluence with underfunded and underinvested health safety nets and woefully insufficient pension structures, the cost bomb could be mindblowing for a state that has made it a habit to exist on the financial edge. Conventional economic wisdom is that countries with debt issues — and boy do we have one — will be hit harder by increases in health and age related spending needs.
Making healthcare more efficient in Lebanon, as in the