A pre­scrip­tion of or­der

In­ject­ing hope into a vir­u­lent health­care set­ting

Executive Magazine - - Leaders -

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

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