BEIRUT: Caretaker Health Minister Ghassan Hasbani said Lebanon should carefully assess reservations in the international community over an expected Hezbollah takeover of the Health Ministry, because “it’s people’s lives at stake.”
“We should be careful with how we handle this situation,” he told The Daily Star in a wide-ranging interview at the Health Ministry. “We can’t take this lightly and dismiss what is being expressed.”
Since President Donald Trump took office, the U.S. has ramped up sanctions against Hezbollah and its patron, Iran. Fears are growing in Lebanon that the country may face collective punishment if the party takes over a prominent service ministry in the next Cabinet, thereby gaining access to public funds that could allow it to circumvent sanctions via the state Treasury.
It is unclear what collective measures the United States would take against the Lebanese government, given the U.S. provides minimal funding to Lebanon’s health sector.
Hasbani did not provide details of what he thought could happen should Hezbollah head the ministry.
So far, the sanctions have been limited to people and entities with alleged links to Hezbollah.
“I hope the next period will pass without consequences on the health sector or on Lebanon in terms of relationships with global entities and the international community,” he said.
The public health sector has already seen devastation once, during the Lebanese Civil War.
By the end of the 15-year conflict, the number of public sector hospital beds had plummeted from 15 percent of total hospital beds, spread over 25 public hospitals, to just 6 percent spread across 12 public hospitals. The Health Ministry found itself increasingly outsourcing care to private hospitals, with its mandate shifting from running public health care to negotiating with the private sector.
Today, nearly 30 years later, Lebanon is back at prewar levels, with 121 private hospitals housing 12,578 beds and 32 public hospitals with 2,653 beds - a split of about 80 percent private to 20 percent public.
Hasbani said the large private hospital sector was nearly twice as efficient as the public sector, pointing to the fact that 28 percent of Health Ministry spending went to the latter even though it only comprised 17 percent of total beds. The ministry spends its half-billion-dollar budget almost entirely on medicine and hospitalization.
Public hospitals in Lebanon have the “enviable” position of being run like private hospitals, he said, each with their own board of directors appointed by Cabinet from outside the purview of the Health Ministry.
But “they are still stuck in the old days of bureaucratic government and suffer from political nepotism and forced employment.”
While Hasbani said the state was not obliged to support public hospitals because they should be self-sufficient, the ministry provides them with LL10 billion ($6.6 million) each year in addition to hospitalization funds.
Nonetheless, Hasbani said lack of funding from the Finance Ministry has forced public hospitals to go into debt and tighten their services. “The biggest problem [facing public sector hospitals] is ... LL200 billion the [Finance Ministry] owes them since 2002,” he said.
“If that’s paid, public hospitals would be thriving today,” he said, but it doesn’t help that “each time someone wants to give political favors to a region they build a hospital without planning it, and then the government has to suffer from having to serve it,” Hasbani added.
“Corruption starts from those politicians creating nepotism and inflated employment in public hospitals. Let’s be clear about that.”
CORRUPTION: THE SICKNESS IN HEALTH
Historically, corruption has been rife in two main parts of the health sector - the contracting and payment of bills between the ministry and private hospitals, and management of the pharmaceutical market.
The ministry has made efforts in the past few years on the former, contracting third-party administrators to check bills from private and public hospitals - a “quantum leap” in transparency, Hasbani said.
In 2017, the move reduced excess spending in the sector from the ministry’s budget by LL35 billion ($23 million), with just $1.5 million paid to third-party administrators.
He said he expected a larger amount to be saved this year.
Hasbani denied any “chaos” in the pharmaceutical sector, claiming it was “created by some journalists and two or three individuals.”
Scathing reports in local media, prominently from daily Al-Akhbar, have claimed Lebanon has highly inflated drug prices, causing people to increasingly head abroad to buy medications, including to Turkey.
Hasbani, a member of the Lebanese Forces, said it was a “logical possibility” that this criticism was setting the ground for the next minister, expected to be a member of Hezbollah, to be able to blast his record. Al-Akhbar is sympathetic to Hezbollah. “The decisions we have made go against the interest of drug companies,” he said.
During his tenure, Hasbani has ordered several markdowns of drug prices. He said the LF bloc was set to introduce a law in Parliament that would remove the “non-substitutable” provision from the medical prescription law that allows physicians to prevent pharmacists from substituting branded products with cheaper generics.
He said that if endorsed, the amendment would end the potential for collusion between drug companies and physicians.
Hasbani also recently issued a decree ordering the price of generic drugs to be lower than their branded versions.
He said another new decision to have the prices of prescription drugs marked down three years after their introduction into the market instead of five would trigger the automatic review of the prices of 3,600 out of Lebanon’s 5,000 drugs, starting in 2019.
“It will significantly bring down the total cost and health care bill.”
The bottom line: In Lebanon, people currently pay much less for drugs than in other countries at a similar level of development - $244 per capita compared to $500 or $600 in Europe and an “insane” $1,200 in America, he said.
Additionally, 60-70 percent of Lebanese got their drugs for free or at heavily subsidies rates, he added, so the real out-of-pocket figure is actually much lower.
The reason for the even cheaper drugs in Turkey luring some Lebanese is a heavily subsidized pharmaceutical sector, Hasbani said.
“It’s effectively not a legal thing to do,” he said of the phenomenon known as medical tourism.
“There is fraud happening on the Turkish side within certain pharmacies that creates this situation.”
Hasbani characterized the relationship between private and public hospitals in Lebanon as “complementary,” because “the idea of pure socialism in service provision can’t be applied anymore; you can get the same efficiency from having both.”
He pointed to the 240 primary health care centers around Lebanon, run by NGOs and local municipalities. If the government ran them, “I’m sure the cost would be skyrocketing, the quality would be well below standard, and, because funding wouldn’t be available, they would be taking on massive amounts of debt.”
Parliament recently endorsed the acquisition of a $150 million loan from the World Bank to fund the treatment of some 1.5 million patients who go through the primary health care sector every year. Hasbani said the loan had taken a load off the ministry’s shoulders and would help the centers better serve their communities.
But with Lebanon’s soaring public debt and stagnant economic growth, additional loans have been criticized for their unsustainability.
ADVICE FOR THE NEXT MINISTER?
Hasbani offered advice for the next person who takes over his office: “Populism is the biggest killer in the health sector, because you can’t run a health care system with knee-jerk reactions.” He denied directing this comment at Hezbollah.
Observers have said the group seeks to lessen the burden of sanctions by shifting services it directly provides to its constituency onto the official Lebanese state apparatus.
“I can’t predict the future; I can only see the past. I just hope the next person seeks to continue what we’ve done, and not destroy it.”