How can excise taxation be utilized to improve health outcomes in Lebanon?

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In Lebanon, six out of the top ten causes of death are directly related to smoking and dietary habits. These include ischemic heart disease, stroke, diabetes mellitus, lung cancer, breast cancer, and hypertensive heart disease. Such morbidities account for 31.1%, 9.4%, 3.7%, 3.6%, 2.6%, and 2.6% of total deaths respectively (WHO, 2015c). As for alcohol, road injury ranked third in the top ten causes of death in Lebanon, with up to 8% of cases directly attributed to alcohol intake. Moreover, alcoholism is responsible for up to 20% of cases of liver cirrhosis (WHO, 2015c). Thus, taxable products such as alcohol and tobacco are associated with adverse health outcomes and have contributed to increased morbidity and mortality among the Lebanese population (WHO, 2015c). At the same time, the expenses of the Lebanese health system are covered by insufficient and disorganized funds, manifesting as high out of pocket expenditure and resulting in suboptimal and inequitable access to healthcare services. Financing the Lebanese Health System In Lebanon, the health expenditure share of the gross domestic product is estimated at 7.2%, compared to the global average of 10%. The governmental spending on health constitutes 10.7% of its total budget (WHO, 2013). Despite acceptable health financial shares, comparable to that in developed countries (WHO, 2013), the financial arrangement of the Lebanese healthcare system faces several challenges: → The financing system is fragmented, reducing the possibility for pooling of both funds and risks. This fragmentation in financing results in limited access to health services and high out-of-pocket expenditure. Fragmented pooling of risks, on the other hand, can reduce the allocation of funds based on risk, thus reducing equity of access and efficiency. → There is little emphasis on preventive care coupled with disorganized and insufficient financial arrangements of ambulatory and primary care services. As a result, escalating health bills are incurred due to the increased need of and demand on curative and specialized care. → The households’ share of health expenses is substantial. The household expenditure is estimated to be 53% of total health expenditure. It comprises out-of-pocket expenditures and contributions, which K2P Rapid Response How can excise taxation be utilized to improve health outcomes in Lebanon? 8 contribute 37.3% and 15.6% of total health expenditures respectively. Out-of-pocket contributions are considered particularly high when compared with the global average of 18.6 % (WHO, 2013). → The Ministry of Public Health, further burdened by the need to respond to the emerging challenges of the Syrian crisis, already has the burdensome obligation to cover the 53% of the uninsured Lebanese public (WHO, 2010). Such challenges have led to difficulties in achieving the three pillars of universal health coverage, namely: health service coverage, financial risk protection, and equity of coverage for the entire population (WHO, 2015a).

 

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