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Syrian Refugees Crisis Impact on Lebanese Public Hospitals- Financial Impact Analysis: APIS Report


The impact of the Syrian crisis on Lebanon has been profound particularly in the healthcare sector. The influx of Syrian refugees has strained the public hospitals and their ability to respond to the crisis, resulting in:
  • An increased demand for healthcare services;
  • An increase in unpaid health services to refugees;
  • A sharp rise in communicable diseases and emergence of new diseases in Lebanon;
  • Increased risks of epidemics such as water-borne diseases, measles, and tuberculosis 1.
Neither United Nations High Commissioner of Refugees (UNHCR) nor other Non-Governmental Organizations (NGO) was able to meet the required level of funding to provide refugees with an acceptable level of secondary and tertiary healthcare services. They, therefore, decided to change their model of response in terms of healthcare support to Syrian refugees. As of 2014, UNHCR started covering 75% instead 85% of the hospitalization cost, leaving the patient with the remaining share of 25% to be paid out of pocket or by a third party. The healthcare referrals covered by UNHCR are limited to deliveries and life-threatening emergencies 2.

Hospitals are overburdened with Syrian patients who are unable to pay their part of the bill (increased to 25% of their total hospital fees) as well as patients whose hospitalizations are not subsidized at all. Some hospitals have put in place strategies to recover as much of the 25% as possible (deposits, retaining IDs/corpses, inflating bills). Referral of uncovered Syrian patients with complicated morbidities to public hospitals has become a common practice by private hospitals.

Overwhelmed by the high demand of healthcare by Syrian refugees, public hospitals end up treating patients without any specific reimbursement scheme thus creating a huge financial burden. This burden adds up to the existing difficult financial situation of public hospitals, putting the whole healthcare sector under stress. Public hospitals are restrained from completing their mission and incapable of providing healthcare services neither to Syrians refugees nor to Lebanese citizens...
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ATC Name B/G Ingredients Dosage Form Price
D07AC14 ADVANTAN B Methylprednisolone aceponate - 1mg/g 1mg/g Ointment 385,683 L.L
L04AX06 IMNOVID B Pomalidomide - 2mg 2mg Capsule, hard 290,515,206 L.L
N02BG09 PENTHROX INHALER B Methoxyflurane - Inhalation 21,080,096 L.L
D07AC14 ADVANTAN B Methylprednisolone aceponate - 1mg/g 1mg/g Cream 385,683 L.L
J01CR02 AUGMENTIN B Amoxicillin (trihydrate) - 250mg/5ml, Clavulanic Acid (potassium) - 62.5mg/5ml 312.5mg/5ml Powder for suspension 542,912 L.L
J01FA10 ZITHROMAX B Azithromycin (dihydrate) - 300mg/7.5ml 300mg/7.5ml Powder for suspension 489,159 L.L
J05AR13 TRIUMEQ B Dolutegravir - 50mg, Abacavir sulfate - 600mg, Lamivudine - 300mg Tablet, film coated 74,756,237 L.L
L01EA01 GLIVEC B Imatinib (mesylate) - 100mg 100mg Tablet, film coated 50,531,993 L.L
L01XX41 HALAVEN B Eribulin mesylate - 0.88mg/2ml 0.88mg/2ml Injectable solution 35,421,768 L.L
L04AX06 IMNOVID B Pomalidomide - 4mg 4mg Capsule, hard 290,515,206 L.L
M05BA06 BONDRONAT B Ibandronic acid (monosodium monohydrate) - 6mg/6ml 6mg/6ml Injectable concentrated powder for solution 24,963,868 L.L
N02CC01 IMIGRAN B Sumatriptan (succinate) - 100mg 100mg Tablet, film coated 616,824 L.L
B01AF02 ELIQUIS B Apixaban - 5mg 5mg Tablet, film coated 4,183,603 L.L
J01FA10 ZITHROMAX B Azithromycin (dihydrate) - 250mg 250mg Capsule 591,291 L.L
J05AR18 GENVOYA B Emtricitabine - 200mg, Tenofovir alafenamide - 10mg, Elvitegravir - 150mg, Cobicistat - 150mg Tablet, film coated 77,789,650 L.L
M05BA06 BONVIVA B Ibandronic acid - 3mg/3ml 3mg/3ml Injectable solution 3,144,591 L.L
N07CA01 BETASERC B Betahistine dihydrochloride - 16mg 16mg Tablet 1,623,708 L.L
S01HA02 ANESTOCIL B Oxybuprocaine HCl (Benoxinate HCl) - 0.4% 0.4% Drops solution 442,124 L.L
A07AA11 NORMIX TAB B Rifaximin alpha - 200mg 200mg Tablet, film coated 827,807 L.L
D07AC18 PEITEL B Prednicarbate - 0.25% 0.25% Cream 507,972 L.L
G04BD08 VESICARE B Solifenacin succinate - 10mg 10mg Tablet, film coated 1,619,330 L.L
J05AR20 BIKTARVY B Bictegravir - 50mg, Emtricitabine - 200mg, Tenofovir alafenamide - 25mg Tablet, film coated 76,569,138 L.L
N02CC01 IMIGRAN B Sumatriptan (succinate) - 50mg 50mg Tablet, film coated 378,964 L.L
R05CB01 FLUIMUCIL B N-acetylcysteine - 600mg 600mg Tablet, effervescent 567,102 L.L
A07AA11 NORMIX SIROP B Rifaximin alpha - 100mg/5ml 100mg/5ml Granules for suspension 477,064 L.L
D07AD01 DERMOVATE B Clobetasol (propionate) - 0.5mg/g 0.05% w/w Cream 245,923 L.L
J05AR24 DELSTRIGO B Lamivudine - 300mg, Tenofovir disoproxil - 300mg, Doravirine - 100mg Tablet, film coated 48,879,793 L.L
A07AA12 DIFICLIR B Fidaxomicin - 200mg 200mg Tablet, film coated 135,347,725 L.L
D07AD01 DERMOVATE B Clobetasol (propionate) - 0.5mg/g 0.05% w/w Cream 245,923 L.L
J01CR02 AUGMENTIN B Amoxicillin (trihydrate) - 400mg/5ml, Clavulanic Acid (potassium) - 57mg/5ml 457mg/5ml Powder for suspension 524,099 L.L
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