Yehia Farah, Nahas Ziad, Saleh Shadi
Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Vandyck Building Room 136A, Beirut, Lebanon,
J Ment Health Policy Econ. 2014 Sep;17(3):131-41.
Inadequate access to mental health (MH) services in Lebanon, where prevalence is noteworthy, is a concern. Although a multitude of factors affects access to services, lack of financial coverage of MH services is one that merits further investigation.
This study aims at providing a systematic description of MH financing systems with a special focus on Lebanon, presenting stakeholder viewpoints on best MH financing alternatives/strategies and recommending options for enhancing financial coverage.
A comprehensive review of existing literature on MH financing systems was conducted, with a focus on the system in Lebanon. In addition, key stakeholders were interviewed to assess MH organizational and financing arrangements. Finally, a national round table was organized with the aim of discussing findings (from the review and interviews) and developing an action roadmap.
Taxation and out-of-pocket payments are the most common MH financing sources worldwide and in the Eastern Mediterranean Region. In Lebanon, all funding entities, except private insurance and mutual funds, cover inpatient and outpatient MH services, albeit with inconsistencies in levels of coverage. The national roundtable recommended two main MH financing enhancements: (i) creating a knowledge-sharing committee between insurers and MH specialists, and (ii) convincing labor unions/representatives to lobby for MH coverage as part of the negotiated benefit package.
There are concerns regarding the equity, effectiveness and efficiency of the MH financing system in Lebanon. The fragmented system in Lebanon leads to differences in MH coverage across different financing intermediaries, which is inequitable. The fact that one out of four Lebanese suffer a mental disorder throughout their lives and very low percentages of those obtain treatment signals a problem in effectiveness. As for efficiency, the inefficient fragmentation of MH financing among seven intermediaries is a problematic characteristic of the healthcare financing system as a whole. Moreover, the orientation of the general healthcare system towards curative rather than preventive care is reflected in MH financing as well. Limitations of the study include the lack of access to data about the MH expenditure of every financing intermediary in Lebanon; therefore it was not possible to calculate a total annual MH spending on a country level. Another limitation was the inability to map the sources of funding with the MH service provision sector, as more extensive data about the MH services provided by each of the public, private, voluntary and informal sectors is needed.
Providing a clear description of the current MH financing system helps policymakers recognize the disparities present in the coverage of MH, guiding them into making informed decisions on allocation of funds. This study therefore constitutes the first step towards achieving more equitable and socially just coverage, advances knowledge and provides well-needed locally relevant research. Findings are expected to inform policymaking and have already contributed to influencing a change in the policy of the Internal Security Forces Health Fund. As a result of the roundtable discussion and follow up that ensued, the fund has removed the suicide attempt exclusion from its insurance policy.
黎巴嫩的心理健康服务获取不足，其患病率值得关注，这是一个令人担忧的问题。尽管多种因素影响服务获取，但心理健康服务缺乏财务覆盖是一个值得进一步研究的因素。
本研究旨在系统描述心理健康融资体系，特别关注黎巴嫩，呈现利益相关者对最佳心理健康融资替代方案/策略的观点，并推荐增强财务覆盖的选项。
对关于心理健康融资体系的现有文献进行全面综述，重点关注黎巴嫩的体系。此外，对关键利益相关者进行访谈，以评估心理健康组织和融资安排。最后，组织了一次全国圆桌会议，旨在讨论（综述和访谈的）结果并制定行动路线图。
税收和自付费用是全球及东地中海区域最常见的心理健康融资来源。在黎巴嫩，除了私人保险和共同基金外，所有资金实体都涵盖住院和门诊心理健康服务，尽管覆盖水平存在不一致。全国圆桌会议推荐了两项主要的心理健康融资增强措施：（i）在保险公司和心理健康专家之间设立一个知识共享委员会，（ii）说服工会/代表将心理健康覆盖作为谈判福利包的一部分进行游说。
黎巴嫩心理健康融资体系的公平性、有效性和效率令人担忧。黎巴嫩分散的体系导致不同融资中介机构在心理健康覆盖方面存在差异，这是不公平的。四分之一的黎巴嫩人一生中患有精神疾病，但获得治疗的比例极低，这表明存在有效性问题。至于效率，心理健康融资在七个中介机构之间的低效分散是整个医疗保健融资体系的一个有问题的特征。此外，一般医疗保健体系倾向于治疗而非预防保健的取向也反映在心理健康融资中。研究的局限性包括无法获取黎巴嫩每个融资中介机构心理健康支出的数据；因此无法计算国家层面的年度心理健康总支出。另一个局限性是无法将资金来源与心理健康服务提供部门进行映射，因为需要关于公共、私人、志愿和非正式部门各自提供的心理健康服务的更广泛数据。
清晰描述当前的心理健康融资体系有助于政策制定者认识到心理健康覆盖方面存在的差距，指导他们就资金分配做出明智决策。因此，本研究构成了实现更公平和社会公正覆盖的第一步，推进了知识并提供了急需的本地相关研究。研究结果有望为政策制定提供信息，并且已经有助于影响国内安全部队健康基金政策的改变。由于圆桌会议的讨论及随后的跟进，该基金已从其保险政策中删除了对自杀未遂的排除条款。
