OVERVIEW
Secondary and tertiary health care institutions in Lebanon are mostly private and cost is a significant barrier to access. UNHCR has put in place Guidelines for Referral Health Care in Lebanon and standard operating procedures (SOP) to support access to life saving and obstetric care and to manage the costs of care. The costs covered by UNHCR vary according to the type of service provided and the vulnerability status of the refugee.
Additionally, UNHCR contracts a third party administrator (TPA) to manage and audit referral care processes and costs. In December 2017, 997,552 Syrian refugees and 20,500 refugees from other countries were registered with UNHCR. However, the referral care programme also supports access to life saving and obstetric care for unregistered refugees.
The total number of approved referrals increased from 73,951 in 2016 to 82,894 in 2017. This is an increase of 12%.
In January 2017 the UNHCR network consisted of 50 hospitals. By 1st of January 2018 the number had been rationalized to 40. The majority (77%) of accepted referrals were treated in 20 hospitals.
A high proportion (59%) of referrals were for maternity care which was an increase from 53% in 2016.
The proportion of births performed by caesarean section was 34% in 2017, showing a slight increase when compared to 32% in 2016.
Out of the total annual approved referrals there were 845 mortalities, of which 58% were in children under one year of age, predominantly in the perinatal period.
TPA financial audit of hospital invoices led to a 5.8% deduction of the overall total cost invoiced by hospitals.
35.1% of total expenditure was spent on maternity care compared to 33.8% in 2016.
The average cost per referral was 642 USD compared to 586 USD in 2016.