Syria: Healthcare Reforms
Valuable insight into health care reform in the middle east
This article was originally distributed in the Searchlight Newsletter produced by Strategic Foresight Group
Public hospitals are the main providers of health care in Syria. Several factors have pushed the government to launch a number of reforms in 2010, aiming to improve the quality of public hospitals. According to Dr Deep Hazimeh, former deputy minister of health, “the strategy now is not to have more hospitals but better quality and more specialised hospitals and we are focusing on that.” A few public hospitals, especially in the capital Damascus, have already implemented the reform programmes and hospitals in other parts of the country are expected to introduce the new system in the next few years. In addition, the government has introduced a National Health Insurance programme, intended to make health services more affordable to a large number of people.
The population of Syria is around 22 million and growing steadily at the rate of 2.5-3 percent annually. The Syrian Central Bureau of Statistics adds roughly half a million people to the total population count every year. Of this, about 20 percent of the population lives below the poverty line. Almost 70 percent of Syrian workers earn less than USD 100 per month. The absence of charitable health care providers and exorbitant fees charged by private hospitals has made the vast majority of poor heavily dependent on public hospitals. In addition, the one million Iraqi refugees living in Syria, who are entitled to free health services, increase the number of those seeking help from public hospitals.
Syria has been grappling with an increasing budget deficit over the last few years. In 2005, the budget deficit was around 5 percent of the GDP, which rose to 7.6 percent in 2007 and by 2009 touched 9 percent or USD 4.8 billion. Despite the deficit, the increasing pressure on public hospitals resulted in an increase in the government spending on health sector from 5 percent of the GDP in 2007 to 8 percent in 2010. The spending is low compared to the neighbouring countries like Jordan and Lebanon, which spend 9 percent and 11 percent of their GDP on health care respectively.
In addition, Syria is yet to appreciate the benefits of health insurance. As a result, a large number of people prefer free health services at government-run hospitals. Less than 5 percent of the total patients in the country pay through insurance.
Therefore, reforms were needed to meet this heavy health burden on public hospitals. In 2010, the government introduced a number of initiatives to improve the quality and access to public health services.
The health reform programme includes payment for all health services at public hospitals that used to be free of charge. Patients are divided into three segments. One segment offers free treatment to the poor people. Another segment is based on a commission system where patients pay less than the actual cost and finally there is a segment for people who can afford to pay the full cost of the treatment. In addition the government has announced the creation of a Social Fund, to pay for poor families availing heath services at public hospitals, in partnership with public, private and the NGO sector.
The government launched a National Health Insurance scheme to cover all government servants and public sector employees. The government employees contribute SYP 250 (USD 5) annually towards the insurance while the government pays rest of the amount. This scheme has already provided health insurance to 400,000 employees so far, and is expected to cover around 700,000 by 2012-13. Analysts in Syria regard this insurance scheme as a cheaper way of funding the health sector than providing a comprehensive free heath care.
The government is set to create a National Emergency System equipped with ambulances and helicopters to reach out to people who have no access to health services in their vicinity or live in remote areas of the country. This centre will be set up by 2015.
Health Insurance in Syria
In the coming years, the pay-principle at public hospitals will offload some of the huge costs associated with providing free health services. It will also allow public hospitals to generate revenue, apart from government grants, which could be invested in advanced technology and medical equipments. As a result, the public hospitals will be able to develop better quality of healthcare facilities. At the Damascus Hospital, the largest public hospital in the capital, the 700 doctors, 600 nurses and other staff will be paid bonuses to discourage them from moving to the private sector.
There are indications that the government is likely to extend the national insurance scheme to include the families of government servants and retired employees. As a result, one-third of the population will be covered by state-sponsored heath insurance. The health insurance will enable the insured people to afford better health services either at public hospitals or private hospitals. Therefore, in the coming years, access to quality health care will likely improve the health indicators of the country.
However, with Syria embroiled in a growing political crisis at present, the impact of healthcare reforms may take longer to manifest than expected.
Health System Reform: Better Services at what Cost?’ Forward Syria. Issue number 48. 12 February 2011.
Healthy Business: Is there a Future for Private Health Care Industry in Syria Syria Today. April 2011.
Decree creates a New Health Insurance Giant Syria Today. May 2011.
Syria: Demand for Health Care soars as Spending Shrinks IRIN News. 21 November 2007.
Budget Deficit at 9 percent of GDP in 2009 Syrian Economic and Business Centre. 21 December 2008.