The billion-dollar health question

In a country where multidimensional poverty has surpassed 80%, according to the latest ESCWA estimates, and where more than half the population falls outside any form of official healthcare coverage, access to medical care in Lebanon has become a costly daily struggle rather than a fundamental right.

As hospital bills continue to rise and direct out-of-pocket payments place growing pressure on households, the National Social Security Fund (NSSF) has returned to the centre of economic and social debate. Alongside it, renewed attention is being directed towards the proposed health card project, designed to redraw Lebanon’s social protection map and access to care.

So what do the latest data and figures show about the sector?

Outside the system

Healthcare in Lebanon has increasingly become a privilege beyond the reach of most citizens.

Joint studies by the Lebanese Center for Policy Studies (LCPS) and the American University of Beirut (AUB) show that more than 51% of residents in Lebanon lack any effective formal healthcare coverage, whether through the National Social Security Fund, the Civil Servants Cooperative, or military and security funds.

In other words, more than half of the population remains entirely exposed to address health treatment costs individually at hospital doors.

The situation recently worsened with the sharp decline in the operational capacity of public insurance systems. The NSSF, which historically covered around 1.3 million beneficiaries, saw its purchasing power deteriorate as the Lebanese pound collapsed, reducing its ability to reimburse medical bills and pharmaceuticals. Private hospitals are increasingly requiring patients to settle differences between cost and coverage directly in cash and in US dollars.

The consequences have been severe. Out-of-pocket healthcare expenditure exceeded 75% of total health spending, according to UNICEF and Médecins Sans Frontières, after standing at only 33% before the crisis, placing Lebanon among the countries with the highest household health spending burdens globally.

This reality has created a visible healthcare divide. One group remains capable of purchasing private insurance in dollars, with annual policies beginning at approximately $600 and exceeding $5,000, depending on age and medical history. Another relies on the NSSF or the Ministry of Public Health. A third remains entirely outside any effective protection system.

A system keeping itself alive

The National Social Security Fund remains Lebanon’s largest healthcare guarantor and continues to function as a stabilising force for nearly one-third of society through coverage for private-sector workers and their families under sickness, maternity, family allowance, and end-of-service programs.

Yet the financial collapse that began in 2019 struck directly at the core of its funding model.

For years, contributions continued to be collected based on salaries that had lost their real value, while healthcare costs became increasingly dollarised. The result was a widening gap between revenues in local currency and medical expenses rising at a significantly faster pace.

Still, 2026 figures reveal an attempt to restore liquidity to the healthcare system and prevent a complete breakdown between hospitals and the Fund.

On 18 May 2026, NSSF Director General Mohammad Karaki issued Decision No. 282, authorising financial advances worth approximately LBP 315 billion to hospitals and contracted physicians in order to cover 4,660 hospitalisation cases for insured patients.

As a result, total spending allocated exclusively to hospital care, excluding dialysis, reached approximately LBP 1,917 billion since the beginning of the year.

Following the inclusion of dialysis treatment, covered at 100% by the Fund and amounting to approximately LBP 526 billion and 171 million, total hospital expenditure would have risen to nearly LBP 2,443 billion by mid-May 2026.

The Lebanese paradox

Lebanon’s healthcare landscape is defined by an uncomfortable contradiction.

The country still possesses one of the region’s historically most advanced medical sectors, supported by more than 160 hospitals equipped with modern technology and strong concentrations of specialised medical talent.

Lebanon records approximately 2.3 to 3.5 physicians per 1,000 people, historically above global averages and among the highest rates in the Arab world. The country has also traditionally attracted substantial levels of medical tourism.

Yet successive crises proved that Lebanon’s problem was never healthcare quality or availability. The real crisis is access.

Today, Lebanese citizens may have little difficulty finding highly qualified doctors while remaining financially unable to access treatment.

The financial collapse that began in 2019 did not weaken medical expertise. It weakened purchasing power.

As wages failed to recover, healthcare gradually transformed from an essential public service into a heavy economic burden. A single surgery, or even several days of hospitalisation, can now wipe out family savings, force borrowing, or push households into selling assets.

Lebanon’s health crisis reveals a deeper economic imbalance. The state still possesses a healthcare system technically capable of delivering advanced services, yet society itself can no longer afford to access them.

The billion-dollar question

Against this backdrop, discussion around Universal Health Coverage (UHC), commonly referred to as the health card, has intensified.

Minister of Public Health Rakan Nassereddine revealed that studies conducted for the project estimated implementation costs at approximately $800 million in 2024, rising to nearly $1 billion in 2025. He added that approximately 1.7 million Lebanese citizens currently have no insurance provider or guarantor whatsoever.

Meanwhile, the Lebanese state allocated only $270 million to the Ministry of Public Health to finance hospitalisation, equivalent to roughly one-quarter of actual needs.

The ministry’s hospitalisation budget also remains approximately $50 million lower than it was in 2019.

These figures expose a widening gap between healthcare demand and state capacity.

At a time when public resources remain under pressure and household health spending continues to rise, the figures suggest that the current model is becoming increasingly difficult to sustain.

More than a card

MP Bilal Abdallah, Chair of Parliament’s Health Committee, describes to The Beiruter the mandatory universal healthcare coverage as an integrated system that connects financing mechanisms, service providers, hospital networks, and rapid access to treatment, while ensuring sustainable funding, which he describes as “the backbone of health economics”.

According to Abdallah, the project extends beyond hospital admission and covers the entire treatment journey, beginning with primary healthcare centers and continuing through hospitalisation, cancer care, dialysis treatment, medical supplies, and approved surgeries under the future national coverage framework.

Funding, however, remains the central challenge.

Abdallah explains that project costs remain adjustable and that any increase or decrease would directly affect contribution schemes, the state’s participation, and potential revisions to financing mechanisms.

Current parliamentary discussions include proposed revenues tied to products harmful to health, including tobacco and alcoholic beverages, alongside additional funding mechanisms that remain under discussion and have not yet been publicly disclosed.

Reform before money

But financing alone does not explain why the project remains stalled.

Economist Layal Mansour told The Beiruter that universal healthcare coverage in Lebanon is not a new concept.

The proposal was seriously examined in 2011 and 2012, during Charbel Nahas’s term as Minister of Labour, through a project developed with the World Bank, but it ultimately never materialised.

For Mansour, the issue extends beyond economics and social policy and enters the realm of sovereignty.

The Ministry of Public Health already manages one of the largest budgets in the Lebanese state, and implementing universal healthcare could effectively place citizens under state protection instead of politically affiliated service networks.

She believes the project cannot succeed without genuine reform, sound governance, complete transparency, and a functional partnership between the public and private sectors.

Without those conditions, she warns, injecting money alone will not produce results.

She adds that external financing will likely be necessary given the scale of the undertaking, but stresses that support should come with oversight mechanisms rather than additional borrowing.

In her view, transportation, education, and healthcare remain the foundations of a strong and respected state.

The real obstacle

Abdallah confirms that preliminary encouragement exists from both the World Bank and the World Health Organization, alongside efforts to study international experiences, including Egypt’s progress in this field.

Still, any meaningful financial support remains tied to passing the legislation first.

For him, the immediate obstacle is not technical but legislative.

He argues that there are no convincing reasons for delaying the process further and believes that the coming phase will reveal where Lebanon’s political forces truly stand.

He concludes:

“We cannot remain idle in the face of the suffering of the Lebanese people and the violation of their dignity, because a person’s health is their dignity.”

Health as investment

Universal healthcare coverage should not be viewed as another item added to state expenditure. It is a long-term economic and social investment.

Every dollar spent on prevention and organised treatment can reduce future emergency healthcare costs, protect household savings, and strengthen productivity across the wider economy.

For a country already paying the economic and social cost of delayed care, the real expense may not be building a universal healthcare system, but continuing to live without one.