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A retrospective health policy analysis of the development and implementation of the voluntary health insurance system in Lebanon: Learning from failure

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  • El-Jardali, Fadi
  • Bou-Karroum, Lama
  • Ataya, Nour
  • El-Ghali, Hana Addam
  • Hammoud, Rawan

Abstract

Public policymaking is complex and suffers from limited uptake of research evidence, particularly in the Eastern Mediterranean Region (EMR). In-depth case studies examining health policymaking in the EMR are lacking. This retrospective policy analysis aims at generating insights about how policies are being made, identifying factors influencing policymaking and assessing to what extent evidence is used in this process by using the Lebanese Voluntary Health Insurance policy as a case study. The study examined the policymaking process through a policy tracing technique that covered a period of 12 years. The study employed a qualitative research design using a case study approach and was conducted in two phases over the course of two years. Data was collected using multiple sources including: 1) a comprehensive and chronological media review; 2) twenty-two key informant interviews with policymakers, stakeholders, and journalists; and 3) a document review of legislations, minutes of meetings, actuarial studies, and official documents. Data was analyzed and validated using thematic analysis. Findings showed that the voluntary health insurance policy was a political decision taken by the government to tackle an urgent political problem. Evidence was not used to guide policy development and implementation and policy implementers and other stakeholders were not involved in policy development. Factors influencing policymaking were political interests, sectarianism, urgency, and values of policymakers. Barriers to the use of evidence were lack of policy-relevant research evidence, political context, personal interests, and resource constraints. Findings suggest that policymakers should be made more aware of the important role of evidence in informing public policymaking and the need for building capacity to develop, implement and evaluate policies. Study findings are likely to matter in light of the changes that are unfolding in some Arab countries and the looming opportunities for policy reforms.

Suggested Citation

  • El-Jardali, Fadi & Bou-Karroum, Lama & Ataya, Nour & El-Ghali, Hana Addam & Hammoud, Rawan, 2014. "A retrospective health policy analysis of the development and implementation of the voluntary health insurance system in Lebanon: Learning from failure," Social Science & Medicine, Elsevier, vol. 123(C), pages 45-54.
    • Handle: RePEc:eee:socmed:v:123:y:2014:i:c:p:45-54
    DOI: 10.1016/j.socscimed.2014.10.044
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    References listed on IDEAS

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    1. Lois Orton & Ffion Lloyd-Williams & David Taylor-Robinson & Martin O'Flaherty & Simon Capewell, 2011. "The Use of Research Evidence in Public Health Decision Making Processes: Systematic Review," PLOS ONE, Public Library of Science, vol. 6(7), pages 1-10, July.
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    1. Maria José Sousa, 2022. "Digital Technologies and Public Policies Applied to Green Cities," Land, MDPI, vol. 11(11), pages 1-18, November.
    2. Olga Gershuni & Katarzyna Czabanowska & Genc Burazeri & Vesna Bjegovic-Mikanovic & Grzegorz Juszczyk & Anna Cichowska Myrup & Volodymyr Kurpita, 2021. "Aligning Best Practices: A Guiding Framework as a Valuable Tool for Public Health Workforce Development with the Example of Ukraine," IJERPH, MDPI, vol. 18(17), pages 1-13, September.
    3. Caitlin M. Walsh & Takondwa Mwase & Manuela De Allegri, 2020. "How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II," International Journal of Health Planning and Management, Wiley Blackwell, vol. 35(6), pages 1571-1592, November.

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