In Lebanon, The National Social Security Fund (NSSF) covers legally employed individuals. The NSSF covers medical services, supplies, and medication at pre-crisis prices (the prices of supplies before the extreme inflation in Lebanon). At the post-crisis prices, NSSF only covers around 9% of the cost of diabetes supplies.

Many patients miss out on health cover as many employers do not register employees due to the high cost of contributions the company has to make (around 25% of an employee's monthly salary). NSSF will cover the employee's children and spouse, and their parents if they are above 60. Only a low percentage of Lebanese have NSSF coverage. Retired employees lose their NSSF, along with all the parties who had been covered with them. As for insurance companies, they are only for people who can afford their cost of a minimum of $700 per year (with the minimum monthly salary in Lebanon being $25).

What Happens if You Need to See a Doctor?
Access to a doctor’s appointment is quite easy and you can access one within the same day, but only if you can pay the fees (between $25 and $100 depending on the doctor). Patients with NSSF need to pay in cash. NSSF refunds 80% of their amount with a maximum limit of $26, which is collected in a duration of 3 to 9 months depending on the NSSF governance you are registered in.

Who Decides What a Doctor Can Prescribe?
Most doctors prescribe based on their individual preference and their affiliation with a certain pharmaceutical company. The Medicines Regulatory Authority also helps determine what is safe to prescribe.

Practically, what is it like with type 1 diabetes in Lebanon?
All materials including blood glucose test strips, ketone strips, pumps, syringes, medication, insulin, therapy and treatment are very expensive, and not accessible to all. Continuous Glucose Monitor (CGM) devices, like the Free Style Libre, are new to the market and it is a long process to get them covered by the NSSF. It is especially hard for pregnant woman due to the high expenses associated with all the follow ups and medical care needed.

Diabetes specialists are available in most regions and you can make an appointment when needed, but the costs are very high. People tend to go and see the specialist every year instead of quarterly where they will check your blood glucose values, make an HbA1c and talk to you about the therapy and see if you might have any complications as an approach to minimize the cost. NSSF reimbursement payments take very long to be distributed and whenever a person with diabetes demands their payment to be given before due (up to 9 months), they claim that we are not cancer patients and can tolerate the wait.

Some NGOs give free medication and medical follow ups to people without NSSF, but only until the age of 21. There are few support groups and if they are present, their activities are directed just towards showing the presence of diabetes in Lebanon and differentiating between types 1 and 2.

There is currently an economic crisis in Lebanon and extreme inflation of their currency, the Lebanese Lira. Everything being imported from the outside like diabetes supplies from insulin, blood glucose monitoring machines, test strips, CGM, pump and pump supplies are extremely expensive. The ministry of health partially covers some of these basic needs, but they are scarce and sometimes you cannot find any so patients often lend supplies to other people with diabetes in their community.

Most people with diabetes usually rely on getting supplies from relatives and friends overseas and some are forced to test their blood glucose once daily or even less. People are being forced to put themselves in danger by skipping taking insulin, due to the extreme shortage of diabetes supplies.

What about getting admitted to hospital?
If you have an emergency, you are not covered by NSSF. Only insurance plans cover such cases; however, they do not cover your diabetes-related cases. Thus, if you don’t have money, you cannot access immediate medical care. In some cases, people are left to die at the doors of hospitals.

How does diabetes care vary throughout the country?
The rules, on which the health care system is based are exactly the same throughout Lebanon. However, the density of doctors and specialists in rural areas is not as big as in cities.

Thank you to Cyrine Farhat for providing this information for us.