Association between payer mix and costs, revenues and profitability: a cross-sectional study of Lebanese hospitals

Abstract

This study aimed to examine the association between the payer mix and the financial performance of public and private hospitals in Lebanon. The sample comprised 24 hospitals, representing the variety of hospital characteristics in Lebanon. The distribution of the payer mix revealed that the main sources of revenue were public sources (61.1%), out-of-pocket (18.4%) and private insurance (18.2%). Increases in the percentage of revenue from public sources were associated with lower total costs and revenues, but not profit margins. An inverse association was noted between increased revenue from private insurance and profitability, attributed to increased costs. Increased percentage of outof-pocket payments was associated with lower costs and higher profitability. The study provides evidence that payer mix is associated with hospital costs, revenues and profitability. This should initiate/inform discussions between public and private payers and hospitals about the level of payment and its association with hospital sector financial viability. RÉSUMÉ La présente étude visait à examiner l'association entre la pluralité des payeurs et la performance financière des hôpitaux publics et privés au Liban. L'échantillon portait sur 24 hôpitaux, représentant la diversité des caractéristiques des établissements au Liban. La répartition des différents payeurs a révélé que parmi les principales sources de revenus figuraient le secteur public (61,1 %), les paiements directs (18,4 %) et les assurances privées (18,2 %). Des augmentations du pourcentage des revenus provenant du secteur public étaient associées à des coûts et à des revenus totaux plus faibles, mais non toutefois aux marges bénéficiaires. Une association inverse a été observée entre l'augmentation de revenus issus des assurances privées et la rentabilité, attribuée à des coûts plus élevés. Une hausse du pourcentage de paiements directs était associée à des coûts moindres et à une meilleure rentabilité. La présente étude fournit des élèments de preuve montrant que la pluralité de payeurs est associée aux coûts, aux revenus et à la rentabilité des hôpitaux. Cette situation devrait non seulement lancer des discussions entre les payeurs publics et privés et les hôpitaux sur le niveau de paiement et son association à la viabilité financière du secteur hospitalier, mais également contribuer aux débats à ce sujet. ‫اللبنانية‬ ‫للمستشفيات‬ ‫مقطعية‬ ‫دراسة‬

Access to primary and secondary health care services for people living with diabetes and lower-limb amputation during the COVID-19 pandemic in Lebanon: a qualitative study

“…Participants were generally positive regarding the attitudes of healthcare providers, predominantly with their physicians, but some acclaimed that their amputation was a consequence of health providers’ malpractice. Participants expressed that some hospitals, especially rural and public ones were not financially, nor resources supported to deliver high-quality care [ 40 ]. PWD sometimes had to travel farther to receive the care they needed because health facilities in rural regions, as also mentioned by the interviewees, were under-equipped and sometimes lacked the required service [ 41 ].…”