Universal health coverage in Lebanon: agenda setting using Kingdon's model and a proposed legal framework for revenue allocation.

Abstract

Background: Health systems globally aim for Universal Health Coverage (UHC), however progress toward UHC remains challenging in many countries. Despite previous unsuccessful parliamentary attempts to secure national commitment to a UHC plan in Lebanon, a renewed and revised effort is currently being made by a dedicated parliamentary committee. This study has two main objectives: to examine the emergence of the UHC bill as a priority on the Lebanese policy agenda using John Kingdon's Framework; and (2) to conduct a policy analysis using Bardach and Patashnik's eight-step framework to identify the most suitable funding option for the proposed UHC program.

Methods: Two policy analysis frameworks were applied: John Kingdon's model, commonly used to study agenda setting, and Bardach and Patashnik's eight-step framework, designed to evaluate policy options and recommend evidence-based solutions. A qualitative document analysis was conducted using the READ approach drawing on secondary literature sources. Data triangulation was also used to ensure consensus and accuracy.

Results: The document analysis identified the emergence of a window of opportunity for the UHC bill as the three streams aligned: mounting public pressure, the formation of a parliamentary committee, and evident political receptiveness through the involvement of multiple parties. Bardach & Patashnik's policy analysis framework identified earmarked excise taxes as the most suitable policy alternative for financing UHC in Lebanon.

Conclusion: This study explains the emergence of an updated UHC bill on the Lebanese policy agenda while conducting a policy analysis of the earmarked excise taxed to fund UHC. To overcome anticipated challenges a legislative framework must be established to ensure transparency in funding and government accountability.