The Government of Lao PDR is committed to pursuing reforms aimed at achieving Universal Health Coverage (UHC) by 2025, ensuring that all people, with heavy focus on the most vulnerable groups, like mothers and children, have equitable access to quality health services without experiencing financial hardships associated with use of health services through strengthening and implementing the social health protection schemes.
Since 2016, to remove financial barriers and strengthen and expand coverage for those working in the informal sector in which most of the population fall under, the government launched a heavily subsidized tax-based scheme called “National Health Insurance” (NHI) with low co-payment for non-insured Lao citizens, while the poor, mothers and children under five are exempted from this co-payment, transportation and food allowances are provided for the poor.
The NHI scheme is managed by the National Health Insurance Bureau (NHIB), the Ministry of Health and operates under the NHI approved law, NHI strategy and its legislations in all 17 provinces and 139 districts, covering 5,647,896 people which is equivalent to 73.6 per cent of the total population, except for Vientiane Capital. Since 2019, all existing health insurance schemes of the National Social Security Fund for civil servants and private enterprises under the Ministry of Labour and Social Welfare have integrated into the NHI scheme. As a result of this integration, this increased the total coverage of social health protection in Lao PDR to 94 per cent in 2019.
The NHI is implemented under the NHI strategy for 2017-2020 with its objectives aligned with the Health Sector Reform Framework 2013-2025, and the strategy is closely linked to other subsector strategies and legislative frameworks of the MOH, including the Reproductive, Maternal, Newborn and Child Health Strategy and Law on Health Care.
Most vulnerable groups especially mother and children will benefit from the equitable access to health services.
To assess progress of the NHI implementation, MOH conducted an assessment with focus on the perspective of patients, providers and purchasers, especially for patients mainly in terms of coverage, awareness of the populations, access and financial protection in 2018-2019, which was supported by WHO with substantive inputs from the Swiss Red Cross (SRC). SRC and Asian Development Bank funded and oversaw data collection and analysis for the health facility and household surveys. Additional fund and inputs were received from Lux-Development, Japan International Cooperation Agency and the World Bank. The NHI assessment provided a set of recommendations to improve NHI implementation. In addition, in order to manage and strengthen the efficiency and transparency on the use of the NHI fund, verification of claims from health facilities under NHI scheme has been conducted before processing payments to health facilities.
To continue with strengthening the NHI implementation, MOH started to update the NHI strategy for 2021-2025 in close collaboration with WHO since 2020. The strategy will be updated in alignment with directions of the draft Health Financing Strategy.
The draft of strategic objectives was presented and discussed at provincial and central consultation meetings. There were two consultations with provinces: one with northern provinces and the other one with southern provinces. Dr Bounfeng Phommalaysith, the Health Minister chaired one of the session with northern provinces in Luangprabang Province (co-chaired by WHO) and guided future directions. The objectives of the meetings were to discuss and get inputs from provincial officers and concerned Ministries and Departments of MOH to the draft NHI strategic objectives. The results from the meetings will be contributed and guided to the development of the NHI strategy on what should be included based on its lessons learnt from the implementation of the previous NHI strategy.
Health facility in Setha district/Attapue province.
The National Health Insurance scheme covers the entire informal sector with co-payment of 5,000 kip to 30,000 kip paid at the point of care with co-payment exemption for the poor, pregnant women and children under five. The current co-payment rates are as follows:
- 5,000 Kip for Outpatient Department (OPD) and hospitalization in a health center;
- 10,000 Kip for OPD and 30,000 for hospitalization at a district hospital;
- 15,000 Kip for OPD and 30,000 for hospitalization at a provincial hospital
- 20,000 Kip for OPD and 30,000 for hospitalization at a regional or central hospital
In general, the introduction of NHI has led to an increase in the utilization of health services. There is no evidence that the introduction of NHI had a negative impact on the vulnerable groups (such as pregnant women) that had been targeted in the earlier vertical schemes. WHO is also planning to support MOH in conducting an analysis of “financial burden of out-of-pocket patient payments”, using data from the 6th Lao Expenditure and Consumption Survey (LECS 6) to assess out-of-pocket (OOP) payments over the past five years and impact of the NHI introduction on OOP trends. This information will also provide a key evidence for MOH to monitor progress towards achieving SDG 3.
A mother holding her infant during the temperature check.
The NHI scheme covers costs of treatment, drugs, hospitalization, consultation, and included high-cost services (major surgery, such as heart and brain surgery, and haemodialysis) and chronic diseases. There are ongoing discussions on the scope of services covered by the NHI scheme and the government budget in the context of donor transition, NHI benefit package, payment mechanism and co-payment rates will be reconsidered based on the ongoing costing exercise of health services supported by World Bank, ILO, Swiss Red Cross, WHO, Fred Hollow Foundation, Lux Dev and UNPFA. Under NHI system, to access health services, a user has to provide the family book, ID card or a certified letter from the village chief to health providers to confirm the Lao citizenship of the user.
In the context of decreasing government budget for health, specifically considering the COVID-19 pandemic and its mid/longer term impact, MOH will make more intensified efforts to strengthen sustainability of the NHI fund and equity in access to care in order to achieve UHC by 2025 as the government planned under strategic directions of the draft National Health Insurance Strategy and Health Financing Strategy.