Achieving equity in access.
Consolidating health insurance schemes to increase coverage and efficiency.
The government of Lao PDR operates as the main provider of health care in the country and, until recently, utilized several financing schemes to serve distinct populations. While the schemes cover civil servants, private employees, the informal sector and impoverished citizens, high out-of-pocket costs and low enrollment still present barriers to health care access and expansion.
To achieve universal health coverage by 2025, Lao PDR’s government has committed to integrating all insurance schemes into a single payer system under the National Health Insurance Bureau, boosting domestic financing and innovating impactful service delivery practices. In 2017, the National Health Insurance scheme was piloted in the Vientiane Province as part of a gradual rollout intended to cover the entire country.
Lao PDR has adopted numerous policies related to health over the last two decades and, with improved economic growth, has increasingly turned toward a fully financed system capable of providing quality health care for all. The introduction of the National Drug Policy marked the first major shift toward health for all. The new policy was implemented in 1993 to hinder the spread of low-quality drugs, regulating drugs introduced into the country and rationalizing their prescription. Shortly thereafter, Lao PDR introduced a revolving drug fund, along with user fees, to mitigate financing shortfalls. Though this did support cost recovery, it also exacerbated problems with inequity and compelled the government to embark on an ambitious series of reforms to expand coverage and reduce costs for its citizens.
This culminated with an introduction to a mandatory social security program for formal sector employees and a voluntary community-based health insurance program for the informal sector. As an additional measure, the government, with the support of outside organizations, introduced Health Equity fund programs, an initiative to cover service fees for the most impoverished parts of the population.
Lao PDR took its first steps toward expanding coverage with the above schemes and the Law on Health Care, passed in 2005, further signified the country’s commitment. Not only does the law recognize the right to health care for all Laotian citizens but it also enumerates the responsibilities of the government and providers to guarantee quality of care.
The country has recently moved to integrate all public health care schemes under a national health insurance initiative and the creation of a national health insurance bureau. The nascent bureau introduced a decree on national health insurance in 2012 which mandated the consolidation of all schemes under a single entity and its branches and tasked the bureau with managing all elements of a single-payer health system.
Recognizing the achievement of universal health coverage also requires targeted approaches to cover vulnerable populations, Lao PDR launched a free maternal and child health project that same year. This policy sprouted from a successful two-year pilot aimed at increasing use of health facilities through removal of user fees. The free maternal and child health project, along with the previously introduced Health Equity Funds, fostered greater utilization of health services. Furthermore, the use of performance-based payment for health providers resulted in improved health care infrastructure and delivery.
Lao PDR in the JLN
As one of the newest members of the Joint Learning Network, Lao PDR is excited to exchange experiences on innovative healthcare reform and financing with resource-scarce countries.