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Lao People's Democratic Republic - P4H Network
Current Health Expenditure (CHE) as % Gross Domestic Product (GDP)2.7%CHE/GDP
Out-of-pocket (OOPS) spending as % of Current Health Expenditure (CHE)30.9%OOP/CHE
Domestic General Government Health Expenditure (GGHE-D) as % General Government Expenditure (GGE)4.4%GGHE-D/GGE
Gross Domestic Product (GDP), in constant (2020) US$ per capita19BGDP (USD)
Population in thousands (K), millions (M) or billions (B)7.4MPopulation
Incidence of Catastrophic Health Spending at 10% Threshold (SDG 3.8.2) Total6.8%Catastrophic Health Spending
Lao People’s Democratic Republic is a lower-middle-income country in Asia. In 2019, current health expenditure (CHE) was 2.6% of GDP [1] while domestic general government health expenditure and out-of-pocket (OOP) expenditure were 37% and 42% of CHE, respectively. Since 2016, significant health reforms have been advancing UHC. 

Extension of social health protection using a tax-based financing model

Health insurance coverage was gradually expanded in the country through multiple health protection schemes, including the State Authority for Social Security (SASS) for civil servants (1995), the Social Security Organization for private employees (2001), community-based health insurance (CBHI) for self-employed and informal workers (2002), the Health Equity Fund for people living in poverty and vulnerable populations (2004), and the Free Maternal Neonatal and Child Health services policy (2010)[2]. Nevertheless, until 2015  less than 30% of the population was insured[1]. This resulted from low enforcement of mandatory schemes and limited enrollment in a voluntary scheme[3]. Insurance coverage significantly increased with the establishment and enforcement of national health insurance (NHI). In 2016, NHI began covering uninsured individuals working in the informal sector, and insurance coverage increased from 45% in 2016 to 94% in 2021[3]. Now, NHI’s main objective is to enhance social health protection and access to health care of the population and to attain UHC-related targets set for 2025[6].

The government heavily subsidizes NHI, and users make a small copayment at the point of service. Pregnant women, children, and people living in poverty are exempted from the copayment. While OOP payments remain high, they did drop from 46% in 2016 to 42% of CHEin 2019[4].  

Integration of social health protection schemes enhances risk pooling

Decree 470/PM on NHI, signed in 2012, aimed to increase risk pooling and harmonize administration under the social health protection scheme. In 2016, three schemes – iCBHI, FMNCH, and HEF – were merged under NHI. In 2019, the Ministry of Health of Lao People’s Democratic Republic merged SASS and SSO under NHI[5]. Thus, NHI now covers both formal and informal employment as well as people living in poverty and vulnerable populations. 


National Health Insurance Strategy 2021-2025

Lao People’s Democratic Republic