General Information
Lao PDR has made impressive progress towards universal health coverage. From 10.5% in 2008, social health protection coverage increased to 94% of the population in 2018. However, the health sector still suffers from chronic underfunding despite the Government’s commitment to increase its allocation to health. This is particularly detrimental to health service readiness at all facility levels, and to effective access to health care.
Vientiane 17°58’N 102°36’E
Official languageLao
ReligionBuddhism 64.7%, Tai folk religion 31.4%, Christianity 1.7%, Islam 0.8%, Other 1.3%
Independencefrom France (22 October 1953)
National UHC Dynamics Card as PDF
A complete overview of the UHC process in Laos can be found in the attached print version of the card.
1995 - 2001
They were aimed at covering public and private employees and their dependents, respectively. They were managed by the National Social Security Fund (NSSF), under the Ministry of Labour and Social Welfare (MoLSW).
2002 - 2012
Programs have been targeting the self-employed and informal economy workers through the Community- Based Health Insurance (CBHI, since 2002) and the poor and vulnerable through the Health Equity Fund (HEF, since 2004).
ImpactLimited coverage due to voluntary enrolement under CBHI and targeting inaccuracies with HEF.
Successful in improving health service utilisation; however, (informal) out-of-pocket (OOP) payments remained significant at facility level, which limited financial protection for the intended beneficiaries.
It aimed to gather all schemes under one umbrella managed by the NHI Management Committee (MC) and its Secretariat the NHI Bureau (NHIB).
Out-of-pocket (OOP) of current total Health Expenditure was 51%.
2016 - 2019
Merging of the former CBHI, HEF and FMNCH under the MoH.
The NHI scheme was rapidly rolled out to all provinces in Lao PDR. Only Vientiane Capital is not included and provides protection to the workers in informal employment through CBHI.
Out-of-pocket (OOP) of current total Health Expenditure was 46%.
Under this model, contributions are no longer collected but replaced by public subsidies transferred to the NHI Fund. Workers in informal employment only have to pay small direct co-payment at the point of services. Poor and Vulnerable, Children under 5 and Pregnant women are exempted from co-payments. Workers in formal employment and their employers still pay their contributions to NSSF SASS or SSO.“
The NHI insured benefit package covers most health services in the public sector, with few exclusions, corresponding to services such as VIP rooms, drugs not belonging to the essential medicine list, work and traffic accidents, services already paid for by vertical projects such as malaria, tuberculosis, AIDS; vertical projects (malaria, tuberculosis, AIDS), non essential services (plastic surgery, dental care etc.).
Out-of-pocket (OOP) of current total Health Expenditure was 48%.
Out-ofpocket payments and effective access to quality health services is still a challenge for a significant portion of the population.
The Government of Lao PDR has recently made progress with the implementation of the long-planned merger of formal sector schemes (SASS, SSO) and police schemes together with the NHI scheme, under the lead of the NHIB. The merged scheme is operational nationwide.
Established as a department of the Ministry of Health (MOH), the NHIB is currently the main purchaser of health services for the Lao population.
The maternal mortality ratio plunged from 250 deaths per 100,000 live births in 2012, to an estimated 197 deaths per 100,000 live births in 2015 . Under-five mortality, also decreased from 79 to 46 per 1,000 live births between 2011-12 and 2017.
• Debates over the status of the NHIB and the necessity to separate it from the MOH, in order to achieve full autonomy.
• Overcoming low service readiness for basic obstetric care.
• Strenghtening strategic purchasing, with the revision of payment mechanisms and the introduction of incentives for greater quality in health care.
• Increase risk pooling, in order to ensure that the risk related to financing health interventions is borne by all the members and not by each contributor individually.
• Mathilde Mailfert / Marielle Phe Goursat (2018): Moving towards universal social health protection in Lao PDR. Genève: International Labour Office (ILO).
Based on the references:
• Lao Statistics Bureau (2018): Lao Social Indicator Survey II 2017, Survey Findings Report. Vientiane, Lao PDR: Lao Statistics Bureau and UNICEF.
• Ministry of Health (2017a): National Health Accounts Report. Vientiane, Lao PDR.
• Ministry of Health (2017b): National Health Insurance Strategy 2017-2020. Vientiane, Lao PDR.
• Ministry of Health (2017c): Report on Progress of HSDP Implementation under National Health Insurance Bureau 2017 and Plan for 2018. Vientiane, Lao PDR.
• Ministry of Health and Lao Statistics Bureau (2012): Lao PDR Lao Social Indicator Survey (LSIS) 2011-12. Vientiane, Lao PDR.
• World Bank Group (2016): Maternal and Child Health Out-of-Pocket Expenditure and Service Readiness in Lao PDR. Washington DC.
This card was created in friendly collaboration with Ms. Marielle Phe Goursat / Mr. Xiong, Thongleck – Program Manager – Social Health Protection, International Labor Organization (ILO) Country Office.
National UHC Dynamics Card as PDF
A complete overview of the UHC process in Laos can be found in the attached print version of the card.
