National UHC Dynamics Card Laos

Flag Laos

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.

Map of Laos
Capital

Vientiane 17°58’N 102°36’E

Official language

Lao

Religion

Buddhism 64.7%, Tai folk religion 31.4%, Christianity 1.7%, Islam 0.8%, Other 1.3%

Independence

from 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

1995
The State Authority for Social Security (SASS) scheme
2001
The Social Security Organisation (SSO) scheme
 

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

COMMUNITY-BASED HEALTH INSURANCE (CBHI) AND HEALTH EQUITY FUND (HEF)
2002-2004

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).

Impact

Limited coverage due to voluntary enrolement under CBHI and targeting inaccuracies with HEF.

2010
The Free Maternal Neonatal and Child Health (FMNCH) services policy is implemented.
Impact

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.

2012
The Decree 470/PM created a National Health Insurance (NHI) Fund.

It aimed to gather all schemes under one umbrella managed by the NHI Management Committee (MC) and its Secretariat the NHI Bureau (NHIB).

OOP 2014

Out-of-pocket (OOP) of current total Health Expenditure was 51%.

2016 - 2019

NHI
NATIONAL HEALTH INSURANCE
 
2016
Implementation of the NHI

Merging of the former CBHI, HEF and FMNCH under the MoH.

 
2016-2017

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.

 
OOP 2016

Out-of-pocket (OOP) of current total Health Expenditure was 46%.

 
2017
Shift to mainly tax-based financing model for the population in informal employment and the poor.

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.“

 
2018

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.).

 
OOP 2018

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.

 
2019

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.

Furthermore, Lao PDR is, to this day, highly dependent on external funding for health.
MORTALITY

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.

TOTAL GOVERNMENT EXPENDITURE ON HEALTH (INCLUDING EXTERNAL FUNDING)
 
SOCIAL HEALTH INSURANCE OF CURRENT HEALTH EXPENDITURE
SOCIAL HEALTH PROTECTION COVERAGE 2018
POPULATION NHI COVERAGE – LAO PDR
OUTLOOK
REMAINING CHALLENGES:

• 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.

 

Source references

• 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.