The views expressed in this presentation are the views of the author and do not necessarily reflect the

views or policies of the Asian

Development Bank Institute (ADBI), the Asian Development Bank (ADB), its Board of Directors, or the governments they represent. ADBI does
not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequences of their use. Terminology used
may not necessarily be consistent with ADB official terms.

Social Health Protection

toward UHC in Lao PDR

Presented by:
Representative of NHIB

1
 Overview
• Current situation
- Health status
- Health financing issues
• Government policies toward Universal health
coverage in Laos
- Social Health protection system
- Key challenges
 Health Situation - overview
Life expectancy at birth (2010) 65
Infant mortality rate (per 1000 live births) (2015) 57
Under-5 mortality rate per 1000 (2015) 86

Birth attended by skilled health personnel (2015) 50.9%

Maternal Mortality Ratio (per 100 000 live
206
births) (2015)
 Health Financing Situation - Overview
GDP per capita US$1049
General Government Expenditure on Health as % of
1.3 %
GDP ( FY 2015))
Total Health Expenditure as % of GDP (WHO NHA 2009) 4%
General Government Expenditure on Health as % of
5.9%
General Government Expenditure (NHA 2015)
Out – of – pocket expenditure as % of Total Health
45%
Expenditure (WHO NHA 2009)
Coverage of Social Health Protection (all schemes)
90%
in 2017
 Government Policy towards UHC
• Universal coverage goal > 80% of the population
covered by 2020, UC achieved by 2025 (Horizontal Dimension)
• Out-of-Pocket payments to be reduced (Vertical Dimension)
• Establishment of 6 social health protection schemes:
– Formal sector: SSO (private sector), SASS (public sector)
– Informal sector: CBHI, HEF (poor), NHI + National policy on
Free MNCH (pregnant women and children under 5)
• Establishment of National Health Insurance (Decree 470)

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 NHI Scheme design
• National Insurance Scheme for the Informal Sector (NHI) to
cover the whole informal sector population (replace CBHI,
integrate HEF and Free MNCH into its benefit package).
• Financing for NHI = mainly government subsidies (tax-
based) + co-payment at point of service.
• Rational for co-payment at point of service
– To reduce moral hazard of demand side, not for revenue
generation of NHI.
– To comply with health insurance regulation (Decree 470).
• Standard payment of providers on capitation at HC and for
OPD at Hospitals and case-based for IPD at Hospitals

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 Copayment rate

Kip/visit HC District Prov. Central

hospital hospital hospital
OP* 5,000 10,000 15,000 20,000

IP* 5,000 30,000 30,000 30,000

MNCH** 0 0 0 0

* Exemption for the poor

** Exemption for free MCH
***Additional transportation and food allowance for the poor

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Progress of social health
protection schemes

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 Social Health Protection Coverage
in 2017
1. NSSF-SASS (civil servants): all provinces and districts
2. NSSF-SSO (private employees): 13 provinces
3. Non-poor informal sector:
- Voluntary HI (50% subsidies since 2016): 40 districts,
progressively integrated into NHI
- NHI tax-based with copayment: started in 4 provinces
in 2016 and cpvers 17 provinces (139
districts) in 2017
4. HEF: 114 districts, progressively integrated into NHI
5. Free MNCH services: 135 districts, progressively
integrated into NHI
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Trend in population coverage
Extension of population coverage
 Challenges encountered
• Funding channels and sustainability
• Integration of formal sector scheme into NHI
schemes
• Change of institutions to single purchaser
• Capacity building of human resources
• Providers’ responsiveness
• Data Management – Tracking

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1. Strengthen legal and governance frameworks of
NHI & NHIB
2. Ensure sustainable funding of the NHI policy
3. Build and sustain NHIB capacity at all levels
4. Ensure effective implementation of the
integrated NHI scheme nationwide
5. Ensure quality of services and responsiveness
of health facilities
6. Raise awareness about NHI
Thank you