National health insurance for UHC in

Lao PDR: Challenges for the

implementation

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author and do not necessarily reflect the views or policies of the Asian Development
Bank (ADB), or its Board of Governors, or the governments they represent. ADB does
not guarantee the accuracy of the data included in this paper and accepts no
responsibility for any consequence of their use. Terminology used may not
necessarily be consistent with ADB official terms.

Outline
1. Country background
2. Government policy towards UHC
3. Challenges of National Health Insurance
Implementation
4. Next steps

1. COUNTRY BACKGROUND
Landlinked country
Three geographical regions:
Northern, Central and Southern
Population of 6,436,000
Area of 236,800 square Km;
Average GDP growth 7-8% pa
Upgrade from a low-income
country to a lower-middle-income
country in 2011;
Health Expenditure: 2.8% GDP
Private Expenditure on Health:
52% of Total Health Expenditure

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 5 social health protection schemes:
Formal sector: SSO (private sector), SASS (public sector)
Informal sector: CBHI & HEF (poor) + National policy on
Free MNCH (pregnant women and children under 5)

Establishment of National Health Insurance system

(Decree 470) in 2013
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2. Overview of Social Health Protection

NSSF-SASS

NSSF-SSO

CBHI 1

Free MNCH

Poor HH

Pregnancy and
<5 children

Target
population

Government
employees
and dependents

Established
year

1995
Revised 2006

2001

2002 (pilot)
2006 extension

2004

~2010

Legislation

PM Decree

PM Decree

MoH National
Regulations

MoH
Guidelines

MoH
Guidelines

Supervising
authority

MoLSW

MoLSW

MoH

MoH

MoH

Government
and government
employee

Employer and
employee

Household

Subsidies

(Government
subsidies since
2016)

(Government and
donors)

Donor
Government

Source of
funds

Enterprise
Informal sector
employees and
HH
dependents 2

HEF

1 In 2016, the MOH introduced a new scheme called National Health Insurance Fund (NHI) targeting the entire
informal sector through a non-contributory mainly tax-based system with low co-payment.
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2 Since 2015, NSSF-SSO also targets informal sector on voluntary basis

Membership coverage by scheme

Coverage by SHP Schemes in 2015
4,500,000

95%

97%

4,000,000

Target
Insured
% insured

100%

92%

3,500,000

90%

80%

3,000,000

70%

60%

2,500,000
2,000,000

46%

44%

50%

40%

35%

1,500,000

30%

1,000,000

20%

500,000

10%

4%

SASS

SSO

CBHI

0%

HEF

FMAT

FCU5

Source: MOH National Health Insurance Bureau, report 2015 (draft)

Challenges
Institutional capacity of National Health Insurance scheme

Integration of different schemes into one umbrella in line

with PM Decree ? Or merging with formal sector under
NSSF?
Extension of coverage to cover non poor informal sector
- Financing through tax-based or mixed
insurance/tax system?
Political commitment and ensuring government subsidy.
Single pool or multiple pools?
Application of Strategic purchasing and take hospital on
board to ensure quality of hralth care services/
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Immediate action
1. Gradual pooling: from small pools to big pool

SASS and SSO

NSSF

HI for informal
& HEF poor
& Free MNCH

NHI

but still continue targeting?

or merge informal sector schemes in one?
2. Develop law on National Health Insurance

Thank you
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