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Progress and Strategy to achieve universal coverage in Lao PDR: Issues for discussion

Progress and Strategy to achieve universal coverage in Lao PDR: Issues for discussion. Presented at 4 th Technical review meeting for Health Policy and Health Finance knowledge Hub Melbourne, Australia, October 7-11, 2011. Current status of social health protection schemes (2011).

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Progress and Strategy to achieve universal coverage in Lao PDR: Issues for discussion

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  1. Progress and Strategy to achieve universal coverage in Lao PDR: Issues for discussion Presented at 4th Technical review meeting for Health Policy and Health Finance knowledge Hub Melbourne, Australia, October 7-11, 2011

  2. Current status of social health protection schemes (2011)

  3. Current financing arrangements  General population Direct payments for fees and medicines (OOP 60% of THE) Salaries  MOH / Province  Budget  Hospital Revenues Budget (GoL & donors) Investment Recurr. cost  Fund / scheme  Civil serv. Formal/informal sector, DPs Contributions (SSO, SASS, CBHI, HEF) Payment • Key issues • Low budget spending → implications for staffing, facility standards, cost of services • Coverage of health insurance is low (around 12% of population) • Heavy reliance on direct payments to fill gaps → implications for equity and access

  4. Possible future financing arrangements  General population Direct payments for fees and medicines Salaries  MOH / Province  Budget  Hospital Revenues Budget Investment Recurr. cost (ensure 9% of Total Gov expenditure is for health  Fund for free MCH services Payment Aim to reduce reliance on direct payments  Fund / scheme  Civil serv. Formal sector Contributions Payment Aim to increase SHI coverage

  5. Progress and Strategy • Free maternal and children under five policy finalized by MOH and submitted to the government for approval by Nov, 2011 • Implementation guidelines for free maternal and children under five policy drafted and presented to the HFTWG • Costing for free maternal and children under five policy completed • NT2 Revenue (Government budget) allocated for Health sectors to expand HEF coverage from 49 to 64 districts • Government commitment to give 9% of total government expenditure to health sector for all levels (central, provincial and district ) • National Health Insurance Decree finalized by MOH and submitted to Government for official approval • Road map for Health insurance merger agreed by Gov and DPs

  6. Road Map 2012 2013 2015 2020 2011 ORGANIZATIONAL Establish NHI Organization Capacity Building Law: Charter And Mandate Begin Merging at Provincial Level Fully Capacitated Full Merge Transfer Staff & Budget FUNDING Establish LT Funding For Indigent Cover Nationwide Risk Pooling Fully Sustainable Funding Four Baskets, One Fund Appropriation to support Law Evaluate Benefits, Contributions, Payment OPERATIONAL Establish Technical Functions Capacity Building on SHI Technical And Operational Functions Integrated NHI IT System Implementing Team Long-term IT Plan Benefit Delivery Database MEMBERSHIP Create a Plan For Membership Management Merging of Membership Databases 14% Coverage 30% Coverage 50% Coverage Universal Coverage PROVIDERS Develop a Plan For Provider Mgt Development of Quality Standards, Capacity Building for Function National QA and Accreditation

  7. Government spending on health has been increasing Health spending has increased steadily over time… …but increases have been quite erratic from year-to-year Note: Planned expenditures, based on official gazette

  8. Medium term expenditure pressures and financing options Expenditure pressures (strategies) Financing (Challenges) • Government budget • Mandatory health insurance (SSO / civil servants) • Difficult to expand coverage due to limited formal sector • Voluntary health insurance • Difficult to expand coverage • Subsidized health insurance • Out-of-pocket payments • Inequitable and makes health care unaffordable for many • External financing • Can fill gap in short to medium term • Wage bill • Increase in quota • Continued salary increases • Incentives for rural / remote service • Policies / programs to subsidize health services • Free MCH service policy • Health Equity Fund • Subsidized health insurance • Expand / maintain health facility infrastructure

  9. What will it take to achieve 9% of government spending on health? – It depends… • If focus is on recurrent spending, share on health is around 3.5-4% • Trend depends on whether we focus on planned or actual • Share of health in total spending has reached over 7% in 10/11 • But erratic due to external financing • Does not reflect commitment of domestic resources

  10. Thank you

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