Aiming to address gaps in the National Health Insurance (NHI) scheme, Minister of Health H.E. Dr. Bounfeng Phoummalaysith has endorsed a revised NHI Strategy for 2021-2025
In the Lao People’s Democratic Republic (Lao PDR), the NHI scheme provides social health protection to the population. Since its introduction in 2016, the NHI has drastically increased the number of people protected from 45% in 2016 to 94% in 2021, and use of public health services by 10-30%.
Funded by tax revenues, the NHI provides health services with a small co-payment at the point of care: depending on the level of facilities, 5,000-20,000 LAK for outpatient care (care when patients don't need to spend a night in a hospital, often routine services) and 5,000-30,000 LAK for inpatient care, and no-cost services for pregnant women, children and the poor.
However, challenges remain in ensuring complete or proper availability of NHI benefits. Some people are requested to pay additional or excessive fees - while a range of other operational challenges impact delivery and sustainability of the scheme. Against this backdrop, rising inflation risks the NHI becoming too costly for the Government.
To address these gaps, and reflect the changes since NHI’s establishment in 2016, the National Health Insurance Bureau (NHIB) (part of the Ministry of Health) – with WHO support – has revised the NHI Strategy for 2021-2025.
The new strategy establishes a range of specific policy actions to improve the implementation and sustainability of the scheme. Broadly, the new strategy:
- Retains the same overall direction – ensure a sustainable and efficient NHI scheme which provides health for all
- Reflects the changes in NHI since its creation, with new goals and strategic objectives – the original strategy focused on establishing the scheme, nationwide expansion, and integration of other schemes into NHI
- Supports NHI-related legislative updates to establish NHI as a semi-autonomous agency with reserve fund
- Outlines a range of policy actions for financial sustainability and revenue management: development of a long-term NHIB management information system, strengthening hotline services and verification processes, improving the timeliness of reimbursements to health facilities
- Strengthens the role of NHIB to ensure the best health outcomes possible within available funding, using data to look at spending, and use of procedures and treatments
- Sets clearer targets for the measurement and evaluation of the above objectives
- Supports progress towards a single-payer system, in which costs for essential healthcare for all are covered by a single national purchaser system (hence "single-payer").
These are outlined in the strategy’s new objectives:
- Improve the legal and policy framework of NHI and strengthen NHIB governance mechanism
- Strengthen financial independence, accountability, and sustainability of the NHI fund
- Strengthen NHIB’s institutional capacity and operational effectiveness and efficiency at the central, provincial and district levels
- Ensure responsiveness of health facilities and improve quality of health care services
- Raise awareness among the general population about NHI benefit entitlements.
Highlighting the work completed, Dr Aphone Visathep, Director of the National Health Insurance Bureau, said: “The goal here is simple: affordable, quality healthcare for all, within a financially sustainable national healthcare system.”
“Significant progress has been made since 2016, and this new strategy outlines how we take the next major steps forward, and better protect the lives of our population.”
WHO’s support for the NHI Strategy revision was made possible with funding from the Government for Luxemburg through the Universal Healthcare Partnership, and the Government of the Republic of Korea. Support will continue as the strategy enters implementation.