Supporting the establishment of the NHI system and the extension of coverage in Lao PDR
Sandra Incorvaia , Sinta Satriana , valérie schmitt
Health financing in Lao PDR relies very heavily on out of pocket expenditure (over 50%) indicating the very low coverage of social health protection. While four different schemes are operating in the country, together, they cover only 27.5 per cent of the population. The four schemes are implemented in a fragmented way and this has led inefficiencies and inequities.
ILO is collaborating with the Ministry of Labour and Social Welfare and Ministry of Health to achieve universal coverage in health, and pursuing the progressive harmonization/merger of existing social health protection schemes under the project called “Supporting the establishment of the National Health Insurance Scheme and the extension of Coverage in Lao PDR”.
The project is financed by the Government of Luxembourg (see donor's factsheet) and it is operating on three levels:
- Supporting the ongoing process through facilitating and strengthening of the policy process;
- Supporting the harmonisation of procedures among the different schemes and the extension of coverage in one province as a demonstration (this will include the creation of a single fund for the social protection floor followed by the establishment of a common risk pool);
- Supporting the establishment of a National Health Insurance Agency (through which all four existing schemes will be merged).
The project develops capacities in social security and social health protection and provides technical support in policy-making, design, implementation and monitoring of the schemes and the progressive harmonization of their operations.
The staircase approach includes the "harmonization" of benefits, operations and MIS & IT systems across existing schemes, support of new enrolments. The establishment of a fund is envisaged to increase access to social health protection for the poor as a pilot in Vang Vieng.
ILO and WHO are promoting and supporting the implementation of the social security staircase in Lao PDR where:
• A subsidized social protection floor for health should successively be guaranteed to all population in Lao PDR.
• Population can have more access to better managed and more gender equitable social security benefits.
Read more on social protection floor programme!
SOCIAL SECURITY LAW
Under this project, ILO in collaboration with WHO, provides also guidance and advice on policy formulation and institutional capacity building on social security provisions.
In July 2013, the Lao National Assembly adopted the law on Social Security (click on the link to view the legal text). The law stipulates social security provisions for public and private sector workers, and the merger of the two existing statutory social security administrations: the State Authority for Social Security (SASS), managing the benefits for public sector workers, and the Social Security Organization (SSO) which manages benefits of private sector workers.
Some provisions have been amended, including the pension formula for retirement pensions, and the benefit provisions for sickness and maternity benefits. In addition, the new law stipulates the provision of unemployment benefits, which requires the introduction of a new benefit branch.
In terms of population coverage, the law includes provisions for the voluntary coverage of self-employed workers through voluntary contributions and enrolment. These provisions target the many workers in the informal economy, which make up for more than 60 per cent of the work force. To create strong incentives for enrolment, and to encourage informal sector workers to join, the law includes provisions regarding contribution subsidies to be provided from the state budget.
Regulation on the implementation of Law on Social Security Law n. 2434, 29 July 2014
The mandate of the NHIB is based on the Decree on the National Health Insurance Scheme
The regulations defining NHIB operations at district levels are yet to be finalized and agreed upon at the provincial level.
• Social Protection: Assessment, Costing and Beyond consists in a workshop on the assessment matrix on social protection for the Lao PDR, aiming to identify policy and implementation gaps for the four guarantees of the social protection floor, including on social health protection
• More about the Workshop on Social Security Law in Thalath here!
• Preparation of Social Security Laws: Standards, Policy and Legislation, Luang Prabang. A seminar that addressed policy issues, design of social security schemes and aspects related to the implementation and governance of schemes.
• A Lao delegation participated in a regional training workshop entitled “Integrating Social Policies and the Delivery of Social Protection Floors” that enabled participants to better conceptualize a joint delivery mechanism and the progressive harmonization of the operations of the five existing social health protection schemes.
Coming soon Opening event/Factsheet/Poster/Videos/Press Release
Baseline Report soon published! It’s a collection of the relevant baseline data and statistical indicators on a national level and in the pilot district (Vang Vieng) on access to health care, health care seeking behavior, health care costs, and other health-related information from 300 households comprising over 1,600 individuals.
Other background documents coming soon