In Lao People's Democratic Republic (Lao PDR), out-of-pocket payments by households
accounted for an estimated 62 percent of total health care expenditures in 2007 (WHO
2007). These payments include user fees for services and drugs in public health facilities,
as well as expenditures in the private sector (i.e., pharmacies, clinics, drug vendors,
private providers, and traditional providers), and facilities outside the country (e.g.,
Thailand and Vietnam). As in other countries, the Government of Laos is trying to
expand coverage of health insurance and risk protection schemes in order to increase
access to health services, increase financial protection, and generate resources for the
health sector. The ultimate goal is achievement of universal coverage (MOH Lao PDR
2010). Currently, four main schemes operate in Lao PDR: a mandatory Civil Servants'
Scheme (eSS) for government employees; a mandatory Social Health Insurance (SHI)
scheme for private and state-owned enterprises'; voluntary community-based health
insurance for the informal sector and self-employed workers; and health equity funds
(HEFs)3 for households living in extreme poverty. However, outside the CSS, which
covers approximately 6.3 percent of the population and reaches approximately 90
percent of its target group, the schemes reach a small segment of the population, with
approximately 1.7 percent of the population enrolled in CBHI, 1.S percent enrolled in
SHI and 2.1 percent enrolled in HEFs in 2009. Thus, just over one tenth of the population is currently covered by risk-pooling schemes. Although part of the reason for
low coverage of health insurance in the population is that the schemes are not yet
operating nationally, coverage remains low even in areas that have been targeted. The
government is considering various options for scaling up to achieve universal coverage
by 2025