Country Report of Lao PDR

Transcription

1 Country Report of Lao PDR Bouathep PHOUMINDR, MD, PhD Rehabilitation Medicine Specialist Vice Dean, Faculty of Medical Technology Head of Rehabilitation Medicine Department

2 Basic information of Lao PDR General information: Lao PDR area : 236,800 km2,density : 24 people / skm Neighboring: Thailand, Cambodia, Vietnam, China and Myanmar. Provinces: 18, Districts : 141, Villages : 10,553 Population : 5.9 millions, ( F ) with 49 multi-ethnic groups and 4 linguistic s Age group: 0-14: 49.35% ( F ), 50.65% ( M ) 15-64: 50.44% ( F ), 49.56% ( M ) > 65 : 53.16% ( F ), 46.84%. ( M ) Farmer is 83 %

3 Basic information of Lao PDR General information: Current situation concerned with poverty 1.Population living below 1 USD a day : 26,3 % 2.Population living below 2 USD a day : 73,2 % 3.Population living below the national poverty line 26,7 % 4. Adult illiteracy rate: 22.8 % 5. Population not using improved water source : 32.9 % 6. Children under weight for age ( under 5 ) : 40 %

4 Basic information of Lao PDR General information: GNI per capital : USD 734 ( year 2010 ) Poverty rate: 26.7 % ( LEC 4; 2010 ) Adult literacy rate age of : 88 %. Urban population: 37%. Budget for social welfare & its percentage of total national budget: 2.97%. Budget for health & its percentage of total national budget: 13.31%

5 Basic information of Lao PDR General information: The Vital statistics: ( Based on year 2007 ) Rate of natural increase of population: 2.4 % / year. Crude death rate : 9.1% Crude birth rate: 32.6% IMR : IMR < 5 Year : 64.4% / 1000 life birth 86.6 / 1000 of life birth Total life expectancy at birth: 62.5 Total fertility rate : 4.2 / one woman

6 Follow up of the 7 th ASEAN and JAPAN High Level Officials Meeting on Caring Societies To promote closer cross sector cooperation between ministries of health and of social welfare and other related lined ministries and to indentify the focal point, through development of a national mechanism and framework

7 Follow up of the 7 th ASEAN and JAPAN High Level Officials Meeting on Caring Societies MOH: - After participating of this meeting, The National Rehabilitation Center, MOH organized a proposal of fabricating new center for Health Care System for children with disability. - This project had been evaluate from Japanese expert on the beginnig of this year February - This project focus on two point : 1. Fabricate new building as a center of complete health care for children with disability 2. Professional training program for short and long term

8 The cooperation of the MOH, MOLSW and other line Ministries MLSW: Drafted the decree on Disable People Decree benefit: described on all the rights of disable people all ages, sexes, prevention, treatment and rehabilitation, education, working, receiving information, social welfare and social assistant from the societies and so on. MOH and MOLSW cooperation, Decree on disable people has not been sign Action has been taken on the Child disable people, and other ages still have continue as much as possible

9 A case study: Good practice of poverty alleviation program Developing Social Health Insurance in LAO PDR a path to Universal coverage

10 Over view Goals for current social health insurance Increase utilization rates Pool resources and risks so that access to health care is not dependent on income levels Provide safety net for households for serious illnesses, diseases and accidents (prevent households falling into poverty) Provide regular funding to support development of district level health services Provide incentives to improve quality of care available through district hospitals Continuous development of provider payment method Provider of services separate from purchaser of services Capitation rate adjustment according to utilization and inflation Development of standard fee schedule Maintain equity between private, community and public social health insurance schemes: (benefit package, capitation system) Develop foundation for compulsory universal coverage

11 Over view ( Cont ) Medical care became more expensive and prepaid health care helped workers and their families be able to get medical treatments more easily. The social health insurance scheme was also to support the development of health care services through regular financing paid in advance. The social health insurance scheme also lets members change their registered health care provider every year, so if they are not satisfied with the services they can change their provider. The social health insurance schemes also aim to keep equity between the different social security and health insurance schemes.

12 Problems analysis Problems Low investment for health expenditure inequity access to Health care service (poor target) High MMR & IMR Problems Solving Health insurance Universal coverage Ensures for Health car financing Take out of barrier access to health facility Goal Decline for MMR & IMR

13 Health care financing strategy to reach UC Universal coverage in 2020? Financial protection for the whole society 1ŒGovernemnt budget from taxation Health protection for half of the population in Œ National health insurance fund 3Œ Tax collection system and health insurance organization are in place Financial protection for a part of the population - - 1Œ Welfare fund at village level No financial protection Majority of health care expenditures in OOP 2Œ Mutual fund for different organizations 3Œ 3 health insurance schemes and private insurance 4Œ Specific fund for vulnerable groups of people coming from taxation

14 Institutions or organizations involved SSS collaborate with the top 4 levels: Ministry of Health central hospitals, provincial hospitals and district hospitals. SSS sign contract with hospitals based on health services with performance of staff, appropriate equipment and patient beds.. The Hospitals services must be for 24 hours. We have signed contracts with 18 district hospitals, 9 provincials, 3 central hospitals and 1 military hospital. Next year, we will extend more to all provinces and districts

15 Cooperation of MOH with MLWF MOH PM MF ML

16 Strategy Pursued SSS in Lao follows the same principles for health insurance, - Capitation based system for pre-paid health care. - Paid direct to the hospitals - Capitation also helps to keep the low costs of medical care with higher quality of care. Costing studies: To calculate the capitation fees based on hospital information for the costs of health care using revenue and expenditure methods.

17 How the strategy was implemented Coverage as projected Coverage ( as % of pop in target area) Coverage as % of total pop Civil servant scheme Social Security Scheme Community Based Health Insurance 900,000 beneficiaries by 2010 ( 180,000 civil servant and 720,000 dependents) 560,000 beneficiaries by 2010 (140,000 workers and 420,000 dependents) > 70% of informal population by ,000 (43%) 6.90% 90,000 (16%) 1.5% 130,000 ( 10% of target area and 5% of target district) 2.2% Health Equity Fund 26.7% of population 170,000 (11%) 2.9% Total 5,900, , %

18 Impact on policy All insurer have the same benefit and equity access health services. We have a comprehensive package for prevention and curative and rehabilitative service. Especially we include maternity care for pre and post natal care to decline MMR and IMR in Laos.

19 Potential for up scaling and replication To extend coverage for all of Lao population The MOH and other line Ministries are drafting the decree on the National Social Health Insurance. We learned from ASEAN and other developed countries to help us for developing the policy framework.

20 Potential for up scaling and replication( Cont ) To attain universal coverage in Activities by the Social Security Scheme, Civil servant Scheme and Community-based Health Insurance are foreseen to merge by Therefore, all schemes cover OPD and IPD care, without copayment or limitations of health services

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