Social health protection

Lao PDR Health Insurance Reform allows 70 year old to access to healthcare for the first time

70-year old’s first experience of medical treatment illustrates progress of Lao PDR’s social health protection system since implementing a National Health Insurance scheme to promote universal health coverage.

News | 29 January 2020
Throughout most of her life, mother of 7 and proud grandmother, Mrs. Thong Theuud, had never set foot in a hospital or been seen by a doctor. As a younger woman, she devoted her life to bringing up her children and working on her farm raising pigs and making wine to pay for their education. Even through the births of her 7 children, she never once considered a visit to the hospital as an option.

Fortunately, for 70 years, the grandmother says she never suffered from any serious health problems, which she attributes to having led a simple life. When asked how she’s managed to stay so healthy and strong all these years, she insists that she has ‘no secrets at all’.

In the past, when she occasionally fell ill with a minor affliction, she would simply go to the nearest pharmacy to buy medicine.

However, one morning, at the age of 70, Thong Theuud woke up with a severe pain in her stomach unlike anything she had felt before. Unsure of what to do, she turned to her children who took her to the local hospital without hesitation.

The doctor was quick to diagnose her with gastric perforation- an acute abdominal condition that is fatal if left untreated. Fortunately, for Thong Theuud, her condition was diagnosed early and she was operated on in time.
Having never experienced hospitalisation before, the 70 year old was understandably apprehensive before the surgery.

When recounting her experience, her voice thickens with emotion. “I was afraid” she admits, followed by a self-effacing laugh, “[…] but they gave me anaesthesia, and then I did not hear anything anymore, and I went to sleep.”

After an hour-long surgery, Thong Theuud was relieved to wake up with barely any pain and nothing to show from the procedure but a small line of stiches on her stomach.

Impressed with the level of care she received during her week-long stay at the hospital, the first-time patient notes that her doctor was particularly attentive, and even brought his wife along to visit her.
She was surprised to learn that, thanks to the country’s recently implemented National Health Insurance (NHI) scheme, her treatment was virtually free of cost, with only a small payment needed to cover her admission into the hospital.

The Democratic Republic of Lao (Lao PDR) significantly increased its subsidies to the NHI in 2016 in line with the country’s ambitious goal to achieve universal health coverage by 2025. The NHI has since been further developed to integrate the country’s previously fragmented array of health insurance schemes into a single harmonised system.

Administered by the National Health Insurance Bureau, NHI relies predominantly on tax-based financing, which is combined with contributions from employers and workers in formal employment. This means that the scheme is non-contributory for patients without formal employment.

To access treatment, NHI beneficiaries pay a minimal co-payment at facility level ranging between 5,000 to 30,000 LAK (roughly 50 cents to 3 US dollars). Workers in formal employment (contributing to the NHI), as well as poor patients, expectant mothers and children under 5 years old are exempt from these co-payments.

For patients like Thong Theuud, this reform has proven life changing. One month on from the operation, she is almost back to her old self. Now that the grandmother has regained her appetite and strength, she’s able to walk around easily again and has the energy to take care of her grandchildren after school as she did prior to her illness.

‘I feel better every day, but I still continue taking the medicines’, she says.

Thong Theuud’s first experience of medical treatment was a resounding success and a revelation to the 70 year old, who would never have imagined being able to access such care free of charge in the past.
“If I get sick in the future, I will ask my children to take me to the hospital again, because they treat people for free” she says.

The ILO works to promote strong social health protection systems to ensure that treatment costs don’t prevent anyone from accessing the care they need. This work is based on the belief that health is a human right, no matter your gender, race, religion, sexual orientation, age, ability or citizenship.

In order to promote this right for all its citizens, the Government of Lao PDR has been working progressively towards a reformation of national health financing. Under the country’s Health Sector Development Plan (2016-2020), the Ministry of Health has defined a target to achieve an 80% coverage rate. The implementation of a unified social health protection scheme is crucial to this goal.

To achieve this goal and support the Government in ensuring equitable access to adequate health care for all of its citizens, the International Labour Organisation (ILO) has been working closely with the Lao government over the past two decades.

Currently in the region, ILO is implementing the Grand Duchy of Luxembourg funded project, ‘Support to the extension of social health protection in South East Asia’. As part of its efforts in Lao PDR, the project has been working on designing the unified scheme, assessing the pilot and strengthening the capacity of the National Health Insurance Bureau in rolling out nationwide and administering the NHI scheme.

Reflecting on ILO’s work in Lao, project manager and social health protection expert, Marielle Phe Goursat, explains that “results so far are extremely encouraging. In less than 10 years, the percentage of the Lao population covered by a social health protection scheme went from 10.5% to 94.3% and in 2018, Lao PDR achieved almost full population coverage”.

She notes however, that despite significant progress made in recent years, the country still has a long way to go in efficiently implementing the merged NHI scheme at provincial and district levels and ensuring that informal workers and vulnerable, hard to reach communities are fully covered and aware of their rights. “Strengthening the quality of services at all levels is also an absolute necessity to improve health indicators nationwide”, she adds.

For patients like Thong Theuud, who went 70 years without experiencing medical treatment, to then go on to receive life-saving surgery virtually free of cost, the progress of the social health protection system in Lao PDR is tangible. While challenges remain, her experience highlights the potential for the NHI scheme to lift the financial burden of ill health for all of those in need.