Health care financing for the poor in Lao PDR

Abstract

As in many other developing countries, an official policy of user fees was adopted for the Lao health system in the 1990s. In principle, the poor were to be exempted from paying user fees at public health providers. This study aimed to contribute to policy on financial protection of the poor by (1) improving understanding of health care utilization and strategies adopted by households to deal with costs of Illness; (2) examining attitudes of policy makers and actual practice of public health care providers on fee exemptions of the poor; and (3) proposing better ways of protecting the poor. Both quantitative and qualitative methods were employed. Data were collected from 172 households of 4 villages in Savannakhet Province; 26 public providers in Savannakhet Province and 3 public providers in Vientiane capital; and 22 policy makers in Vientiane capital, between October 2005 and July 2006. The exemption policy has been ineffectively implemented. In practice, criteria for identifying the poor were not specified and no budget was provided to hospitals to finance exemptions. Providers preserved exemptions for 'the destitute'. The payment of user fees could be delayed without interest when 'the poor' had insufficient cash. Villagers strongly believed in the principle of paying user fees to providers either at the point of service or through delayed payment, even though they lived In difficult conditions and their average consumption was below $US1.00 a day. Importantly, they did not perceive exemption from fees to be possible for 'the poor'. The majority of households did not access health care services when III for reasons such as financial and geographical barriers; some of them suffered adverse health consequences as a result such as death or disability. The better the socio-economic group, the better was access to health care services. Among a total of 172 sampled households, twelve households were faced with catastrophic health expenditure, most from the middle and poorest socio-economic group. The villagers managed health crises themselves mainly through drawing on social networks within the community in order to sell assets, borrow, and get other forms of support from neighbours. Although the study of households was small in scale, it was likely to echo households' difficulties elsewhere as the studied villages were similar to other rural areas without roads of Lao PDR. This study suggests that there is an urgent need for the government to improve two main areas: accessibility to adequate health care for everyone, everywhere; and reform of the nationwide policy on health financial risk protection for the poor and the less-poor in order to reduce catastrophic health expenditure.