Laos' Social Health Insurance (SHI) program's impact on older people's accessibility and financial security against catastrophic health expense.

Laos has introduced various SHI schemes for multiple groups of the population, such as government officials and other population groups under the NHI schemes. There is no specific health insurance policy for this group of people who need special health services and may have a higher possibility of entering financial catastrophe. This study aims to assess the impact of SHI schemes on accessibility and financial catastrophe against catastrophic health expenditures for older people in Laos. A structured questionnaire has been used to retrieve information from 400 older people across 39 villages in Kaysone Phomvihane District, Savannakhet province, the largest province in Laos. In the analytical process, this study used a cross-sectional study design and binary logistic regression models to predict the likelihood of accessing health facilities and experiencing financial catastrophe. The study outcome shows that the increase in age, occupation, number of older people within a household, and presence of chronic conditions increase the likelihood of using health services. Despite the existence of various SHI schemes, this study found that 74 out of 165 households reported using health services experienced catastrophic health expenditure. Several characteristics are associated with catastrophic health expenditure: age, income level, and gender are prone to suffer from catastrophic health expenditure. The difficult problems stem from the absence of comprehensive legislation regarding the older population. Recommendations for policymakers in various timeframes have been made, which cover short- and long-term policy proposals, including providing a specialized lane or fast-track for an older population, building health facilities exclusively for older people, and providing transportation services for older individuals living alone.

The influence of the National Health Insurance scheme of the Lao People's Democratic Republic on healthcare access and catastrophic health expenditures for patients with chronic renal disease, and the possibility of integrating organ transplantation into the health financing system.

Citizens of the Lao People's Democratic Republic have difficulties in obtaining proper health services compared to more developed countries, due to the lack of available health facilities and health financing programmes. Haemodialysis (HD) is currently included under the coverage of the National Health Insurance (NHI) scheme. However, there are several technical barriers related to health service utilization. This study aims to analyse the effects of the Lao NHI on issues of accessibility and the possibility of encountering catastrophic health expenditures for patients with chronic kidney disease. In addition, the study provides policy recommendations for policy-makers regarding the provision of organ transplantation under NHI in the future. Savannakhet Province was purposively selected as a study site, where 342 respondents participated in the study. Two logistic regression models are used to assess the effectiveness of the NHI in terms of accessibility and financial protection against catastrophic health expenditures. The Andersen behavioural model is applied as a guideline to identify factors that affect accessibility and economic catastrophe. NHI is found to improve accessibility to health service utilization for household members with chronic kidney disease. However, due to the limited HD services, there are barriers to accessing health services and a risk of financial hardship due to nonmedical expenditures. Chronic conditions, in addition to kidney issues, dramatically increase the chances of suffering catastrophic health expenditures. In the short run, collaboration with neighbouring countries' hospitals through copayment programmes is strongly recommended for NHI's policy-makers. For long-term policy guidelines, the government should move forward to include kidney transplantation in the NHI healthcare system.

The accessibility and probability of encountering catastrophic health expenditure by Lao patients in Thai hospitals.

It is common for people in Laos to use health services in Thailand and other foreign countries. This study analyzes and compares the probability of using health care services and the financial catastrophe occurring due to health service utilization in both local and Thai hospitals. This study includes 390 respondents from Savannakhet Province, Laos. Households' income levels play an essential role in selected locations of hospital admission. The regression model proves that lower income quintiles were more likely to use local health services, whereas the higher income households preferred Thailand's hospital services. There is a negative relationship between income level and the probability of experiencing catastrophic health expenditure. The National Health Insurance (NHI) is recommended to seek greater cooperation with foreign hospitals, to allow Lao patients to use NHI's coverage as a co-payment system for specific health services not available in Lao hospitals. NHI should have to include proper-nutrition meal services in hospitals for patients to reduce the need for accompanied household members during patients' time at hospitals. It is proven that NHI successfully enhances accessibility to local health services; in the long run, the government should expand national hospitals' capacity, medical equipment availability and quantity of health care personnel.

The impact of National Health Insurance upon accessibility of health services and financial protection from catastrophic health expenditure: a case study of Savannakhet province, the Lao People's Democratic Republic.

INTRODUCTION: Many schemes have been implemented by the government of the Lao People's Democratic Republic to provide equity in health service utilisation. Initially, health service utilisations were fully supported by the government and were subsequently followed by the Revolving Drug Fund. In the 2000s, four health financing schemes, namely the Social Security Organization, the State Authority for Social Security, the Health Equity Fund and Community-Based Health Insurance (CBHI), were introduced with various target groups. However, as these voluntary schemes have suffered from a very low enrolment rate, the government decided to pilot the National Health Insurance (NHI) scheme, which offers a flat, co-payment system for health service utilisation. This study aims to assess the effectiveness of the NHI in terms of its accessibility and in providing financial protection from catastrophic health expenditure. METHODS: The data collection process was implemented in hospitals of two districts of Savannakhet province. A structured questionnaire was used to retrieve all required information from 342 households; the information comprised of the socioeconomics of the household, accessibility to health services and financial payment for both outpatient and inpatient department services. Binary logistic regression models were used to discover the impact of NHI in terms of accessibility and financial protection. The impact of NHI was then compared with the outcomes of the preceding, voluntary CBHI scheme, which had been the subject of earlier studies. RESULTS: Under the NHI, it was found that married respondents, large households and the level of income significantly increased the probability of accessibility to health service utilisation. Most importantly, NHI significantly improved accessibility for the poorest income quantile. In terms of financial protection, households with an existing chronic condition had a significantly higher chance of suffering financial catastrophe when compared to households with healthy members. As probability of catastrophic expenditure was not affected by income level, it was indicated that NHI is able to provide equity in financial protection. CONCLUSION: The models found that the NHI significantly enhances accessibility for poor income households, improving health service distribution and accessibility for the various income levels when compared to the CBHI coverage. Additionally, it was also found that NHI had enhanced financial protection since its introduction. However, the NHI policy requires a dramatically high level of government subsidy; therefore, there its long-term sustainability remains to be determined.

Factors affecting the willingness to join community-based health insurance (CBHI) scheme: A case study survey from Savannakhet Province, Lao P.D.R.

PURPOSE: Community-based health insurance (CBHI) targets independent worker (self-employed) is currently struggling with inadequate size of risk pooling, low enrollment, and high dropout rate as well as financial sustainability. The objective of this study is to find out the factors that significantly affect the CBHI enrollment incentive. The study applied cross-sectional study design to perform situation analysis, in which the Andersen behavioral model was used as a guideline to identify preliminary characteristics that involved with enrolling incentive. FINDINGS: The model found that existence of both outpatient department (OPD) and inpatient department (IPD) health service utilization had significant impact on the CBHI enrollment, this statement is strongly related to adverse selection issues. Households resides in Kaysone Phomvihane district had higher probability of joining the scheme in comparison with relatively less-developed Champhone district. Households with no CBHI knowledge were also more likely to enroll the scheme. Occupation was also found to be a significant factors; of which farmers and laborers had lower possibility enrollment. CONCLUSIONS: Economic condition of the district has a significant impact on enrolment. However, the increase in personal income does not directly enhance the desire for enrolment. Most of the high-income households prefer to use a local, private clinic, and foreign hospitals in Thailand or Vietnam. Households with unemployed heads had the highest possibility of enrolling. The reason is the unemployed respondents include the elderly who stay at home without performing major tasks in exchange for their living. That group of people has the highest probability of either OPD or IPD.

The Impact of Community Based Health Insurance in Enhancing Better Accessibility and Lowering the Chance of Having Financial Catastrophe Due to Health Service Utilization: A Case Study of Savannakhet Province, Laos.

The Lao population mostly relies on out-of-pocket expenditures for health care services. This study aims to determine the role of community-based health insurance in making health care services accessible and in preventing financial catastrophe resulting from personal payment for inpatient services. A cross-sectional study design was applied. Data collection involved 126 insured and 126 uninsured households in identical study sites. Two logistic regression models were used to predict and compare the probability of hospitalization and financial catastrophe that occurred in both insured and uninsured households within the previous year. The findings show that insurance status does not significantly improve accessibility and financial protection against catastrophic expenditure. The reason is relatively simple, as catastrophic health expenditure refers to a total out-of-pocket payment equal to or more than 40% of household income minus subsistence. When household income declines as a result of inability to work due to illness, the 40% threshold is quickly reached. Despite this, results suggest that insured households are not significantly better off under community-based health insurance. However, compared to uninsured households, insured households do have better accessibility and a lower probability of reaching the financial catastrophe threshold.