Government Spending on Health in Lao PDR : Evidence and Issues

Abstract

The note analyzes overall trends in government health financing and expenditure patterns and discusses some of the efficiency and equity issues pertaining to current government health spending patterns. The policy note is one of a series of health financing analyses, complementing earlier policy notes focusing on out-of-pocket spending as well as community-based and social health insurance schemes in the country. This reliance on out-of-pocket payments represents a considerable financial barrier to utilization of health services. The prominence of out-of-pocket spending in the form of user fees and revolving drug funds (RDFs) also raises concerns over management of funds at health facility level and regarding the potential for over prescription. In contrast, social health insurance expenditures are very low in Lao PDR: social insurance schemes cover about 11.4 percent of the population but account for only about 2.8 percent of total health spending. The Lao government has committed to increasing government spending to 9 percent of the budget, implying roughly a three-fold rise compared to plan spending for fiscal year 2011/12. If the policy goal is to raise government health spending equitably across the provinces, achieving it will be challenging. The overall economic outlook for Lao PDR is positive. Economic growth is projected to be 8.3 percent in 2012, and is expected to be in the range of 7-8 percent over the period 2013-2015. This note is one of a series of complementary health financing analyses on out-of-pocket spending and community-based and social health insurance schemes in the country. Additional analytical work in progress will review and assess demand-side pilot interventions currently being initiated by the government, such as the national free maternal and child health policy and the conditional cash transfer pilot.