Publication: Achieving Universal Health Coverage through Voluntary Insurance: What Can We Learn from the Experience of Lao PDR?
Loading...
Files in English
248 downloads
Published
2013-12-17
ISSN
Date
2015-11-30
Author(s)
Editor(s)
Abstract
The Government of Lao Peoples’ Democratic Republic (Lao PDR) has embarked on a path to achieve universal health coverage (UHC) through implementation of four risk-protection schemes. One of these schemes is community-based health insurance (CBHI) – a voluntary scheme that targets roughly half the population. However, after 12 years of implementation, coverage through CBHI remains very low. Increasing coverage of the scheme would require expansion to households in both villages where CBHI is currently operating, and new geographic areas. In this study we explore the prospects of both types of expansion by examining household and district level data.
Link to Data Set
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Citations
- Cited 34 times in Scopus (view citations)
Collections
Related items
Showing items related by metadata.
Publication Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Brazil(World Bank Group, Washington, DC, 2014-09)Over the last 20 years, Brazil has seen profound economic, political, and demographic changes. After a period of military dictatorship (from 1964 to 1985), political and economic stability was achieved in the mid-1990s. The country has urbanized, improved access to water and sanitation, achieved solid economic growth, and reduced income inequality. It was one of the first Latin American countries to establish universal health coverage (UHC) as a fundamental right, based on the principles that health care is a duty of the state and should be free at the point of use. The reform in the late 1980s created the Unified Health System (Sistema Único de Saúde, or SUS) and was based on the principle that health care should be free at the point of use to all Brazilian citizens.Publication Vietnam : Learning from Smart Reforms on the Road to Universal Health Coverage(World Bank Group, Washington, DC, 2014-08)Universal Health Coverage is a powerful framework for a nation aiming to protect their population against health risks. However, countries face multiple challenges in implementing, achieving and sustaining UHC strategies. Sharing and learning from diverse country experiences may enable to foster global and country progress toward that goal. The study seeks to contribute to the global effort of sharing potentially useful lessons to address policy concerns on the design and implementation of UHC strategies in LMICs. Vietnam is one of the LMICs that have taken relatively quick and effective actions to expand health coverage and improve financial protection in the last two decades. The country study, first, takes stock of UHC progress in Vietnam, examining both the breadth and the depth of health coverage and assessing financial protection and equity outputs (chapter one). Chapter two includes an in-depth analysis of some of the major success strategies and policy actions that the country took to expand health coverage and financial protection for all, including for the poor. Chapter three focuses on some of the UHC-related challenges that the country faces in pursuing expansion and sustaining UHC. Vietnam s experience suggests that, moving toward greater UHC outputs, the system must be constantly adjusted, and that UHC strategies must be adaptive, those used in the past to cover the formal sector and the poor may turn out inadequate to reach the uninsured in the informal sector.Publication Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Vietnam(World Bank Group, Washington, DC, 2014-09)Vietnam is regarded as a development success story. Political and economic reforms ( Doi Moi ) launched at the end of the 1980s have transformed the country from one of the poorest in the world to a lower middle-income country in a quarter century, with per capita income of $1,130 (World Bank, 2013). Over the past 10 years, Vietnam has seen average annual economic growth of nearly 8 percent. Poverty tumbled from 58 percent in 1993 to 12 percent in 2009. Economic development and innovative policy interventions led to steep gains in health outcomes and access to health care, although large disparities persist between the rich and poor, and between poorer and better-off regions (Vietnam General Statistics Office 2011b). Infant mortality declined from 30 to 16 per 100,000 live births, and under-five mortality rates from 42 to 25 per 100,000 live births, between 2001 and 2009 (Vietnam General Statistics Office 2011a, 2011c). Vietnam has shown strong political commitment toward universal health coverage (UHC), making it a national goal for 2014. A major challenge lies now in expanding coverage to the non-covered population (64 percent had coverage in 2012) while addressing the model s financial sustainability.Publication Actuarial Costing of Universal Health Insurance and Coverage in Indonesia(World Bank, Washington, DC, 2011-04)This series is produced by the Health, Nutrition, and Population family (HNP) of the World Bank's Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The cost of a health insurance program will largely be determined by the size and composition of the covered population, the benefit package, cost sharing arrangements, the current and future supply of health care providers and facilities, and the provider payment mechanisms used. This note summarizes in broad strokes the subset of the possible Universal Coverage (UC) transition scenarios and their related costs in Indonesia. These scenarios were selected based on initial discussions with key stakeholders, and further broad-based discussion with stakeholders will be needed to finalize the design, financing and transition options. This note shows how decisions regarding the transition steps, benefit package and the choice of eligible population affect public Health Insurance (HI) expenditures as Indonesia transitions to UC. This work follows closely the earlier World Bank report health financing in Indonesia; a road map for reform.Publication Can Insurance Increase Financial Risk? The Curious Case of Health Insurance in China(World Bank, Washington, DC, 2005-10)The most basic argument for insurance is that it reduces financial risk. But since insurance opens up new opportunities for consuming expensive high-technology care which permits health improvements that are valued by the insured, and because in many settings the provider is able and has an incentive to exploit the informational advantage he has over the patient, it is not immediately obvious that insurance will in practice reduce financial risk. The authors analyze the effect of insurance on the probability of an individual incurring "high" annual health expenses using data from three household surveys-one a cross-section survey, the other two panel surveys. All come from China, a country where providers have until recently largely been paid fee-for-service (often according to a schedule that encourages the overprovision of high-technology care and the underprovision of basic care) and who are only lightly regulated. The authors define annual spending as "high" if it exceeds 5 percent of average income in the sample and as "catastrophic" if it exceeds 10 percent of the household's own per capita income. The estimates of the effect of insurance on financial risk allow for the possible endogeneity of health insurance in the panel datasets by allowing for a time-invariant fixed effect capturing unobserved risk that may be correlated with insurance status, and in the cross-section dataset by using instrumental variables, where availability of and eligibility for health insurance are used as instruments. The results suggest that during the 1990s China's government and labor insurance schemes increased financial risk associated with household health care spending, but that the rural cooperative medical scheme significantly reduced financial risk in some areas but increased it in others (though not significantly). From the results, it appears that China's new health insurance schemes (private schemes, including coverage of schoolchildren) have also increased the risk of high levels of out-of-pocket spending on health. Where the authors find evidence of health insurance increasing the risk of "high" out-of-pocket expenses, the marginal effect is of the order of 15-20 percent; in the case of "catastrophic" expenses, it is even larger.
Users also downloaded
Showing related downloaded files
Publication World Development Report 2006(Washington, DC, 2005)This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.Publication Sourcebook on the Foundations of Social Protection Delivery Systems(Washington, DC: World Bank, 2020-07-30)The Sourcebook synthesizes real-world experiences and lessons learned of social protection delivery systems from around the world, with a particular focus on social and labor benefits and services. It takes a practical approach, seeking to address concrete “how-to” questions, including: How do countries deliver social protection benefits and services? How do they do so effectively and efficiently? How do they ensure dynamic inclusion, especially for the most vulnerable and needy? How do they promote better coordination and integration—not only among social protection programs but also programs in other parts of government? How can they meet the needs of their intended populations and provide a better client experience? The Sourcebook structures itself around eight key principles that can frame the delivery systems mindset: (1) delivery systems evolve over time, do so in a non-linear fashion, and are affected by the starting point(s); (2) additional efforts should be made to “do simple well”, and to do so from the start rather than trying to remedy by after-the-fact adding-on of features or aspects; (3) quality implementation matters, and weaknesses in the design or structure of any core system element will negatively impact delivery; (4) defining the “first mile” for people interface greatly affects the system and overall delivery, and is most improved when that “first mile” is understood as the weakest link in delivery systems); (5) delivery systems do not operate in a vacuum and thus should not be developed in silos; (6) delivery systems can contribute more broadly to government’s ability to intervene in other sectors, such as health insurance subsidies, scholarships, social energy tariffs, housing benefits, and legal services; (7) there is no single blueprint for delivery systems, but there are commonalities and those common elements constitute the core of the delivery systems framework; (8) inclusion and coordination are pervasive and perennial dual challenges, and they contribute to the objectives of effectiveness and efficiency.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication Lebanon Economic Monitor, Fall 2022(Washington, DC, 2022-11)The economy continues to contract, albeit at a somewhat slower pace. Public finances improved in 2021, but only because spending collapsed faster than revenue generation. Testament to the continued atrophy of Lebanon’s economy, the Lebanese Pound continues to depreciate sharply. The sharp deterioration in the currency continues to drive surging inflation, in triple digits since July 2020, impacting the poor and vulnerable the most. An unprecedented institutional vacuum will likely further delay any agreement on crisis resolution and much needed reforms; this includes prior actions as part of the April 2022 International Monetary Fund (IMF) staff-level agreement (SLA). Divergent views among key stakeholders on how to distribute the financial losses remains the main bottleneck for reaching an agreement on a comprehensive reform agenda. Lebanon needs to urgently adopt a domestic, equitable, and comprehensive solution that is predicated on: (i) addressing upfront the balance sheet impairments, (ii) restoring liquidity, and (iii) adhering to sound global practices of bail-in solutions based on a hierarchy of creditors (starting with banks’ shareholders) that protects small depositors.Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.