Institutional design and organizational practice for universal coverage in lesser-developed countries

Challenges facing the Lao PDR

Bibliographic Data

ID8018691
AuthorsShakil Ahmed (0000-0003-3631-5832, The University of Melbourne), Peter Annear (0000-0001-7887-8292, The University of Melbourne), Bouaphat Phonvisay (Ministry of Health), Chansaly Phommavong (Ministry of Health), Valeria de Oliveira Cruz (World Health Organization - Pakistan), Asmus Hammerich (World Health Organization - Pakistan), Bart Jacobs (0000-0003-0075-6732)
Year2013
Volume96
Pages250-257
Publication date2013-02-04
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2013.01.019
PMID23433544
OpenAlexW2022773113
LanguageEN
Citations received5
References cited14

There is now widespread acceptance of the universal coverage approach, presented in the 2010 World Health Report. There are more and more voices for the benefit of creating a single national risk pool. Now, a body of literature is emerging on institutional design and organizational practice for universal coverage, related to management of the three health-financing functions: collection, pooling and purchasing. While all countries can move towards universal coverage, lower-income countries face particular challenges, including scarce resources and limited capacity. Recently, the Lao PDR has been preparing options for moving to a single national health insurance scheme. The aim is to combine four different social health protection schemes into a national health insurance authority (NHIA) with a single national fund- and risk-pool. This paper investigates the main institutional and organizational challenges related to the creation of the NHIA. The paper uses a qualitative approach, drawing on the World Health Organization's institutional and Organizational Assessment for Improving and Strengthening health financing (OASIS) conceptual framework for data analysis. Data were collected from a review of key health financing policy documents and from 17 semi-structured key informant interviews. Policy makers and advisors are confronting issues related to institutional arrangements, funding sources for the authority and government support for subsidies to the demand-side health financing schemes. Compulsory membership is proposed, but the means for covering the informal sector have not been resolved. While unification of existing schemes may be the basis for creating a single risk pool, challenges related to administrative capacity and cross-subsidies remain. The example of Lao PDR illustrates the need to include consideration of national context, the sequencing of reforms and the time-scale appropriate for achieving universal coverage

Business · Economic growth · Economics · Government (linguistics · Health care · Insurance policy · Key person insurance · Political science · Public economics · Public relations · Risk pool · Subsidy · Global Health Care Issues · Global Maternal and Child Health · Healthcare Systems and Reforms · Finance · Health Policy

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