The Determinants of Enrolment in Community-Based Health Insurance in Lao PDR

Presenter: Magnus Lindelow, World Bank

Abstract

Health care in Lao P.D.R. is primarily financed through direct out-of-pocket payments by households, contributing to underutilization and health related financial risk. As part of a broader health financing strategy, community-based health insurance (CBHI) has been implemented across 12 districts in Lao PDR and plans are underway to expand coverage to reach all 142 districts in the near future. The government is optimistic that the CBHI scheme will generate substantial resources to the health sector and help to increase coverage of risk-protection schemes. By linking with other schemes, including social health insurance and health equity funds, CBHI is also expected to improve equity of health care utilization. However, uptake rates among the target population are low, due to a combination of demand and supply-related factors. This presentation will explore the factors influencing the demand for insurance using a mix of quantitative and qualitative methods. The presentation will also highlight the challenges and opportunities for linking with other schemes in the transition toward a pluralistic system of universal coverage.

To explore the determinants of CBHI enrolment we estimate a probit regression model using results from a cross-sectional survey of 3000 households. Key independent variables explored are socioeconomic status, health status and risk preferences, health seeking behavior, perceived quality of the health care system, and village-level factors including social capital and trust. Focus group discussions with 9 groups of members, non-members and drop-outs elaborate on quantitative findings by focusing specifically on supply-side factors related to the health system and the management of the schemes.

Given that the CBHI scheme is still in the pilot phase, this study provides an opportunity to inform the government about the role that CBHI can play in the broader health financing strategy, including the scope for using CBHI to expand coverage, opportunities and constraints for linking CBHI to other financing schemes, the potential for mandatory CBHI enrolment, and the potential for using government subsidies to increase sustainability of CBHI and improve equity of the health care system.