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Institutional design and organizational practice for universal coverage in lesser-developed countries: Challenges facing the Lao PDR

descriptionPublicationkeyboard_double_arrow_right Article 01 Nov 2013Elsevier BVSocial Science & Medicine, volume 96, pages 250-257 (issn: 0277-9536,

Authors: Shakil Ahmed; Peter Leslie Annear; Bouaphat Phonvisay; Chansaly Phommavong; Valeria de Oliveira Cruz; Asmus Hammerich; Bart Jacobs;

doi: 10.1016/j.socscimed.2013.01.019

pmid: 23433544

Institutional design and organizational practice for universal coverage in lesser-developed countries: Challenges facing the Lao PDR

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Abstract

AbstractThere 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.

Related Organizations

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Subjects by Vocabulary

Microsoft Academic Graph classification: Social determinants of health Health policy Government Public economics Informal sector business.industry Capacity building Subsidy Public relations Conceptual framework Risk pool business

Keywords

Capacity Building, Health (social science), National Health Programs, Institutional development, Social health insurance, Health(social science), Lao PDR, History and Philosophy of Science, Universal Health Insurance, Universal health coverage, Humans, Community health insurance, Developing Countries, Qualitative Research, Social health protection, Laos, Health Resources

48 references, page 1 of 5

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Chan, M. (2010). The path to universal coverage, statement to the press at the launch of the World Health Report Health Systems Financing: The path to universal coverage. http://www.who.int/dg/speeches/2010/launvh_WHR_2010/en/index.html Accessed 19.02.12.

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	citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).	12
	popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.	Average
	influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).	Average
	impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.	Average

	citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).	12
	popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.	Average
	influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).	Average
	impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.	Average