Maternal Health Out-of-Pocket Expenditure and Service Readiness in Lao PDR : Evidence for the National Free Maternal and Child Health Policy from a Household and Health Center Survey
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Although Lao PDR has made notable
progress in improving maternal and child health (MCH),
attainment of the Millennium Development Goal 5 (MDG5) still
remains a challenge. This is largely due to the barriers
imposed by financial restrictions. In order to address these
financial barriers, the Government of Lao PDR has introduced
a national free MCH policy. However, certain non-financial
barriers are also impediments to the achievement of this
goal, such as physical access to remote communities,
especially during rainy season, cultural practices and
beliefs, and poor educational outcomes. In seeking to inform
the implementation and scale-up of this national free MCH
policy at this crucial initial stage, this paper reports on
findings from a household, village and health center survey
The policy implications of the findings from the survey are:
1) although financial protection implied by the national
free MCH policy is strong, reducing financial barriers alone
would not be sufficient to increase the utilization of
services, 2) this policy has the potential to be regressive
due to the higher utilization of MH services by wealthier
households, 3) health providers at all levels of health
facilities would experience substantial marginal decreases
in revenue, given the reimbursement schedules under the
national free MCH policy, and 4) the supply-side readiness
and management capacity of health centers needs to be
improved. This paper is organized to present the background
context, analyses, the equity of MH service utilization, the
supply-side perspective, and key findings and recommendations.
Palabras clave
ACCESS TO HEALTH CARE, ACCESS TO HEALTH CARE SERVICES, ACCESSIBILITY, AGED, ANTENATAL CARE, BABY, BIRTH ATTENDANT, BIRTH ATTENDANTS, BIRTH RATES, CAESAREAN SECTION, CAESAREAN SECTIONS, CAPITATION, CARE FOR CHILDREN, CHILD HEALTH, CHILD HEALTH SERVICES, CHILDBIRTH, COMMUNITIES, COMMUNITY HEALTH, COMPLICATED PREGNANCIES, COMPLICATIONS, CROSSING, CULTURAL PRACTICES, DESCRIPTION, DEVELOPING COUNTRIES, DISSEMINATION, DISTRICTS, DRUGS, ECONOMIC STATUS, ECONOMIES OF SCALE, ELASTICITY, ELASTICITY OF DEMAND, EMERGENCIES, EMPOWERMENT OF WOMEN, EQUAL ACCESS, ETHNIC GROUP, EXPENDITURES, FAMILY MEMBERS, FAMILY PLANNING, FAMILY PLANNING SERVICES, FAMILY SIZE, FEE FOR SERVICE, FEMALE, FERTILITY, FERTILITY RATES, FINANCIAL INCENTIVE, FINANCIAL MANAGEMENT, FIXED CHARGES, FIXED COSTS, FIXED FEE, FORMAL EDUCATION, GENDER, HEALTH CARE, HEALTH CARE FACILITIES, HEALTH CARE SERVICES, HEALTH CENTERS, HEALTH EXPENDITURE, HEALTH FACILITIES, HEALTH FINANCING, HEALTH INSURANCE, HEALTH OUTCOMES, HEALTH POLICY, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SECTOR REFORM, HEALTH SERVICE, HEALTH SERVICE UTILIZATION, HEALTH SERVICES, HOSPITAL, HOSPITAL BIRTHS, HOSPITAL DELIVERIES, HOSPITALIZATION, HOSPITALS, HOUSEHOLD LEVEL, HOUSEHOLD SIZE, HOUSEHOLDS, ILLNESS, INCOME, INDIVIDUAL HEALTH, INDUCED DEMAND, INFANT, INFECTION PREVENTION, INFORMATION CAMPAIGNS, INSURANCE SCHEMES, INTERNATIONAL COMPARISONS, INTERVENTION, INTERVENTIONS, IRON, ISOLATION, JOURNEY, LEGAL STATUS, LIVE BIRTHS, MANAGEMENT OF PATIENTS, MATERNAL HEALTH, MATERNAL HEALTH SERVICES, MATERNAL MORTALITY, MATERNAL MORTALITY RATES, MATERNITY SERVICES, MEDICAL EXPENSES, MEDICINES, MIDWIFE, MINISTRY OF HEALTH, MORTALITY, MOTHER, NATIONAL POPULATION, NATURAL RESOURCES, NEWBORNS, NUMBER OF PERSONS, NURSE, NUTRITION, OBSTETRIC CARE, OUTPATIENT SERVICES, PATIENT, PATIENTS, PEOPLE WITH DISABILITIES, POLICY IMPLICATIONS, POPULATION DISTRIBUTION, POSTNATAL CARE, PREGNANCIES, PREGNANCY, PREGNANT WOMAN, PREGNANT WOMEN, PRIMARY CARE, PRIMARY SCHOOL, PROGRESS, PROVIDER PAYMENT, PROVINCIAL HOSPITAL, PROVINCIAL HOSPITALS, PUBLIC HEALTH, QUALITY OF CARE, QUALITY OF HEALTH, QUALITY OF SERVICES, REFERRAL SYSTEM, RESPECT, ROAD, ROUND TRIP, RURAL AREAS, RURAL COMMUNITIES, RURAL RESIDENCE, SANITATION, SANITATION FACILITIES, SECONDARY EDUCATION, SERVICE PROVIDER, SERVICE PROVISION, SERVICE QUALITY, SERVICE UTILIZATION, SKILLED ATTENDANT, SKILLED BIRTH ATTENDANTS, SOCIAL HEALTH INSURANCE, SOCIAL SECURITY, TRADITIONAL BIRTH ATTENDANTS, TRANSPARENCY, TRANSPORT, TRANSPORT COSTS, TRANSPORTATION, TRANSPORTATION COSTS, TRAVEL TIME, TRIP DISTANCE, TRIPS, TRUE, UNIVERSAL PRIMARY EDUCATION, USER FEES, VAGINAL DELIVERY, VILLAGE DEVELOPMENT, VILLAGES, WEALTH, WORKERS