Financing Universal Health Coverage in the Lao PDR: A Health Public Expenditure and Institutional Review
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Washington, DC: World Bank
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Financing Universal Health Coverage in the Lao PDR: A Health Public Expenditure and Institutional Review examines how the Lao People's Democratic Republic finances its health sector and how public institutions translate resources into services, at a time when progress toward universal health coverage is under strain from tightening fiscal space, sharp currency depreciation, declining external assistance, and a rising burden of noncommunicable diseases. The report finds that domestic government health expenditure stood at only $11 per capita in 2023, among the lowest globally and well below the lower-middle-income country average, while out-of-pocket payments remain the single largest source of health financing and service utilization has declined. Drawing on government administrative and financial data, household surveys, national health accounts, and international benchmarks, the review offers a coherent three-pillar reform package: mobilizing more predictable domestic resources for health, including through a roadmap to raise health's share of government spending to 9 percent by 2030 and strengthened health taxes; improving efficiency by re-centering service delivery on primary health care, strengthening strategic purchasing through the National Health Insurance system, and actively steering the public-private mix, especially for medicines; and fixing the last-mile public financial management and digital constraints that prevent approved budgets from reaching facilities on time. Implemented together, these reforms can help public funds reach frontline providers predictably, reduce financial hardship for households, and sustain equitable gains in coverage, quality, and resilience, particularly for poor and remote communities.
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GOOD HEALTH, UNIVERSAL HEALTH COVERAGE, HEALTH PUBLIC EXPENDITURE, HEALTH INSURANCE, HEALTH ECONOMICS AND FINANCE, HEALTH SERVICE MANAGEMENT AND DELIVERY