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The 2 nd Workshop on Equity Indicator Analysis EQUITAP Project 27-31 July 2009

The 2 nd Workshop on Equity Indicator Analysis EQUITAP Project 27-31 July 2009 International Health Policy Programme, Ministry of Public Health, Thailand. Background of Lao PDR.

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The 2 nd Workshop on Equity Indicator Analysis EQUITAP Project 27-31 July 2009

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  1. The 2nd Workshop on Equity Indicator Analysis EQUITAP Project 27-31 July 2009 International Health Policy Programme, Ministry of Public Health, Thailand

  2. Background of Lao PDR • Lao People's Democratic Republic (Lao PDR) is a small, land-locked country in the heart of South-East Asia • Encompassing 236,800 Square kilometers • Sharing borders with Thailand to the west, Viet Nam to the east, China and Myanmar to the north and Cambodia to the south • Source: NSC, Lao Census, 2005

  3. Background of Lao PDR • According to the 2005 Population and Housing Census, In March 2005, Lao PDR had a total population of 5.62 million • Growth rate of 2.5 % per year • The population comprises 49 ethnic groups • The population density is 24 persons per square kilometre • 73 % of the population lives in rural area • Source: NSC, Lao Census, 2005

  4. Background of Lao PDR • The adult literacy rate is 73 percent • Life expectancy at birth is 59 years for males and 63 years for females • The average household size was 5.9 persons • The major cities are Vientiane Capital, Savannakhet, Champasack and Luangphrabang • Source: NSC, Lao Census, 2005

  5. Background of Lao PDR • Buddhism is the dominant religion with more than 65 % of the population as believers • The official language is Lao • The administrative system of the country includes about 11,000 villages in 142 districts in 16 provinces, 1 city (Vientiane) and 1 Special region (Xaisomboun) • Source: NSC, Lao Census, 2005

  6. Health care system of Lao • In Lao PDR, there are two categories of health care providers • formal health care • non-formal / informal health care. • The system of formal health care: • (1) services/cares, provided by hospital (hospital system) • (2) services/cares, provided by primary health care (PHC system) • (3) services/cares, provided by vertical programme (vertical programmes) • Source: NIOPH, Lao Health Survey as apart of WHS, 2006

  7. Health care system of Lao • The system of non formal/informal health care provision includes: • traditional healers • traditional herbalists • traditional birth attendants • registered pharmacies (including informal advisers), drug sellers • village health volunteers • Source: NIOPH, Lao Health Survey as apart of WHS, 2006

  8. Health Facilities in Laos • 4 central hospitals (Mahosot, Mittaphab, Sethathirath, and Mother & child health) • 9 specialized centers (Ophthalmology, Tuberculosis, Dermatology, Orthopaedic and Rehabilitation, Mother & Child Health, Malaria-parasitology and entomology, Traditional Medicine Research, Laboratory and epidemiology, HIV/AIDS centers) • 16 provincial hospitals • 126 district hospitals • 734 health centers • Source: NIOPH, Lao Health Survey as apart of WHS, 2006

  9. Health Facilities in Laos • 308 private clinics • 2,132 private pharmacies • 6 pharmaceutical factories • no private hospital • Source: NSC, Lao Census, 2005

  10. Health insurance schemes in Lao Civil Servant Scheme (CSS) Social Health Insurance (SHI or Social Security Office) Community-based health insurance schemes (CBHI) Health Equity Fund Private health insurance Source: NIOPH, Lao Health Survey as apart of WHS, 2006 10

  11. Objectives • To explore the incidence of catastrophic health expenditure of Lao • To assess the magnitude of impoverishment from health care expenditure • To compute Benefit Incidence Analysis (BIA) • To compute Financial Incidence Analysis (FIA)

  12. Catastrophic health expenditure • A situation where household out-of-pocket payments for health are higher than 10% of household resources (income or expenditure) • This study uses HH expenditure due to the limitation of reported HH income that tend to underreported

  13. FIA and BIA • BIA • An approach to examine who benefits from public spending (on health), • It indicates how well government health resources are targeted and gained by different socio-economic groups, especially the poor and the disadvantaged • FIA • Who pays for health care among different socio-economic groups

  14. RESEARCH METHODOLOGYSources of data 1. Lao Expenditure and Consumption Survey (LECS3), 2002-2003 that has already officially permitted to use data from the Department of Statistics, Ministry of Planning and Investment 2. Socio-economic profile and satisfaction of insured and un-insured people in Lao P.D.R. with contracted health care providers, 2007, NIOPH-IHPP

  15. Plausible Data sources using for health equity analysis

  16. Findings  Catastrophic analysis  Impoverishment analysis  Financial incidence analysis (FIA)  Benefit incidence analysis (BIA)

  17. Catastrophic incidence

  18. Monthly out of pocket payment for health per household, LECS3

  19. Catastrophic health expenditure 2003

  20. Catastrophic health expenditure 2007, Health Insurance Survey, NIOPH/IHPP

  21. Catastrophic health expenditure 2003

  22. Catastrophic health expenditure 2007

  23. Catastrophic health expenditure 2003

  24. Impoverishment

  25. Impoverishment incidenceLECS3

  26. The effect of health payment on per capital consumption

  27. The effect of health payment on poverty headcount by region in Lao PDR

  28. Financial incidence analysis (FIA)

  29. Gini coefficient Gini = 0.74

  30. Concentration and Kakwani index CI = 0.31 Kakwani index = - 0.43

  31. Benefit incidence analysis (BIA)

  32. Distribution of ambulatory service utilization in Lao PDR by quintiles and types of health facilities, 2003

  33. Distribution of hospitalization in Lao PDR by quintiles and types of health facilities, 2003

  34. Concentration curve of ambulatory service use by types of health facilities, 2003

  35. Concentration curve of hospitalization by types of health facilities, 2003

  36. Concentration indices of ambulatory service use and hospitalization by health facilities

  37. Mean Unit cost for hospitalization by type of health facilities in Lao PDR

  38. Percent distribution of net government health subsidies among different health facilities in 2003

  39. Limitation of the study • LECS3 • Combination of Provincial and district hospitals • No data on OP expenditure • Use expenditure replaced income • Sequence of questionnaire • Unspecified other health facilities • Health Insurance (NIOPH/IHPP) • Not country Representativeness • Utilization of health services focused on urban areas • Use expenditure replaced income • Cannot compute BIA and FIA

  40. Limitation of the study • Lack of unit cost • Update of data • New knowledge of participants • Lack of experiences of participants

  41. Discussion • Low catastrophic: • Poor people tend to spend on food consumption more than health care • Time period of data collection • Access to central hospital and PH and DH • Improving quality of care both public and private sectors and medical ethic of health care provider

  42. Recommendation for further studies • Improving instrument of health related national survey that can apply to equity in health • Unit cost study at different levels • Knowledge Transfer to Lao Health Staff

  43. Thank you

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