Extending Healthcare to the Informal Sector in Laos

Abstract

In 2000, the Ministry of Health of Laos was faced with the seemingly insurmountable problem of how to extend healthcare coverage to the country’s informal sector. Laos had just implemented a social health insurance scheme for the formal private sector to complement the existing civil servants insurance scheme, leaving a huge vacuum in healthcare for the remaining 80 percent of the population in the informal sector. Health financing for this group of people was difficult due to the challenges of obtaining financing from a government with low tax revenues as well as aid from external donors, the decentralized nature of the health system and operational difficulties in extending healthcare to the informal population. By illustrating the problems and the policy options available, this case prompts readers to consider the complexity in striking a balance between the trade-offs of efficiency versus equity, expediency versus sustainability and quantity in terms of coverage versus quality.