2012年-世界发展银行全球_Government_Spending_on_Health_in_Lao_PDR___Evidence_and_Issues_52页_10mb

Summary of Government Spending on Health in Lao PDR: Evidence and Issues

Core Content

This report examines government spending on health in the Lao People's Democratic Republic (Lao PDR) from FY 2005/06 to FY 2011/12, highlighting trends, challenges, and policy implications. It is part of a series of health financing analyses conducted by the World Bank.

Main Points

1. Health Financing Structure

• Out-of-pocket (OOP) payments constitute the largest share (46.4%) of total health expenditure, creating significant financial barriers to accessing health services.
• Social health insurance coverage is low, accounting for only 2.8% of total health spending, despite covering 11.4% of the population.
• Government budgetary spending on health is a secondary source, representing about 40.7% of total health expenditure in FY 2009/10, with external financing contributing 31.9%.
• Government health spending as a share of GDP is low at 1.1%, with domestically-financed spending averaging 0.5% of GDP.

2. Health Outcomes and System Challenges

• Lao PDR is one of the poorest countries in the East Asia and Pacific (EAP) region, with a GNI per capita of $1,130 in 2011.
• Despite progress in some health indicators (e.g., increased life expectancy, reduced under-five and infant mortality), maternal and child health (MCH) outcomes remain poor, with the maternal mortality ratio (MMR) at 470 per 100,000 live births, among the highest globally.
• Health service utilization is uneven, with the richest quintile spending five times more on OOP payments than the poorest.
• Human resources for health (HRH) are insufficient, with only 13 health workers per 10,000 people, far below the WHO recommendation of 23.
• Health service quality and accessibility are limited, especially in rural and remote areas, due to poor planning, weak financial management, and low service readiness.

3. Government Spending Trends

• Government health expenditure has increased over time, both in absolute terms and as a share of the total government budget.
• In FY 2009/10, health accounted for 4.3% of total government expenditure, up from 3.3% in FY 2005/06.
• The government has committed to increasing health spending to 9% of the total budget, which would represent a three-fold increase from FY 2011/12 levels.
• Recurrent spending dominates government health expenditure (80-90%), with wages accounting for a decreasing share over time.
• Capital health expenditure is minimal at the sub-national level, with provinces accounting for only 7% of such spending.

4. Sub-National Spending Disparities

• Less than a third (27%) of government health spending occurred at the provincial level in FY 2009/10.
• There are large disparities in health spending across provinces, with more populated and affluent provinces receiving more funding.
• Per capita health spending is higher in sparsely populated and poorer provinces such as Sekong and Attapeu.
• Revenue generation at health facilities is uneven, with more affluent provinces relying more on user fees and drug sales.

5. Policy Challenges and Recommendations

• The planned free maternal and child health policy is a positive step, but implementation requires improving the capacity of health facilities.
• Efficiency and equity remain major concerns, particularly in the allocation and use of resources.
• Demand-side incentives and supply-side reforms are necessary to improve access and utilization, especially in rural areas.
• Budget norms should be used to guide equitable and efficient allocation of health resources, considering not only population size but also capacity and health needs.
• Performance incentives, provider payment mechanisms, and drug procurement practices require further reforms to ensure effective and fair use of health resources.

Key Information

• Government health spending as a share of GDP has been low and inconsistent, mainly due to reliance on external financing.
• Health equity issues persist, with significant disparities in access and utilization across provinces and socioeconomic groups.
• The free maternal and child health policy aims to reduce OOP payments but may not be sufficient without strengthening facility capacity and financial management.
• The Lao government has committed to increasing health spending to 9% of the total budget, which would require substantial planning and resource allocation.
• Health financing reforms are needed to ensure sustainable and equitable health funding, including expanding prepayment schemes and improving efficiency of existing spending.

Conclusion

The report underscores the need for a more equitable and efficient health financing system in Lao PDR, with a focus on improving access to health services, especially in remote and underserved areas. It recommends a combination of demand-side and supply-side interventions, along with the use of informed budget norms, to support the government's goal of increasing health spending to 9% of the total budget.