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Background:
Social
protection (health care, in particular), is part of a strategy
that aims to reduce insecurity and poverty by focusing on
employment/livelihoods with social security.
The major insurable risks that all households face are:
Of all of these risks, coverage for sickness is the main
priority, as a serious illness can lead to large expenditures,
loss of daily income and ultimately the sale of assets to meet
the costs. The end result, of course, is that it pushes
families into poverty.
The
ILO has been assisting the Ministry of Labour and Social
Welfare (MoLSW) to introduce Social Health Insurance as part
of their Social Security Schemes to make health care more
affordable for Lao workers and their families. The ILO Social
Security project (ILOSSP) has been financed through the
support of the Luxembourg Government as part of their country
assistance to Lao PDR.
The
ILOSSP objectives are to assist
Lao PDR in designing a comprehensive approach to the extension
of social security, with a vision towards universal coverage.
An important principle of health insurance is for family
coverage, so that the entire family is insured and through
this method, the whole family obtains protection from risks. When
a worker is a member of a social security scheme they receive
other benefits including maternity and sickness benefits to
replace the income of the worker when they are unable to work.
When a worker
retires or is injured and unable to work, they can receive an
old-age pension or employment injury befits.
Elderly Pensioners, including disabled persons, are
also able to continue to access affordable health care through
health insurance.
In
Lao PDR both compulsory and voluntary health insurance exists:
The Civil Servant Scheme (CSS) and Social Security
Organization (SSO) are compulsory whereas the Community-based
Health Insurance (CBHI) is voluntary and operates in the
informal sector.
Results
so far:
The
ILOSSP
has supported the social security department of MoLSW to
develop a new social security scheme for civil servants which
has been endorsed by the Government through a new Decree
(Decree 70/PM). Approximately
180,000 government and para-statal employees[1]
will be covered by this new scheme, with approximately 540,000
beneficiaries.
The
major reforms are for health insurance benefits, disability
pension and survivors benefits with a sustainable financial
system. The ILOSSP
conducted extensive research, costing studies and piloting of
new policies prior to the finalisation of the new decree.
The pilot of the health insurance scheme resulted in
more than 60,000 beneficiaries in Vientiane Capital and
Vientiane
Province
receiving pre-paid medical treatment at district,
provincial and central hospitals (including 19,000 civil
servants, 2,400 pensioners, 12,000 spouses and 28,500
children).
ILOSSP
also supported the social security scheme for the private and
state-owned enterprise workers and their families (SSO) to
extend coverage.
The
SSO now operates in
Vientiane
City
,
Vientiane
Province
,
Savannkhet
Province
and
Khammouane
Province
. in
Savannakhet
Province
around 3,000 beneficiaries are now covered by the scheme. In
Khammouane province the ILOSSP provided
social security and health insurance training to 4,800
workers at the Ngam Theun 2 hydropower dam.
The
SSO has increased its registered members to more than 300
enterprises employing approximately 70,000 workers.
The number of contributing members and beneficiaries
has tripled to more than 55,000 since the SSO started in 2001.
The SSO currently covers 50% of workers in
Vientiane
capital[2]
and approximately 50% of private sector and SOE wage workers
nationally in Lao PDR[3].
The
current labour law applies to enterprises with 10 or more
workers, however ILO has been working with the Ministry of
Labour and Social Welfare, Lao Federation of Trade Unions and
Lao National Chamber of Commerce and Industry to amend the
labour law to cover all enterprises with 1 or more workers.
ILOSSP
supports the SSO to participate in the ASSA (ASEAN Social
Security Association) Board and Technical meetings held every
year. SSO Lao
was the Chairman of ASSA from October 2005 until September
2006 and hosted the ASSA meeting in October 2005.
As
part of the development of social and labour protection in Lao
PDR, the ILOSSP
has also worked with the Lao Federation of Trade Unions and
APHEDA to train 958 factory workers in HIV/AIDS awareness and
prevention in 28 factories in Oudomxay, Luangnamtha and
Xayaboury provinces. ILOSSP/APHEDA
and the Lao Federation of Trade Unions also conducted 31
occupational health and safety surveys and trained 480 workers
in 17 garment, plastic and wood processing factories in
Khammouane, Savannakhet and
Vientiane
provinces in occupational health and safety hazards and the
prevention of accidents and injuries. The ILOSSP also supports
tripartite activities for the international OSH Day.
The
ILOSSP has drafted a Social Protection Roadmap based on the
previous reports and studies undertaken by the project,
national poverty and socio-economic development plans, and
including relevant studies and reports from other
organisations. The
draft Social Protection Roadmap is being translated into Lao
language and will then be assessed through a series of
consultations with relevant government counterparts and donor
organisations. The
Social Protection Roadmap report includes alternative
strategies for the extension of social security coverage to
population groups not covered under the existing social
security schemes, in particular social health insurance.
Actuarial
reports
have been completed for both the civil service and the private
sector social security schemes.
ILOSSP activities have included introducing a referral system
for District, Provincial and Central levels hospitals,
building a social health insurance information system, and
supplying the system and the IT equipment to each of the
participating District, provincial and central level
hospitals. ILOSSP has also provided quality assurance training
to hospital staff as part of the process to improve the
quality of health care available in Lao PDR.
Future
plans:
ILOSSP
will continue to support the Ministry of Labour and Social
Welfare to implement nationally the new Decree 70/PM for
social security for civil servants during the period
2007-2010. During
the same period ILOSSP will support the SSO to extend coverage
to all provinces in Lao PDR and to cover small enterprises in
existing and new provinces, in line with the new Labour Law.
The ILOSSP will also assist the Lao PDR to implement
the social protection roadmap in line with the Lao PDR
National Socio-Economic Development Plan for 2006-2010.
[1]
Based on figures
contained in the 2005 Population
and Housing Census
[2]
Based on results of 2002 enterprise survey data from the
national statistics centre of 48,000 enterprises in
Vientiane
Municipality
[3]
Estimate based on figures contained in the 2005 population
census – 121,786 private employees and 19,486 state
owned enterprise employees.
Total = 141,272 workers
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Social Security and Health Insurance in Lao PDR
