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Maternal health out-of-pocket expenditure and service readiness in Lao PDR : evidence for the national free maternal and child health policy from a household and health center survey (Inglês)

Although Lao PDR has made notable progress in improving maternal and child health (MCH), attainment of the Millennium Development Goal 5 (MDG5) still remains a challenge. This is largely due to the barriers imposed by financial restrictions. In order to address these financial barriers, the Government of Lao PDR has introduced a national free MCH policy. However, certain non-financial barriers are also impediments to the achievement of this goal, such as physical access to remote communities, especially during rainy season, cultural practices and beliefs, and poor educational outcomes. In seeking to inform the implementation and scale-up of this national free MCH policy at this crucial initial stage, this paper reports on findings from a household, village and health center survey The policy implications of the findings from the survey are: 1) although financial protection implied by the national free MCH policy is strong, reducing financial barriers alone would not be sufficient to increase the utilization of services, 2) this policy has the potential to be regressive due to the higher utilization of MH services by wealthier households, 3) health providers at all levels of health facilities would experience substantial marginal decreases in revenue, given the reimbursement schedules under the national free MCH policy, and 4) the supply-side readiness and management capacity of health centers needs to be improved. This paper is organized to present the background context, analyses, the equity of MH service utilization, the supply-side perspective, and key findings and recommendations.


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  • País

    República Democrática Popular do Laos,

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    Leste Asiático e Pacífico,

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  • Nome do documento

    Maternal health out-of-pocket expenditure and service readiness in Lao PDR : evidence for the national free maternal and child health policy from a household and health center survey

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    integrated management of pregnancy and childbirth;household expenditure;access to health care service;elimination of user fee;survey population;district hospital;maternal and child health;skill need;alternative sources of financing;health facility;financial protection;financial barrier;provincial hospital;cost of delivery;pregnant woman;caesarean section;caesarean section birth;private health expenditure;health financing scheme;elasticity of demand;public health facility;incidence of poverty;official exchange rate;health service utilization;equity of access;health service provider;public health system;change in behavior;accessing health care;improved sanitation;health facility level;quality of health;child health service;conditional cash transfer;point of service;people with disability;skilled birth attendants;average exchange rate;round trip travel;fee for service;demand-side health financing;traditional birth attendant;episodes of care;maternal mortality rate;transportation expenditure;vaginal delivery;fee exemption;poor community;delivery service;informal payment;Antenatal Care;live birth;poor household;health finance;rainy season;household head;vaginal birth;road access;government budget;survey questionnaire;skilled attendant;risk pool;Postnatal Care;household size;catchment area;ministerial regulation;dry season;reimbursement schedule;provider payment;free service;informal sector;social security;cash allowances;cultural practice;maternal education;provider behavior;net surplus;medical expense;opportunity cost;perverse incentives;financial incentive;reform plan;rural area;outpatient service;baseline scenario;health area;marginal incentive;average cost;national groups;comparator country;physical accessibility;maternity services;disadvantaged community;reducing expenditure;poor road;obstetric care;referral system;baseline data;productivity loss;survey design;pilot program;transport cost;cash payment;household level;hidden cost;reimbursement rates;unskilled personnel;skewed distribution;survey respondent;economic hardship;health outcome;household characteristic;consultation fees;entrance fees;household questionnaire;benefit incidence;basic subsistence;hospital deliveries;socio-economic survey;drug cost;household survey;consumption module;hospital fees;financing mechanism;risk sharing;direct transport;service charges;traditional beliefs;trip distance;household borrowing;individual household;government entity;donor financing;legal instrument;survey sampling;physical barrier;cultural barrier;primary care;price level;benefit package;targeted population;food cost;domestic revenue;national population;baseline analysis;state expenditure;small sample;private private;technical department;government service;utilization rate;state enterprises;expenditure policy;financing source;equitable utilization;rural community;monthly payment;Maternal Health;subsidiary right;Fiscal Sustainability;health utilization;remote community;health health;caesarean delivery;external source;healthcare services;external financing;



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