INTRODUCTION Many schemes have been implemented by the government of the Lao People's Democratic Republic to provide equity in health service utilisation. Initially, health service utilisations were fully supported by the government and were subsequently followed by the Revolving Drug Fund. In the 2000s, four health financing schemes, namely the Social Security Organization, the State Authority for Social Security, the Health Equity Fund and Community-Based Health Insurance (CBHI), were introduced with various target groups. However, as these voluntary schemes have suffered from a very low enrolment rate, the government decided to pilot the National Health Insurance (NHI) scheme, which offers a flat, co-payment system for health service utilisation. This study aims to assess the effectiveness of the NHI in terms of its accessibility and in providing financial protection from catastrophic health expenditure. METHODS The data collection process was implemented in hospitals of two districts of Savannakhet province. A structured questionnaire was used to retrieve all required information from 342 households; the information comprised of the socioeconomics of the household, accessibility to health services and financial payment for both outpatient and inpatient department services. Binary logistic regression models were used to discover the impact of NHI in terms of accessibility and financial protection. The impact of NHI was then compared with the outcomes of the preceding, voluntary CBHI scheme, which had been the subject of earlier studies. RESULTS Under the NHI, it was found that married respondents, large households and the level of income significantly increased the probability of accessibility to health service utilisation. Most importantly, NHI significantly improved accessibility for the poorest income quantile. In terms of financial protection, households with an existing chronic condition had a significantly higher chance of suffering financial catastrophe when compared to households with healthy members. As probability of catastrophic expenditure was not affected by income level, it was indicated that NHI is able to provide equity in financial protection. CONCLUSION The models found that the NHI significantly enhances accessibility for poor income households, improving health service distribution and accessibility for the various income levels when compared to the CBHI coverage. Additionally, it was also found that NHI had enhanced financial protection since its introduction. However, the NHI policy requires a dramatically high level of government subsidy; therefore, there its long-term sustainability remains to be determined.

中文翻译：

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国民健康保险对医疗服务的可及性和灾难性医疗支出的财务保护的影响：以老挝人民民主共和国萨凡纳赫特省为例。

简介老挝人民民主共和国政府已实施了许多计划，以公平利用卫生服务。最初，卫生服务利用得到了政府的全力支持，随后是循环毒品基金。在2000年代，引入了四个健康筹资计划，分别是社会保障组织，国家社会保障局，健康公平基金和基于社区的健康保险（CBHI），并针对了不同的目标群体。但是，由于这些自愿性计划的入学率非常低，因此政府决定试行国家健康保险（NHI）计划，该计划为医疗服务利用提供统一的共付系统。这项研究旨在评估NHI的可及性，并提供针对灾难性医疗费用的财务保护的有效性。方法数据收集过程在沙湾拿吉省两个地区的医院中实施。使用结构化调查表从342户家庭中检索了所有必需的信息；这些信息包括家庭的社会经济状况，获得医疗服务的机会以及门诊和住院部门服务的财务付款。二进制逻辑回归模型用于发现NHI在可访问性和财务保护方面的影响。然后将NHI的影响与先前自愿CBHI计划的结果进行比较，该计划曾是早期研究的主题。结果根据国民健康保险，研究发现，已婚的受访者，大家庭和收入水平显着提高了获得卫生服务的机会。最重要的是，NHI极大地改善了最贫困收入人群的可及性。在财务保护方面，与拥有健康成员的家庭相比，患有慢性病的家庭遭受金融灾难的机会要大得多。由于灾难性支出的可能性不受收入水平的影响，因此表明国民健康保险能够提供公平的金融保护。结论模型发现，与CBHI覆盖范围相比，NHI显着提高了贫困家庭的可及性，改善了医疗服务的分布和各种收入水平的可及性。此外，人们还发现，国民健康保险自推出以来已经加强了金融保护。但是，国民健康保险政策要求政府提供高水平的补贴。因此，它的长期可持续性还有待确定。