1. CBHI in Vientiane Capital The way forward
Dr Aviva Ron
Consultant
16 July 2010

2. The objectives of CBHI
Provide the non-insured population with protection against the high costs of health care - decrease out-of-pocket payment health care, and reduce financial barriers to care
Increase the utilization of health care by the population of Lao PDR
Improve the quality of health care
Channel health care expenditure to the public health care system in a stable and predictable way
Accelerate achievement of MDG goals
Reduce maternal, infant and child mortality

3. Accelerate reaching MDG goals WHO data 2007
Under 5 mortality:
Lao PDR - 91/1000 children under 5 years
Vietnam - 23/1,000 children under 5 years
Maternal mortality ratio (maternal deaths/100,00 live births
Lao PDR :WHO estimate (reported )
Vietnam

4. What CBHI has achieved National SASS SSO CBHI OPD/visit
/person/year *
Hospital days
/person/year
* 0.8 visits/year -General population of Vientiane Capital
Amount transferred from CBHI to District and Central Hospitals in Vientiane Capital
- 500,000,000 Kip
When 2% of the target population were covered
Hospitals report that patients seek health care earlier than before

5. The challenge for VC Total population: 780,000 in 9 Districts
SASS, SSO – about 180,000
Target for CBHI - 600,000 persons
Membership today - 17, % of target
How can we change to increase coverage?
How can we increase satisfaction of the population and the providers?
How can we move towards Universal Coverage?
When can CBHI be compulsory for the non-salaried population?

6. Why CBHI needs to change
Loss of members in existing schemes - too much “adverse selection” now with only 3% of target population covered.
Loss of interest of the Central and also District hospitals- unstable and low capitation amount
Loss of credibility of social health protection for the informal sector/non-salaried population
Need to set an example for the rest of country

7. Proposals for CBHI change in VC
Increase capitation and improve collection
Single VC Management with pooled funds
Fixed capitation
Additional payment to Central Hospitals for outreach services and high cost services
Selection of District Hospital and referral to Central Hospital
Additional benefit of funeral grant

8. Contributions
Update the amount of contribution according to the increase in the Consumer Price Index since 2005
increase of 42%:- about 43,000 kip as the amount for family of 5-7 members
Collect contributions quarterly.
Improve collection efficiency and compliance with regulations
Allow for regular payment through the bank for members with bank accounts (10%?)
Request subsidizes for poor and near poor families through District Government - 100% for poor and 50 % of contribution, on annual basis
Update in the future on the same basis, every three years.

9. CBHI VC Management
CBHI Management will be carried out through a single administration
Funds pooled and managed for all the 9 Districts
Registration and contribution collection will remain as district level responsibilities, with supervision by the CBHI VC Office
The pooled fund management will allow:
Fixed allocation of the contribution revenue to enable an appropriate level of capitation remuneration to the contracted hospitals
Management of a reserve fund for high cost and other benefits/services

10. CBHI VC Office
Essential CBHI VC Team: Minimum of 5 persons, with qualifications:
Manager - provider contracts and quality of care
Financial management
Business administrator
Accountant/auditor
Promotion and monitoring staff
Clerical support services
Based on reaching 150,000 in 2 years

11. Capitation
The capitation transferred to hospitals will be a fixed amount
The fixed capitation will be split according to the burden between District and Central Hospitals
An additional payment to the Central Hospitals for Outreach Services to improve the quality and scope of care in the District Hospitals - according to Outreach done by each Central Hospital.
Additional payments for high cost services, to be negotiated
Target - fix capitation at 65,000-70,000 kip for the CBHI population
Link capitation to changes in the contribution amount, every 3 years.

12. Provider selection
Each Family will select the District Hospital in accordance with travel time and cost
Each District Hospital will be linked to a Central Referral Hospital
Central Hospitals will be accessed by referral only, except in real emergencies
Central Hospitals will select the Districts for Outreach Services.

13. New Benefits Funeral grant
Motor Vehicle Accident Injuries - studies will be done on covering motor vehicle accident treatment, and discussion with government on compulsory insurance to cover injuries

14. What is needed?
Acceptance of the principle changes by all the players -the VC Health Department and its District Hospitals and Health Centres, the Ministry of Health and the Central Hospitals, District Governors
Creation of a strong Management Team at VC Health Dept level following training
Effective management of registration, contribution collection and financial activities assisted by a computerized information system
Continued support in the promotion of the scheme
Subsidies for the poor and near poor families to allow for compulsory coverage –after reaching 35% coverage
Monitoring and evaluation following defined indicators

15. In conclusion
CBHI VC can make the effort to get a good contribution level and give a higher and fixed capitation amount
The CBHI VC Management will take the responsibility for this revenue and provider contracting
VC has good health care resources
The actual success and extension of coverage will depend on member and provider satisfaction
If coverage cannot be extended - the CBHI in VC may need to be suspended

16. We believe that CBHI VC can do it and be an example for Lao PDR
Thank you and Chok Dee