Equity, privatization and cost recovery in urban health care: the case of Lao PDR

This article, published in Health Policy and Planning, reports on a study that assessed the impact of privatisation and cost recovery on health care equity in the Lao PDR. The study compared two urban neighbourhoods of different socioeconomic status, using in-depth interviews and focus group discussions to assess perceptions and utilisation of health care services. Findings revealed a strong preference for private health services among both socioeconomic groups, including private clinics and treatment abroad for those with high socioeconomic status, and private pharmacies for poorer socioeconomic groups. Unwelcoming attitudes of health staff and procedural barriers were cited as the main disincentives to using public sector services.

The authors note that, since use of private services limits patients to what they can afford, the poor generally access drugs alone, with no examination, no diagnosis and only limited advice. This often means receiving inappropriate and insufficient medication. They conclude that equity in health care remains theoretical rather than practical in Lao PDR and the social goals of health reform have not been achieved. Further privatisation, they argue, is not likely to improve this situation. Rather, they propose a system of public neighbourhood health posts in urban areas with significant populations of low socioeconomic status.