This paper examines the planned expansion of the coverage of health insurance schemes in Lao PDR. The
purpose of the study is to identify the factors that impede the expansion of health insurance and whether or
not co-payment for healthcare services should be introduced to improve the quality of care for insured
people in Lao PDR. The study applies qualitative methods after reviewing the existing relevant literature
and documents, by interviewing key informants involved in the implementation of health insurance
schemes in Lao PDR, as well as providers of health services at various levels from the ministry down to the
district level. The results of the study show that low capitation fees, overutilization of health services,
unclear roles and mandates of institutions responsible for health insurance schemes, weak law enforcement,
and low levels of social solidarity are crucial factors that have slowed the expansion of health insurance
schemes in Lao PDR. In regard to co-payments, concerned authorities have different perspectives on the
introduction of this scheme; the health service providers’ perspective is that a co-payment is necessary to
improve the quality of care and eliminate abuse of healthcare services. However, the view of health policy
makers and health insurance managers is that co-payments should not be introduced in Laos at this point in
time, because it may discourage people from joining health insurance schemes.