The Healthcare System in Laos: National Insurance, Care in Vientiane, Evacuation and Health Risks

According to the International Labour Organization, the Laotian system rests on several arrangements: the national health insurance scheme, which harmonised previously fragmented administrations, the community-based insurance scheme, whose lessons are under review, and a contributory scheme for employees of the formal sector, where compliance with contribution obligations remains a challenge. The Ministry of Health announces that 94% of the population has social health protection; out-of-pocket payments by households represent 49% of current health expenditure. Access to care remains uneven in a largely rural and remote country, and the risk of catastrophic spending persists.

The national health insurance strategy and the social security and health insurance laws are evolving with the support of the ILO. These schemes benefit Laotian residents first; access for a foreigner and contribution rates are confirmed with the body concerned and the employer.

A foreign employee declared by their employer may fall under the contributory scheme, under the conditions set by the Lao Social Security Organization; other profiles have no affiliation scheme described in the official pages consulted. In practice, foreign residents rely on international health insurance or on the CFE (the French social security fund for expatriates), because the French embassy recalls that the French State does not cover healthcare costs abroad.

France Diplomatie is categorical: an assistance contract or insurance covering medical costs, surgery, hospitalisation and medical repatriation is indispensable, because without it, access to care can be refused, including in a life-threatening emergency. The page on healthcare reimbursement in Laos compares the solutions available.

In Vientiane, a medical centre and a clinic open 24 hours a day, cited by the French embassy, can handle routine consultations and organise evacuations to Thailand. An establishment opened in August 2021 is described as a modern facility in case evacuation is impossible. For everything else, France Diplomatie is clear: no major care is available in Laos and evacuation to Thailand, preferably to the cities of Nong Khai or Udon Thani near the Friendship Bridge, must be sought systematically; helicopter evacuation is possible, at the expense of the patient or their insurance.

• Emergency police: 191; fire brigade: 190.
• Vientiane police: +856 21 21 27 06; tourist police: +856 21 24 36 47.
• French embassy (Setthathirath Road, PO Box 06, Vientiane): +856 21 26 74 00.

Outside the capital, emergencies can become worrying because of the lack of transport and the scarcity of ambulances: choose your housing according to the distance to a care point, and warn your insurer or assistance provider at the start of a serious episode. See the guide to the course of a medical repatriation.

France Diplomatie recommends taking only strictly necessary medicines, in their original packaging, with a prescription using the international nonproprietary name, and checking that they are authorised in Laos. No medicine should be bought in the street, because of the risk of counterfeits. The preventive measures are as follows: covering clothing, repellents, treated mosquito nets and elimination of standing water against mosquitoes; hand washing, cooking food, avoiding raw vegetables and cold buffets, safe or sealed water; not touching or feeding animals, with cleaning and emergency consultation in case of a bite, scratch or lick on broken skin; closed shoes and covering clothing against snakes, scorpions and spiders.

Slash-and-burn fires in the region cause pollution peaks, which have reached about 200 µg/m³ of PM 2.5 fine particles. The elderly, children, pregnant women and people with chronic illnesses are the most exposed: the French administration advises postponing the trip if risk factors are present, limiting outings early in the morning and in the evening, wearing an N95 or FFP2 mask, preferably bought before departure, keeping doors and windows closed, including in the car, with air conditioning at least on air recirculation.

France Diplomatie asks you to check the vaccines in the French schedule (diphtheria, tetanus, polio, whooping cough, measles), then to consider, depending on the conditions and length of stay: hepatitis A, typhoid fever, hepatitis B (frequent or prolonged stays), rabies (young children, stays in rural or remote areas), chikungunya, dengue in an epidemic or on a prolonged stay in an endemic area, and Japanese encephalitis. A travel medicine consultation early enough before departure leaves time for boosters.

• Dengue and chikungunya: flu-like symptoms, sometimes a rash; no curative treatment for dengue, and anti-inflammatory drugs should be avoided; the local authorities report a multiplication of cases.
• Malaria: resurgence in the south of the country, particularly risky for hikers; prevention through mosquito protection and preventive treatment.
• Japanese encephalitis: incubation of 4 to 15 days, about one serious case in 250, mortality that can reach 30%, with no curative treatment.
• Avian influenza: exceptional human cases, but several H5N1 cases have been reported in Laos, some of them fatal.
• Rabies: almost always fatal once symptoms have appeared; immediate consultation after any exposure, even if vaccination is up to date.
• Zika, anthrax, typhoid: medical advice before travelling for women who are pregnant or planning a pregnancy; avoid infected animals and their carcasses; water and food hygiene.

As no major care is available in Laos, evacuation to Thailand is the reference scenario for a serious emergency. France Diplomatie seeks it first towards the Thai cities of Nong Khai or Udon Thani, near the Friendship Bridge, from where ambulances can collect the patient at the border. In the capital, the medical centre and the clinic open 24 hours a day can organise the transfer; when Thailand is impossible, a modern establishment opened in August 2021 remains a fallback in Vientiane. A local operator also offers helicopter evacuations to Bangkok, at the expense of the patient or their insurance.

• Before the emergency: keep on you your assistance provider’s contact details, your contract number and the names of your medicines under their international nonproprietary name.
• At the time of the emergency: warn the assistance provider before any decision to evacuate, because it validates the choice of establishment and the means of transport.
• Documents: keep your passport and visa to hand for crossing the border, as the border with Thailand is crossed at the Friendship Bridge.

For women who are pregnant or planning a pregnancy, France Diplomatie recalls that the Zika virus can cause neurological complications and microcephaly in newborns: medical advice is needed before travelling. See also repatriation and assistance.

A resident organises their cover before arrival: choice of contract, checking coverage of evacuation to Thailand and direct billing, medical questionnaire. The guide to the medical questionnaire and medical history helps you anticipate exclusions, and the guide to budgeting for health abroad gives benchmarks for setting your budget. For life on the spot, also see the page on living in Laos.