Rwanda Social Security Board

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Rwanda Social Security Board

• (RSSB)
• Medical Insurance Scheme
• May 2013

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Social insurance

• Professional solidarity of all insured employees
  between
• employees with high salaries and
• those with lower salaries
• bachelors and
• employees with many dependants
• healthy employees and
• those who are sickly

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Source of financing

• Contribution calculated on employees basic
  salary
• Rate 15, shared out in equal parts between
  employer and employee (7.5 - 7.5)
• Periodicity monthly basis
• each staff pays his/her contribution in
  accordance with his/her means and is given
  medical care covered by RSSB in accordance with
  his/her health needs
• Amount of contribution does not vary as number of
  dependants increases.

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beneficiaries

• - Affiliated member, i.e. the one who pays
  his/her contributions
• - His/Her dependants  
• members legitimate spouse,
• legitimate or legally recognized children,
• child of whom the affiliated member is legally
  responsible,
• legally adopted child.

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Registration
Date Category
01/03/2001 Government employees National Police
01/01/2002 Public institutions Government projects
01/05/2003 Private sector
01/06/2011 Retirees
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Registration (beneficiaries, 01/05/2013)
Type of Institutions Public Private Total
Affiliates 168.227 23.718 191.945
Dependents 291.610 36.738 328.348
Total 459.837 60.456 520.293
Coverage rate of Rwandan population Coverage rate of Rwandan population Coverage rate of Rwandan population 5
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Medical services providers
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Medical benefits package

• Medical consultations
• Drugs, including chemotherapy
• Surgical interventions
• Dental care (including prosthesis 01/01/2009)
• Medical imaging, including CT Scan MRI
  (November 2010)
• Laboratory investigations
• Physiotherapy
• Hospitalization
• Corrective glasses lenses and frames
  (15/03/2007)
• Lower / upper limb prosthesis orthesis
  (01/01/2009)
• Dialysis (01/01/2009)
• Medical check-up (01/08/2010)

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Reimbursement modalities for
medical services providers

• Periodicity Monthly
• invoices
• services providers RSSB
• System of Direct payment of up to 85
• Patients contribution equal to 15 of overall
  amount of invoice for medical care and drugs

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Medical Check-up

• Who RSSB affiliates dependents (only women
  aged 35 years above men aged 40 years
  above)
• Where KFH, CHUK Biomedical Center
• From when 01/08/2010
• Frequency once a year
• What radiography laboratory investigations all
  aimed at finding out if a beneficiary has a risk
  factor or has an early disorder
• Cardiovascular disorders,
• Liver disorders
• Kidney disorders
• Diabetis
• Cancers

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Risk management

• 1. Adverse selection risk
• Persons with high risk register in numbers
  whereas healthy persons refrain from registering
• How to manage it ?
• Compulsory membership (public sector)
• Group membership (private sector no free or
  individual membership)
• Contributions paid for 3 months before access to
  medical care (waiting period)

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Risk management (contd)

• 2. Moral risk
• Insured persons abusively take advantage of
  proposed medical care or take more than is
  usually necessary in order to draw maximum profit
  from their contributions
• How to manage it ?
• Patients participation (15 of medical invoice)
  
• Counter attending staff
• Systematic verification of invoices from health
  facilities before payment

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Risk management (contd)

• 3. Cost escalation
• Sharp increase in medical cost by prescribing
  unnecessary care without opposition on behalf of
  patient due to the fact that he/she is insured.
• Control of health-related expenditures
• Patients participation (15 of medical invoice)
• Counter attending staff
• Systematic verification of invoices from health
  facilities
• Prior authorization from RSSB medical advisor for
  some treatment, tests and drugs
• List of refundable drugs
• Medical treatment refunded in accordance with
  MINISANTE price list
• Home care provision RSSBs own pharmacies
  drug price regulation

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Challenges

• Fraud by persons not yet covered by any medical
  insurance scheme
• Lack of tariffs based on real cost of medical
  treatment
• Lack of a medical standard nomenclature
• Lack of a standard treatments protocol
• Lack of integrated software interconnection

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Perspectives

• 1. Issuing individual magnetic cards to all RSSB
  beneficiaries
• 2. Extending the list of medical services covered
  by RSSB after prior opportunity and feasibility
  studies (abroad medical treatment coverage).
• 3. Improving the coverage rate by affiliating
  other categories of people people in informal
  sector the remaining staff in formal private
  sector not yet covered.
• 4. Computerizing the whole process of medical
  benefits access (in pharmacies procedures of
  providing drugs affiliates identification
  already computerized. In clinics affiliates
  identification already computerized).
• 5. Increase the number of medical services
  providers in order to guarantee choice
  proximity to our affiliates
• 6. In collaboration with the Ministry of Health,
  drawing up the following documents
• a tariff based on real cost of medical treatments
• a codified nomenclature of medical acts
  procedures
• a standard treatments protocol

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• Thank
• you