rwanda social security board (rssb) medical insurance scheme may 2013
TRANSCRIPT
![Page 1: Rwanda Social Security Board (RSSB) Medical Insurance Scheme May 2013](https://reader035.vdocuments.mx/reader035/viewer/2022081421/56649dac5503460f94a9c5f2/html5/thumbnails/1.jpg)
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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Rwanda Social Security Board (RSSB) - Medical Scheme
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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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Rwanda Social Security Board (RSSB) - Medical Scheme
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beneficiaries
- Affiliated member, i.e. the one who pays his/her contributions
- His/Her dependants :
1. member’s legitimate spouse,2. legitimate or legally recognized children,3. child of whom the affiliated member is
legally responsible,4. 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 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% »
«Patient’s 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 management1. 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 (cont’d)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 ?
Patient’s participation (15% of medical invoice) Counter attending staff Systematic verification of invoices from health
facilities before payment
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Risk management (cont’d)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: Patient’s 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: RSSB’s 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
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