Is insurance a viable strategy for promoting srh experiences from bolivia egypt and rwanda
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Is insurance a viable strategy for promoting SRH? Experiences from Bolivia, Egypt and Rwanda Tania Dmytraczenko Abt Associates Inc., Partners for Health Reform plus Leeds, UK September 8-11, 2003 Outline of Presentation Background Bolivia: Health policy strategy in Bolivia

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Is insurance a viable strategy for promoting srh experiences from bolivia egypt and rwanda l.jpg

Is insurance a viable strategy for promoting SRH? Experiences from Bolivia, Egypt and Rwanda

Tania Dmytraczenko

Abt Associates Inc., Partners for Health Reformplus

Leeds, UK

September 8-11, 2003


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Outline of Presentation Experiences from Bolivia, Egypt and Rwanda

  • Background

  • Bolivia:

    • Health policy strategy in Bolivia

    • Results from Bolivia

    • Contributions and next steps

  • Rwanda:

    • Health policy strategy in Rwanda

    • Results from Rwanda

    • Contributions and next steps

  • Concluding remarks


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Poverty and Health Experiences from Bolivia, Egypt and Rwanda

Bolivia

  • Poverty

    • USD 950 per capita income

  • Maternal Mortality Rate

    • 371 per 100,000 live births

      Rwanda

  • Poverty

    • USD 100 mean monetary consumption expenditures per capita per year

  • Maternal Mortality Rate

    • 1071 per 100,000 live births



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Rwanda: Equity in Access to Curative Care for Women User Fee System

Source: Household and Living Condition Survey 1999/2001


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The common thread between Bolivia and Rwanda System

  • Recognition that financial constraints are a barrier to access

  • Health policy strategies aimed at reducing maternal and child mortality by reducing economic barriers to access

  • Health insurance as an alternative to user fees


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Health Insurance in Bolivia System

  • Insurance for Mothers and Children (SNMN) – mid 1996

    • Women and children under 5 receive treatment free-of-charge for set services

      • MOH facilities at all levels, some social security hospitals, very few NGOs

    • Financed from general taxation

      • 20% of government revenues transferred to municipalities

      • 3.2% of municipal funds (for investment) earmarked for health

    • Facilities are reimbursed on a per service basis by municipal government

      • Drugs, supplies, hospitalization, lab exams


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Evolution of the Insurance Program System

  • Basic Health Insurance (SBS) – 1999

    • Beneficiary population broadened

    • Package of benefits expanded

    • Participating facilities increased

      • Social security facilities

  • Health Insurance for Mothers and Children (SUMI) – 2003

    • Return to original target population

    • Universality of services covered

  • Facilities still reimbursed on a per service basis by municipal government

    • Increase in earmark for health

      • SMNM: 3.2%

      • SBS: 6.4%

      • SUMI: 10%






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At least some of the increase can be attributed to the Insurance Program

Source : SNIS, MSPS


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Contributions of Health Insurance in Bolivia Insurance Program

  • Utilization of maternal and child health services increased

  • The rural poor are using insurance services

  • Government promotional efforts informed the public

  • Primary level facilities increased drug availability

  • Utilization of public health infrastructure increased


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Next Steps In Bolivia Insurance Program

  • Some of the increase in public services is due to transfers from the private sector

    • Address issues related to appropriate public private mix

  • Costs differ across facility type, but reimbursement rates do not

    • Differentiate reimbursement rates across the different service delivery levels

    • Reimbursement rates do not cover labor costs

      • Issues related to health worker motivation

  • Free services encourage patients to seek care at higher level facilities

    • Establish a referral system



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Rwanda: Health Policy Strategy Insurance Program

  • Pilot-Test Micro-Health Insurance in 3 Rural Districts (with 1 million population)

  • Evaluate Effectiveness of Insurance Function in Improving

    • Equity in Access and in Health Financing

    • Sustainability

    • Community Participation


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Equity in Access to Care: Sick MHI Members Use Modern Health Facilities at a Higher Rate Across Consumption Quartiles

Source: HH-survey



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Equity in Health Financing: Members Pay Lower Price at Time of Consumption

Source: Patient exit interviews


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Contributions of Micro-Health Insurance in Rwanda of Consumption

  • Lifted financial barriers in access to maternal, preventive and curative services

  • Families with children and women in child-bearing age were most likely to enroll, and have fully benefited from better financial accessibility


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Next Steps In Rwanda of Consumption

  • To respond to the demand of other districts and scale up the prepayment plans nationwide

  • To expand the benefit package to full district coverage

  • To subsidize the demand of annual premiums for the poor through a community fund


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Concluding remarks of Consumption

  • Organizational and legal form of health insurance embedded in country’s socio-economic context

    • Political viability

  • Design phase is critically important

    • Appropriate incentives

      • Adverse selection, moral hazard, cream skimming, etc.

      • Health worker motivation

  • Human and organizational capacity building

  • Monitoring and evaluation


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Partnerships for Health Reform is implemented by of Consumption

Abt Associates Inc. under contract

No. HRN-C-95-00024 with the

U.S. Agency for International Development (USAID)


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