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

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

outline of presentation
Outline of Presentation
  • 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
poverty and health
Poverty and Health

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
rwanda equity in access to curative care for women user fee system
Rwanda: Equity in Access to Curative Care for Women User Fee System

Source: Household and Living Condition Survey 1999/2001

the common thread between bolivia and rwanda
The common thread between Bolivia and Rwanda
  • 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
health insurance in bolivia
Health Insurance in Bolivia
  • 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
evolution of the insurance program
Evolution of the Insurance Program
  • 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%
at least some of the increase can be attributed to the insurance program
At least some of the increase can be attributed to the Insurance Program

Source : SNIS, MSPS

contributions of health insurance in bolivia
Contributions of Health Insurance in Bolivia
  • 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
next steps in bolivia
Next Steps In Bolivia
  • 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
rwanda health policy strategy
Rwanda: Health Policy Strategy
  • 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
slide18
Equity in Access to Care: Sick MHI Members Use Modern Health Facilities at a Higher Rate Across Consumption Quartiles

Source: HH-survey

equity in health financing members pay lower price at time of consumption
Equity in Health Financing: Members Pay Lower Price at Time of Consumption

Source: Patient exit interviews

contributions of micro health insurance in rwanda
Contributions of Micro-Health Insurance in Rwanda
  • 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
next steps in rwanda
Next Steps In Rwanda
  • 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
concluding remarks
Concluding remarks
  • 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
slide24
Partnerships for Health Reform is implemented by

Abt Associates Inc. under contract

No. HRN-C-95-00024 with the

U.S. Agency for International Development (USAID)

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