Rwanda Social Security Board

1. Rwanda Social Security Board (RSSB) MedicalInsuranceScheme May 2013

2. 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 Rwanda Social Security Board (RSSB) - Medical Scheme

3. 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. Rwanda Social Security Board (RSSB) - Medical Scheme

4. beneficiaries - Affiliated member, i.e. the one who pays his/her contributions - His/Her dependants : • member’s legitimate spouse, • legitimate or legally recognized children, • child of whom the affiliated member is legally responsible, • legally adopted child. Rwanda Social Security Board (RSSB) - Medical Scheme

5. Registration Rwanda Social Security Board (RSSB) - Medical Scheme

6. Registration (beneficiaries, 01/05/2013) Rwanda Social Security Board (RSSB) - Medical Scheme

7. Medical services providers Rwanda Social Security Board (RSSB) - Medical Scheme

8. 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) Rwanda Social Security Board (RSSB) - Medical Scheme

9. 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 Rwanda Social Security Board (RSSB) - Medical Scheme

10. 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 Rwanda Social Security Board (RSSB) - Medical Scheme

11. 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) Rwanda Social Security Board (RSSB) - Medical Scheme

12. 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 Rwanda Social Security Board (RSSB) - Medical Scheme

13. 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 Rwanda Social Security Board (RSSB) - Medical Scheme

14. 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 Rwanda Social Security Board (RSSB) - Medical Scheme

15. Perspectives 1. Issuingindividualmagneticcards 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 Rwanda Social Security Board (RSSB) - Medical Scheme

16. Thank you Rwanda Social Security Board (RSSB) - Medical Scheme