Rwanda Social Security Board (RSSB) Medical Insurance Scheme May 2013.

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

Wednesday, April 19, 2023

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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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.



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

5Wednesday, April 19, 2023


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%



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



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



Thank

you



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Rwanda Social Security Board (RSSB) Medical Insurance Scheme May 2013.

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