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

2. 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 Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

3. 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. Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

4. 4 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. Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

5. Registration DateCategory 01/03/2001  Government employees  National Police 01/01/2002  Public institutions  Government projects 01/05/2003Private sector 01/06/2011Retirees 5Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

6. Registration (beneficiaries, 01/05/2013) Type of Institutions PublicPrivateTotal Affiliates168.22723.718 191.945 Dependents291.61036.738 328.348 Total459.83760.456520.293 Coverage rate of Rwandan population5% 6Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

7. Medical services providers 7Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

8. 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) Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

9. 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 Thursday, August 13, 2015 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 10Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

11. 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) Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

12. 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 Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

13. 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 Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

14. 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 Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

15. 15 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 Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme

16. Thank you 16Thursday, August 13, 2015 Rwanda Social Security Board (RSSB) - Medical Scheme