2.7. The interventions on the policy of health insurance
Five intervention orientations were strengthening the process
of implantation, extension and monitoring of mutual health insurance in the
country. The concern notably:
i. Establishment of a technical unit, in charge of the
day-to-day management and monitoring of mutual health insurance.
ii. Strengthening of the legal and regulatory framework of
mutual health insurance.
iii. Improvement of the funding mechanisms of mutual health
insurance.
iv. Strengthening of frameworks for partnerships with
mutual health insurance.
v. Strengthening of national and provincial capacities in the
area of mutual benefit systems.
vi. Most of mutual health insurance in Rwanda uses a policy of
family subscription; and even when the insurance premium is individual, the
family must register all the members.
Concerning the insurance premium, there is vast disparity in
the present operation of mutual health insurance. In fact, the premium per
household members varies from 2000Rwf for those in category I (for this
category, its premium is given by the government) 3000Rwf for those in category
II and 7000Rwf those in category III and above. (PRS annual progress report
2003-2004:56). The patient's contribution towards the cost of medical
treatment, or contribution of the mutual health member at the time of using
health services, also varies between 200Frw and 250Frw per disease episode or
between 10% and 25% of co-payment of the real cost of healthcare.
Healthcare and services covered by mutual health insurance
comprise all services and drugs provided at the health centre. The annual
contribution and registration is done at section level (Health center). (PRS
annual progress report 2003-2004:56). This rapid increase in the number of
mutual health insurance, and beneficiaries testifies undoubtedly to the
affirmation of a community dynamics in the search for solutions to the problems
of financial accessibility to healthcare and protection against financial risks
associated with diseases. The government has designed a scale-up program to
expand the community health insurance schemes to all Provinces of the country
over the coming years. (Development indicator, 2003:29)
A detailed proposal has been submitted to create a national
co-ordination unit or an executive secretariat to oversee the policy
implementation of the three-year national mutual support program (PRS annual
progress report 2003-2004:56). As explained in the Rwanda Development indicator
(2003:29), in order to improve its utilization, the quality of health service
is improving through the quality insurance projects within the Ministry of
health. Whilst ensuring that the population has adequate financial
accessibility to healthcare services which are also improving through community
associations for healthcare (Mutuelle de Santé). (Development indicator
2003:29)
2.8. Organization and management
At the village, cell and sector level there are health
« mutuelles » committees in charge of the sensitization and
mobilization. At the health centre level `Mutual Section' is in charge of
reimbursing the cost care to the health centre (cost-based reimbursement).
There is a committee in charge of the sensitization and mobilization. At the
district level, a Mutual Institution is in charge of reimbursing the
cost of care at the district hospital. There is a committee in charge of the
sensitization and mobilization. (Atim. C 1999:46)
At national level, there is a technical support cell (CTAMS)
and the Pooling Risk in charge of: The capacity building for
« mutuelles » managers, the development of policy,
strategies and legal frameworks, the payment of the cost of the package
of referral hospital development of management modules and tools, monitoring
and training, management of the data base & IT awareness. (Atim. C 1999:46)
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