Rwanda Social Security Board
(RSSB)
Medical Insurance Scheme
May 2013
Social insurance
Professional solidarity of all insured employees;
between:
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employees with high salaries and
those with lower salaries;
bachelors and
employees with many dependants;
healthy employees and
those who are sickly
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Rwanda Social Security Board (RSSB) - Medical Scheme
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Source of financing

Contribution calculated on employees’ basic salary
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Rate : 15%, shared out in equal parts between employer
and employee (7.5% - 7.5%)
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Periodicity : monthly basis
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« 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.
2.
3.
4.
member’s legitimate spouse,
legitimate or legally recognized children,
child of whom the affiliated member is
legally responsible,
legally adopted child.
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Rwanda Social Security Board (RSSB) - Medical Scheme
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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
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Rwanda Social Security Board (RSSB) - Medical Scheme
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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
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Rwanda Social Security Board (RSSB) - Medical Scheme
5%
6
Medical services providers
Private pharmacies
6%
RSSB pharmacies
Private clinics
2%
6%
Referral hospitals
1%
District hospitals
8%
Health centers
77%
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Medical benefits package
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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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Rwanda Social Security Board (RSSB) - Medical Scheme
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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
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Rwanda Social Security Board (RSSB) - Medical Scheme
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Medical Check-up
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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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Rwanda Social Security Board (RSSB) - Medical Scheme
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Risk management
1. Adverse selection risk:
Persons with high risk register in numbers whereas
healthy persons refrain from registering
How to manage it ?
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
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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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Rwanda Social Security Board (RSSB) - Medical Scheme
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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 ?
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Patient’s participation (15% of medical invoice)
Counter attending staff
Systematic verification of invoices from health
facilities before payment
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Rwanda Social Security Board (RSSB) - Medical Scheme
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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
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Lack of tariffs based on real cost of medical
treatment
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Lack of a “medical standard nomenclature”
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Lack of a “standard treatments protocol”
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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:
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a tariff based on real cost of medical treatments
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a codified nomenclature of medical acts & procedures
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a standard treatments protocol
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Thank
you
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