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Rwanda Social Security Board
(RSSB)
Medical Insurance Scheme
May 2013
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
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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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Rwanda Social Security Board (RSSB) - Medical Scheme
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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
Monday, April 13, 2015
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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Rwanda Social Security Board (RSSB) - Medical Scheme
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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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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 ?



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 ?



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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Rwanda Social Security Board (RSSB) - Medical Scheme
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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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Rwanda Social Security Board (RSSB) - Medical Scheme
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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
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Rwanda Social Security Board (RSSB) - Medical Scheme
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Thank
you
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Rwanda Social Security Board (RSSB) - Medical Scheme
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