SLIDE 1: Family Planning and Health Insurance
Cheickna TOURE
Deputy General Manager
Union Technique de la Mutualité Malienne UTM
SLIDE 2: Presentation Outline
- Health Situation
-
Description of health insurance plans
-
Implementation of the reform
-
Impact on access to health services
-
Conditions for success
-
Conclusion
SLIDE 3:
A Few Reference Points Concerning the Health Situation
Indicators
2005
2006
2007
2008
2009
Number of CSComs
753
785
826
858
993
Proportion of pop. living within a 15
75%
Km radius
76%
79%
80%
88%
Use of services #Cons./Person/Year) 0.26
0.26
0.29
0.29
0.33
Prenatal visits (%)
75
75
77%
82%
90%
Assisted deliveries (%)
53
55
59%
61%
64%
DTCP 3<12 months (%)
91
92
94%
94%
101%
Contraceptive prevalence: 6.9% in 2006 according to DHSM IV
SLIDE 4:
A Few Reference Points Concerning the Health Situation
Reste du
Monde
14%
Etat
22%
Autres privés
4%
Ménages
51%
Collectivités
décentralisées
9%
Autres privés = Other Private
Reste du Monde = Rest of the World
Etat = Central Government
Collectivités décentralisées = Local Governments
Ménages = Households
SLIDE 5: A Few Reference Points Concerning the Health Situation
-
A major share of health care expenditures is financed by households
-
In the breakdown of household-financed health care expenditures, the proportion of
money spent on drugs is comparatively higher for poorer households
-
Half of the money spent on health care is received by the private sector
SLIDE 6: Health Insurance Plans
Eliminating the financial barriers restricting access to health care services in Mali
2 contributory schemes and 1 non-contributory scheme
- Compulsory health insurance
- Target: Government workers, recipients of subsidized benefits, employees,
members of parliament, retirees, and recipients of pensions
- Financing: Contributions by employers and employees
-
Medical assistance programs
- Target: The poor
- Financing: Subsidies by the central government and local governments
-
Mutual/community health organizations
- Target: informal and agricultural sectors
- Financing: Subsidies by the central government and contributions from
members
SLIDE 7: Health Insurance Plans
Distribution of the Target Population among the
Various Health Insurance Plans
Mutual/community health organizations 78%
Compulsory medical insurance 17%
Medical assistance programs 5%
SLIDE 8: Implementation of the Reform
- For compulsory medical insurance and medical assistance programs
-
Creation of a legal framework and development of organizational structures to
enable a launch in 2010
Mutual/community health organizations
- A legal framework for mutual/community health organizations in existence
since 1996 has even inspired policies developed at the community level
- Absence of an organizational framework conducive to their expansion
- Incentives for restructuring the community health movement, among other
things through the principle of complementary financing of the
mutual/community health organizations in addition to members’ contributions
- Desire to promote equity in terms of access to health care
SLIDE 9: Implementation of the Reform
-
Setting up of a minimum package of benefits for the entire population corresponding
to those offered by the compulsory medical insurance and medical assistance
programs
Typical basic Benefit Packages (CSCOM)
Outpatient Services
·
Primary care visits
·
Dental diagnostic visits
·
Dressings, shots, transfusions
·
Immunization card
·
Minor outpatient surgery
·
Dental care
·
Ultrasounds
·
Medical tests/Labs
·
Branded or specialty drugs
·
Generic drugs
Transportation
·
Ambulances
Inpatient services (case follow-up)
·
Hospital stay package (user fee: perfusion)
·
Ultrasounds
·
Medical tests/Labs
·
Branded or specialty drugs
·
Generic drugs
·
Medical consumables
Maternity
·
Prenatal visit+ cost of materials
·
·
·
·
·
·
·
·
Postnatal visit
Family Planning
Delivery without complications
Inpatient stay
Ultrasounds
Medical tests/Labs
Branded or specialty drugs
Generic drugs
Extended Benefit Package (Hospitals)
Outpatient care
·
Primary care visit
·
Dental diagnostic visit
·
Ophthalmology visit
·
Consultations with other medical specialists
·
Dressings, shots, transfusions
·
Minor outpatient surgery
·
Dental care
·
X-rays/Scans/Ultrasounds
·
Medical tests/Labs
·
Branded or specialty drugs
·
Generic drugs
Transportation
·
Ambulance
Inpatient services
·
Hospital stay package
·
X-rays/Scans/Ultrasounds
·
Medical tests/Labs
·
Branded or specialty drugs
·
Generic drugs
·
Medical consumables
·
Surgery
Maternity
·
Gynecology visit
·
Delivery with complications
·
C-section (free)
·
Inpatient stay
·
X-rays/Scans/Ultrasounds
·
Medical tests/Labs
·
Branded or specialty drugs
·
Generic drugs
SLIDE 10: Implementation of the Reform
Why and how should family planning be included in the health insurance benefit
package?
-
prevention
-
control of health expenditures. which includes controlling the cost of services
-
appropriate rate structure for contributions
-
making health insurance services more appealing
-
top-down approach to health care expenditures
SLIDE 11: Impact on Access to Health Services
-
Offering health insurance to 50% of the population of Mali within 5 years
Anticipation of Population Coverage by Mutual/Community
Health Insurance Organizations
Proportion of the population
covered by a
mutual/community health
insurance organization
-
Raising to .47 the utilization index of health care services
-
Increasing to 50% the share of mutual/community health insurance organizations in
the total income of all health centers
SLIDE 12: Conditions for Success
- Having a systematic vision of health care that eliminates the fracture between supply
and demand for health services
-
Accepting the necessity to change the paradigm for the health financing model
-
Requiring a real commitment - not just a promise - from decision-makers to support
a system whose results will be visible mostly in the long run
-
Insisting on performance, but also being patient