[Profile of members and non members of mutual health insurance system in Rwanda: the case of the health district of Kabutare].

Ministère de la Santé, Kigali, Rwanda.
Tropical Medicine & International Health (Impact Factor: 2.3). 12/2004; 9(11):1222-7. DOI: 10.1111/j.1365-3156.2004.01318.x
Source: OAI

ABSTRACT The establishment of mutual health insurance systems is one of the priorities of the Rwandan government. Pilot studies have been conducted in three districts of the country. Nonetheless, after 4 years of implementation (1999-2003), the population coverage by these insurance systems remains relatively low. A cross-sectional study of 1042 households in the Kabutare health district allowed for a comparison of socio-economic and demographic variables, and the medical, surgical, gynaecological, and obstetrical history of health insurance scheme members and non-members. The results of the study demonstrate that the distribution of members and non-members is similar in terms of sex, marital status, professional status and medical history. However, larger households (more than five members) and those having a relatively higher income (more than USD 230 per annum) are more likely to be insured than other households. Members of the mutual health insurance use more the health services than non-members, spend less on health care and increasingly maintain membership. The study emphasizes the relevance to further promote mutual health insurance, but also points to the need for mechanisms to ensure financial access for the poor rural population.

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    ABSTRACT: Objectives Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance. Methods We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010. Results Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme. Conclusion CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic.
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    ABSTRACT: After the war and the 1994 genocide, Rwanda drew up a national health policy with a view to realigning its health system. The reform, which was designed to remedy the deficiencies of the previous system, focused on community involvement in managing and financing health services. Achieving this objective was never going to be easy, but thanks to a growing number of initiatives 37.8 per cent of the Rwandan population now have some degree of sickness insurance cover. However, the system in general, and more particularly the mutual associations organized around the community, needs to be strengthened.
    International Social Security Review 04/2006; DOI:10.1111/j.1468-246X.2005.00235.x

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