3. Mutolere health insurance scheme

The (catholic) St Francis hospital in Mutolere, started a community based health insurance scheme in 1998. Their objective is to increase the access to quality health care even at times of the year when families have little income. Cordaid supports the health insurance scheme since 2007.

You can find details of the scheme below.

 

Category

q       Tax financed

q       Social insurance

X   Micro insurance (community based)

Compulsory

No

Ownership

q       Private for profit

q       Private not for profit

X   Private not for profit (provider involvement)

q       Public (government involvement)

q       Public (community based)

q       Mutual (members participate in management)

Organizational capacity building (staff training)

Yes

Target population

100,000

Competing schemes/free choice

Yes

Nr of insured

1,119 (in 2006)

Nr of policies

1

Subscription unit

q       Individual

q       Household

X   Group

Contribution type

X   Flat rate (app. USD 3.5 / person / year)

q       Income related

Benefit package

X   Primary care

X   Child and maternity care

q       Specialist physician (ambulatory care)

X   Hospital inpatient care

X   Drugs

q       Dental care

q       Eye care

q       Transport to and fro hospital

Extra benefits

q       Health promotion

q       Immunization

q       Birth control

q       Long-term care

q       Mental illness

q       Rehabilitation

Health care provision

X   Direct (medical services free of charge)

q       Indirect (reimbursement)

Co-payments

Yes

Deductibles

No

Provider payment system

q       Salary or budget    

q       Case payment

 

 

X   Flat rate

X   Fee for service

q       Capitation fee

q       Bonus payment

Cost containment

Yes

Management information system

Yes

Pay-as-you-go system

Yes

Technical reserves

No

Co-insurance

No

Re-insurance

No

Subsidies

q       (Local) government

X   International agencies (DFID up to 2002)

X   NGO, Cordaid starting in 2007

q       Other

Risk rating

q       Individual

q       Group

X   Community

Underwriting

X   Direct

q       Broker

Load ratio

(administration costs/premium income)

App. 70 %

Loss ratio

(claims/premium income)

App. 150 %