Pilot testing prepayment for health services in Rwanda : results and recommendations for policy directions and implementation

In response, in 1999 the Rwandan Ministry of Health (MOH), in collaboration with three rural district communities and with technical and financial assistance from the Partnerships for Health Reform (PHR) project, developed and implemented a pilot activity that included 54 prepayment health insurance plans managed by community members. Under the activity, member benefits cover preventive and curative care in health centers and ambulance transport to the district hospital, where a limited package of services is available. This report draws first-year results of the Rwanda prepayment pilot test from different analyses conducted and compares these prepayment accomplishments with the MOH"s objectives. Findings show that prepayment plans are a viable method of improving both providers" productivity and sustainability in health care financing while providing better access to care for the poor. In addition to the incentives that have been set by the financing reform to providers, consumers, and insurers, enhanced community participation under the prepayment scheme has increased the population"s awareness and understanding of issues related to health care financing and service delivery. Health insurance schemes with large membership pools have become important interest groups, requiring better value for the money paid to the health facilities, and have helped add health and health financing to the political agenda of the districts. Prepayment schemes have proved to be a promising tool for targeted subsidizing of care for vulnerable groups such as widows, orphans, and high-risk patients, and this has helped strengthen equity in access to health care. Based on these findings, policy recommendations are made for scaling-up prepayment in the remaining 37 health districts in Rwanda. (Author abstract, modified)