5043.0: Wednesday, November 15, 2000 - 8:45 AM

Abstract #18387

Popular Participation in Prepayment Schemes in Three Low-Income Rwandan Districts

Pia Schneider, MPH, Partnerships for Health Reform, Abt Associates Inc, P.O. Box 2848, Kigali, Rwanda, 250-71719, abt@rwandatel1.com

Nearly three-fourths of the Rwandan population falls below the poverty line. It is no surprise that a poor population consumes less health care when user fees are charged. Primary health care consultation rates for rural populations had dropped to 0.25 per capita per year in 1999, prompting testing of prepayment schemes in three districts. Prepayment schemes focus on improving equity in access to quality care for rural populations, strengthening financial management in health centers, and increasing community participation in health financing management. Members pay an annual premium of $7 per family of up to seven members. The benefit package includes all services and essential drugs provided in public and mission health centers and ambulance transfer to the district hospital where a limited package of services is offered. Prepayment schemes pay health centers a monthly capitation rate and hospitals a per episode payment. Prepayment schemes were evaluated in a quasi-experimental study using quantitative and qualitative data. Within the first nine months, more than 73,000 individuals joined prepayment scheme plans, reflecting 6 % of the target population. Preliminary findings reveal that members seek care more often than non-members do and contribute a higher per capita contribution to health care. Overall, members receive fewer drugs per consultation than non-members an observation supported by health center personnel: members seek care earlier, thus need fewer drugs and recover faster. Prepayment schemes are a viable tool to improve financial autonomy in health centers where average fixed costs remain low, and members use care moderately.

Learning Objectives: 1. Develop modalities of prepayment schemes. 2. Articulate cost-recovery mechanisms associated with prepayment schemes

Keywords: Financing, Access

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA