Compare: Benefits package

Joint Learning Network for Universal Health Coverage

The Joint Learning Network for Universal Health Coverage systematically documents the reforms of its member countries and other countries that have expanded health coverage through demand-side financing. The case studies contained in these pages are brief, comparative and modular in nature, describing the key highlights and technical features of each program.


Compare various dimensions of country reform efforts using our interactive tool.


Program Types of benefits Benefits package
Estonia: Estonian Health Insurance Fund
  • Comprehensive

The EHIF covers a broad range of services, including family physicians services, in- and out-patient care, long-term care, rehabilitation, and prescription drugs. Children through 19 years of age are also eligible for free dental care, including preventive and curative services. Meanwhile, adults receive partial reimbursement for dental care.

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The EHIF covers a broad range of services, including family physicians services, in- and out-patient care, long-term care, rehabilitation, and prescription drugs. Children through 19 years of age are also eligible for free dental care, including preventive and curative services. Meanwhile, adults receive partial reimbursement for dental care.
Patients are free to choose the doctors and hospitals they prefer, since the EHIF contracts with most providers. The primary constraint in the system is the waiting list that a highly preferred doctor or facility may have.

All Estonians register on a family doctor’s practice list. Doctors can refuse to add a patient if the patient lives outside the practice region or when the practice list is full. In 2005 only 13% of patients changed doctors and these cases were primarily due to a change in residence. Family doctors are required to hold a minimum of 20 visiting hours per week and the practice must remain open at least eight hours per day. Patients must get access to their doctor within one day for acute problems and within three days for chronic conditions.

If certain services are not available in Estonia, patients can seek care abroad. In non-urgent situations, patients must seek approval from the EHIF. The service must be medically justifiable and must be proven efficacious with a probability of success of at least 50%.

In order to add new benefits to be covered under EHIF, the managerial board conducts an evaluation process and recommends services to the supervisory board, which then proposes them to the Ministry of Social Affairs where they are reviewed and sent to the government for approval once per year. There are four criteria for including or excluding services from the benefits package:

  • Medical efficacy
  • Cost effectiveness
  • Appropriateness and compliance with national health policy
  • Availability of financial resources
Mali: Mutuelles
  • Comprehensive

The social protection policy aims to have the three systems cover the same services. The laws and decrees assured consistency in the services between the AMO and RAMED when the two organizations were founded.

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The social protection policy aims to have the three systems cover the same services. The laws and decrees assured consistency in the services between the AMO and RAMED when the two organizations were founded.

For the Mutuelles, payment for services is not yet consistent. The risks that the Mutuelles cover as they exist today in Mali are paid for partially or completely for the following:

  • Preventive and promotional health: pre- and post-natal consultation, monitoring of healthy infants, vaccination, family planning, health education, sanitation, etc.
  • Curative care: consultations, nursing care, drugs, laboratory tests, chronic diseases, malnutrition and nutritional rehabilitation, etc.
  • Hospital care: hospital stays, medical and surgical procedures, and drugs
  • Specialized care: consultation of specialist physicians, medical procedures such as radiology, clinical biology, dental and eye care, etc.
  • Patient transportation: emergency transportation, referrals

Most Mutuelles limit themselves to the services provided at the first level of contact, which is the community health center (CSCOM), where patients receive the first level of care, but not for the more costly risks. The national Mutuelle extension strategy seeks to bridge this gap through the Mutuelle Support Fund by paying for care at the secondary and tertiary levels. With regard to standardizing the services that are covered, the starting point is the package of services covered by the AMO and RAMED, with certain modifications possible for more comprehensive coverage of preventive care, in particular for reproductive health.

Table 3: Package of services covered, 2010

SystemServices covered
AMO and RAMED
  • Outpatient care (medical consultations, nursing care, dental care, medical imaging, laboratory tests and minor surgery)
  • Hospitalization (hospital stay costs, medical procedures, surgery and medical techniques, transportation expenses)
  • Pharmaceuticals (list of approved drugs)
  • Maternity services (medical and drug costs, tests, hospitalization for pregnancy, delivery and its effects up to week 8)
Mutuelles
  • Preventive and promotional health (Pre- and post-natal consultation, monitoring healthy infants, vaccination, family planning, health education, sanitation, etc.
  • Curative care (Consultations, nursing care, drugs, laboratory testing, chronic diseases, malnutrition and nutrition rehabilitation, etc.)

Source: Ministry of Social Protection