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 |
|---|---|---|
| Rwanda: Mutuelles de Sante |
|
The benefits package in Rwanda has two primary parts: the Minimum Package of Activities (MPA) and the Complementary Package of Activities (CPA). The MPA covers all services and drugs provided at the health centers including pre- and post-natal care, vaccinations, family planning, minor surgical operations, and essential and generic drugs. All individuals in Rwanda with health insurance are entitled to comprehensive, subsidized preventative care through the MPA. The CPA covers a limited number of services at the district hospitals, including the cost of hospitalization, caesarian operations, minor and major surgical operations, medical imaging, and all diseases afflicting children ages 0 to 5 years. Read full sectionThe benefits package in Rwanda has two primary parts: the Minimum Package of Activities (MPA) and the Complementary Package of Activities (CPA). The MPA covers all services and drugs provided at the health centers including pre- and post-natal care, vaccinations, family planning, minor surgical operations, and essential and generic drugs. All individuals in Rwanda with health insurance are entitled to comprehensive, subsidized preventative care through the MPA. The CPA covers a limited number of services at the district hospitals, including the cost of hospitalization, caesarian operations, minor and major surgical operations, medical imaging, and all diseases afflicting children ages 0 to 5 years. As of 2006, the CPA benefits package was extended to cover select services in national hospitals. In order to receive these benefits, individuals must be referred from the health centers to district or national level hospitals. Mutuelle members are entitled to comprehensive benefits for primary care, secondary care, and tertiary care provided through public or private non-profit contracted facilities. The scheme provides basic services such as family planning, pre-natal care, consultations, basic laboratory examinations, generic drugs, and hospital treatment. All medications from hospitals are also included in the benefits. For those covered under RAMA, benefits include all the major preventative services in addition to all curative services and pharmaceuticals. The benefits package for MMI is the same as RAMA, with the addition of prostheses coverage added under MMI. Excluded are contact lenses and braces as well as cosmetic surgery for purely aesthetic reasons. RAMA and MMI have signed contracts with all public health centers and reference hospitals, as well as 16 private institutions. MMI has the added advantage of using military hospitals, thus, individuals covered under these plans are able to access health care benefits at almost all health centers in Rwanda. Mutuelles de SanteBenefits package Types of Benefits: Comprehensive The benefits package in Rwanda has two primary parts: the Minimum Package of Activities (MPA) and the Complementary Package of Activities (CPA). The MPA covers all services and drugs provided at the health centers including pre- and post-natal care, vaccinations, family planning, minor surgical operations, and essential and generic drugs. All individuals in Rwanda with health insurance are entitled to comprehensive, subsidized preventative care through the MPA. The CPA covers a limited number of services at the district hospitals, including the cost of hospitalization, caesarian operations, minor and major surgical operations, medical imaging, and all diseases afflicting children ages 0 to 5 years. As of 2006, the CPA benefits package was extended to cover select services in national hospitals. In order to receive these benefits, individuals must be referred from the health centers to district or national level hospitals. Mutuelle members are entitled to comprehensive benefits for primary care, secondary care, and tertiary care provided through public or private non-profit contracted facilities. The scheme provides basic services such as family planning, pre-natal care, consultations, basic laboratory examinations, generic drugs, and hospital treatment. All medications from hospitals are also included in the benefits. For those covered under RAMA, benefits include all the major preventative services in addition to all curative services and pharmaceuticals. The benefits package for MMI is the same as RAMA, with the addition of prostheses coverage added under MMI. Excluded are contact lenses and braces as well as cosmetic surgery for purely aesthetic reasons. RAMA and MMI have signed contracts with all public health centers and reference hospitals, as well as 16 private institutions. MMI has the added advantage of using military hospitals, thus, individuals covered under these plans are able to access health care benefits at almost all health centers in Rwanda. |
| Nigeria: National Health Insurance System |
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The benefits package for the National Health Insurance Scheme for workers in the formal sector is pre-determined and includes:
The benefits package for the National Health Insurance Scheme for workers in the formal sector is pre-determined and includes:
Exclusions for the package include:
The benefits packages for the informal program of the National Health Insurance Scheme (NHIS) are determined by the stakeholders through a process of consensus building. Members determine the benefits package according to local needs. National Health Insurance SystemBenefits package Types of Benefits: Comprehensive The benefits package for the National Health Insurance Scheme for workers in the formal sector is pre-determined and includes:
Exclusions for the package include:
The benefits packages for the informal program of the National Health Insurance Scheme (NHIS) are determined by the stakeholders through a process of consensus building. Members determine the benefits package according to local needs. |
| Mexico: Seguro Popular |
|
The design of the Seguro Popular essential benefits package was informed by two key sets of analytical inputs. The first set of analytical tools was composed of estimates of the burden of disease used to assess the severity of different health problems. The second set was made up of cost-effectiveness analyses used to weigh the potential population-level benefits of distinct interventions against their financial costs. The first benefits package was selected in 2002 and consisted of 78 health interventions. These interventions included primarily preventive activities as well as the detection and treatment of degenerative diseases. Read full sectionThe design of the Seguro Popular essential benefits package was informed by two key sets of analytical inputs. The first set of analytical tools was composed of estimates of the burden of disease used to assess the severity of different health problems. The second set was made up of cost-effectiveness analyses used to weigh the potential population-level benefits of distinct interventions against their financial costs. The first benefits package was selected in 2002 and consisted of 78 health interventions. These interventions included primarily preventive activities as well as the detection and treatment of degenerative diseases. In 2004, the number of interventions increased to 91 and by 2005 the number increased to 155. In 2006-2007, the number of covered interventions increased significantly up to 255 interventions, covering most causes of primary care visits and nearly 95% of all causes of hospital admissions. As of 2009, there were 266 interventions that were covered under the Universal Catalog of Health Services (CAUSES). The benefits package can be divided into six distinct categories of services as follows:
There is also a distinct benefits package for protection against catastrophic expenditures. This centrally managed fund, known as the Protection Fund Against Catastrophic Expenditures (FPGC) covered 17 interventions in 2006. By 2010, the number of interventions grew to 49 and included treatment for HIV/AIDS, bone marrow transplant, and childhood cancer. Care for most of these catastrophic events (84%) is provided by private service providers. Seguro PopularBenefits package Types of Benefits: Comprehensive The design of the Seguro Popular essential benefits package was informed by two key sets of analytical inputs. The first set of analytical tools was composed of estimates of the burden of disease used to assess the severity of different health problems. The second set was made up of cost-effectiveness analyses used to weigh the potential population-level benefits of distinct interventions against their financial costs. The first benefits package was selected in 2002 and consisted of 78 health interventions. These interventions included primarily preventive activities as well as the detection and treatment of degenerative diseases. In 2004, the number of interventions increased to 91 and by 2005 the number increased to 155. In 2006-2007, the number of covered interventions increased significantly up to 255 interventions, covering most causes of primary care visits and nearly 95% of all causes of hospital admissions. As of 2009, there were 266 interventions that were covered under the Universal Catalog of Health Services (CAUSES). The benefits package can be divided into six distinct categories of services as follows:
There is also a distinct benefits package for protection against catastrophic expenditures. This centrally managed fund, known as the Protection Fund Against Catastrophic Expenditures (FPGC) covered 17 interventions in 2006. By 2010, the number of interventions grew to 49 and included treatment for HIV/AIDS, bone marrow transplant, and childhood cancer. Care for most of these catastrophic events (84%) is provided by private service providers. |