A study on RSSB medical scheme financial viability 2011-2015

Abstract

The study intends to assess the financial viability of Medical Scheme as a branch of Rwanda Social Security Board (RSSB). Since the Vision 2020 development and implementation, policies, laws, strategies and actions aiming at each Rwandan citizen to have access to quality essential health care and be protected from financial risks due to illness have been elaborated and implemented by the Government of Rwanda ( GOR); it is in line with this long term development strategy (Vision 2020) that the former RAMA, currently RSSB Medical Scheme has been established. The study is documentary, quantitative, qualitative (interviews), analytical and retrospective from 2011 to 2015. A desk review done focussing on social health insurance historical, organization, functioning, and management and risks especially those relating to financial aspects worldwide, regional and RSSB Medical Scheme precisely. A four years retrospective secondary data collection concerning affiliation, contribution from affiliated members and employers, other revenues, medical expenditures, administrative costs (overhead) and other expenses, assets, liabilities (brief the annual income statements. The research has done a scrutiny analysis on the balance sheet in the perspective of generating financial ratios as financial indicators which has helped the researcher to assess the financial health of the scheme. The findings from the survey indicated a variation registered in the unit cost was on average 11, 8% between 2011/2015 for the category of health center, 22.4% for District hospitals, 14.9% for Referral hospitals, 34.4% for King Faisal Hospital and 2.9 % for Private clinics. The total expenditure is calculated at RWF 23,461,0 million out of which medical expenses account 70.75%, operating costs, depreciation and amortization account 22.98% and 6.27% respectively. For the same Financial Year 2014-2015, the working capital is calculated at RWF 101,637,463,461 (1,179,070,491+170,335,899,565) - (69,877,506,595) by the upper side of the Balance sheet and at the same amount by the lower side of the Balance sheet worth RWF 101,637,463,461 (85,819,577,701 + 20,136,158,313)-(4,318,272,553). Based on the findings, the researcher concluded that financial viability of the scheme is impressive but it lies on the consistent cumulated reserves and investments income which should finance the scheme and address eventual financial gaps in bad circumstances but not in the long term. Decision-makers and RSSB Seniors managers are invited to paying sufficient attention to study findings and recommendation. The following recommendations were made Reinforce the verification system (team/pools) and setting a monitoring and evaluation system, establishing rigorous control/inspection and supervisory annual calendar;, Introduce the biomedical electronic card as soon as possible in order to fight and prevent fraudulent cases.