Lesotho's Deputy Principal Secretary of Health and Social Welfare, Moliehi Khabele, explained that the pilot phase is meant to develop and test effective systems for targeting, enrolment, payment to beneficiaries, monitoring, procurement and financial management – as well as training of stakeholders, public awareness and community involvement.
Enrolment payments were instituted in the early 2000s with the introduction of FMGs.
Formal enrolment of patients with physicians is relatively new, and patient enrolment payments represent only a marginal proportion of physicians' income in Quebec.
According to Kumar, in India, admission to medical school is so profitable that the transactions are patronised by politicians who take the enrolment payments as a source of income [ 20].
The main health insurance design elements raised to be most important are monthly contribution rate, benefit packages, quality of services, health care providers, enrolment, co-payment, and payment mechanism.
As the SSO strengthens enforcement of enrolment, evasion of payments will likely become a bigger concern that will require greater attention.
It was only recently, in 2009, that payments for enrolment of non-vulnerable patients were extended to all other family physicians (i.e., those not in FMGs).
When you put a payment trigger on enrolment or learning improvements, you feel accountable to every child.
Through enrolment in community financing schemes, payment is disassociated from the use of the health services, creating a financial buffer between service fees and seasonal fluctuations in income (Diop et al. 2000; McCord 2000; Preker et al. 2002).
FHGs are paid primarily through fee for service payments, however, they also receive incentive and premium payments for patient enrolment, health promotion activities, and for the management of certain conditions (e.g., diabetes care incentives).
In contrast, a large majority of inflow (61.5%) was derived from the 2.5% tax levy, and a sizeable amount (16.9%) from Social Security contributors, who are provided exemptions from premium payments for NHIS enrolment.
