According to a member of the St. Alphonse Development Commission, many residents in the catchment area are salaried workers with employer health coverage. St. Alphonse health center does not bill employers for care, so there is no record of the number of patients who may not have joined the insurance plan because they are already covered by their employer.

The insurance premium for 1989 was set in March, at 300 Z ($0.85) per person. The 1988 premium price was 150 Z ($0.80), increased from the initial price of 50 Z ($0.39) in 1987. In early planning meetings, community members expressed a preference for family enrollment, but the health center staff and development commission members felt that without a census such a system was open to abuse. All individuals pay the same premium.

As discussed above, the insurance plan has a co-payment of 500 Z ($1.41) per episode of illness. The insurance plan has not established any deductibles. In 1987 and 1988, the co-payment differed according to age, with a lower co-payment paid by children. All SPTK-supported health zones abandoned this practice in 1989, in favor of a single co-payment. Table C.l shows co-payments from past periods. The episode of illness covered is restricted to five days, and does not cover expensive, special drugs.

The health center treats patients who are not members of the insurance plan; in fact, almost _85%_ of new cases seen at the health center in 1988 were in non-members (see Table C.2 for utilization figures). Non-members do not qualify for the episode of illness price, but are required to pay for each day of care. Currently non-members pay 400 Z ($1.13) for the first day of care, and 150 Z ($0.42) for each subsequent day of care. The average number of visits per episode of illness for non-members thus far in 1989 was 3.6, or an average cost per episode of 790 Z ($2.23) [(I visit x 400 Z) + (2.6 visits x 150 Z)]. As with members, while consultations and basic drugs are included in the price, laboratory exams and special drugs are charged separately.

**Table C.2** Utilizatiln, **St. Alphonse Health** Centar Kinshasa, 1968-1989

<!-- Start of picture text --> ........................ ...................................... ............<br>1968 1 1989<br>----- ------------------ -1----------- ----- ------ 1<br>1X IX I number 1 I<br>I umber Itotal irew I (8 mo.) Itotal Inew I<br>I -utI. Icas&$ I (*) lutil Icses I<br>I----- --- 1--I--1---- I------ I-----1--- I---1-------1I<br>Members episodes 1 1,413 1 5.2X1 13.7X1 434 1 3.011 10.3X1<br>hon-members first visit I 8, 8981 32.6X1 86.3X1 3,788 1 26.4X1 89.7X1<br>Mon-m'rbers other visits(+)I 16,477 1 60.3X1 - 9,710 1 67.861 --- I<br>CPH new cases enrolled 376 1 1.4Z% - 302 j 2.1X1 --- I<br>CPS rew cases enrolted 168 0.6O 1 -- 98 1 0.7X1 --- I<br>TOTAL: |27332 ....... |100.OX1iO0.OX| .... --- 1----I-1-- I ------- 14.332 1I------I------1I 1100. 01100.0%1<br>1-------------- ------- -1- ------------ --------- 1<br>Visits per episode I I<br>(nomrebs) I 2.9 1 3.6 l<br>.................................................<br><!-- End of picture text -->

- **Jan.** to Sept., *xcltud1n **Aprlt (no** deta avalt. for **April)**

- * Follow-up **visits are calculated** by dividing total **receipts** for **follow-up** visits by priee **per follow-up visit.**

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