between 700 to 1,000 (10 to 14%) are members who pay their monthly premiums regularly. Since 1986, the REMEF has had a total of about 2,000 members. Currently small local businesses who enroll employecv and their dependents account for _557_ members, or between 55 to 80% of total membership.

In 1989, the adult monthly membership premium was set at 5;80 Z ($1.41), or 6,000 Z ($16.92) per person per year. Students and children are charged a lower rate of 250 Z ($0.70) per month, or 3,000 Z ($8.47) per peCson per year. Farmers ('paysan") are also charged the lower rate of 250 Z. A full-time public relations worker assumes the task of verifying membership category, either by calling schools or making home visits. Lower income families may be charged different rates, depending on the decision of the REMEF administrator, again pending investigation by the public relations worker. Company membership rates are the same as individual rates.

The plan has no limits on spending or duration of episodes of illness. There are no deductibles or co-payments. Membership is voluntary (except in the case of company employees) and whole families are not required to join if one member joins. The plan covers both treatment at the facility as well as the cost of referrals elsewhere.

Non-insured residcn:s may be treated at the faci'ity. They are charged 500 Z ($1.41) for each consultation, with drugs and laboratory payable separately. It is rare that non-members come to the facility to be treated, however.

# **L** Resourc Mobilization

-

Record-keeping is not well-developed at the REMEF polyclinic, so it is difficult to analyze the financial situation of the plan. No utilization registers or financial account books were available for review, and procedures for recording and verifying membership seem lax.

To gain some estimate of the size of operations, salary information was obtained for polyclinic employees other than doctors. Monthly salary expense excluding REMNEF's two doctors (one of whom is the Director) is approximately 95,000 Z ($268). Assuming a salary of 150,000 Z per month for each doctor (the high-end of the Bwamanda pay range), total personnel expense is about 395,000 Z ($1,115) per month, or 4.7 million Z ($13,380) per year. Since personnel expense probably accounts for 60% of total expenses (it was 56% at St. Alphonse), REMEF's total annual expenses for polyclinic operations may be 8 million Z or more ($22,590).

Revenue from premiums cannot be estimated accurately, since the number of individuals falling into each membership category is unknown. But even if all members were adult and the maximum membership figure is assumed (1,000), revenue only comes to 6 million Z per year. This indicates that REMEF may be receiving external operating subsidies from some source, or that the estimates of doctors' salaries and/or total membership are wrong.

## 1,1 Utilization

'Ttilization figures were available for two months, August and September 1989. These figures sn,o)w that utilization is much lower than either CASOP or St. Alphonse. REMIEF treated an average of 152 new cases per month in Aug. to Sept. 1989, whereas the average number of new cases treated each month at St. Alphonse is about 528, and at CASOP the number is close to 1,200. REMIEF't utilization data are shown in Table E.2.

9 The average family size of these members is small (3.2) which may be due to the large number of single persons employed in the hotel industry. Two small hotels are among the businesses which have contracted with REMEF to provide health care to employees.

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