Mutual health insurance and financial risk protection in Rwanda

Presenter: Priyanka Saksena, World Health Organization

Abstract

Rwanda has seen a massive expansion of health insurance schemes in recent years. Mutual health insurance, referred to as "mutuelles", has been at the heart of reforms towards universal coverage. We analyse financial risk protection and access to care in Rwanda in the context of this insurance expansion and other reforms and postulate on the internal resource generation capacity.

Objective: The objectives of this paper are to analyse financial risk protection and utilization of care in Rwanda as a result of access to health insurance. This is within the larger context of the rapid expansion of mutuelle insurance in the population, whose coverage has grown from 7% in 2003 to 75% in 2007.

Methodology: We use household budget survey data (from the second "Enquete integrale sur les conditions de la vie", 2005), including a health services utilisation model to analyse the effects of insurance coverage. We examine the current financial burden on households from health payments and propose alternatives to increase fairness of contributions through various prepayment thresholds (including the currently stipulated schedule). Additionally, we assess the resource generation capacity of Rwandan households in relation to the expansion of insurance.

Results: Our findings suggest that access to health insurance has increased utilisation of services but this is sensitive to the particularities of the insurance scheme. Additionally, we also find that the currently proposed contributions for "mutuelles" place a high burden on poorer households and that alternatives may be more conducive in ensuring equity in insurance contributions.

Conclusions: We find that having insurance protection is a positive and significant development for the Rwandan households: However, the apparent limits of current contribution and coverage schedules should now be addressed as health insurance has become accepted and valued by the population. We suggest progressively increasing contribution rates in order to make use of the higher internal resource generation opportunities found by our analyis. This could be possible if the process was linked to existing community wealth assessment classifications.