Thresholds for health insurance in Rwanda: who should pay how much?

Abstract

SummaryCommunity-based health insurance schemes were introduced in Rwanda in 1999 and now cover 27% of the population. Due to widespread poverty, it remains unclear to what degree poorer population strata can be anticipated to pay into the system. This study investigates the extent to which the Rwandan population can financially contribute to obtain health insurance. More specifically, researchers explored the relationship between resource mobilization for the health system and the ability to provide community-based health insurance across socio-economic strata. Data from six household surveys are analysed revealing a consistent pattern: the goals of maximizing health revenue and maximizing participation in community-based health insurance are mutually exclusive. However, the upper three quartiles of the Rwandan population are able to contribute US$1 per capita per year. In order to extend coverage to the poorest quartile, a corresponding subsidy for the coming years has to be considered.

Community health insurance in Uganda: Why does enrolment remain low? A view from beneath

“…They could dialogue with the communities, scheme staff and the providers to improve enrolment in the plans. Subsidies to the poorest members of the community could increase enrolment and thus access to care [22,23]. More importantly, donors and governments could finance research/projects that test different approaches to extending insurance to the poorest [24].…”

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“…This example has been suggested to ensure that the poor and other vulnerable groups of the populace are covered. 45,46 Limitations. Expressed concerns of participants about prepayment schemes could not be discussed deeply because of the quantitative nature of this study.…”

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“…However, the average Rwandan population will be incapable to raise these resources. Schmidt et al. (2006) found that only 75% of the Rwandan population could afford to pay insurance premiums of 1 US$ per capita per year.…”

“…However, the average Rwandan population will be incapable to raise these resources. Schmidt et al (2006) found that only 75% of the Rwandan population could afford to pay insurance premiums of 1 US$ per capita per year. Their results imply that current premiums of 1.75 US$ already exceed the contributory capacity of more than 25% of Rwandan households.…”