…health insurance — called Mutuelle de Santé — is nearly universal. Andrew Makaka, who manages the health financing unit at the Ministry of Health, said that only 4 percent of Rwandans are uninsured.
Mutuelle is a community system — premiums go into a local risk pool and are administered by communities. Until last year, Mutuelle’s premiums were about two dollars a year. This system turned out to be untenable…
…Last year Mutuelle adopted a sliding scale. For the wealthiest, premiums essentially quadrupled, to about $8 a year. Each visit to a clinic has a co-pay of about 33 cents. If you need to go to the hospital, you pay a tenth of your hospital bill. But now the poorest — as judged by their communities — pay nothing…
This NYT Fixes blog also refers to the fact that Rwanda fixed the problem of doctors not coming to work and the lack of medical equipment.
This 2008 presentation by a doctor from the Ministry of Health in Rwanda explains how. Three key steps that potentially improved the supply-side:
- Performance-based service contracts with local governments and with health workers; also indicative of decentralised service delivery arrangements
- Health sector financing predicated on a composite index of gaps/bottlenecks in health care
- Functional autonomy to health facilities (this might have been the most critical of them all)