According to the 2012 report published in The Lancet -Universal Coverage Healthcare Coverage series, Rwanda is among the top countries globally that have introduced healthcare coverage ’Mutuelle’, as well as creating new model to do it.
With lessons learned from Rwanda, countries like South Africa are also beginning to shape the way in piloting their bids for universal coverage.
The managing director at the results for development institute, lead author Gina Lagomarsino observed that rationale for moving to universal healthcare is also largely the same.
“In most cases, the move to universal coverage is a response to people feeling like they’re paying too much out of pocket for healthcare that they can’t afford or can’t even get because it’s too expensive,” said Lagomarsino.
Over 90 percent of Rwanda’s population is subscribed to the health insurance cover which the World Health Organisation (WHO) considered something worth learning from.
“So far more than 17 countries have visited Rwanda to learn about the best practices in Rwanda’s health systems. Rwanda was recommended by WHO as a model to other countries due to its success in community health based financing (mutuelle),” said the health Minster Agnes Binagwaho.
Other countries commended by Lancet include Ghana and India.
Mutuelle subscribers are assigned to one of the three categories that include; the well-to-do who pay Rwf 7,000, relatively modest families pay Rwf 3,000 and the vulnerable whose contributions are covered by the government at a cost of Rwf 2,000 per individual annually.
The government subsidises mutual health insurance programme with US$ 4 million annually while the Global Fund contributes US$ 5million. Contributions by beneficiaries add up to US$ 30 million.
Rwanda is the only country in sub-Saharan Africa in which 85% of the population participates in mutual insurance programmes for their health coverage, according to the World Health Organization.
The community based Mutuelle programme has registered a lot of progress, including reduction in out of pocket spending, treatment is now affordable to many, and has also encouraged most of them to seek medical services unlike other unhealthy options.
In the early 20th century, two models of universal healthcare coverage emerged in the United Kingdom and Germany. The UK uses general taxes to fund publicly provided healthcare in its one risk pool model, while Germany’s multiple risk pool model relies on household premiums and payroll taxes, and relies on private healthcare providers. Industrialized countries like Japan, Canada and France have all implemented variations of these two models.
The research, which surveyed nine developing countries in Africa and Asia (which are now part of a joint learning network on the issue), found that the new models vary considerably but have several common characteristics, including increased revenue and health budgets, larger risk pools and use of the private sector.
International aid accounted for more than a quarter of funding in only three countries – Mali, Kenya and Rwanda – where almost half of universal healthcare coverage was donor-funded, according to the research.
The government drafted a new plan for community-based health insurance in 2001. Preventative services would be provided for all Rwandans at no cost while curative medical treatment would be made affordable through voluntary community health insurance plans.