In February of this year, Rwanda’s world renowned universal healthcare policy (Mutuelle de Sante) took a price increase in premiums. The then Minister of Health, Dr. Richard Sezibera, announced the annual premium increased from a range of Rwf 1,000-7,000 to Rwf 2,000- 7,000 Rwandan francs.
To explain the 100% increase for those in the lowest sectors of the plan, Sezibera pointed to an increased in the cost of health per person in Rwanda from Rwf 2,000 to Rwf 2,900-3,400.
The new Mutuelle de Santé will be based upon a similar three-tier system based upon member’s financial capacity to pay the premium.Government programme, Ubudehe, will categorize members on various gradients within the system with the extremely poor now requiring to pay the minimum of Rwf. 2,000.
Prior to this price increase, despite the 85% enrollment in the plan, the extremely poor contained within the remaining 15% remained marginalized due to their inability to pay the former annual premium of Rwf.1000. Now it seems this population will be asked to pay double this amount.
For patients residing in the University Teaching Hospital of Kigali (CHUK) this increase has brought about mixed reactions.
Yankurije Francoise from the village Buha (Kimundu Sector/Nyamasheke District) arrived at CHUK late in June to receive an operation on her stomach. She used to pay Rwf. 1000 for her mutuelle.
“According to the explanations they give us about the new medical insurance, we all understand the situation, but the problem we are having is capacity. Which results from low income, and we don’t know whether we can manage to buy it [new medical insurance].”
For some like 22-year old Grace Murekatete from Mparanyondo sector (Nyamata District), this could mean the end of care.
“I’ve been sick for 16 months. I have been here in the hospital for only four months. But I have not yet improved. I don’t know what I will do if they increase the price to 3000 because I am alone here no one is looking after me,”she told Igihe on Sunday.
More than the patients, however, it seems public hospitals are facing the greatest challenges due to the price increase.
Dr. Umurangwa Florence (Post-graduate CHUK surgery RMC 1164) told Igihe, “We don’t wait to see whether or not the patient has mutuelle de santé, because have to take care of them first.”
“It is a bit difficult because some people who couldn’t even afford to pay Rwf. 1000 before are now being asked to pay three times that amount. Moreover it would be difficult for the hospital to continue operating because so many people will be treated that have not paid for the new mutuelle de santé.”
“When we go to the stock and take medicine, and the patient is not paying, it is a big challenge to the hospital.”
CHUK Hospital Director Dr. Theobard Hatekamana told Igihe more specifically, “We have some issues with people who can’t pay the 10% of fees, so the hospital loses this money. Since we cover Rwf. 100,000 for these kinds of cases, and there is no mechanism for recovery of this money,”
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