Focus Media (Kigali)
Sam Ruburika
29 July 2008
James Gashagaja is recovering from malaria at the Kicukiro health center. He has spent almost a week in there, and is now worried about the bill he will have to pay. Mr. Gashagaja does not have any medical insurance.
A survey is planned to examine why certain people are reluctant to take a health insurance.
According to a nurse at the health center, James Gashagaja's bill now amounts to some Frw 20,000 for the week-long stay at the health center and he is expected to be there for two more days.
"I just don't know if I will be able to pay the bill," says Mr. Gashagaja, a construction site helper in the city. "I just wish I had known the importance of the mutuelle (health insurance, ed.) card, then I wouldn't have to worry about the money."
And indeed, being a member of a mutuelle might have saved Mr. Gashagaja up to Frw 14,000. James Gashagaja's is not an isolated case. Francine Nyiribambe, a single mother with four children, complains she always had to pay higher tariffs because she too has no health insurance. She has now changed her mind, and registered her two children in a mutuelle.
"Before, I was weary of the mutuelle; I thought it was away of exonerating money from people, and that I would not receive health care according to my contribution," Ms. Nyiribambe says.
There are indeed those who have the misconception that adhering to a mutuelle is related to the health services one receives. Damascene Birinda, for example, has completely lost faith in the health insurance scheme. He argues that the health centers do not offer quality services.
"I took my son to the health center but it took almost four hours before we were attended to," Birinda complains. He further points out that most nurses are quite rude to the patients and are more ready to serve those people who have no health insurance cards, since they have to pay the entire bill directly in cash.
Others only consider the cost of health insurance, and not the cost of any medical assistance they might need, and thus prefer not to insure all family members.
"I have only provided mutuelle cards to my wife and two kids, as they are the ones who tend to get sick," says Augustine Biraboneye who lives in Kicukiro. He is confident that he doesn't get sick often, so he does not find it necessary to have insurance for himself.
Free insurance
Another argument is that some people are simply too poor to afford health insurance. Yet according to local authorities, the poorer people in society are freely registered in mutuelles.
"We have provided health insurance services to the people in our cell," says one official in Nyakabanda cell in reply to claims that some people do not have the money to get health insurance.
The government has also made sure that whatever insurance a person has, it is valid on all levels of health care-whether health centers, district or national hospitals.
"We can say we have an exemplary health insurance system, given that even foreigners come to learn from us," says Hertilan Inyarubuga, head of the health insurance department at Minisante.
He adds that what is special about the national health insurance program is that other health insurance such as RAMA, the Military Medical Insurance (MMI), CORAR as well as the government offer support to the mutuelles at the national hospital level where they contribute to the to the national health insurance program.
"Rwanda is the first country where solidarity among health insurance schemes as well as the government is evident," Mr. Inyarubuga says.
He further explains that the health insurance system has been decentralized down to the districts which play a big role in sensitizing the population which is commonly done during community work, church services and through plays aired on radio.
"It is part of the districts performance contracts to improve the health of the citizens by making them join the health insurance system," Hertilan Inyarubuga says.
Patient roaming
The ministry of health also airs talk shows on the radio stations across the country with the aim of disseminating information related to the importance of health insurance.
Mr. Inyarubuga remarks that in August the ministry of health will soon start research as to why Rwandans are not joining the health insurance system, in order to take the necessary measures to ensure 100% coverage. Amongst the barriers to health insurance, he says, are the poor quality service offered by certain health centers, poverty of the population as well as lack of understanding of the importance of health insurance.
Yet the Rwandan system has many benefits, Mr. Inyarubuga points out, such as the patient roaming system which means that a member of a mutuelle in Kigali will receive treatment in any health care center in the country. The repayment process is then handled by the health insurance department of Minisante.
He acknowledges however that some of the health centers are not yet cooperating with the patient roaming system as they fear of losing money. "We are working on harmonizing the system, so that wherever you go in the country you can have access to treatment."
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