Rwanda’s health insurance program has improved care utilization, reduced household spending

In Rwanda, the community-based health insurance program Mutuelle de Santéhas improved medical care delivery and reduced household catastrophic spending since it was adopted in 1999, according to a new study. The researchers found nationwide improvement in maternal and child care coverage, which has led to significant decreases in women and children’s mortality. The findings suggest that health insurance can be effective in improving coverage even in the poorest settings.

Rwanda is one of the few countries in Africa likely to meet the 2015 health targets of the United Nation’s Millennium Development Goals, according to the researchers. A July 3, 2012 New York Times column reported that the country’s health gains over the past 10 years also include increasing life expectancy from 48 to 58 years and cutting malaria deaths by two-thirds. The column’s writer concluded, “It couldn’t have happened without health insurance.”

The study, led by Harvard Medical School researcher Chunling Lu with co-authors including Harvard School of Public Health’s Kenneth Hill and Megan Murray, drew from national surveys conducted during the first eight years of Rwanda’s health insurance program. The researchers found that 85 percent of the population was covered by the end of the study period in 2008. Medical care for children under five with acute conditions including diarrhea increased from 13 to 33 percent and the utilization of skilled birth attendants rose from 39 to 67 percent. Rwandans living in extreme poverty had the lowest medical care utilization and faced the highest burden of medical costs, suggesting that the program’s modest copays should be eliminated for the poorest enrollees, according to the authors.

The study was published online June 18, 2012 in PLoS One.

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