2.10.
Health insurance and willingness to pay (WTP)
Health insurance is a mechanism for spreading the risks of
incurring healthcare costs over a group of individuals or households. This
definition is not dependent on the nature of the administrative arrangements
employed, but not the outcome of risk sharing and subsequent
cross-subsidization of healthcare expenditure among the participants.
An arrangement designed to provide risk sharing for
illness-related events, and which is accessible to households in the informal
sector in low-income countries, is a health insurance scheme regardless of the
orthodoxy of its operational modalities. In such arrangement, an insured
individual acquires «a state-contingent income claim» before the
state of the world is known and is entitled to resources, income, or both to
address the event for which he or she is insured if the event is occurred.
(Manning et. Al 1987).
2.11.
The situation of mutual health insurance schemes in Rwanda
According to Mutual Health Insurance policy report in Rwanda
(December 2004), it was in1960's that community based health insurance system,
like the association Muvandimwe de Kibungo (1960) and the association Umubano
mu bantu de Butare (1975) started to be constructed. However, these communities
based health insurance initiatives were further developed only since the
reintroduction of the payment policy in 1966. The development of community
health insurance in the form of modern mutual health insurance has been on the
increase during the first five years. (Social Science and Medicine 48,
881-886)
In fact, the number of mutual health insurance has increased
to six (6) in 1998 to 76 in 2001 and 226 in November 2004. The geographical
coverage of mutual health insurance was also extended: where as initially in
1999, these mutual health insurances were mainly developed in the four
Provinces of the country as well as the City hall of Kigali. They cover about
2,101,034 beneficiaries, representing 27% of the population of Rwanda. This
rapid increase in number of mutual health insurance, and beneficiaries
testifies undoubtedly to the affirmation of community dynamics in the search
for the solutions to the problems of financial accessibility to healthcare and
`protection against financial risks associated with diseases. (Social Science
and Medicine 48, 881-886)
Dr. Claude Sekabaraga, an official in charge of Planning in
the Ministry of Health, has said 90 percent of Rwandans countrywide have joined
health insurance. He was speaking at a three-day recent meeting at Serena Kivu
Sun Hotel in Gisenyi recently. The meeting, that brought together various
health officials in the country including those from the World Health
Organization (WHO) and GTZ, was meant to evaluate the achievements and failures
of the health insurance policy. While officially opening the meeting,
Sekabaraga explained that 85 percent of Rwandans were enrolled in health
insurance commonly referred to as Mutuelle de Santé, while five percent
belong to other health insurances such as RAMA and MMI. (Poverty Reduction
Strategy annual progress report 2003-2004:56)
He disclosed that the ministry is doing everything possible to
have the remaining 10 percent that are not registered under any insurance
schemes to join Mutuelle de Santé because it's the cheapest and operates
in all government health centers countrywide. He hailed the contribution of the
health insurance schemes in enhancing improved health. Sekabaraga noted that
research indicates that in 2001 only 23 percent of Rwandans afforded medical
care, while the remaining 77 percent used traditional means which increased
adult death and infant mortality rates. «Today 200% of residents have full
access to medical care; that is to say, they access medical care at least twice
a year,» he explained.
He observed that health insurance schemes have greatly reduced
infant mortality rates because mothers are able to access antenatal care during
their pregnancy. Poverty Reduction Strategy annual progress report
2003-2004:56). According to Sekabaraga, the government has controlled malaria
infection which is the leading cause of infants' death. «There has been a
tremendous decrease in deaths caused by malaria these days due to the campaign
against the disease. Expectant mothers are sleeping under mosquito nets while
the few malaria patients have access to good medical care due to Mutuelle de
Santé,» he said. Fred Rugumira, one of the participants and a
health work said that health insurance has reduced conflicts hither caused by
patients who were incapable of meeting medical bills. (Poverty Reduction Strategy annual progress report
2003-2004:56)
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