Profile of members and non members of mutual health insurance system in Rwanda: the case of the health district of Kabutare

Ministère de la Santé, Kigali, Rwanda.
Tropical Medicine & International Health (Impact Factor: 2.33). 12/2004; 9(11):1222-7. DOI: 10.1111/j.1365-3156.2004.01318.x
Source: PubMed


Le Rwanda a retenu la mise en place des mutuelles de santé dans ses priorités. Des expériences pilotes ont été lancées dans trois districts du pays. Quatre ans durant (1999–2003), le taux d'adhésion de la population à ces systèmes est resté relativement faible (15,6%). Une étude transversale de 1 042 ménages dans le district sanitaire de Kabutare nous a permis de comparer les caractéristiques socio-économiques et démographiques, les antécédents médicaux, chirurgicaux et gynéco-obstétriques des membres et des non membres de la mutuelle développée dans le district. Il ressort de l’étude que les membres et les non membres sont comparables en termes de sexe, ètat civil, statut professionnel et antécédents de maladie. Les ménages de grande taille (>5 personnes) et ceux ayant un revenu relativement plus élevé (>230 $ EU/an) adhèrent plus. Les membres de la mutuelle utilisent plus les services de santé que les non membres, dépensent moins pour leurs soins de santé et se fidélisent à la mutuelle au fil des années. L’étude plaide en faveur de la poursuite de ces systèmes de mutualisation du risque maladie, tout en rèfléchissant à la mise en place de mécanismes qui permettront aux pauvres d'adhérer.
The establishment of mutual health insurance systems is one of the priorities of the Rwandan government. Pilot studies have been conducted in three districts of the country. Nonetheless, after 4 years of implementation (1999–2003), the population coverage by these insurance systems remains relatively low. A cross-sectional study of 1042 households in the Kabutare health district allowed for a comparison of socio-economic and demographic variables, and the medical, surgical, gynaecological, and obstetrical history of health insurance scheme members and non-members. The results of the study demonstrate that the distribution of members and non-members is similar in terms of sex, marital status, professional status and medical history. However, larger households (more than five members) and those having a relatively higher income (more than US$230 per annum) are more likely to be insured than other households. Members of the mutual health insurance use more the health services than non-members, spend less on health care and increasingly maintain membership. The study emphasizes the relevance to further promote mutual health insurance, but also points to the need for mechanisms to ensure financial access for the poor rural population.

Download full-text


Available from: Bart Criel
  • Source
    • "Pregnant women are exempt from any financial contribution to NHIS. A problem that health insurances in Africa are facing frequently is the low enrolment coverage among those who fulfil the criteria of exemption from premiums (Musango et al. 2004; De Allegri et al. 2006; Basaza et al. 2008). At the beginning of 2007, it was estimated that more than 7 million people in Ghana had enroled, corresponding to a coverage of 35% of the entire population. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To explore the association between socio-economic status (SES) and health insurance subscription to the Ghanaian National Health Insurance Scheme (NHIS) of residents of the Asante Akim North district of the Ashanti Region, Ghana. In the course of a community survey, data on asset variables (e.g. electricity, housing conditions and other variables) and on NHIS subscription were collected on the household level in 99 villages. Using principal components analysis, households were classified into three categories of SES (20% high, 40% middle and 40% low SES). Odds ratios of NHIS subscription were calculated for all SES categories, using the low category as the reference group and adjusting for travelling time to health facilities by public transport. Of the 7223 households surveyed, 38% subscribed to the NHIS, of these 21% were low, 43% middle and 60% high SES households. SES was significantly associated with NHIS subscription (high SES: OR 4.9, 95% CI 4.3-5.7; middle SES: OR 2.5, 95% CI 2.2-2.9; low SES: OR 1, reference group). Four years after its introduction, the NHIS has reached subscription rates of 38% in the district surveyed. However, to achieve the aim of assuring universal access to health care facilities for all residents of Ghana, in particular for individuals living under socio-economic constraints, increasing subscription rates are necessary.
    Full-text · Article · Dec 2009 · Tropical Medicine & International Health
  • Source
    • "Since notions of risk-aversion are culturally bound (Letourmy 2006b) and the concept of insurance often foreign to the African tradition (Platteau 1997), culturally sensitive interventions are urgently needed to explain how insurance works in practice and what are the benefits derived from membership (Sommerfeld et al. 2002). Since equity in enrolment also challenges the development of most schemes (Jü tting 2002; Osei-Akoto 2004; Waelkens & Criel 2004; De Allegri et al. 2006; Chee et al. 2002; Musango et al. 2004), policy makers ought to work to identify the poorest and subsidize their membership, channelling, as in the case of Rwanda (Twahirwa 2008), international monetary support towards this aim (Waelkens & Criel 2004; Carrin et al. 2001; Tabor 2005; Huber et al. 2002; Waelkens et al. 2004 "
    [Show abstract] [Hide abstract]
    ABSTRACT: In recent years, a number of reviews have generated evidence on the potential of community health insurance (CHI) to increase access to care and offer financial protection against the cost of illness for poor people excluded from formal insurance systems. Field experience, however, shows that in sub-Saharan Africa (SSA), a series of operational difficulties still hampers the successful development of CHI, yielding negative effects on potential progress towards increased access to care and improved financial protection. Through a careful assessment of the existing literature, including peer-reviewed articles, books, consultancy reports, and manuscripts from international organizations, we produce an analytical review of such difficulties. Our aim is to provide policy makers with the necessary knowledge on the problems at stake and with policy propositions to offset such problems, strengthening CHI and enhancing its role within SSA health systems. Our review of the literature reveals that the major difficulties currently faced by CHI in SSA are operational in nature and cluster around five areas: (i) lack of clear legislative and regulatory framework; (ii) low enrolment rates; (iii) insufficient risk management measures; (iv) weak managerial capacity; and (v) high overhead costs. Consequently, our review calls for appropriate policy interventions, specifically: (i) greater commitment towards the development of adequate legislation in support of CHI; (ii) increasing uptake of measures to expand equitable enrolment; (iii) the adoption of adequate risk management measures in all schemes; (iv) substantial investments from host countries as well as from sponsoring agencies to improve managerial capacity; and (v) collective efforts to contain overhead costs.
    Full-text · Article · Apr 2009 · Tropical Medicine & International Health
  • Source
    • "On the positive side, community health insurance schemes: • Increase access to health care, through reducing the costs at the point of use when using health services (Atim et al 1998, Musango et al 2004 "

    Full-text · Article ·
Show more