Despite a remarkable uptake in health insurance coverage, challenges remain in the quality of essential medical care services, especially in Mutuelles de Santé.
Poor medical attention and delays in transfers to referral hospitals have been cited as some of the challenges affecting the scheme.
According to official data, 81 per cent of the population has subscribed to the community-based health insurance scheme under various social categories. The rest of the population use other insurance schemes such as RAMA for public servants, Military Medical Insurance (MMI) for security organs and other private healthcare schemes. Six per cent of the population is not be covered under any medical scheme.
Zuberi Muvunyi, the director-general for Clinical Services in the Ministry of Health, said it was impossible to get equal healthcare treatment with different healthcare schemes.
“It is difficult to get similar services for people who have different healthcare insurance contracts,” said Dr Muvunyi.
The issue was raised at the just concluded Rwanda Medical Association’s scientific conference, which brought together medical professionals to discuss issues affecting universal healthcare coverage.
Delays in transfers to referral hospitals was cited by medical practitioners and members of the scheme as a major issue that needs to be resolved.
“Mutuelle de Santé allows you to go from a heath centre to the district hospital, but when you need further medical attention a special transfer is required,” said an official from the Ministry of Health.
However, medical experts say universal health insurance should provide healthcare and financial protection through equity in accessing quality health services.
It seems the low premium contribution of Mutuelle de Santé, which is mainly subscribed to by lower social groups is a barrier to accessing quality care.
However, under the right to healthcare, any citizen that needs specialised treatment can access it within the country or abroad through a referral by the Medical Board.
According to data from Finscope survey 2016, a financial inclusion report released by the National Institute of Statistics, about 3.9 million adults got ill and 1.2 million (about a third) of them did not use their Mutuelle de Santé subscription to cover the cost of treatment. They instead used savings or borrowed money to cope with the situation.
Low income earners
Solange Hakiba, director-general in charge of Social Security benefits at Rwanda Social Security Board (RSSB), said majority of the members of the community health scheme are low income earners and this affects the medical services they receive. It also makes it difficult to offer better medical services.
Dr Hakiba suggested that the five per cent that other health schemes contribute to the scheme on an annual basis be increased.
Other constraints to the community-based insurance scheme include forgery and members who don’t update their information. The medical card is easy to duplicate and there are suggestions to use biometric cards instead.