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Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection

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  • Saksena, Priyanka
  • Antunes, Adélio Fernandes
  • Xu, Ke
  • Musango, Laurent
  • Carrin, Guy

Abstract

Objective Rwanda has expanded mutual health insurance considerably in recent years, which has a great potential for making health services more accessible. In this paper, we examine the effect of mutual health insurance (MHI) on utilization of health services and financial risk protection.Methods We used data from a nationally representative survey from 2005-2006. We analysed this data through summary statistics as well as regression models.Findings Our statistical modelling shows that MHI coverage is associated with significantly increased utilization of health services. Indeed, individuals in households that had MHI coverage used health services twice as much when they were ill as those in households that had no insurance coverage. Additionally, MHI is also associated with a higher degree of financial risk protection and the incidence of catastrophic health expenditure was almost four times less than in households with no coverage. Nonetheless, the limitations of the MHI coverage also become apparent.Conclusion These promising results indicate that MHI has had a strong positive impact on access to health care and can continue to improve health of Rwandans even more if its limitations are addressed further.

Suggested Citation

  • Saksena, Priyanka & Antunes, Adélio Fernandes & Xu, Ke & Musango, Laurent & Carrin, Guy, 2011. "Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection," Health Policy, Elsevier, vol. 99(3), pages 203-209, March.
  • Handle: RePEc:eee:hepoli:v:99:y:2011:i:3:p:203-209
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    References listed on IDEAS

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    1. Schneider, Pia, 2005. "Trust in micro-health insurance: an exploratory study in Rwanda," Social Science & Medicine, Elsevier, vol. 61(7), pages 1430-1438, October.
    2. Pia Schneider & Kara Hanson, 2006. "Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro‐health insurance and user fees in Rwanda," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 19-31, January.
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    Cited by:

    1. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2015. "Enrollment in Ethiopia’s Community-Based Health Insurance Scheme," World Development, Elsevier, vol. 74(C), pages 58-76.
    2. Marijke Verpoorten, 2014. "Growth, poverty and inequality in Rwanda: a broad perspective," Working Papers of LICOS - Centre for Institutions and Economic Performance 490896, KU Leuven, Faculty of Economics and Business (FEB), LICOS - Centre for Institutions and Economic Performance.
    3. Mebratie, A.D. & Sparrow, R.A. & Alemu, G. & Bedi, A.S., 2013. "Community-Based Health Insurance Schemes," ISS Working Papers - General Series 568, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    4. Macha, Raphael Rasiel, 2015. "Community Based Health Insurance Schemes and Protection of the Rural Poor: Empirical evidence from Tanzania," African Journal of Economic Review, African Journal of Economic Review, vol. 3(2), July.
    5. Nikolaos Grigorakis & Christos Floros & Haritini Tsangari & Evangelos Tsoukatos, 2017. "Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece," International Journal of Health Economics and Management, Springer, vol. 17(3), pages 261-287, September.
    6. Daniel M Kagabo & Catherine M Kirk & Benjamin Bakundukize & Bethany L Hedt-Gauthier & Neil Gupta & Lisa R Hirschhorn & Willy C Ingabire & Dominique Rouleau & Fulgence Nkikabahizi & Catherine Mugeni & , 2018. "Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-18, January.
    7. Deepak Balasubramanian & Shankar Prinja & Arun Kumar Aggarwal, 2015. "Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-15, May.
    8. Desai, Raj M. & Rudra, Nita, 2019. "Trade, poverty, and social protection in developing countries," European Journal of Political Economy, Elsevier, vol. 60(C).
    9. Ngo, Diana K.L. & Bauhoff, Sebastian, 2021. "The medium-run and scale-up effects of performance-based financing: An extension of Rwanda’s 2006 trial using secondary data," World Development, Elsevier, vol. 139(C).
    10. Chunling Lu & Brian Chin & Jiwon Lee Lewandowski & Paulin Basinga & Lisa R Hirschhorn & Kenneth Hill & Megan Murray & Agnes Binagwaho, 2012. "Towards Universal Health Coverage: An Evaluation of Rwanda Mutuelles in Its First Eight Years," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-16, June.
    11. Chemouni, Benjamin, 2018. "The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda," World Development, Elsevier, vol. 106(C), pages 87-98.
    12. Hari S Iyer & Lisa R Hirschhorn & Marie Paul Nisingizwe & Emmanuel Kamanzi & Peter C Drobac & Felix C Rwabukwisi & Michael R Law & Andrew Muhire & Vincent Rusanganwa & Paulin Basinga, 2017. "Impact of a district-wide health center strengthening intervention on healthcare utilization in rural Rwanda: Use of interrupted time series analysis," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-19, August.
    13. Klasen, Stephan & Reimers, Malte, 2017. "Looking at Pro-Poor Growth from an Agricultural Perspective," World Development, Elsevier, vol. 90(C), pages 147-168.
    14. Hsiao, William C. & Yip, Winnie, 2024. "Financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution?," Social Science & Medicine, Elsevier, vol. 345(C).
    15. Osei Afriyie, Doris & Loo, Pei Shan & Kuwawenaruwa, August & Kassimu, Tani & Fink, Günther & Tediosi, Fabrizio & Mtenga, Sally, 2024. "Understanding the role of the Tanzania national health insurance fund in improving service coverage and quality of care," Social Science & Medicine, Elsevier, vol. 347(C).
    16. Hiwot Tilahun & Desta Debalkie Atnafu & Geta Asrade & Amare Minyihun & Yihun Mulugeta Alemu, 2018. "Factors for healthcare utilization and effect of mutual health insurance on healthcare utilization in rural communities of South Achefer Woreda, North West, Ethiopia," Health Economics Review, Springer, vol. 8(1), pages 1-7, December.
    17. Kpienbaareh, Daniel & Atuoye, Kilian N. & Ngabonzima, Anaclet & Bagambe, Patrick G. & Rulisa, Stephen & Luginaah, Isaac & Cechetto, David F., 2019. "Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs?," Social Science & Medicine, Elsevier, vol. 226(C), pages 164-175.
    18. Binagwaho, Agnes & Hartwig, Renate & Ingeri, Denyse & Makaka, Andrew, 2012. "Mutual health insurance and its contribution to improving child health in Rwanda," Passauer Diskussionspapiere, Volkswirtschaftliche Reihe V-66-12, University of Passau, Faculty of Business and Economics.
    19. Marijke Verpoorten, 2014. "Growth, poverty and inequality in Rwanda: a broad perspective," Working Papers of LICOS - Centre for Institutions and Economic Performance 490896, KU Leuven, Faculty of Economics and Business (FEB), LICOS - Centre for Institutions and Economic Performance.
    20. Woode, Maame Esi, 2017. "Parental health shocks and schooling: The impact of mutual health insurance in Rwanda," Social Science & Medicine, Elsevier, vol. 173(C), pages 35-47.
    21. Kai Liu & Benjamin Cook & Chunling Lu, 2019. "Health inequality and community-based health insurance: a case study of rural Rwanda with repeated cross-sectional data," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(1), pages 7-14, January.
    22. Mebratie, A.D. & Sparrow, R.A. & Debebe, Z.Y. & Alemu, G. & Bedi, A.S., 2014. "Dropping out of Ethiopia’s Community Based Health Insurance scheme," ISS Working Papers - General Series 76960, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    23. Benjamin Chemouni, 2016. "The political path to universal health coverage: Elite commitment to community-based health insurance in Rwanda," Global Development Institute Working Paper Series esid-072-16, GDI, The University of Manchester.

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