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


RESULTS
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.


CONCLUSIONS
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.
Saksena
Priyanka
P
Department of Health Systems Financing, World Health Organization, 20, Avenue Appia 1211 Geneva 27, Switzerland. saksenap@who.int
Antunes
Adélio Fernandes
AF
Xu
Ke
K
Musango
Laurent
L
Carrin
Guy
G
D000368:Aged; D002388:Catastrophic Illness / Q000191:economics; D002675:Child, Preschool; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage; D007348:Insurance, Health / Q000458:organization & administration* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D017059:Models, Econometric; D015999:Multivariate Analysis; D009313:National Health Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D012432:Rwanda