Thresholds for health insurance in Rwanda: who should pay how much?

Community-based health insurance schemes were introduced in Rwanda in 1999 and now cover 27% of the population. Due to widespread poverty, it remains unclear to what degree poorer population strata can be anticipated to pay into the system. This study investigates the extent to which the Rwandan population can financially contribute to obtain health insurance. More specifically, researchers explored the relationship between resource mobilization for the health system and the ability to provide community-based health insurance across socio-economic strata. Data from six household surveys are analysed revealing a consistent pattern: the goals of maximizing health revenue and maximizing participation in community-based health insurance are mutually exclusive. However, the upper three quartiles of the Rwandan population are able to contribute US$1 per capita per year. In order to extend coverage to the poorest quartile, a corresponding subsidy for the coming years has to be considered.