The Rwanda Social Security Board (RSSB) has told lawmakers that delays in paying hospital bills stem from shortage of funding that the community-based Health insurance scheme– commonly known as Mutuelle de Santé has been facing.

Regis Rugemanshuro, the Director-General of RSSB made the disclosure on Friday, May 29, during a budget hearing session with the Parliamentary Standing Committee on National Budget and Patrimony in which the Ministry of Health and its affiliated agencies were presenting their proposed budget allocation for the 2020/2021 financial year.

He was reacting to the issue of delays in covering bills for healthcare provided to the scheme affiliates by health facilities including hospitals.

 "As we speak today, we have a funding gap of Rwf20 billion for the community-based health insurance scheme. While there were Rwf35.6 billion contributions made to the scheme [in the current fiscal year], over Rwf39 billion has been spent on covering medical bills. Yet, there is still more than Rwf15 billion in outstanding invoices,” he said.                                                    

"Sometimes we use resources from the workers’ medical insurance scheme, RAMA, to cover the shortage,” he said, describing such an arrangement as shifting arrears.

To this end, he said, the institution has held several discussions with the Ministry of Finance and Economic Planning on how to bridge the funding gap.

Mutuele de Santé was established in 2003 and seeks to offer medical cover to people with low incomes and those who are in informal employment through solidarity.

It has been managed by RSSB since 2015 when it took it over from the Ministry of Health.

Daniel Ngamije, the Minister of Health said that "sometimes RSSB delays paying hospitals for the medical services they offered to patients for up to four, or five months.”

The Minister added that such an issue affects their operations, and they face penalties when they are not able to meet the 15-day deadline for payment of water and electricity bills which are needed for their work.

As of now, the community-based health insurance largely gets finances from the community, with its most users contributing Rwf3,000 each per year, while the Government covers Rwf2,000 for each neediest person.

However, the Government recently proposed new avenues to subsidise this health insurance initiative including increasing its contribution for each neediest person from Rwf2,000 to Rwf3,000.

Overall, the new financing ways could generate an estimated Rwf27 billion annually.

That money will come from various avenues such as the Government's Rwf6 billion direct financing to the scheme, and between 2.5 per cent and 3 percent of the telecommunication sector's annual turnover.

There is also 0.5 per cent deduction from each employee’s salary both in the private and public sectors, which could bring about Rwf7.5 billion per year. This is in addition to charges on fuel sales, parking fees, RSSB/RAMA schemes and charges on tourism revenues sharing.

The government will also commit part of the fees on change on motor vehicle ownership toMutuelle de Santé.

However, challenges such as Covid-19 seem to impede development as they have negative economic impact.

Mutuelle de Santé covers more than 80 per cent of Rwanda’s 12 million people.  

As of February 13, this year, the scheme’s coverage rate was 78.6 per cent with more than 9 million beneficiaries, according to statistics from RSSB.