From July to December 31, 2020, Rwanda Social Security Board (RSSB) collected Rwf11.5 billion in additional funding to the community-based health insurance scheme, mutuelles de santé.
The money, which represents 42.6 per cent of the estimated Rwf27 billion that was supposed to be generated from additional subsidies has helped bridge the funding shortage for mutuelles de santé, Regis Rugemanshuro, RSBB’s Director-General, has said. It also represents 75.8 per cent of the half-year target.
Contributions to mutuelles de santé, a scheme that offers medical insurance cover to low-income earners and people who work in the informal sector, have been less than the total expenditure on medical services provided to its members.
In May 2020, RSSB told parliamentarians during the budget hearing that delays in paying medical bills from hospitals and other health facilities stem from the shortage of funding that mutuelles de santé was facing.
This issue also adversely affects health care provision to members of the scheme, such as inadequate access to medications.
Regis Rugemanshuro, Director-General, Rwanda Social Security Board. / Photo: Sam Ngendahimana
For instance, in the 2019/20 fiscal year, the scheme had a funding gap of Rwf20 billion, according to data from RSSB.
That gap resulted from the fact that Rwf35.6 billion contributions were made to the scheme in that fiscal year, yet over Rwf39 billion had been spent on covering medical bills for health services provided to its affiliates. There were also outstanding invoices of more than Rwf15 billion.
Sources of the financial supports to the scheme
The subsidies are supposed to come from various sources including from health insurance entities operating in Rwanda, Rwf6 billion direct financing from the government, fees collected on vehicle mechanical inspection, road traffic fines, medical research fees, and levies on telecommunication companies’ annual turnover.
Others are supposed to be generated from charges on fuel sales, parking fees, salaries for private and public sector workers, RSSB/RAMA schemes and charges on tourism revenues sharing.
"Those already received in addition to members’ contribution have helped a great deal, starting from covering last year’s CBHI funding gap to this year’s current health facilities invoices,” he said.
Covid-19 impedes collections
Some of the payments, Rugemanshuro said, are one-off or made at once, citing additional Government contributions.
However, he said, other sources have not yet started coming in due to the Covid-19 impact.
They include the medical research fees, charges on tourism revenue sharing, gaming companies, marshland and hillside and radical terraces, parking fees, penalties on trade of substandard products, and registration fees for pharmaceutical products.
"We have a commitment from those who have not paid yet but we hope it will be done sooner rather than later to avoid funding gaps that could delay payments to health facilities,” he said.
Mutuelles de Santé covers healthcare services for more than 80 per cent of Rwanda’s estimated 12 million people. Data from RSSB show that as of January 22, 2021, the scheme’s coverage rate was at 84.4 per cent or some 9 million subscribers.