Public health and economic experts have welcomed the government’s revised Mutuelle de Santé premium structure, saying the shift to income-based contributions marks a fairer and more sustainable approach as the national health insurance scheme expands to cover more complex and costly treatments.

They say aligning premiums with household earnings while maintaining government subsidies for low-income earners will help secure the scheme’s long-term viability without undermining access to essential healthcare.

Joseph Ryarasa Nkurunziza, a public health practitioner and governance and social development expert, said that even with the revised premiums, Mutuelle de Santé remains heavily subsidised when compared to what the state spends on healthcare per person.

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"On a per capita basis, Mutuelle de Santé premiums are far lower than what the government spends annually to treat one individual,” Nkurunziza said. "Government health expenditure per person is estimated at more than $57 annually. When you compare that to the mutual premium, it is clear that households are contributing only a fraction of the actual cost, yet the healthcare package has expanded significantly.”

He noted that the scheme has evolved dramatically since its introduction in the early 2000s.

"When Mutuelle began, it mainly covered basic illnesses such as malaria and headaches. Today, it includes complex and costly treatments like dialysis and cancer care. When you consider both the expanded benefits and rising healthcare costs, the reforms are understandable,” he said.

Nkurunziza added that quality healthcare, like education, requires sustained investment.

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"These are sectors that cannot function without funding. But because the government is citizen-centred, it continues to subsidise healthcare to ensure access for all,” he said.

Economic analyst Teddy Kaberuka echoed the view, saying the premium revisions were long overdue, especially after more than two decades of relatively unchanged contributions.

"It is reasonable to revise a Rwf3,000 annual premium after 25 years, particularly given inflation, market growth, and the expanded benefits package,” Kaberuka said. "When you compare what the scheme offered in the early years to what it provides now, the revision was inevitable.”

Kaberuka said the new structure is more equitable because it links contributions directly to financial capacity.

"Those with limited means will contribute as little as Rwf1,000, while higher-income households will pay more. Importantly, only about six per cent of the population falls into the highest-paying category. The majority are in categories two and three,” he said.

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"Given the structure of our economy and household incomes, this system is fair and ensures the sustainability of the scheme while expanding access to healthcare.”

Under the revised income-based structure, households are now grouped into five income levels, replacing the previous classification system that relied largely on socio-economic categories.

Individuals with no income will contribute Rwf4,000 per year, fully subsidised by the government. Those earning below Rwf30,000 per month will also pay Rwf4,000, with a government subsidy of Rwf1,000.

People earning between Rwf30,000 and Rwf60,000 per month will contribute Rwf5,000 annually, while those earning between Rwf60,000 and Rwf120,000 will pay Rwf8,000. Households earning above Rwf120,000 per month will contribute Rwf20,000, with no subsidy.

The reforms also expand the benefits package to include specialised and high-cost services such as dialysis, cancer treatment, and major surgeries—changes aimed at improving access to quality healthcare while ensuring the scheme’s long-term sustainability.

Françoise Mujawamariya, a midwifery lecturer at the University of Rwanda, said the income-based premiums appear fair, provided households are accurately classified.

"If the data used to place households is correct and no one is wrongly assigned to a category, then there is no injustice,” she said. "The premiums should reflect people’s ability to pay and the services they receive.”

She noted that higher premiums are largely driven by the inclusion of services that were previously excluded.

"These services come with costs, but they significantly improve access to care. Overall, I see this as a positive change,” Mujawamariya said.

Pelagie Karuhimbi, a Psychologist also welcomed the reforms, saying the addition of specialised services such as cancer diagnosis and treatment, kidney transplants, and other advanced care addresses long-standing gaps in access.

"Previously, many people needed these services but simply could not afford them,” she said. "With the revised premiums, access will improve, and quality care will become more affordable for those who need it most.”