Private health facilities across Rwanda are closely evaluating the impact of new medical tariffs that came into effect on July 1. This marks the first comprehensive review since 2017, aiming to reflect current market dynamics, healthcare advancements, and sustainability in service provision—particularly in the private sector, according to healthcare providers. ALSO READ: New medical tariffs to take effect in July – health minister On why the old tariffs were a challenge, Dr. Peace Mukabalisa, Medical Director of Dream Medical Centre (DMC) Hospital in Kigali, told The New Times that they were intended to be in effect for just one year. However, they remained unchanged for eight years, a situation that severely strained the financial viability of private facilities. “There were no profits, honestly speaking. So, we were just trying to make sure that we make ends meet,” she said, observing that with inflation, rising equipment costs, and staff salaries to manage, many facilities operated at a loss. ALSO READ: Private health facilities body appeals for review of medical tariffs The following are six key things to know as the new tariffs take effect 1. Positive developments in the new tariffs Dr. Mukabalisa said that the new tariffs come with both improvements and uncertainties. While some fees were increased in ways that reflect actual service value, others remained unchanged. “Some prices were positive, others were not, for reasons we did not understand. But, whatever the case, we appreciated the effort.” One of improvements, she said, is the increase as well as differentiation in consultation fees based on the doctor’s level of experience, indicating that while a consultation with a specialist previously cost around Rwf9,800 at a private hospital, a junior specialist or consultant is now paid Rwf14,000, while a senior consultant receives Rwf16,000 per consultation – at private hospital level. This, she observed, reflects the value of experience in healthcare provision. Christian Ntakirutimana, Executive Secretary of the Rwanda Private Medical Facilities Association, commended the Ministry of Health for revising the national medical tariffs, observing that the updated tariffs now include a broader range of medical procedures than before — eight years ago. ALSO READ: Private medical body on why setting new medical tariffs is a matter of urgency “The Ministry of Health made great efforts to create a comprehensive list of medical procedures, including those that were previously unrecognised but are now included and commonly used due to advancements in technology. These included new procedures were difficult to bill under the old tariffs, which hadn’t been updated since 2017,” Ntakirutimana told The New Times. 2. A shift from fee-for-service to bundled payments The most notable structural change in the new system is the shift from a fee-for-service model to bundled payments. Previously, facilities charged separately for procedures, consumables, and other relevant items. Now, they receive one fixed payment per procedure that includes medical staff salaries, consumables like gloves and syringes, as well as overhead costs such as cleaning services, electricity, and water. Dr. Mukabalisa cautioned against direct comparisons with previous tariffs because the two systems based on to set them are fundamentally different. She cited a caesarean section (C-section), which was previously priced at Rwf112,000 – excluding essential consumables and medications – at private hospital level. Yet, she said, such additions could bring the total bill to up to Rwf300,000, depending on the case and facility. Under the new system, the bundled fee for C-section is Rwf158,000, inclusive of all components, she said. While it might seem that the price has increased from Rwf112,000 to Rwf158,000 – an apparent difference of Rwf46,000 – Dr. Mukabalisa indicated, this comparison is misleading since the fee in the old system was only a partial price, and the real total cost was often much higher. Ntakirutima said that the change in pricing model now requires a deep assessment on the included costs of consumables and other costing factors to determine which costs have increased or decreased compared to the previous system, which billed consumables separately. “We will also compile any challenges medical facilities face under the new tariffs and present them to the Ministry of Health for review and possible solutions,” he said. 3. Volatile consumable costs as a concern that must be adequately considered While the bundled model aims to simplify billing, reduce unpredictability for patients, and could address delays in paying medical facilities for healthcare provision, it introduces new financial risks for providers. Dr. Mukabalisa expressed concern over the fixed pricing for consumables amid volatile market conditions, whereby the costs keep increasing, with inflation related to the US dollar exchange rates aggravating the situation. This is the case because most of medical items are imported using the dollar, which has continuously been appreciating against the local currency. Dr. Jean de Dieu Gatsinga, Managing Director of Polyclinique du Carrefour, echoed this concern in an interview with The New Times, noting that health facilities now lack flexibility when the cost of consumables increases. This situation puts us in a difficult position, he said. We are committed to continuing to provide healthcare, but when the costs become unsustainable, it can threaten the very ability of facilities to remain prerational. Ntakirutimana said “as per the current clear related ministerial instructions, we believe that there will be a regular review to consider the consumables prices increment and other issues due to changing inflation rates.” 4. Laboratory services still unresolved One area still under review is laboratory testing. Ntakirutimana stated that while laboratory services are vital for diagnosis and widely used across health facilities, their fees have not been updated. Meanwhile, the cost of laboratory equipment has risen, creating potential financial strain. “Laboratory is a key part of medical services. If the pricing for lab tests isn’t adjusted to reflect the increased equipment costs, facilities may continue to operate at a loss in this area,” Ntakirutimana warned. Polyclinique du Carrefour’s Dr. Gatsinga “while the prices of machines increased, with some of them even tripling, the laboratory fees have not been changed, yet, without laboratory, you cannot perform well.” 5. New tariff categories introduced The new system also introduces differentiated tariffs based on insurance type and nationality, which was not the case before. For private medical facilities, the five patient categories are Rwandan citizens under social insurance (RAMA, MMI, MIS/UR), private insurance holders and uninsured Rwandans, East African Community (EAC) citizens, other African nationals, and citizens from outside Africa – referred to as citizens from the rest of the world. EAC citizens, private insurance holders, and uninsured Rwandans now share similar rates, which are relatively higher than those considered for Rwandans who are members of RSSB RAMA, MMI, and MIS/UR which is health insurance for the University of Rwanda staff, while citizens of the rest of the world face the highest rates. “We used to have one tariff that combined social insurances and private insurances. So, each facility would come up with a tariff for private patients, Rwandans, and the rest,” Dr. Mukabalisa said. She welcomed the new structure for bringing consistency and transparency, stating that this level of categorisation is a positive step because it harmonises rates across the country and provides a fair and structured approach to healthcare pricing. 6. When is next review of the tariffs expected? According to ministerial instruction of June 23 determining the health services tariffs, the current tariffs will be implemented for a period of two years, after which a comprehensive review will be conducted – in 2027 – to ensure that pricing aligns with market dynamics and accurately reflects the cost of consumables and medications. However, a review focused on consumables and the inclusion of newly adopted procedures, will take place one year following the date of publication – which means July 1, 2026 – the ministry indicated. Private medical facilities are advocating for an earlier review of consumables to reduce financial risks, especially since it has been realised that costing to come up with the current tariffs took a long time – six months after the Cabinet approved the revision of the old ones.
