How revised medical tariffs are reshaping healthcare access

As of July 2025, the government rolled out a new pricing structure for medical services in private healthcare facilities, ushering in the first major tariff revision since 2014. Aimed at reflecting inflationary pressures and changing service costs, the new tariffs apply to private providers serving clients under the Rwanda Social Security Board (RSSB)/RAMA (Rwandaise d’Assurance Maladie), MMI (Military Medical Insurance), and MIS (Mutuelle for University of Rwanda staff) schemes. However, one month later, the impact is rippling far beyond the consultation rooms. From patients navigating increased out-of-pocket costs to insurers recalibrating premiums, and healthcare providers adjusting operations amid patient drop-offs. Shaking up the insurance systems Marc Rugenera, Chief Executive Officer (CEO) of Radiant Insurance Company Ltd, one of the country’s leading private insurers, says the revisions have imposed a heavy burden on ongoing contracts priced under the old tariff. The tariff revision has had a significant and immediate impact on insurers, particularly for existing corporate and individual health insurance policies that are still active under pre-negotiated terms, Rugenera told The New Times. These pre-existing policies did not anticipate the sudden cost hike, meaning clients may now exhaust their benefits more quickly. For Radiant and similar insurers, the effect has been financially destabilizing. ALSO READ: What you need to know as new medical tariffs come into force The health insurance product was already experiencing high loss ratios, and this change further worsens the situation. For new clients or renewals, premiums will inevitably rise to align with the new pricing structure, which in turn raises concerns around affordability and market retention, he said. While insurers acknowledge that tariff updates are sometimes necessary, Rugenera noted the process lacked adequate consultation. We were not involved in the development of the new tariff and did not have the opportunity to review the assumptions or key elements considered in its formulation. Ripple effects on affordability and care seeking Beyond insurance implications, the new tariffs are affecting where and how Rwandans access care, especially in private facilities. Dr. Barbara Joy Mukamabano, a pediatrician at Polyclinique La Médicale, said patient numbers have noticeably dropped. Because of the new prices, we lost many patients who used to come to private clinics. It’s not that they don’t need care; it’s just that they can’t afford it anymore. The few who can still come are those with means, she said. The result, she noted, is not only fewer consultations but also possible impacts on quality of care. Sometimes, a patient with money may expect the best, but the healthcare worker is also stretched. It creates a different dynamic in service delivery. Real-life patient struggles Angelique Mwiseneza, whose husband is managing a chronic heart condition, described the toll of navigating new prices. Now he has to buy medication that we used to access more affordably, and we have to search far and wide for pricing that fits our budget. A patient is already in a vulnerable state. They shouldn’t be worrying about whether they’ll be able to afford the next appointment or dose, she said. ALSO READ: New medical tariffs to take effect in July – health minister Mwiseneza added that even discussing the possibility of sourcing medication abroad has come up, despite the strain. “If things continue like this, it might reach a point where we have to look outside the country just to find a more sustainable solution. It’s exhausting.” Another family, who preferred anonymity, shared that their relative undergoing chemotherapy was recently told to seek care at Butaro Hospital because the usual facility could no longer accommodate him under their insurance. It’s not just about money anymore, it’s also about where you can physically access the service, the family member said. Understanding the numbers The tariff increases vary widely by procedure and level of facility. For instance, general anesthesia for routine use now costs Rwf98,975 at a primary-level facility, Rwf103,870 at secondary, and Rwf109,948 at tertiary. A spinal anaesthesia for routine use ranges from Rwf55,945 to Rwf62,954 depending on the facility level while coronary artery bypass surgery is now set at Rwf2,670,569. Aortic valve replacement costs up to Rwf3,257,606. Some complex CT surgeries exceed Rwf3.8 million, reflecting a sharp hike compared to what these procedures used to cost before. Dental procedures have also seen sharp increases. Root canal therapy for three or more canals now costs up to Rwf329,998, while a single composite filling can cost over Rwf50,000 depending on size and facility. Calls for harmonisation According to Rugenera, one key concern is that public and private insurers are not reimbursed at the same rates. The reimbursement rates used by public schemes such as RSSB and MMI remain significantly lower than those applicable to private insurers, despite the fact that we all serve the same population, he said. “In many cases, private insurers are charged at the same rates applied to patients from the broader East African Community, creating further disparity.” He urged harmonisation of reimbursement policies to ensure fairness across the ecosystem. What lies ahead? When contacted, Dr. Regis Hitimana, Chief Benefits Officer at RSSB, clarified that the medical procedure tariff adjustments are not expected to affect the pricing or demand for prescription medications, since pharmaceutical pricing operates under a separate regulatory framework. “Pharmacies in public health facilities are reimbursed based on the purchase price plus a mark-up set by the Rwanda Food and Drugs Authority (RFDA), while private pharmacies apply market survey-based prices reviewed every six months,” he told The New Times. He added that a new private sector medicine pricing list has already been completed and will take effect from August 1, ensuring more frequent updates that reflect current market conditions. Asked whether the revised tariffs might impact access to or stocking of medicines, he responded that they do not expect any major disruptions. “We do not anticipate any change in medicine stock levels or dispensing practices as a result of these new clinical tariffs. The pharmaceutical supply chain and pricing are managed independently.” As of press time, Old Mutual Rwanda had not responded. ALSO READ: Private health facilities body appeals for review of medical tariffs In the meantime, patients and providers alike are adapting. Some private hospitals are reviewing service packages. Insurers are renegotiating benefits. And patients, especially those managing chronic illnesses, are navigating difficult trade-offs. Insurance uptake and systemic implications As Rwanda continues to pursue universal access to quality healthcare, the evolving conversation around medical tariffs is raising fundamental questions: Can cost recovery coexist with equity? How can private and public players find common ground? And ultimately, what does sustainability mean in a system built on solidarity? The answers may lie not just in numbers, but in the lived experiences of the people seeking care every day. While the revised medical tariffs impact insurers and patients directly, it is important to situate these challenges within Rwanda’s broader insurance landscape, which continues to face structural hurdles. As highlighted by industry leaders, during the 47th Annual Ordinary Meeting of the General Assembly of the African Reinsurance Corporation (Africa Re), held in Rwanda in June, the low penetration of insurance services across Rwanda remains a persistent concern that exacerbates vulnerabilities within the healthcare financing system. Despite significant progress in expanding insurance providers – from just one company fifty years ago to thirteen today, the overall uptake among Rwandans remains relatively low. Certain key demographic groups, notably women and youth, who represent essential segments for national development, are still underrepresented among insurance beneficiaries. Observers say this gap contributes to heightened financial risks for both households and the state. The consequences of low insurance enrollment extend beyond individual hardships. When a significant portion of the population lacks coverage, the government inevitably bears the brunt of catastrophic events and health crises, absorbing costs that could otherwise be mitigated through insurance mechanisms. Experts argue that increasing insurance participation could substantially alleviate fiscal pressures on the government, allowing funds to be redirected towards development initiatives rather than emergency responses. Moreover, sectors highly exposed to natural and economic shocks, such as agriculture, suffer from minimal insurance uptake despite being vulnerable to recurring disasters. This insufficient coverage not only imperils farmers’ livelihoods but also risks larger systemic strain on state resources when disaster relief becomes necessary. ALSO READ: Ministry of Health explains revision of medical tariff To address these challenges, Rwanda is actively developing a ten-year strategic plan to expand access to insurance and enhance the overall functionality of the market. This initiative involves close collaboration among key stakeholders, including the Central Bank, the Ministry of Finance, and insurance associations. Their collective goal is to make insurance more inclusive and innovative, while establishing clear regulations to build trust and ensure long-term sustainability. This forward-looking approach reflects the government’s recognition that a strong, accessible insurance sector is essential for both health and economic resilience, especially in the face of rising medical costs and recent tariff adjustments. Increasing insurance uptake will be critical in addressing affordability challenges raised by private insurers and healthcare users, helping to strike a balance between sustainable healthcare financing and equitable access for all.

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How revised medical tariffs are reshaping healthcare access