When the government revised its national healthcare tariffs in July 2025, nearly eight years after the last adjustment, the move was widely welcomed as a long-overdue lifeline for private medical facilities struggling under rising operating costs. Beneath the new bundled pricing model, however, lies one of the pressing questions: are doctors expensive for private healthcare providers? That question took centre stage during the General Assembly of the Rwanda Private Medical Facilities Association (RPMFA), held on December 19, in Kigali. ALSO READ: How revised medical tariffs are reshaping healthcare access Presenting a comprehensive analysis of Rwanda’s healthcare tariff reforms, which was commissioned by RPMFA, Dr. Peace Mukabalisa, the Secretary of the association, laid bare the financial realities confronting private facilities, where human resources account for the largest share of costs they incur to providing healthcare. The revised tariffs, which came into force in July 2025, are expected to remain in effect for two years, with the next review scheduled for 2027. A major shift introduced by the reform was the transition from fee-for-service payments to a fixed bundled pricing model. Adopted in July 2025, the new provider payment mechanism pays each medical procedure as a single package that incorporates human resources, consumables, equipment, and overheads, with only a limited list of high-cost items, such as implants, excluded. Human resources as the key driver for health facilities’ costs One of the most significant improvements under the new framework is cost transparency, according to the analysis. The revised methodology breaks down tariffs into clear cost components, indicating that human resources account for more than 70 per cent of total costs across facility types. Consumables represent between 10 and 15 per cent, while indirect costs and equipment account for between 12 and 18 per cent. This transparency enables providers to better understand cost drivers, make more informed financial decisions, and improve planning and efficiency initiatives. ALSO READ: How Rwanda will regulate medics under dual clinical practice Despite these improvements, the new system presents operational challenges. One major concern is the wide disparity in human resource costs across facilities, with specialist salaries ranging from Rwf3 million to Rwf9 million per month. Mukabalisa said that healthcare is a labour-intensive service that depends primarily on human resources. Under the bundled system, she said, human resources alone account for up to 70 per cent of facility operating costs. “You are paying doctors, nurses, and support staff. If you’re not careful, you will spend all the money you make on human resources,” she said. She said the association is urging private facilities to be extremely cautious in their recruitment practices, warning that indiscriminate hiring could undermine financial sustainability. Dr. Mukabalisa also described a troubling trend in the labour market, where doctors move between facilities in pursuit of higher salaries, sometimes leaving patients unattended. She likened the situation to an auction or speculation in salaries, where facilities continuously outbid one another without carefully assessing whether the increased salaries are financially viable under the existing tariff structure. The problem, she said, is compounded by a national shortage of doctors. With demand far exceeding supply, salaries tend to be driven upward. Mukabalisa indicated that long-term sustainability increasingly depends on efficiency, discipline, and collective action. Dr. Athanase Rukundo, Acting Head of Clinical and Public Health at the Ministry of Health, acknowledged the shortage and high cost of doctors, saying the solution lies in training more, with the involvement of private medical facilities, particularly hospitals. He said this would support the government’s 4x4 programme, which aims to quadruple the number of doctors by 2028. While observing that setting up medical schools for private medical facilities – as it is the case in some countries – is costly, Rukundo said the facilities could feasibly serve as training sites or teaching hospitals, with the ministry sending students for hands-on practice as long as standards are met. “How private facilities contribute to the ongoing 4x4 programme is what will help address the imbalance between demand and supply,” he said. Methodology behind the review The analysis was based on an independent financial evaluation covering 1,263 common procedures across clinics, polyclinics, and hospitals. Hospitals accounted for 52 per cent of the procedures reviewed, polyclinics 38 per cent, and clinics 20 per cent. In absolute numbers, Mukabalisa indicated, the review identified 249 procedures in general clinics, representing roughly 20 per cent, 484 procedures in polyclinics, and 653 procedures in hospitals. These were procedures that existed in the old tariff and reappeared in the new tariff, including those that cut across all facility categories. Financial sustainability and margins The analysis showed that the Ministry of Health applied a 15 per cent markup for social insurance schemes such as Rwanda Social Security Board (RSSB) – comprising the Community-based Health Insurance Scheme (Mutuelle de Santé), and workers’ medical insurance known as RAMA – the Military medical Insurance (MMI), and MIS/UR which is health insurance for the University of Rwanda staff. It also applied a 25 per cent markup for private insurance. As per the analysis, average margin for social insurance stood at 15.7 per cent, while that of private insurance averaged 22.6 per cent. Hospitals generally enjoyed higher margins, ranging from 18.1 to 24.7 per cent, compared to clinics, which ranged between 13 and 20.9 per cent. While the findings suggest that the new tariffs offer a pathway to sustainability, Dr. Mukabalisa stressed that this will only be achievable if facilities manage their costs efficiently. As of December 2023, Rwanda had close to 28,000 healthcare workers. Nearly 15,000 of them were nurses, over 2,000 midwives, about 7,000 allied health professionals, and about 700 specialist doctors. Rwanda currently has about one healthcare worker per 1,000 people and aims to reach the World Health Organization’s recommended minimum of four healthcare workers per 1,000 people by 2028. Tags:
