The Rwandan example
by David Atkins
Tina Rosenberg in the New York Times has another reminder about the dramatic benefits of universal health insurance, this time in post-massacre Rwanda:
Its most impressive gains, however, have been in health. AIDS has been cutting life expectancies in Africa and is widespread in Rwanda. Yet life expectancy at birth in Rwanda has increased from 48 to 58 — in the last 10 years. Deaths of children under 5 have dropped by half in five years; malaria deaths have dropped by roughly two-thirds. “Of all countries in Africa Rwanda is probably getting the closest to having health for all, health access for all,” said Josh Ruxin, a longtime resident of Rwanda who is the founder of the Access Project, a Rwandan-run health program.One of the marks of a truly great country is to heed the experience of others, and to learn by example when others have success. Like truly great people, a truly great nation never stops learning and attempting to improve itself.
One key reason that Rwandans are so much healthier today is the spread of health insurance. In 1999, Rwanda’s health facilities sat unused, as the vast majority of people couldn’t afford them. In response, the Health Ministry began a pilot project of health insurance in three districts. In 2004, the program began to spread across the nation. Now health insurance — called Mutuelle de Santé — is nearly universal. Andrew Makaka, who manages the health financing unit at the Ministry of Health, said that only 4 percent of Rwandans are uninsured.
Mutuelle is a community system — premiums go into a local risk pool and are administered by communities. Until last year, Mutuelle’s premiums were about two dollars a year. This system turned out to be untenable — even two dollars a year was too much for a lot of people. (If you are a rural farmer with an income of some $150 a year, you have to spend every penny on food.)
Last year Mutuelle adopted a sliding scale. For the wealthiest, premiums essentially quadrupled, to about $8 a year. Each visit to a clinic has a co-pay of about 33 cents. If you need to go to the hospital, you pay a tenth of your hospital bill...
But now the poorest — as judged by their communities — pay nothing. The Health Ministry says that the poorest 25 percent of Rwandans get free care.