Page 260 - GHES-3-3

Global Health Economics and
Sustainability
Sustainability of Rwanda’s UHC: 2011–2021 and vision 2050

Through this approach, Rwanda promotes health Development Bank, 2002), based on the CBHI coverage
equity by subsidizing healthcare costs for members of the criteria. This model is helpful when the costing and/or
Community-Based Health Insurance (CBHI) scheme, financing analysis requires the application of a weighted
affiliates of other insurance programs, and the general mean based on coverage criteria to infer the weighted
population. Consequently, public and faith-based health average from the study group to the national (entire) target
facilities operate as providers of nearly free healthcare group, specifically the CBHI structure per CBHI structure
services. The CBHI is managed efficiently and is positioned in this case.
to absorb previous co-payment obligations through a
third-party payer mechanism. 2.6.1. Weighted mean
To shield CBHI members from catastrophic health This study used the following equation to derive the
expenditures, the annual individual premium of RwF weighted mean unit cost and/or unit income:
3,000 (equivalent to USD 2.56 as of July 21, 2023) will be Weighted mean = ∑ n (x ×c / n c
) ∑
maintained at its current level through to 2050. i=1 i i i=1 n (I)
Strategy B: Cost- and HRV 2050-Conscious, Modestly This implies that the weighted mean is (x ×c + x ×c +…+
2
2
1
1
Financed Reforms for Innovation and Long-Term x ×c )/(c +c +…+c ), where denotes the summation, c is the
n
n
n
1
2
Sustainability (Target-Based Approach) coverage (weight), and x is the value (income or expenditure).
This strategy introduces a minimum 1% specific tax Based on the weighted mean, this study extrapolated
levy to support the effective implementation of Universal the findings nationally across similar CBHI structures by
Health Coverage (UHC) and the Health Resilience Vision multiplying the mean with the total number of relevant
(HRV) 2050. The funding will support the modernization entities in 2014, i.e., 450 CBHI sections in 2014/2015
of the healthcare system, ensure universal access to versus 510 in 2020/2021, along with 30 CBHI districts and
specialized care, upgrade infrastructure and equipment, one national pooling risk for national referral hospitals
and strengthen clinical capacity. It also promotes career and patient rooming system data. At present, the weighted
development, the retention and repatriation of specialized mean is no longer relevant because the CBHI system
professionals, broader health resilience measures, vertical shifted from fragmented pools to one central pool in the
health equity, and the targeted inclusion of vulnerable RSSB/CBHI head office.
groups. Finally, Strategy B emphasizes addressing any
emerging priority programs, objectives, or unmet needs 2.6.2. Compound annual growth rate
within the health sector through to the year 2050. According to the Provider for Health Network (P4H
The implementation of these two complementary dual- Network), “SimIns is a computerized tool that facilitates
track strategies is expected to facilitate the achievement of health financing policy decisions by projecting health
the study’s three initial objectives ahead of schedule and expenditure and funding for 10 years. It can be applied to
with outcomes exceeding expectations. both existing and planned schemes” (P4H Network, 2023).
As the annual growth rates (AGRs) for the past 10 years
2.5.3. Simulated scenarios
are known, they were named AGR , AGR , AGR ,…, AGR ,
3
n
2
1
The simulated scenarios in this study include: where AGR refers to the AGR of the first period and AGR
9
1
(i) The first scenario is based on the current FFS refers to the AGR of the final period. The equation applied
provider payment mechanism (PPM) to calculate the compound AGR (CAGR) from 2011/2012
(ii) The second scenario is based on the FASP PPM to 2020/2021 is:
(iii) The third scenario simulates HRV 2050 financial
preparedness by mobilizing funds throughout the CAG R = AGR + AGR + AGR +…+ AGR n
1
2
3
HRV 2050 era before allocating them to P/A health- 9 (II)
care facilities The mathematical linear regression equation is:
(iv) The fourth scenario simulates the gradual strengthening
of clinical capacity through an upward tariff-setting V V r n1
1
system in line with HRV 2050 requirements. n 0 (III)
Where V is the value at the n year (year 10 in this case),
n
2.6. Equations and formulas V is the initial value, n is the number of years (10 years in
0
This study applied the Mongolia model, which is accepted this case), and r is the CAGR calculated for each specific
in the scientific literature on health costing analyses (Asian key variable.
Volume 3 Issue 3 (2025) 252 https://doi.org/10.36922/ghes.5842