Page 264 - GHES-3-3

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

in criticisms of the health-care system being exclusive to monthly amount from 43.11% + 25.89% (Table S6),
the wealthy. reflecting overcharging. The monthly budget is as follows:
Additional supply-side shortcomings that could not (i) Prepayment of 70%: supports health-facility
be quantified were also identified. These include: (i) operations and improves health-care quality. This is
fraudulent cases at the health-post level, where utilization divided into:
increased by 1,645% between 2016 and 2019/2020, and (ii) • 45% for improved functioning and quality health
at district hospitals, fewer patients are treated, while more care
are referred to university teaching hospitals, with 85% of • 10% to cover co-payments unpaid by CBHI
district-hospital patients being sent to tertiary hospitals in • members
15% for staff incentives, including support staff.
FY 2019/2020, compared to 7% being sent to provincial (ii) The remaining 30% is paid after verifying and
hospitals. This indicates a clinical bottleneck at the
provincial hospital level and a cost-inefficiency that risks reconciling the invoice. This 30% comes from the 31%
undermining the Rwandan WHO organizational system. saved through avoided over-quantification of services
(Table S5) and can be utilized in:
Excessive referrals to tertiary hospitals lead to unnecessary • 10% for disability-related medications and other
inpatient stays and increased costs, resulting in financial rare essential medicine shortages
losses for CBHI.
• 10% for patient feeding and diet services during
Suggested solutions include (i) combating fraud at inpatient stays
the health post-level and addressing clientelism through • 10% for contributing to a mandatory 20% annual
community health workers or ghost patients, (ii) safety margin, aiding health facilities in their
strengthening the clinical capacity of district and provincial goal of self-sufficiency after 5 years of FASP PPM
hospitals, and (iii) profiling provincial hospitals based on implementation.
quality and quantity, with outliers potentially downgraded Researchers ensured that the full 100% of the previous
to district hospital status to reduce cost inefficiency.
total bill, including the 56.89% that was overpaid, is used
3.3. Reforms and modernization of the CBHI and effectively, as outlined above.
public/agree (faith-based) health-care system: Best 3.3.1. Modernizing the faith-based health-care system
practices, innovations, and alternative financing and the partial cost-recovery system
mechanisms (Specific Objective 3)
Modernizing the P/A health-care system and the partial
This involves modernizing the CBHI through results-based cost-recovery framework aims to strengthen Rwanda’s
financing from a resilience perspective in the following CBHI and P/A health-care facilities while addressing
way:
challenges, such as the lingering effects of the 1994 genocide,
A business plan developed by P/A health-care facilities the COVID-19 pandemic and global inflation, all from
includes a 69% (Table S5) (rounded to 70%) prepaid the HRV 2050 perspective. The revised tariff system seeks

Table 2. Baseline tariff rates (to be periodically updated)
Client/patient Subsidized cost (%) Prepaid or OOP paid (%) DRG unit price
CBHI Category A (Ordinary) 97.00 3.00 (3.00/3)
CBHI Category B (Comfortable Package subscribers) 94.00 6.00 (6.00/3)
Public/social health insurance institutions 94.00 6.00 (6.00/3)
Private health insurance companies 92.80 7.20 (7.20/3)
Uninsured Rwandan citizens 91.00 9.00 (9.00/3)
Neighboring countries 85.00 15.00 (15.00/3)
EAC countries 80.00 20.00 (20.00/3)
SSA+Sudan and South Sudan 75.00 25.00 (25.00/3)
North Africa+South Africa 70.00 30.00 (30.00/3)
Rest of the world 65.00 35.00 (35.00/3)
Not identified 60.00 40.00 (40.00/3)
Source: Authors’ illustration and creation.

Volume 3 Issue 3 (2025) 256 https://doi.org/10.36922/ghes.5842