Page 265 - GHES-3-3

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

to shift the supply side from non-profit to mixed-profit which is applicable to both wealthier Rwandans and the
status, fostering industry self-reliance through enhanced Rwandans in the diaspora.
internal revenue. It also modernizes the cost-recovery Category B members can visit any public or agreed-
model (Bamako Initiative), originally reinstated by the upon health-care facility nationwide without the
government of national unity from a resilience perspective. compulsory referral process, except for King Faisal

Equity in financial access is demonstrated by the DRG Hospital (KFH). For KFH, a transfer note from the medical
unit price for CBHI category A, with a base rate of 3.2% of committee at each university teaching tertiary hospital is
costs recovered (USD 2.56 out of USD 81.17), following required. The referral process has shifted from the RSSB
the removal of co-payments at P/A service points. The medical commission to a new committee at university
USD 2.56 represents the individual annual premium, teaching tertiary hospitals. This committee, consisting of
whereas the USD 81.17 reflects Rwanda’s per capita health three specialist doctors, aims to speed up decision-making
expenditure. in emergencies, avoiding delays by administrative staff
without clinical expertise. Rwandans in the diaspora who
3.3.2. Basic tariff rates wish to join CBHI Category A will pay USD 15 annually,
For CBHI category A, the minimum tariff rate is 3.2%, which is more than approximately 5 times the premium
and the basic rate has been reduced to 3%, as shown in for ordinary Category A members. This fee grants access
Table 2. This results in an annual individual premium of to the CBHI system with the compulsory referral process
USD 2.56, down from USD 81.17 (previously USD 57.5 from the district hospital level and treatment at no extra
in 2020 with a 9% AGR) for Rwanda’s per capita health charge while vacationing in Rwanda. However, uninsured
expenditure in 2024/2025. The rates in Table 2 also diaspora members will be treated as uninsured Rwandans
reflect the updated co-payment structure and benefits and will pay the same subsidized rate (91%) as that paid by
from CBHI modernization, including food and dietetic uninsured Rwandan citizens (9/3) (Table 2).
services for both Rwandan and foreign patients. Luxury
accommodation is excluded from these rates. 3.3.4. Medical tourism in the public/agree (faith-
based) health care delivery system
The authors demonstrate that ordinary members of
Rwanda’s CBHI contribute only 3% (USD 2.56 of the The concept of medical tourism has been introduced in
projected USD 81.17 per capita health expenditure for Rwanda’s public health sector to promote and export the
2024/25), with the remaining 97% covered by government country’s “equitable and dignified health-care provision,”
offering comprehensive quality care from self-reliance and
subsidies. Other Rwandan population groups contribute self-esteem (kwihesha agaciro) perspective. This concept,
between 6% (with 94% subsidized) and 9% (with 91% part of a 2014 study by the Rwanda Development Board,
subsidized). Although foreigners pay higher fees, their primarily targeted the private sector, and its implementation
contributions remain substantially subsidized – on average, is highly anticipated in P/A health-care sectors. Researchers
between 70% and 85% for individuals from neighboring have also proposed the following recommendations and
countries, 75% for most African nationals, and 65% for advice, which extend beyond the scope of medical tourism
individuals from other regions.
and are applicable to the broader health-care system:
Rwanda’s pricing system, as shown in Table 2, is (i) Rare or expensive medical procedures will be billed
designed to promote self-reliance (kwigira/ubwihaze) and separately from the DRG unit price
sovereignty (ubusugire) while ensuring dignified, equitable (ii) CBHI beneficiaries who opt for Income-Generating
health care for both Rwandan citizens and the global Activity-Health Service Related (IGA-HSR)
community. This acknowledges the significant contribution treatment shall be responsible for covering the cost
of the international community to Rwanda’s healthc-are difference between DRG Category B and Category
resilience since the 1994 genocide. With the health-care A. The CBHI scheme will reimburse up to the
system now restored, Rwanda aims to provide affordable, standard cost of Category A only
high-quality health care to the global community. (iii) Rwandan citizens abroad who are not enrolled in
CBHI will be required to pay 3 times the CBHI
3.3.3. Comfortable benefit package of the CBHI system
Category A (ordinary) beneficiary rate, similar to
The study introduced a CBHI beneficiary Category B, with the cost for uninsured residents
a premium set at twice the DRGs unit price of Category A. (iv) Internal professional dualism is permitted; however,
The annual individual premium for Category B is USD 35, the regular workload remains the priority
which is more than approximately five times higher than (v) Standard honorary fees will be set by the MoH and
the premium for ordinary, wealthier Category A members, professional councils

Volume 3 Issue 3 (2025) 257 https://doi.org/10.36922/ghes.5842