2021-06-14-世界卫生组织-Impact_of_mutual_health_insurance_on_access_to_health_care_and_financial_risk_protection_in_Rwanda_14页_1mb

Mutual Health Insurance in Rwanda: Impact on Access to Care and Financial Protection

Objective:
Analyze the effect of mutual health insurance (MHI) on health service utilization and financial risk protection in Rwanda.

Methods:
Used nationally representative survey data from 2005-2006 (Integrated Living Conditions Survey) and logistic regression models to assess utilization and ordered logit models for financial risk.

Key Findings:

• Increased Utilization:
  MHI coverage was positively associated with higher use of health services (inpatient and outpatient) and reduced unmet needs, especially among lower-income groups. Insured individuals used services twice as often compared to uninsured counterparts.

• Improved Financial Protection:
  MHI significantly reduced out-of-pocket (OOP) health expenditures and catastrophic health expenditure. Households with MHI spent 3.5% of their capacity-to-pay (CTP) on average, compared to 6.6% for uninsured households. The incidence of catastrophic expenditure (above 40% of CTP) was nearly four times higher for uninsured households.

• Limitations:
  Despite benefits, significant gaps remain. Over 40% of MHI-insured individuals still reported unmet needs, and 20% of MHI households faced financial burdens exceeding 10% of CTP.

Conclusion:
MHI has substantially improved health access and financial risk protection, particularly for the poor. However, enhancements to the benefit package and sustainability are necessary for further progress toward universal health coverage. The findings support continued MHI expansion but highlight the need for policy refinements in resource allocation and financial protection mechanisms.