Health insurance in a very poor nation

92 percent of Rwanda is covered under a national health insurance plan, which is quite extraordinary for one of the world's poorest nations. The government is unable to insure everyone without help, it does rely on donations from aid groups. Despite all of the donations the government does hope to someday make the health insurance plan sustainable.

From the New York Times, writer Donald McNeil witnessed the health system at work.

Sunny Ntayomba, an editorial writer for The New Times, a newspaper based in the capital, Kigali, is aware of the paradox: his nation, one of the world’s poorest, insures more of its citizens than the world’s richest does.

He met an American college student passing through last year, and found it “absurd, ridiculous, that I have health insurance and she didn’t,” he said, adding: “And if she got sick, her parents might go bankrupt. The saddest thing was the way she shrugged her shoulders and just hoped not to fall sick.”

For $2 a year, of course, Rwanda’s coverage is no fancier than the Mayange maternity ward.

But it covers the basics. The most common causes of death — diarrhea, pneumonia, malaria, malnutrition, infected cuts — are treated.
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Still, even with rationing this strict, how can any nation offer so much for $2 a year?

The answer is: It can’t. Not without outside help.

Partners in Health, the Boston-based health charity, which runs two rural hospitals and a network of smaller clinics in Rwanda, said its own costs ran $28 per person per year in areas it serves. It estimated that the government’s no-frills care costs $10 to $20.

According to a study recently published in Tropical Medicine & International Health, total health expenditures in Rwanda come to about $307 million a year, and about 53 percent of that comes from foreign donors, the largest of which is the United States. One big donor is the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is experimenting with ways to support whole health systems instead of just treating the three diseases in its name. It pays the premiums for 800,000 Rwandans officially rated as “poorest of the poor.”