Global Ethics Corner: Rwandan Health Care: A Model for the West?

Jun 18, 2010

In Rwanda, 92 percent of citizens have government-mandated health insurance, collectively owned by the policy-holders themselves. Does organizing health care based on this mutual ethical obligation make sense for other countries? What do you think?

In Rwanda, 92 percent have health care coverage that is mandated by the government.

The foundations, however, are mutual health insurance schemes where policy holders are the joint owners. "Voluntary risk-sharing groups are set up to ensure their members better access to health care."

Life expectancy increased from 48 to 52 years, and deaths from diseases, infection, and childbirth are down dramatically.

Amazingly, the Rwandan health care premium was $2 a year. By 2008 World Bank figures, Rwanda's GDP per capita was about $500, while the world average was around $9,000 and the US was at $46,000.

One issue is the need for international aid subsidies, since the cost of care averages $10 to $28 per person.

Another has been that premiums are not scaled to wealth.

A third is a lack of understanding of insurance. Some who used no services during the year asked for their $2 back.

Rwandan health care is not Western coverage. Services are limited, the basic causes of death are the focus, and even general surgery is rationed.

McNeil notes that "many things that are routine in the United States, like M.R.I. scans and dialysis, are generally unavailable...The whole country, with a population of 9.7 million has one neurosurgeon and three cardiologists."

Importantly, Antunes notes that Rwanda "by basing its health financing systems on solidarity and fairness...can move towards the universal coverage needed for its society to grow socially and economically."

What do you think? Does organizing health care based on this mutual ethical obligation make sense for others?

By William Vocke

For more information see:

Donald G. McNeil, Jr. "A Poor Nation, With a Health Plan," The New York Times, June 14, 2010.

"Sharing the Burden of Sickness: Mutual Health Insurance in Rwanda," Bulletin of the World Health Organization. Vol. 86. No. 11.

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