RWANDA: Many Poor Locked Out of Mutuelle De Sante for Defaulting

October 2015 TheEastAfrican; Many subscribers have failed to pay their premiums for Mutuelle de santé, prompting the administrators of the community-based health insurance system to lock them out of the mutual health insurance scheme.

According to information reaching Rwanda Today, of the total Mutuelle de santé subscribers only 65 per cent have paid their premiums up to date and are therefore eligible for medical treatment under the scheme. The defaulters will miss out on the medical insurance cover, officials said.

This means that a large segment of the country’s poor, most of whom fall in the category of those who failed to pay, will go without treatment under the scheme. Others are likely to resort to unorthordox treatment windows — such as buying drugs from village pharmacies without a prescription, which is feared to endanger people’s lives.

“There is nothing we can do for them, there is nothing RSSB (Rwanda Social Security Board) can do for those who haven’t fully paid their premiums; they will go without the insurance cover,” said Deogratias Ntigurirwa, officer in charge of advocacy and Mutuelle accounts at RSSB.

RSSB is the public pensions body that manages the mutual insurance scheme in the country.

Critics, especially the people who have been sidelined, have complained that the current system is unfair. They said the rules of the scheme should be changed so that it covers individual members of the household who have paid for Mutuelle de santé as opposed to denying cover to the entire household in cases where one person has not paid up.

“The worst thing about this Mutuelle system is the fact that for a person to access treatment even after paying for it, everyone in the household has to have paid; they don’t allow it even if half the household has paid,” said Fulgence Ndikubandi. “This is unfair.

“They should change it. It’s as if they don’t mind how much we are struggling to survive down here.”

In what can be seen as a conservative approach to ensure that the entire household pays, the Mutuelle system does not allow partial access to medical insurance, something the locals find to be insensitive to their realities.

Mr Ntigurirwa said the rationale for this is that the Mutuelle scheme has a social mandate of facilitating general access to medical insurance and that is why they do not allow partial access.

The biggest outcry came from the rural poor, who say that however much they try they cannot get the money to pay premiums for their families, some of which are so big that they do not even afford to feed them.

“I have two children and I also take care of my elderly and sickly mother,” said Jacquiline Nyiransabimana. “And also I am a single mother.

“All I can afford now is a meal a day for the family, which is also not everyday because sometimes I fail to get the casual jobs that I do. I can’t afford Mutuelle; right now we are only at God’s mercy.”

As it is now, in case of any illnesses, the lives of the 35 per cent are at stake since private medical treatment is out of the picture due to the high costs.

Taking a malaria diagnosis, for example, in a regular hospital is not less than Rwf10,000. Add to that the costs of drugs and you have a bleak picture of the sick poor.

“We all know that paying for Mutuelle is the best thing that can happen to anyone,” said Aimable Niwemugabo. “When you see me unable to pay for Mutuelle for my kids, it’s because I can’t afford it.

“The life we live is hopeless; there’s nothing we can do.

“Our leaders down here are not helping us at all; they can’t even dialogue with us to come up with payment models which can be friendly to us. They look at us as if we don’t matter at all. It’s painful.”

Although government reports indicate that poverty levels have reduced over the years, a large segment of the country’s poorest households cannot afford to feed themselves, which has led to high levels of malnutrition.

This has made the poor more susceptible to illnesses, and now that many of them will be without any treatment cover, mortality numbers are likely to go up.




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