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New Changes Introduced to Health Insurance Scheme

by Dan Ngabonziza
10:55 am

Changes in Rama reimbursement was triggered by the rise in health costs incurred by private health providers.

If you are subscribed to RAMA – one of the biggest health insurance schemes, you will be asked to pay more for specialist treatment – a development that reverses what has been available for years.

RAMA is managed by Rwanda Social Security Board (RSSB), serving nearly all government employees. Effective May 1, a client of Rama will have to provide a medical transfer from a General Hospital if they want to be treated at a specialized Private Hospital in Rwanda, according to a communiqué from Rwanda Social Security Board (RSSB).

Without a transfer, they will have no choice, but to top up an extra balance on the normal 85% paid by RSSB.

A general clinic/hospital is a medical facility that offers general services, but does not have specialists.

Going by Ministry of Health Tariffs established in 2012 for instance, a wheelchair is given at Rwf 219, 635 ($266) at a private clinic, which means that a patient with a general clinic health transfer will have to pay Rwf 32,94 (15%).

The cost will increase should the patient go straight to a referral or specialized hospital without passing through a general clinic.

Health officials say changes in Rama reimbursement was triggered by an the rise in health costs incurred by private health insurance providers.

Last year, the cabinet approved an upward adjustment whereby patients subscribing to Rama scheme pay 25 per cent more for healthcare while those subscribing to schemes offered by private insurance companies would pay 15 per cent more.

The Director General of Rwanda Social Security Board, Jonathan Gatera told KT Press that his office will remain cordial to its clients.

“Without abandoning our members, RSSB will keep reimbursing 85% of medical services according to instructions and modalities based on the system of referral,” he said.

According to Gatera, the decision to go by the General Clinic tariffs was because “60% of our members under health insurance scheme seek healthcare at general clinics.”

The new tariffs enable medical service providers to improve service delivery and invest in new capacity and equipment, says the health ministry.