An Overview of Healthy System and Insurance in Rwanda

국문 초록 (Abstract)

르완다는 1994년 제노사이드로 보건부의 기능이 붕괴되었으며, 이후 보건체계의 재구축과 개혁을 계속해 오고 있다. 아직 보건재정의 상당 부분이 해외원조에 의존하고 있는 것이 큰 과제이지만 보험제도 도입과 보건분야의 역량강화 등의 노력을 기울이고 있다. 르완다정부는 경제발전과 빈곤퇴치를 위해서는 르완다 국민의 건강증진이 필수적이라고 인식하여 3개년 보건분야 전략계획(Health Sector Strategic Plans)를 시행하고 있으며, 국가재정 중 상당부분을 보건부 재정으로 지출하고 있다. 도시를 제외한 지역에 거주하는 르완다 국민은 지리적 여건으로 인해 보건서비스에 접근하는 것이 매우 어렵다. 때문에 르완다는 각 지역 및 마을 마다 보건시설을 확충하고 있다. 르완다는 유아사망률 등 모자보건에서 성과를 보이고 있으며 말라리아와 HIV/AIDS 감염자도 감소하고 있는 추세인 반면, 어린이 영양 결핍은 여전히 만성적인 문제로 남아 있다.
르완다 국민이 주도적으로 참여하고, 국민의 요구에 부합하는 보건서비스를 제공할 수 있는 보건체계를 구축하고 있다. 2010년 78%의 가정이 보험에 가입하였는데, 보험가입 가정 중 98%는 공동체 기반의 Mutuelle de Sante 보험제도에 가입했으며, 나머지는 La Rwandaise d’Assurance Maladie(RAMA), Military Medical Insurance(MMI), 민영보험 등에 가입했다.

다국어 초록 (Multilingual Abstract)

In many African countries a considerable proportion of the population faces problems of financial access to essential health care services. This holds especially true for the informal sector and people living in rural area. This holds especially true for the informal sector and people living in rural areas.
In order to enhance care coverage and provide financial protection against impoverishment due to the costs of catastrophic illness, the Government of Rwanda has implemented several financing mechanisms. Apart from social health insurance schemes covering employees in the formal public and private sector, a community-based health insurance was established to improve access and offer financial protection to the majority of the Rwanda population working in the informal sector. In addition to the Community-Based health Insurance Policy, the present policy has been elaborated to provide a comprehensive guiding framework for a National Health Insurance system in Rwanda. Among the measures proposed is the creation of an overarching health insurance council that will take on an advisory and coordination role for all insurance mechanisms as well as the strengthening of partnerships between public and private institutions. By looking at the wider social health protection perspective it is hoped to fill current gaps in coverage and link the existing mechanisms more effectively.
The mutual health insurance (Mutuelle de Sante) system in Rwanda is one of the most extensive community based health insurance schemes operated in Sub-Saharan Africa covering over 90% of the population. Several studies, so far, have documented the success of the Mutuelle de Sante in addressing the two prime objectives of health insurance in a low-income setting, namely to increase access to health care and to reduce the burden of catastrophic health spending particularly for the poorer groups of society.

목차 (Table of Contents)

• [ABSTRACT]
• Ⅰ. Introduction
• Ⅱ. Health System Organization in Rwanda
• Ⅲ. Health Financing and Resources in Rwanda
• Ⅳ. Community-based Health Insurance
• Ⅴ. Health Insurance System
• Ⅵ. Conclusion
• 《Bibliography》
• 【국문초록】

참고문헌 (Reference)

1 "http://www.rebero.com/success_story_details.php?com_contents=23&location=8"

2 "http://www.rbc.gov.rw"

3 "WHO"

4 Case, A., "The lasting impact of childhood health and circumstance" 24 (24): 365-389, 2005

5 Dhillon, R. S., "The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda" 2011 : 1-16, 2011

6 Alderman, H., "The economic cost of a poor start to live" 1 : 19-25, 2010

7 Heckman, J., "Skill Formation and the Economics of Investing in Disadvantaged Children" 312 (312): 1900-1902, 2006

8 "Rwanda: How the genocide happened, BBC, April 1, 2004, which gives an estimate of 800,000, and OAU sets inquiry into Rwanda genocide, Africa Recovery, Vol. 12 1#1"

9 "Rwanda National Formulary" 2009

10 Macro, "Rwanda Interim Demographic and Health Survey 2007. 2008. 2009" Ministry of Health. Rwanda. District Health System Strengthening Framework 2008

11 Behrman, J. R., "Returns to Birthweight" 86 (86): 586-601, 2004

12 Makanga M, "Paediatric cancers at Butare University Teaching Hospital in Rwanda" 13 (13): 60-65, 2008

13 Alderman, H., "Long term consequences of early childhood malnutrition" 58 (58): 450-474, 2006

14 "Law N° 62/2007 of 30/12/2007, related to the establishment, organization, functioning and management of community based health insurance"

15 "Kim and Porter, 2, Oxman and Fretheim, 4"

16 Logie, "Innovations in Rwanda’s health system: looking to the future" 372-356 : 71-, 2008

17 Chankova, S., "Impact of mutual health organizations: evidence from West Africa" 23 : 264-276, 2008

18 Aggarwal, A., "Impact Evaluation of India’s ‘Yeshasvini’ Community-based Health Insurance Programme" 19 (19): 5-35, 2010

19 Almond, D, "Human Capital Development before Age Five" National Bureau of Economic Research 2010

20 Currie, J., "Healthy, Wealthy and Wise: Socioeconomic Status, Poor Health in Childhood and Human Capital Development" 47 (47): 87-122, 2009

21 Government of Rwanda, "Health Sector Strategic Plan II" 2009

22 Cutler, D. M., "Handbook of Health Economics" Elsevier 563-643, 2000

23 Parkin DM, "Global Cancer Statistics, 2002" 55 : 74-108, 2005

24 Hoddinott, J, "Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults" 371 : 411-416, 2008

25 Evelyn Korkor Ansah, "Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial" Public Library of Science (PLoS) 6 (6): e1000007-, 2009

26 Wooldridge, J. M., "Econometric Analysis of Cross Section and Panel Data" MIT Press 2002

27 Juetting, J., "Do Community-based Health Insurance Schemes Improve Poor People’s Access to Health Care? Evidence From Rural Senegal" 2 : 273-288, 2004

28 Ekman, B., "Community-based health insurance in low-income countries: a systematic review of the evidence" 19 (19): 249-270, 2004

29 Newton R, "Cancer in Rwanda" 66 (66): 75-81, 1998

30 Yilma, Z., "A perverse ‘net’ effect? Health insurance and exante moral hazard in Ghana" 2012 : 138-147, 2012