Determinants of willingness and ability to pay for an improved community-based health insurance in Rwanda

Abstract

The Rwanda Community-Based Health Insurance (CBHI) is the most crucial financial mechanism against catastrophic health expenses in the country, covering over 87 % of the population since its inception in 2003. Although the scheme has expanded significantly in terms of coverage, premium rates have remained unchanged. In 2021, the Rwanda Social Security Board (RSSB), which manages the CBHI, initiated a study to assess the population's willingness and ability to pay higher CBHI premiums and explore strategies for attracting the remaining informal population into the scheme. The study used the Contingent Valuation method to collect responses from a random sample of 6086 households.

The analysis revealed a strong reputation for the CBHI among the general population, despite some challenges such as recurring drug shortages and the unavailability of certain services in health centers. Regarding the willingness to enroll, many respondents, including non-CBHI members, expressed interest in joining the scheme. Most were willing to pay a maximum premium ranging from RWF 3229 (USD 3.2) to RWF 3817 (USD 3.8), which is higher than the current premium of RWF 3000. The logistic regression model identified key determinants of enrollment, including the age of household heads, household size, healthcare utilization, and economic status. In terms of willingness to pay, the most significant factors were the household's economic status (proxied by their socioeconomic classification, or Ubudehe category), household size, employment status of the head, healthcare utilization, savings habits, and participation in economic activities.