By Tina Rosenberg
The New York Times, July 3, 2012
Last week’s Supreme Court decision upholding of the constitutionality of President Obama’s health care law moves the United States closer to the goal of health coverage for all. All other developed countries have it. But so do some developing nations — Brazil, Thailand, Chile. These countries are mostly middle income. But one country on the list is among the poorest of the poor: Rwanda.
The point is not that Americans should envy Rwanda’s health system — far from it. But Rwanda’s experience illustrates the value of universal health insurance. “Its health gains in the last decade are among the most dramatic the world has seen in the last 50 years,” said Peter Drobac, the director in Rwanda for the Boston-based Partners in Health, which works extensively with the Rwandan health system.
It couldn’t have happened without health insurance.
Rwanda is known, of course, for the 1994 genocide that killed 800,000 Tutsi and moderate Hutu. Since 1994, the country has been ruled by Paul Kagame, at first as de facto leader and, since 2000, as president. Kagame runs a repressive regime that equates criticism with treason; opposition journalists or politicians in Rwanda have disappeared or died mysteriously.
But Kagame is also widely admired as the most effective leader in Africa. A country in ashes 18 years ago is now safe and clean. It is one of the least corrupt countries in Africa. Per capita income has tripled — although the fact that it is now only $550 a year tells you how destitute Rwanda was.
Its most impressive gains, however, have been in health. AIDS has been cutting life expectancies in Africa and is widespread in Rwanda. Yet life expectancy at birth in Rwanda has increased from 48 to 58 — in the last 10 years. Deaths of children under 5 have dropped by half in five years; malaria deaths have dropped by roughly two-thirds. “Of all countries in Africa Rwanda is probably getting the closest to having health for all, health access for all,” said Josh Ruxin, a longtime resident of Rwanda who is the founder of the Access Project, a Rwandan-run health program.
One key reason that Rwandans are so much healthier today is the spread of health insurance. In 1999, Rwanda’s health facilities sat unused, as the vast majority of people couldn’t afford them. In response, the Health Ministry began a pilot project of health insurance in three districts. In 2004, the program began to spread across the nation. Now health insurance — called Mutuelle de Santé — is nearly universal. Andrew Makaka, who manages the health financing unit at the Ministry of Health, said that only 4 percent of Rwandans are uninsured.
In most poor countries — and in the United States — health disasters are a leading cause of a family’s decline into poverty, but not for Rwandans. “It gives relief to people knowing that if you get sick, you don’t need to have a lot of money,” said Dr. Agnes Binagwaho, Rwanda’s health minister. “It gives you psychological stability so you can concentrate on something else. The money can be used for other things — this is very important in trying to stimulate economic development.”
“You can bring on all the diagnostic services, new technologies and specialties,” said Drobac. “But if those things can’t reach people in need, what’s the point?”
We could ask the same thing in the United States. Rwanda, starting from nothing, decided to build a health system that includes everyone. And it found economic value, alongside human value, in doing so. Now we can get started.
http://opinionator.blogs.nytimes.com/2012/07/03/rwandas-health-care-miracle/
Comment:
By Don McCanne, MD
Rawanda, one of the poorest nations in the world, has seen a dramatic improvement in the health of their people since the establishment of their near-universal health insurance program, Mutuelle de Santé, covering all but 4 percent of their population.
After the Affordable Care Act is fully implemented in the United States, over 8 percent of our population will still be uninsured – over twice the percentage of Rawanda’s uninsured. Shouldn’t we be ashamed? We know how to do better than that; we just have to do it.