Despite efforts to make healthcare more affordable, particularly through the hugely successful community health mutual insurance scheme, Mutuelle de Santé, hospitals continue to lose millions of Francs in unsettled bills.The New Times understands that some people, even when they are required to pay as little as 10 per cent of the total amount, they slip away before clearing their bills.A patient subscribing to Mutuelle de Santé is required to raise only 10 per cent of the total cost of treatment. The scheme covers more than 80 per cent of Rwandans, while the majority of civil servants and employees of huge corporations are have Rama among other private insurance schemes. However, according to officials from the Ministry of Health, errant patients have continuously landed various hospitals into losses.To reverse the trend, however, the ministry has devised a new payment system that will oblige patients to pay 10 percent upfront, according to Arthur Asiimwe, the Director General, Health Communication Centre."Mutuelle de Santé has brought sustainable financial access to healthcare. For it to be strengthened, members have to pay their 10 percent portion once they visit any of our (public) health facilities. You know well that government pays for a quarter of the population,” he said. This new system will also apply to other insurance cover subscribers, he noted.According to Asiimwe, for emergency cases, patients will be received and provided with immediate care. However, they will be given 48 hours (two days) for relatives to pay the 10 per cent. Giving examples, Asiimwe says that Kigali University Teaching Hospital (CHUK) loses almost Rwf20 million every year to patients on Mutuelle de Santé cover, who escape without paying their 10 per cent."With this (new system), we hope to cut on the losses that we have been making from patients who receive treatment and sneak out of our health facilities without paying their contribution.”According to the Director of Kibagabaga Hospital, Dr Christian Ntizimira, they lose between Rwf 18 to 22 million annually to patients who escape from the hospital after getting treatment and those who are unable to pay."We make such a big loss but we have now strengthened the security system so we are optimistic that we won’t be getting many such cases anymore,” Ntizimira said.He also noted that, lately they ask patients to provide a guarantee. For treatment that doesn’t require a lot of money, they ask patients to pay upfront.Dr Theobald Hategekimana, the Director of CHUK, confirmed that they do have patients who run away but that the number has reduced in the recent past.Meanwhile, Sheila Etherington, who is in charge Nursing Management at Kibagora Hospital, noted that they have so many such cases of people who walk away without clearing their medical bills.She, however, said that the habbit is common with people who don’t subscribe to health insurance or are unable to pay.Etherington stated that Kibagora loses about Rwf 5 million to patients who evade paying, those who can’t afford and those who depend on food supplements (because they can’t afford food) from the hospital.Dr Alex Butera, the CEO of King Faisal Hospital, noted that they don’t get such cases very often but the few they get are genuine cases of patients who don’t have the capacity to clear their bills.According to another official from the Ministry of Health, there is need to strengthen the tracking system such as having patients leave behind their identity cards until they clear their medical bills.