Health insurance: New guidelines for RAMA card holders spark controversy

A new directive by the Rwanda Social Security Board (RSSB) that requires RAMA insurance card holders to only go to private polyclinics or private hospitals on referral, or risk footing a bigger bill, has drawn sharp criticism from private practitioners. On April 18, RSSB informed the public that, effective May 1 (yesterday), it will no longer cover 85 per cent of the bill for patients that go to private polyclinics or hospitals without a transfer, but will rather cover a percentage calculated on the basis of the standard tariff for private clinics. Under the new policy, RAMA card holders, a majority of them working class subscribers employed mostly in civil service and medium-sized private companies, will however continue to seek medical services from all public health facilities and private clinics (also referred to as ‘general clinics’) as has been the case before – with RSSB covering 85 per cent of the total bill. The Ministry of Health designates private health facilities as clinic, polyclinic or private hospital depending on their size and nature of services offered. Clinics are small establishments, often run by a family and with a small workforce – sometimes with one or two specialists and a handful of support staff. Polyclinics employ more personnel and offer more services than clinics, while private hospitals are the larger establishments with more specialist services. Jonathan Gatera, the director general of RSSB, told The New Times yesterday that about 60 per cent of their annual payouts to private establishments go to clinics, while the remaining 40 per cent is shared between polyclinics and private hospitals. “What we are saying is that people should only go to these larger private facilities when they have been referred there by either a public health facility or a private clinic, the whole idea is to ensure proper management of the fund (RAMA),” he said. He added: “There are different tariff rates in place, and under the new rules, should a RAMA card holder go to a private hospital or polyclinic without a referral, we’ll no longer just cover 85 per cent of the bill as has been the case before, instead we’ll cover part of the bill based on the tariff of the private clinics and not the one of the facility they went to, in that case their top-up will be higher than if they had sought the same services from a private clinic or public health facility or were referred there (by a private clinic or public health facility.” Asked if it was common for public health institutions to refer patients to private establishments, Gatera answered in the affirmative, citing the example of CHUK, which he said often refers cases to Agarwal’s Eye hospital in Kigali. However, at a general assembly of Rwanda Private Medical Practitioners Association (RPMPA), held in Kigali on Sunday, the directive was sharply criticised with private practitioners warning that the new policy would adversely affect both private health facilities and patients. “In reality, the ‘general clinic’ category doesn’t exist in private practice. Besides, private hospitals do not work on the basis of referrals as is the case with many public hospitals,” said Dr Jean Nyirinkwaya, the proprietor of the Gasabo-based Hôpital La Croix du Sud, better known as Kwa Nyirinkwaya. A patient should have the right to choose which private hospital to go without seeking any restrictions, he said. Created in 1997, RPMPA brings together private medical hospitals, polyclinics, and clinics operating in the country. Dr Jean-Dieudonné Gatsinga, the RPMPA head, said the new policy is likely to affect their members which he said were already grappling with consequences caused by a lack of clear working framework between them and medical insurance companies. He described the new policy as unfair and misplaced, adding that the affected private health facilities would continue to receive patients without asking for transfers. However, Gatera rejected suggestions that the new guidelines were unfair, calling on the private practitioners to cooperate. “It’s only natural they would complain because they fear fewer patients will be coming to them directly as has always been the case,” he told The New Times. He added: “Health facilities in the country increased prices in February and this necessitated adjustments in the management of the fund.” A spot check by The New Times yesterday indicated that some private health facilities in Kigali were yet to implement the directive, while others had effected the changes. For instance, RAMA card holders were being turned away at Hôpital La Croix du Sud, while they were being welcomed at the Nyarugenge-based Polyclinique du Plateau. editorial@newtimes.co.rw

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Health insurance: New guidelines for RAMA card holders spark controversy