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Trust in micro-health insurance: an exploratory study in Rwanda


  • Schneider, Pia


Micro-health insurance (MHI) has been proposed as an alternative to user fees to improve access to medical care without the threat of financial impoverishment. To enrol in health insurance and pay a premium, consumers should be able to trust that insurers use their funds to reimburse providers who will deliver quality care when needed. In 1998, shortly after the re-introduction of user fees, the Rwandan Ministry of Health in close collaboration with the local population developed and implemented MHI in three districts. Member benefits cover preventive and curative care in health centres and ambulance transport to the district hospital where a limited package of services is also covered by MHI. This paper examines trust-building structures and practices in MHI in Rwanda. It is an exploratory, descriptive analysis using information collected from focus groups. Findings suggest that MHI managers, providers and policy-makers need to think systematically about a wide range of initiatives that enhance trust and caring, and to design trust-building structures and practices in the consumer-insurance-provider arrangement.

Suggested Citation

  • Schneider, Pia, 2005. "Trust in micro-health insurance: an exploratory study in Rwanda," Social Science & Medicine, Elsevier, vol. 61(7), pages 1430-1438, October.
  • Handle: RePEc:eee:socmed:v:61:y:2005:i:7:p:1430-1438

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    1. Arun, Thankom & Bendig, Mirko & Arun, Shoba, 2012. "Bequest Motives and Determinants of Micro Life Insurance in Sri Lanka," World Development, Elsevier, vol. 40(8), pages 1700-1711.
    2. Clara Delavallade, 2014. "Quality Healthcare and Health Insurance Retention: Evidence from a Randomized Experiment in the Kolkata Slums," Working Papers id:5916, eSocialSciences.
    3. Agier, Isabelle & Ly, Antarou & Kadio, Kadidiatou & Kouanda, Seni & Ridde, Valéry, 2016. "Endorsement of universal health coverage financial principles in Burkina Faso," Social Science & Medicine, Elsevier, vol. 151(C), pages 157-166.
    4. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    5. Bocoum, Fadima & Grimm, Michael & Hartwig, Renate & Zongo, Nathalie, 2017. "Nudging Households to Take Up Health Insurance: Evidence from a Randomized Experiment in Burkina Faso," IZA Discussion Papers 10744, Institute for the Study of Labor (IZA).
    6. Binagwaho, Agnes & Hartwig, Renate & Ingeri, Denyse & Makaka, Andrew, 2012. "Mutual health insurance and its contribution to improving child health in Rwanda," Passauer Diskussionspapiere, Volkswirtschaftliche Reihe V-66-12, University of Passau, Faculty of Business and Economics.
    7. Francisco Galarza & Ingo Outes Leonb, 2016. "Do you want some cash-back? Assessing the demand for a no-claim rebate life-insurance product," Working Papers 16-04, Centro de Investigación, Universidad del Pacífico.
    8. Elder, Sara D. & Zerriffi, Hisham & Le Billon, Philippe, 2012. "Effects of Fair Trade Certification on Social Capital: The Case of Rwandan Coffee Producers," World Development, Elsevier, vol. 40(11), pages 2355-2367.
    9. Ridde, Valery & Haddad, Slim & Yacoubou, Moussa & Yacoubou, Ismaelou, 2010. "Exploratory study of the impacts of Mutual Health Organizations on social dynamics in Benin," Social Science & Medicine, Elsevier, vol. 71(3), pages 467-474, August.
    10. Mladovsky, Philipa & Mossialos, Elias, 2008. "A Conceptual Framework for Community-Based Health Insurance in Low-Income Countries: Social Capital and Economic Development," World Development, Elsevier, vol. 36(4), pages 590-607, April.
    11. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance?: findings from an exploratory household survey in Senegal," LSE Research Online Documents on Economics 55820, London School of Economics and Political Science, LSE Library.
    12. Saksena, Priyanka & Antunes, Adélio Fernandes & Xu, Ke & Musango, Laurent & Carrin, Guy, 2011. "Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection," Health Policy, Elsevier, vol. 99(3), pages 203-209, March.
    13. Lin, Wanchuan & Liu, Yiming & Meng, Juanjuan, 2014. "The crowding-out effect of formal insurance on informal risk sharing: An experimental study," Games and Economic Behavior, Elsevier, vol. 86(C), pages 184-211.
    14. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal," Social Science & Medicine, Elsevier, vol. 107(C), pages 78-88.


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