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Community based health insurance schemes in Africa: The case of Rwanda


  • Shimeles, Abebe

    () (Development Research Department African Development Bank)


Community-based health insurance schemes (Mutuelles) in Rwanda are one of the largest experiments in community based risk-sharing mechanisms in Sub-Saharan Africa for health related problems. This study examines the impact of the program on demand for modern health care, mitigation of out-of-pocket catastrophic health expenditure and social inclusiveness based on a nationally representative household survey using traditional regression approach and matching estimator popular in the evaluation literature. Our findings suggest that Mutuelles have been successful in increasing utilization of modern health care services and reducing catastrophic health related expenditure. According to our preferred method, higher utilization of health care services was found among the insured non-poor than insured poor households, with comparable effect in reducing health-related expenditure shocks. This reinforces the inequity already inherent in the Mutuelles system.

Suggested Citation

  • Shimeles, Abebe, 2010. "Community based health insurance schemes in Africa: The case of Rwanda," Working Papers in Economics 463, University of Gothenburg, Department of Economics.
  • Handle: RePEc:hhs:gunwpe:0463

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    References listed on IDEAS

    1. Heckman, James J, 1978. "Dummy Endogenous Variables in a Simultaneous Equation System," Econometrica, Econometric Society, vol. 46(4), pages 931-959, July.
    2. Guido W. Imbens, 2010. "Better LATE Than Nothing: Some Comments on Deaton (2009) and Heckman and Urzua (2009)," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 399-423, June.
    3. Alberto Abadie & Guido W. Imbens, 2006. "Large Sample Properties of Matching Estimators for Average Treatment Effects," Econometrica, Econometric Society, vol. 74(1), pages 235-267, January.
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    Cited by:

    1. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2015. "Enrollment in Ethiopia’s Community-Based Health Insurance Scheme," World Development, Elsevier, vol. 74(C), pages 58-76.
    2. Mebratie, A.D. & Sparrow, R.A. & Alemu, G. & Bedi, A.S., 2013. "Community-Based Health Insurance Schemes," ISS Working Papers - General Series 568, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    3. Ncube, Mthuli & Brixiova, Zuzana & Bicaba, Zorobabel, 2014. "Can Dreams Come True? Eliminating Extreme Poverty in Africa by 2030," IZA Discussion Papers 8120, Institute for the Study of Labor (IZA).
    4. Woldemichael, Andinet & Gurara, Daniel Zerfu & Shimeles, Abebe, 2016. "Community-Based Health Insurance and Out-of-Pocket Healthcare Spending in Africa: Evidence from Rwanda," IZA Discussion Papers 9922, Institute for the Study of Labor (IZA).
    5. Zelalem Yilma & Anagaw Mebratie & Robert Sparrow & Marleen Dekker & Getnet Alemu & Arjun S. Bedi, 2015. "Impact of Ethiopia's Community Based Health Insurance on Household Economic Welfare," World Bank Economic Review, World Bank Group, vol. 29(suppl_1), pages 164-173.
    6. Jacopo Bonan & Philippe LeMay-Boucher & Michel Tenikue, 2014. "Households' Willingness to Pay for Health Microinsurance and its Impact on Actual Take-up: Results from a Field Experiment in Senegal," Journal of Development Studies, Taylor & Francis Journals, vol. 50(10), pages 1445-1462, November.
    7. Shimeles Abebe & Andinet Woldemichael, 2015. "Working Paper 225 - Measuring the Impact of Micro-Health Insurance on Healthcare Utilization: A Bayesian Potential Outcomes Approach," Working Paper Series 2166, African Development Bank.
    8. 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.
    9. Mebratie, A.D. & Sparrow, R.A. & Debebe, Z.Y. & Alemu, G. & Bedi, A.S., 2014. "Dropping out of Ethiopia’s Community Based Health Insurance scheme," ISS Working Papers - General Series 76960, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    10. Mebratie, A.D. & Sparrow, R.A. & Debebe, Z.Y. & Abebaw Ejigie, D. & Alemu, G. & Bedi, A.S., 2014. "The impact of Ethiopia’s pilot community based health insurance scheme on healthcare utilization and cost of care," ISS Working Papers - General Series 77021, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    11. Léonce Ndikumana, 2013. "Overcoming Low Political Equilibrium in Africa: Institutional Changes for Inclusive Development," Working Papers wp331, Political Economy Research Institute, University of Massachusetts at Amherst.

    More about this item


    demand for health services; catastrophic health expenditure; average treatment effects; endogenous dummy variable; matching estimator;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

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