Community based health insurance schemes (Mutuelles) in Rwanda: an evaluative note using household surveys

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Community-based health insurance schemes (Mutuelles) in Rwanda are one of the larges  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-ofpocket 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, much higher utilization of health care services was found among the insured non-poor than insured poor households, with comparable effect on income protection. This reinforces the inequity already inherent in the Mutuelles system. Key Words: demand for health services, catastrophic health expenditure, average treatment effects, endogenous dummy variable, matching estimator.