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Patients waiting outside Murunda Hospital in Rutsiro District

When anyone falls sick they quickly walk into any nearby health facility for medical attention. It is always the duty of the patient to pay their bills as is the duty of the physician to save lives.

However, in Northern  Rwanda, some patients at Ruhengeri hospital seek treatment and refuse or fail to pay. This has placed the hospital in a dilemma.

For example in August this year, the hospital management dragged a number of patients to court for failing to pay their bills worth Rwf23 million.

In the same month, other four new patients wanted to leave the hospital without clearing bills worth Rwf2.4 million.

“We have patients owing us millions of francs. This issue is putting us into losses,” says Jean de Dieu Muhire – Public Relations Officer at Ruhengeri hospital.

According to Muhire, the latest four patients owe the hospital Rwf600, 000 each. “This is just one single case among many others,” he says adding that at times the hospital runs short of medicine due to this.

Similarly a number of patients at Masaka hospital in Kicukiro district in Kigali have camped at the hospital for sometime claiming that they were denied to go home despite failing to raise money to pay medical bills.

Patients in a maternity ward in Ruhengeri Hospital. There are cases of patients failing to pay their medical bills

More than 30 patients at Masaka hospital are stranded after failing to pay medical bills. Some owe the hospital as much as Rwf500, 000. Most of these don’t have basic health insurance (Mutuelle de Sante) and are required to clear all bills under private arrangement.

Gihundwe hospital in Rusizi district is also going through a similar challenge and management has resorted to engaging local leaders for help.

“The issue is common here. We have cases that have actually left our coffers dry,” Dr. Placide Nshizirungu, Director of Gihundwe hospital told KT Press.

“The last option is to sign a payment process agreement with defaulters. But we do this just to keep a supporting document in case of any audit. Of those who leave the hospital with debts behind, only 1% of them come back to pay,” Dr. Nshizirungu told KT Press.

In Nyagatare district, Eastern Province, hundreds of patients have been held hostage at the hospital premises for failing to clear medical bills.

The problem in Nyagatare is quite different compared to other hospitals.

“90% of patients who fail to pay bills are those with no health insurance (Mutuelle De Santé),”a health official at the hospital told KT Press.

A dentist treating a patient at Gakenke District hospital. Every Rwandan is required to acquire health insurance payable annually and is dependent on their income category

Between 2010 and 2013, Nyagatare district was overwhelmed by the influx of emigrants from neighbouring districts. Most of these, according to local leaders, do not pay for medical insurance.

Some patients admit they don’t  have basic health insurance cards.

“When I arrived in Nyagatare with my 10 children, we could not raise money to pay for insurance. But I admit that this time I can afford if I get chance to be freed and go back home,” said Hamis Ndanyuzwe, one of the patients held at Nyagatare hospital.

Ndanyuzwe failed to clear medical bills. Ndanyuzwe and his family migrated from Gicumbi district to Nyagatare in 2012.

In 2015, government handed over the Community- Based Health Insurance (CBHI) commonly known as ‘Mutuelle De Santé ‘to Rwanda Social Security Board.

Mutuelle De Santé, introduced in 2003, caters for over 85% of the population, with beneficiaries paying only between Rwf3000 and Rwf7000 per year, depending on the revenue of a household defined by Rwanda’s status categorisation.

However, according to Muhire, some patients report to hospitals during the recess period after their cards have expired and fail to raise the cash privately.

Murunda Hospital in Rutsiro District. Some hospitals are struggling with patients that don’t pay  medical bills after receiving treatment

No free medical services

The Ministry of health is aware of patients that can’t afford to clear medical bills. But also warns that no hospital should offer free services and encourages all Rwandans to acquire basic health insurance.

Malick Kayumba – head of communications division at Rwanda Biomedical Centre toldKT Press that the Ministry is aware of the issue at the hospitals.

“Medical services are not given free of charge. We request the media to help us and inform the public about this,” Kayumba said.

However, Kayumba told KT Press that in some cases, a patient may be subsidized in case the hospital and the district discover he or she is incapable of footing the medical bill.

“We commend hospitals for acting professionally by admitting and treating every patient irrespective of financial status,” he said, adding that affordability issues are considered after people have been treated.




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