Mutual Health Insurance and the Contribution to Improvements in Child Health in Rwanda

─ The mutual health insurance (Mutuelle de Santé) system in Rwanda is one of the most extensive community based health insurance schemes operated in Sub-Saharan Africa covering over 90 per cent of the population. Several studies, so far, have documented the success of the Mutuelle de Santé in addressing the two prime objectives of health insurance in a lowincome setting, namely to increase access to health care and to reduce the burden of catastrophic health spending particularly for the poorer groups of society. This paper builds on these earlier works on the Mutuelle de Santé but despite considering the overall population, it aims to provide more detailed insights on the effects of the Mutuelle by concentrating on the contribution of the insurance towards improvements in child health in Rwanda. In order to identify the effect of health insurance enrolment on measures of care and health we propose an instrumental variable approach. The analysis in this paper is based on data from the 2010 Rwandan Demographic and Health Survey (RDHS) and administrative records on insurance coverage. Overall, our results do confirm the positive perceptions and show that Mutuelle enrolment increases the probability of small children receiving medical treatment when ill. Furthermore, we also find a positive effect on children’s health status documented through improvements in height-for-age z-scores. Unlike some studies from other contexts we do not find any indications that insurance coverage leads households to reduce preventative measures, quite to the contrary, our results rather suggest that insured households are more precautionary.