Talks Underway to Avert Healthcare Crisis After Hospitals Cut Ties With 3 Insurance Firms

The Government has intervened to help avert a potential healthcare crisis after the Rwandan Private Medical Facilities Association (RPMFA) decided to suspend services to patients with insurance policy from three firms.

Private medical health providers on Friday, January 21, resolved to terminate their contracts with Radiant, Sanlam and Britam effective January 25, over non-payment.

This means that hundreds of thousands of patients might be turned away starting tomorrow unless they pay the full amount out of their own pocket.

"We are having a meeting today about the issue and will communicate the solution before the deadline set by the association," Tharcisse Mpunga, the State Minister for Primary Healthcare, told The New Times earlier Monday.

It is understood that the meeting involves representatives of both the association and individual health care facilities, as well as officials from the Ministry of Health and National Bank of Rwanda, the regulator of the insurance sector.

An official at the central bank, speaking on condition of anonymity, confirmed that BNR had also intervened in the matter to avert a potential healthcare crisis.

The decision came as a surprise, the source said, adding that they were holding talks over the matter.

Legality of decision questioned

Meanwhile, Mpunga questioned the legality of RPMFA's move, saying that insurance companies enter into agreements with individual health facilities and not the association.

"It is not right because insurance companies sign contracts with a particular health facility, not the association," he said.

He, however, allayed fears that the deadline might reach before a solution has been found, saying he was confident they would reach a breakthrough before tomorrow.

The decision to suspend the contracts with the three insurance firms was reached during a general assembly of the association on Friday.

The association says the three companies owe their members payment for up to five and 12 months.

The statement was signed by the association head Dr Savio Dominique Mugenzi.

The association counts more than 130 health facilities as members across the country.

Meanwhile, Rwanda Health Insurers Association has come out to challenge RPMFA's decision.

The New Times understands that it has since petitioned the Ministry of Health, arguing that their members sign contracts with individual companies and not the association of health care providers, and therefore the latter has no powers to suspend or terminate the contracts.

They insist that only the signatories to health insurance contracts can legally terminate such contractual relationships.

Venuste Kagaba, a commercial lawyer, agreed, arguing that "every clinic has a legal status of its own, it's them that can legally end their agreement with any insurance company."

He added, "Neither the association, or any union or coalition of clinics can lawfully terminate the contracts."

Britam, one of the three insurance companies in question, released a statement on Monday, January 24, reassuring its clients.

"As we continue to engage the association to align on and resolve any irregularities in payment to member facilities, we are confident that we shall quickly reach a consensus that is in the best interest of the association, ourselves and, most importantly, our clients and beneficiaries," reads part of the statement, signed by chief executive Andrew Kulayige.

What is the issue?

Private medical service providers accuse the insurance companies of delaying to clear bills or rejecting invoices.

In response, some insurance companies have cited suspected fraud or invoices that do not have sufficient supporting documents, including missing tax invoices, commonly known as EBMs (invoices generated by Electronic Billing Machines).

One insurance expert argued that some of the private healthcare providers engage in unethical practices.

"In some instances, you find that clinics overcharge our clients, or recommend tests of which they do not have capability to conduct, just for the sake of increasing the amount they want to receive from insurance companies," the expert told The New Times on condition of anonymity.

However, RPMFA has dismissed the allegation, saying any issues raised by insurance companies are addressed immediately.