Trust in micro-health insurance: an exploratory study in Rwanda.

Micro-health insurance (MHI) has been proposed as an alternative to user fees to improve access to medical care without the threat of financial impoverishment. To enrol in health insurance and pay a premium, consumers should be able to trust that insurers use their funds to reimburse providers who will deliver quality care when needed. In 1998, shortly after the re-introduction of user fees, the Rwandan Ministry of Health in close collaboration with the local population developed and implemented MHI in three districts. Member benefits cover preventive and curative care in health centres and ambulance transport to the district hospital where a limited package of services is also covered by MHI. This paper examines trust-building structures and practices in MHI in Rwanda. It is an exploratory, descriptive analysis using information collected from focus groups. Findings suggest that MHI managers, providers and policy-makers need to think systematically about a wide range of initiatives that enhance trust and caring, and to design trust-building structures and practices in the consumer-insurance-provider arrangement.