NCPA - National Center for Policy Analysis


June 25, 2010

Last week, the New York Times published, "In Desperately Poor Rwanda, Most Have Health Insurance."  The main theme was the contrast between Rwanda's compulsory health insurance system and the as-yet-non-compulsory U.S. health insurance market, says Michael F. Cannon, director of health policy studies at the Cato Institute. 

Rwanda has had national health insurance for 11 years now.  Some 92 percent of the nation is covered and the premiums are $2 a year. 


  • Rwanda is so poor, its per capita income is about 1 percent that of the United States ($370 vs. $39,000).
  • Its health care sector is an international charity case: "Total health expenditures in Rwanda come to about $307 million a year, and about 53 percent of that comes from foreign donors, the largest of which is the United States."
  • Dialysis is "generally unavailable," as are many treatments for cancer, strokes and heart attacks, making those ailments "death sentences" more often than in advanced nations.
  • Life expectancy at birth is 58 years, compared to 78 years in the United States.
  • Rwandan children are 15 times more likely to die before their first birthday and 25 times more likely to die before turning five than U.S.-born children. 

Yes, the poorer nation has a higher levels of health insurance coverage.  But the wealthier nation does a better job of providing medical care to everyone, insured and uninsured alike.  The same is true of other acute conditions, like heart attacks and strokes, for which uninsured Americans receive better treatment than insured Rwandans, says Cannon.  

The Healthcare Economist puts it this way: "Would you rather be sick in the United States without insurance or sick with insurance in Rwanda?"  

Insurance status does not necessarily correlate with access to medical care: uninsured people in the wealthy nation actually have better access to care than insured people in the poor nation, says Cannon. 

Source: Michael F. Cannon, "Rwanda and the Psychic Benefits of Universal Coverage," Cato Institute, June 21, 2010. 


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