OBJECTIVES: Since 2000 when the Rwanda CBHI scheme was establishment, premiums have only been revised in 2011. To ensure the CBHI’s sustainability, there have been calls for various reforms including the revision of the premiums to reflect current socio-economic conditions.

METHODS: The DBDC Contingent Valuation was employed to elicit responses from 6,044 randomly sampled respondents across the 30 districts. The sample size was calculated at 95% Confidence Interval. Logistic and linear regression models were applied to examine determinants to join and pay the CBHI respectively.

RESULTS: 80% of respondents indicated that they would enroll in an improved CBHI if all essential medical services and medicines are available. The overall average the households were willing to pay was RWF3,572 per person. However, current CBHI members were willing to pay a maximum of RWF3,572 per person compared to RWF3,229 among previous members and RWF3,817 among respondents who have never enrolled in the CBHI. Respondents from Ubudehe category-II households were willing to pay a maximum of RWF 3,518 per person, lesser than respondents from category-III RWF4,648.

CONCLUSIONS: The determinants (statistically significant) to enroll and pay include household’s socio-economic classification, size, head’s age and employment status, income, expenditure, participation in income-generating-activities, saving behavior, healthcare utilization, knowledge and understanding of the CBHI, perception of quality of healthcare, and price of the CBHI. Importantly, most respondents indicated that the current CBHI’s challenges must be addressed before any premium adjustments.