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ORIGINAL ARTICLE
Open Access

Financial Implications of Tariffs for Medical Oxygen on Rwandan Public Hospitals’ Finance Management During the Coronavirus Epidemic

Diana Kizza, Hyacinth Mushumbamwiza, Siyabonga Ndwandwe, Moyo Butholenkosi, Regis Hitimana, Damien Kirchoffer, Jason Houdek, Eoghan Brady, Logan Brenzel, Nathalie Umutoni, Donatien Bajyanama and Zuberi Muvunyi
Global Health: Science and Practice October 2022, 10(5):e2200058; https://doi.org/10.9745/GHSP-D-22-00058
Diana Kizza
aClinton Health Access Initiative, Kigali, Rwanda.
bUNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya.
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  • For correspondence: dskizza@yahoo.co.uk
Hyacinth Mushumbamwiza
aClinton Health Access Initiative, Kigali, Rwanda.
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Siyabonga Ndwandwe
aClinton Health Access Initiative, Kigali, Rwanda.
cDepartment of Primary Care and Population Health, University College London, London, United Kingdom.
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Moyo Butholenkosi
aClinton Health Access Initiative, Kigali, Rwanda.
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Regis Hitimana
dRwanda Social Security Board, Kigali, Rwanda.
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Damien Kirchoffer
eClinton Health Access Initiative, Barcelona, Spain.
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Jason Houdek
fClinton Health Access Initiative, Boston, MA, USA.
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Eoghan Brady
gClinton Health Access Initiative, Johannesburg, South Africa.
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Logan Brenzel
hThe Bill & Melinda Gates Foundation, Seattle, WA, USA.
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Nathalie Umutoni
iMinistry of Health, Kigali, Rwanda.
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Donatien Bajyanama
iMinistry of Health, Kigali, Rwanda.
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Zuberi Muvunyi
iMinistry of Health, Kigali, Rwanda.
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Figures & Tables

Figures

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  • FIGURE 1
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    FIGURE 1

    Comparison of Patients and Total Oxygen Consumption by Hospital Ward, Rwanda, June 2019 to June 2020

    Abbreviation: OPD, outpatient department.

  • FIGURE 2
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    FIGURE 2

    Patient Source of Financing for Oxygen Therapy in Rwanda

    Abbreviations: RSSB-CBHI, Rwanda Social Security Board-Community Based Health Insurance; RSSB-RAMA, Rwanda Social Security Board-Rwandaise d'Assurance Maldie.

  • FIGURE 3
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    FIGURE 3

    Hospital Revenue Versus Oxygen Procurement Costs in Rwanda

    Abbreviations: OPD, outpatient department; RWF, Rwandan franc.

  • FIGURE 4
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    FIGURE 4

    Profit Margins From Oxygen Costs by Ward in Rwanda

    Abbreviation: OPD, outpatient department.

  • FIGURE 5
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    FIGURE 5

    Box Plot of Oxygen Use During Patient Treatment (A) Distribution of the Rate Used During Treatment and (B) Distribution of the Duration of Oxygen Treatmenta

    Abbreviations: hrs, hours; min, minute.

    a The box represents the lower and upper quartiles of the middle 50% of the data. The line in the box represents the median of that data. The ends of the whiskers represent the nonusual minimum and maximum. Dots represent outliers, and extreme dots represent minimum and maximum values. The plus sign represents the mean duration, which when contrasted with the median, exposes the skewness of the distribution.

  • FIGURE 6
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    FIGURE 6

    Oxygen Revenues Based on An Alternative Insurance Reimbursement Tariff Model in Rwanda

    Abbreviations: CBHI, Community Based Health Insurance; RWF, Rwandan franc.

Tables

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    TABLE 1.

    Tariffs for Medical Oxygen by Financing Sources, Rwanda

    Insurance SchemesTariff, RWF (US$)aTotal Amount Reimbursed, %
    Rwanda Social Security Board-Community Based Health Insuranceb635 (0.67)85.1
    Rwanda Social Security Board-Rwandaise d'Assurance Maldieb1125 (1.20)2.5
    Other insurance1035 (1.11)4.8
    Nonec1656 (1.77)7.5
    • Abbreviation: RWF, Rwandan franc.

    • ↵a US$1=RWF935.

    • ↵b Rwanda Social Security Board includes 2 types of insurance schemes. Rwandaise d'Assurance Maldie provides civil servants with additional benefits and simpler administration, and the mandatory Community Based Health Insurance Scheme covers the rest of the population.

    • ↵c Refers to patients with no insurance or no recognized insurance.

    • View popup
    TABLE 2.

    Clinical Guidelines for Oxygen Therapy in Rwanda

    Hospital WardsAverage Flow Rate, LPM
    Intensive care unit10
    COVID-19 isolation10
    Neonatology1
    Internal medicine6
    Pediatrics2
    Obstetrics and gynecology6
    Minor surgery and post operations6
    Emergency10
    General 6
    • Abbreviations: COVID-19, coronavirus disease; LPM, liters per minute.

    • View popup
    TABLE 3.

    Profit Margins Using Mean Flow Rates, by Hospital Ward, Rwanda

    DepartmentShare of Patients Requiring Oxygen, %Share of Hours of Oxygen Use, %Mean Flow Rates, Liters/MinuteProfitability/ Margins, %
    Emergency14910−44
    Surgery5210−44
    Anesthesia13210−44
    Theater9110−44
    Internal medicine7226−6
    Maternity1416−6
    Outpatient department106−6
    Other106−6
    Pediatric12172181
    Neonatology24471462
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Global Health: Science and Practice: 10 (5)
Global Health: Science and Practice
Vol. 10, No. 5
October 31, 2022
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Financial Implications of Tariffs for Medical Oxygen on Rwandan Public Hospitals’ Finance Management During the Coronavirus Epidemic
Diana Kizza, Hyacinth Mushumbamwiza, Siyabonga Ndwandwe, Moyo Butholenkosi, Regis Hitimana, Damien Kirchoffer, Jason Houdek, Eoghan Brady, Logan Brenzel, Nathalie Umutoni, Donatien Bajyanama, Zuberi Muvunyi
Global Health: Science and Practice Oct 2022, 10 (5) e2200058; DOI: 10.9745/GHSP-D-22-00058

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Financial Implications of Tariffs for Medical Oxygen on Rwandan Public Hospitals’ Finance Management During the Coronavirus Epidemic
Diana Kizza, Hyacinth Mushumbamwiza, Siyabonga Ndwandwe, Moyo Butholenkosi, Regis Hitimana, Damien Kirchoffer, Jason Houdek, Eoghan Brady, Logan Brenzel, Nathalie Umutoni, Donatien Bajyanama, Zuberi Muvunyi
Global Health: Science and Practice Oct 2022, 10 (5) e2200058; DOI: 10.9745/GHSP-D-22-00058
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