Service availability and association between Mutuelles and medical care usage for under-five children in rural Rwanda: a statistical analysis with repeated cross-sectional data

Objective: To compare the association between Mutuelles enrolment and medical care utilisation among under-five rural children between 2005 and 2010; that is, before and after substantial improvements in service availability took place in rural areas. Methods: We tracked the change in service availability between 2005 and 2010. Using the nationally representative population-based Rwanda Demographic and Health Surveys 2005 and 2010, we conducted a statistical analysis using multilevel logistic random-effects models. We included Mutuelles enrollees and uninsured children who had diarrhoea, cough or fever in the previous 2 weeks of the surveys. The final sample size was 4071 children. Results: We observed a substantial increase in the availability of health facilities, medical staff and child health services from 2005 to 2010. In both years, under-five children with Mutuelles were more likely to use medical care than uninsured children. Children in 2010 had a higher probability of using medical care than their counterparts in 2005, regardless of the children's poverty or Mutuelles status. Mutuelles enrollees in 2010 had the highest probability of using care among children in both years. The findings were robust to model specifications and estimation methods. Conclusions: This study suggests the importance of strengthening service provision at the supply side in promoting equitable utilisation of childcare with prepayment schemes.