Government trials expansion of Aasandha to Maldivians in Sri Lanka, India

The government is this month expanding the Aasandha universal health insurance for Maldives nationals with resident visas in Sri Lanka and India to specific “empanelled” hospitals.

National Social Protection Agency (NSPA) Chair and State Minister State for Health Thoriq Ali Luthfee has said that to coincide with the Islamic Holy month of Ramadan, Maldives nationals residing in the two countries would now be covered for 397 surgical and medical procedures under the universal health scheme.

The coverage will be available at a set number of hospitals that have already been providing services under Aasandha in Sri Lanka and India.

The Aasandha universal health insurance program was introduced by former President Nasheed’s government in January 2012 and retained by President Waheed’s administration after the controversial transfer of power in February the same year.

The scheme, a public-private partnership with Allied Insurance, covers up to MVR100,000 (US$6500) in healthcare costs for Maldives nationals with valid national identity cards.

State Minister Luthfee claimed that the extension of the services to Maldivians residing in Sri Lanka and India was possible as a result of cutting systematic “waste” from the Aasandha system present from its inception under the previous government.

Healthcare challenge

The government has announced the launch of the new services at a time where health authorities have continued to come under criticism about limited health services being offered to patients domestically.

In June, President Waheed told staff at Indhira Gandhi Memorial Hospital (IGMH) in Male’ that his government was working to try and overcome “budgetary challenges” it has been facing in providing healthcare services.  The pledge was made amidst concerns about limited services at domestic health centres in the country.

Earlier the same month, the Ministry of Health had told Minivan News that insufficient salaries and concerns over staff safety were key issues driving “shortages” in the number of trained medical staff coming from abroad to work at hospitals in the Maldives, resulting in impacts to services.

However, despite economic difficulties facing the provision of health care in the Maldives at domestic hospitals and health centres, Luthfee said that Aasandha was funded and overseen by the NSPA under a separate budget budget to health finance – which was handled by the health Ministry.

He claimed that the outcome of extending Aasandha coverage for residents in Sri Lanka and India would need to be monitored to see if the system could be extended to for Maldivian expatriates in other parts of the world.

Monitoring

Luthfee claimed that one key consideration of the success of expanding Aasandha coverage would in whether Maldivians used the scheme “responsibly”.

Shortly after the launch of the scheme in January 2012, Health Minister Dr Ahmed Jamsheed – then Chief Operating Officer at Male’s ADK hospital – said the private health centre had been overwhelmed at the time by patients. He cited a 100 percent increase in demand for basic services in the first 14 days of the scheme.

Dr Jamsheed at the time contended that limited information on Aasandha’s financial structure was leading some members of the public to exaggerate their medical needs, with the mindset that all of their MVR100,000 allowance needed to be spent without regard for the system’s sustainability.

Luthfee claimed today that initial high pressure on the Aasandha system as a result of exaggerated medical needs had seemingly been tempered by greater accountability and a better understanding among the public of how the system was being financed.

“We have been able to balance this, partly through the use of a cost share agreement with private institutions participating in Aasandha,” he said.

Luthfee argued that the potential irresponsible use of universal medical care limiting services for the most in need was an issue initially seen in the early days of public healthcare systems all over the world – pointing to the early days of the UK’s National Health Service (NHS) model as one example.

He claimed that despite some of the challenges facing the system, Aasandha was now being operated in sustainable manner resulting from decreased costs to when the system was launched last year.  He claimed that despite the decreased costs, services offered through the scheme had not been compromised as a result.

Credit limits

Earlier this year, the Amrita Institute of Technology Hospital in Kochi, India, announced that it had been forced to impose a credit limit on services being offered to Maldivian nationals travelling for treatment under Aasandha.

As with other similar insurance schemes, the hospital at the time told Minivan News that it had been forced to control patient admittance as a result of over 7 million rupees (US$130,536) in unpaid charges.

Aasandha’s management said there had been some issues receiving money from the Finance Ministry to cover bills owed as a result of the insurance scheme last December – traditionally a “peak” period for Maldivians wishing to seek medical treatment abroad.

A spokesperson for the hospital could not be reached for comment today.

However, Cosmopolitan Hospital in Travandrum, India, one of several health centres “empanelled” under the Aasandha scheme, said it continued to offer medical services to Maldivian nationals under the programme.

The spokesperson added that he had not been made aware of any issues presently with payments or services being provided through the system.

Nawaloka Hospital, based in Colombo, Sri Lanka, which is also offers treatments under Aasandha, confirmed that it was not aware of any issues with payments being received for treatments and continued to provide medical services to Maldives nationals without any significant limitations.

Last July, the present government pledged that Aasandha would “not collapse”, despite the state owing four months of unpaid premium charges sought to cover medical treatments.

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