Protesters not covered under health insurance schemes: participation “high risk and voluntary”

State television journalist Moosa Naushad has had a successful operation in Colombo for injuries sustained during a protest on Male’ last week, and will return to the Maldives in a few days’ time, according to Maldives National Broadcasting Corporation (MNBC) Director Adam Shareef.

Naushad was attacked outside of MNBC by 15 people while covering an  opposition-led protest on January 23. The aggressors broke his hand and left him with fractures to his shoulder blades and feet, while MNBC editor Thoyyib Shaheem was tasered after trying to intervene. Both sides of the political spectrum blamed the other for the attack, with the opposition alleging that MDP activists mistook Naushad for a VTV reporter.

Since the nightly  protests began on Male’ over two weeks ago a number of journalists, activists and police officers have sought medical attention for related injuries. Although security personnel are covered by their employer, others have discovered that injuries sustained during a protest are excluded from coverage by most available insurance programs, including the government’s recently introduced Aasandha scheme for every Maldivian citizen.

“As far as I know, no insurance scheme in the Maldives would cover somebody injured during a protest,” said Allied Insurance and Aasandha Program Manager Ahmed Shabiq, pointing out that protests are considered high-risk and voluntary.

To fill the coverage gap, Naushad’s injuries have been treated with “a gift from the government, and some contributions from MNBC,” MNBC’s Shareef said. He added that the station tries to cover injuries other journalists have sustained while working, but said that there is no company insurance program.

Some hospital patients have been surprised to discover the caveat, and several have filed queries and complaints with Aasandha. Shabiq pointed out that “that policy is clearly listed in our exclusions section, printed in pamphlets and on the website. But I think people just aren’t aware of those details.”

However, “it’s not so easy to identify if someone was involved in a protest, and if they’re responsible for their injury.”

All injured individuals are treated on the assumption that they did not engage in high risk behavior until evidence to the contrary is presented. Shabiq claimed hospitals are asked to determine the individual’s level of involvement in any high-risk behavior, while another Allied official said police reports are used to clarify responsibility.

Private practitioner at Central Medical and Clinic, Dr Ahmed Razee, agrees with the policy: “Insurance should not cover intentional injuries. If you jump off the roof of a house you jump off the roof of a house!” he said.

However Dr Fathimath Nadia at Indira Gandhi Memorial Hospital (IGMH) believes the scheme’s policy leaves room for skepticism.

“I think injuries should be covered, but then again if you go to a protest I guess you have to expect that something could happen. But it’s difficult for a medical staff member to know if a person has been injured because of something they did or not.”

Dr Nadia suggested that the policy could have a preventative impact.

“At a protest you should expect that injuries could happen, so if you’re not going to be covered then maybe you won’t go, or you’ll be very careful,” she supposed.

In a separate case, Dr Nadia pointed out that some of the most important partnerships exist in the no-coverage grey zone.

“Three days ago I saw a 22 year-old boy who had had a diving accident. He needed a decompression chamber so we wanted to send him to Bandos but Bandos isn’t part of Aasandha so he wouldn’t be covered,” she explained, adding that the high cost of decompression chambers – of which only one of the Maldives’ five is not operated by a resort – effectively reserves them for the elite.

“It’s a problem, because we see a lot of dive- and sea- related injuries. The boy is now paralysed from his waist down, but what to do?”

However, Dr Nadia pointed out that Bandos had seen the boy and to her knowledge the family had kindly not been billed.

Health insurance programs around the world have their limits. The Maldivian public appears keen to find out first-hand just where those limits lie.

In a previous article Minivan News reported that hospital traffic had increased dramatically since Maldivians became eligible for up to Rf100,000 (US$6500) in free health care annually.

Public health expert and Chief Operating Officer at Male’s ADK hospital, Dr Ahmed Jamsheed, noted in a January 16 blog post that during the scheme’s first two weeks ADK had seen a 50 percent increase in specialist consultations and a 100 percent increase in demand for basic services.

In addition, 41,000 individuals sought health care at ADK – 11 percent of the country’s population – costing the scheme millions and raising serious concerns over its sustainability, Dr Jamsheed observed.

“In the absence of an ongoing epidemic, statistically and epidemiologically speaking, it is unlikely that so many people would be sick needing health care simultaneously,” he wrote, later noting that some patients are seeking multiple and even extraneous appointments.

At IGMH, Dr Nadia has also seen the appointment book fill up. She suggested that repeat appointments stem from a public belief that bi-monthly check-ups are merely proper maintenance – you can’t have too much of a good thing.

However, she noted that the validity of a person’s complaint could be hard to gauge. “It’s difficult to know if a person will receive correct medication from the pharmacy staff, and what they will do with that medication. We can’t follow them to find out,” she said.

In Dr Razee’s opinion, multiple visits to the doctor are important, even if only to put one’s worries to rest.

“Medically speaking, it’s not a waste of time or money,” he said.

“Many people are coming in with complaints that they couldn’t afford to address before. And they are seeing several doctors in succession because they want to get a second, even third, opinion, or they are looking for a doctor they feel comfortable with, or they were unable to tell everything in the short period of time they were first given with the doctor and they want to finish the story,” he said. “It’s normal human nature.”


2 thoughts on “Protesters not covered under health insurance schemes: participation “high risk and voluntary””

  1. The point about protesters and insurance is valid.

    However Aasandha should have been implemented after proper and reasonable assessment. We are not yet certain that our GDP can support the program. Also the terms and conditions under which coverage is provided has not been made clear to the public.

    More awareness programs are needed. Instead of airing political propaganda and baseless rumors, MNBCOne could lead the initiative in creating Aasandha-awareness.

    Emphasis needs to be placed on educating the public on the reasonable use of insurance. Frivolous consultations and going to the doctor for entertainment should be limited so as to decrease the burden on medical service providers.

    Also, Aasandha should go hand-in-glove with sustained efforts to develop IGMH. The place is clearly falling apart under the strain of trying to operate on a revenue basis. We need a public hospital which is subsidized by the government. What we have now is a government enterprise which is bleeding money - IGMH.

  2. Agreed. More work needs to be done on the awareness-raising front, especially by MNBC One.


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