Aasandha director claims service not suspended in India’s Amrita hospital

The Amrita Institute of Technology Hospital in Kochi, India has not suspended Aasandha health care services despite reports in local media to the contrary, the scheme’s managing director has stated.

Local media reported yesterday (January 28) that services offered under the universal health care scheme Aasandha had been suspended due to unpaid bills for treatment provided to Maldivians by Amrita hospital.

However, Aasandha Managing Director Mohamed Niyaz told Minivan News today that services had not been suspended.  Niyaz said that Aasandha was instead having to control patient admittance to keep in line with the credit limit recently imposed by the hospital.

“Because of the large number of patients who went to receive treatment at the hospital in December last year and delays in paying those bills, Amrita hospital put a credit limit on the treatment they can offer that is paid for by Aasandha,” he explained.

“We are now controlling the number of patients we are admitting to the hospital in order for Aasandha to not go over the imposed credit limit,” Niyaz said.

An official from Amrita hospital told Minivan News that while it is still treating patients who are covered by Aasandha, there had been a period of four days earlier this month where it stopped admitting patients due to unpaid bills.

“There is a total of 7 million rupees (US$ 130,536) outstanding in payment to be made by Aasandha through Hospital Professional Liability (HPL) insurance, who we deal with.

“We ceased treating outpatients covered by Aasandha for four days, but HPL then paid part of the bill and so we resumed our services,” the hospital official told Minivan News.

The credit cap imposed on Aasandha by Amrita hospital was introduced to match a similar credit cap applied to all other health insurance companies who work with the hospital, the hospital official said.

“Originally we had a special agreement with Aasandha whereby they had no credit cap on the treatment we could provide. However our Financial Controller has now introduced it because it is the same as other insurance companies we deal with,” the hospital official added.

“Even now Aasandha’s credit cap is a lot higher than the other insurance companies. We have a great relationship with the Maldives and we treat our Maldivian patients as our own.”

According to Niyaz, patient treatment is currently being prioritised on a case-by-case basis in order for the service they are receiving to not be “compromised”.

In regard to bill payment, Niyaz claimed there had been a number of factors as to why the money had not been paid to Amrita hospital.

“It takes two to four weeks for the treatment bills to come through after a patient has been discharged from the hospital and then we have to pay for the treatment in US dollars,” he said.

“It takes a further two weeks for us to secure the dollars as we have to buy at a bank rate. We are trying to find ways to work around this problem at the moment.”

During December – a “peak” period for Maldivians wishing to seek medical treatment -Niyaz said there had been some issues receiving money from the Finance Ministry in order to pay the bills.

Finance Minister Abdulla Jihad was not responding to calls from Minivan News at time of press.

Niyaz revealed that Aasandha had experienced similar issues at a hospital in Colombo and three other hospitals in India, but that these have all been resolved.

Free health care of up to MVR 100,000 (US$ 6,476) was initially available to citizens under Aasandha. Changes to the system were made by the government in August last year, after concerns the scheme would run out of money.


Parliament sittings canceled indefinitely by Speaker

Speaker Abdulla Shahid has announced that parliament sittings will be cancelled indefinitely as “a peaceful atmosphere could not be assured” for sittings to proceed amidst rising political tension.

In a press statement today, Speaker Shahid said that MPs of the formerly ruling Maldivian Democratic Party (MDP) confronted the Speaker in his private chambers after MDP MP Mohamed Rasheed ‘Kubey’ was forcibly removed at the beginning of today’s sitting.

“Moreover, confrontations occurred between MPs in the chamber to the point of becoming dangerous,” the statement read, adding that “an atmosphere of calm necessary to conduct sittings could not be assured” as all recent sittings had to be cancelled due to disorder.

Shahid explained that he decided to invoke the Speaker’s authority under section 213(e) of the rules of procedure to cancel sittings indefinitely as he believed a political solution had to be sought through dialogue among parliamentary group leaders.

Section 213(e) states that the Speaker has the discretion to not conduct sittings for a period “as a precautionary measure if there is fear of a certain type of danger facing the Majlis.”

Both today and yesterday’s sitting were cancelled after MDP MPs vociferously raised points of order to protest the arrest of MPs during the party’s ongoing street demonstrations and the government’s decision to alter the ‘Aasandha’ health insurance scheme to charge patients from private hospitals and clinics.

MDP MPs led by MP Ali Waheed also disrupted today’s meeting of the Finance Committee alleging that the committee had failed to investigate the government “illegally borrowing” MVR 300 million from the Bank of Maldives.


Speaking at a press conference yesterday, MDP MP Ali Waheed argued that parliament has been “paralysed” since the transfer of power on February 7 and that “nothing productive” had been done in the past six months.

MP Ibrahim Mohamed Solih ‘Ibu’, parliamentary group leader of the MDP, contended that the government was violating the Public Finance Act by borrowing large sums of money without parliamentary approval.

Ibu claimed that the Finance Minister had written to parliament’s Finance Committee seeking MVR9 billion (US$583 million) for the budget as well as MVR 3 billion (US$194 million) in additional expenditure.

MP Ali Waheed meanwhile noted that MPs last month overwhelmingly rejected a Finance Committee recommendation to make changes to the Aasandha health insurance scheme.

Speaking to press after today’s sitting, MDP Chairperson and Hulhu-Henveiru MP ‘Reeko’ Moosa Manik said the party would not allow parliament to resume while the current government was altering the MDP’s flagship free universal health insurance scheme.

MDP MP Eva Abdulla claimed that the government was facing a shortfall in budgeted funds for the health insurance scheme due to increasing expenditure on the police and army.

“What we’re seeing is the result of a group of people assuming power without making any pledges to the public,” she said. “That is, they do not have to be accountable to the people. They do not have to let the people know what is going on.”


Patients to be charged at private clinics under Aasandha from August 1

Treatment from private hospitals and clinics will be covered under the “Aasandha” universal health insurance schemes  from August 1, with an agreed amount to be charged from people going to those clinics.

According to a statement released by the Aasandha Company on Sunday, private clinics are being included in the scheme after they agreed to a revised price list for health services with the National Social Protection Agency (NSPA).

The scheme will cover the treatments from those private clinics based on the revised price list, while the clinics are allowed to charge their patients to cover any additional costs.

“Therefore, patients will likely have to share the costs of outpatient care and other services,” the company adds.

The authorities have not revealed the amount to be charged, but State Health Minister and National Social Protection Agency (NSPA) Board Chairman Thorig Ali Luthfee told local media that the “charge will not be a burden to the patients.”

“In addition to what is being (covered) from Aasandha, they might charge a small amount from the patient. Once they agree to the price with us, they cannot alter that price,” Thorig told Haveeru.

According to Thorig, four clinics have so far agreed to the prices, and Aasandha services will be offered at the clinics as soon as the agreements are signed.

Price negotiations with several other clinics are still reportedly pending as over 60 private healthcare providers have applied for Aasandha coverage.

According to the Aasandha website, the scheme currently covers treatment from IGMH, ADK Hospital, IMDC Hospital in Addu and other hospitals and health centres currently operated by state-owned health corporations.

Thoriq observed that privately-owned ADK, the second largest healthcare provider in the country, will also have to confirm the revised prices agreed with NSPA to keep providing Aasandha services from next month on wards.

Under the parliament-approved scheme which commenced in January, all Maldivian citizens will receive government-sponsored coverage up to Rf100,000 (US$6,500) per year, including further provisions to citizens who require further financial assistance. Expatriate workers are also eligible for coverage providing their employers pay an upfront fee of Rf1,000 (US$65).

MDP’s critical response

Following the decision to charge patients at private health premises, the former ruling Maldivian Democratic Party (MDP) which initiated the universal insurance scheme, under its affordable healthcare pledge, contended that the government’s decision reflects attempts to “restore the tradition of begging to afford health care services”.

According to the statement released by the MDP, the agreement signed between Aasandha company and the government explicitly states that no amount can be charged from the patients.

“The agreement signed by the Finance Ministry, Health Ministry and Aasandha Company explicitly states that no amount should be taken in fees or as any other charge from the people,” the statement reads. “Therefore, we condemn the coup government’s attempts to charge people a fee for healthcare services.”

The party also accused the government aligned Progressive Party of the Maldives (PPM) and coalition alliance of deliberately attempting to sabotage the health insurance scheme.

The MDP noted that while the party was in power it had regularly made the payments to Aasandha company as per the agreement, however, the incoming government of President Dr Mohamed Waheed Hassan Manik had not made the payments, pushing the scheme to the brink of collapse.

Aasandha is a public-private partnership with Allied Insurance. Under the agreement, Allied splits the scheme 60-40 with the government. The actual insurance premium is paid by the government, while claims, billing and public awareness is handled by the private partner.

Aasandha Managing Director Mohamed Shafaz told Minivan News last week that the government had failed to cover weekly premium payments as agreed under the Aasandha contract since March 2012.

He alleged that while the scheme was continuing to run, the shortfall in state funding was creating some difficulties for service providers such as hospitals and pharmacies both in the Maldives and outside the country in the wider South Asia region.

Without detailing specifics, State Health Minister Luthfee said that the government was presently involved in consultations to clear outstanding bills. He added that a target of 30 days had been set to try and settle outstanding debts to creditors.


Over 250 people reach Aasandha outpatient care finance limit

The manager of the Aasandha Private Limited company Ahmed Shabig has revealed that 257 people have reached their entitlement limit of Rf10,000 for outpatient care provided under the recently launched healthcare scheme, local media has reported.

These 257 people will now have to pay for their own outpatient care, although they will still be entitled to other services as part of the Aasandha universal healthcare scheme introduced on January 1.

Shabig told Sun Online that an SMS text service had also been introduced that would allow people to check how much of their allowance had been used.

The scheme has come under fire in recent weeks after its current rate of expenditure has reportedly  threatened to reach Rf1billion on an approved budget of Rf720 million.  The government has anticipated its annual spending will be Rf2billion over budget this year as the International Monetary Fund (IMF) warned this week that economic growth and stability in the Maldives were unlikely to be maintained “in the medium term” unless the government substantially cut its spending.

Amid suspicions of corruption, the Majlis Finance Committee announced its intention to audit the scheme earlier this week.

The President’s Office claimed last week that figures showing 150,000 people had used the healthcare scheme a total of 250,000 times indicated something must have gone wrong with the system.

Despite the Maldivian Democratic Party’s (MDP) claims that President Waheed’s administration intends to end the scheme, the government has stressed repeatedly that it aims instead to reform the existing system.


Finance Committee seeks to reform Aasandha without charging public

The Health Ministry has suggested to Parliament’s Financial Committee that a co-payment be introduced to the Aasandha health care programme in order to mitigate the system’s spiralling costs.

Members of the committee were keen not to impose any fee on the public, however, and insisted that the focus of efforts should be on reducing costs and introducing controls that will reduce demand over time.

They were said to be open to the idea of charging a small fee for outpatient care. Aasandha Chairman Thorig Ali Luthufee told Miadhu recently that outpatient care had made up 65 percent of the costs incurred in the first three months.

In the same article, Luthufee noted that the programme did not have the standard controls required of such a scheme.

The cost of the system, introduced in January this year, has come under increasing criticism as the projected budget looks increasingly unrealistic. Ahmed Nazim, head of the Parliamentary Financial Committee recently described the system as a “hole in the government’s pocket”.

After yesterday’s meeting Nazim told Sun Online that the current Rf720 million (US$46million) budget for the scheme would run out by August or September.

The current costs of Rf3 million a day (US$200,000) would take the yearly cost to over Rf1billion (US$2.3 million).

The sustainability of the Aasandha scheme has become a particularly prominent issue as the government looks for ways to slash spending in order to reduce the budget deficit.

The International Monetary Fund (IMF) told the People’s Majlis last week that urgent measures should be taken to reduce expenditure, warning against further borrowing or printing of money.

Finance Minister Abdulla Jihad yesterday informed local newspaper Haveeru that the budget was being sent to Parliament for revision after it became clear that the government’s income would fall Rf2billion (around $130million) short of its anticipated expenditure this year.

Jihad warned that the country must avoid resorting to selling treasury bonds due to the country’s unsustainable levels of debt.

Members of the formerly ruling Maldivian Democratic Party (MDP) have criticised the current government’s financial policies. Former President Mohamed Nasheed argued that money has been wasted on police and military bonuses whilst the former Tourism Minister Mariyam Zulfa has argued that around $150 million has been lost after the government opted to change the way island lease extension payments were made.

Recent figures from the Maldives Inland Revenue Authority (MIRA) revealed that this lost revenue amounted to over Rf350million ($22million) in March alone.

Chairman of the National Social Protection Agency (NSPA) and State Minister of Home Affairs Thoriq Ali Luthfee had said previously in the local media that the Aasandha scheme “cannot continue to operate without interventions to control the demand.”

He alleged that the scheme was introduced “for political motives” without any proper planning.

Nazim echoed these concerns last week, telling Minivan News that the system had been “introduced in a rush” and had “gone horribly wrong.”

The Financial Committee is in the process of producing a report on Aasandha in an attempt to resolve these problems which Nazim reports as having resulted to “abuse on a massive scale”.

Regardless of opposition suspicions regarding the government’s long term intentions with the programme, however, Nazim has maintained his determination to continue the program on a more sustainable footing.

“Aashanda is here to stay”, said Nazim.


Universal health insurance scheme under review

The government’s universal health insurance scheme ‘Aasandha’ is currently being reviewed by the authorities to introduce a measure to  share the cost of  healthcare services covered under the scheme.

The discussions follow concern from the government over the scheme’s sustainability, as the demand for healthcare continues dramatically increase, costing the country millions.

The newly-appointed Chairman of the National Social Protection Agency (NSPA) and State Minister of Home Affairs Thoriq Ali Luthfee recently suggested in the local media that the Aasandha scheme “cannot continue to operate without interventions to control the demand.”

He alleged that the scheme was introduced “for political motives” without any proper planning.

Subsequent to the remarks, members of the public raised concerns over a possible cancellation of the scheme and loss of access to free healthcare. The new administration of President Dr Mohamed Waheed Hassan has shut down some initiatives introduced by his predecessor, including the  Maldives Volunteer Corps and the Second Chance Program for inmate rehabilitation.

However, in an interview to Minivan News on Tuesday, Aasandha Private Limited’s Managing Director Mohamed Shafaaz confirmed that the scheme will go forward although measures will be taken to control the rising demand for health care.

According to Shafaaz, since the inception of the Aasandha scheme on January 1, over 138,000 individuals have sought health care under the scheme – which accounts for almost 40 percent of the total population.

Meanwhile, on a daily basis almost 7000-8000 people are using the scheme, totaling a daily cost of the scheme of up to Rf 3 million (US$194,552), he further noted.

“We expected the demand to increase initially with the inception and hoped it would reduce later. but the trend has not changed. Demand is still increasing,” Shafaaz explained. “There are some people with serious illnesses like cancer, heart conditions and kidney problems etc, but most people are going for consultations just because it is free,'” he added.

Therefore, he noted that the current discussions focus on introducing a co-sharing model to share an extent of the healthcare cost with the people, instead of sole coverage by the state.

Currently the ‘Aasandha’ scheme, a public-private partnership with Allied Insurance, provides free coverage of up to Rf100,000 (US$6485) annually for health services for all Maldivian nationals.

“The problem is it is completely free. People do not have to pay anything. But if we bring a small change like levying a charge of  around Rf 10 (US$0.65), people going for unnecessary consultations will be discouraged,” Shafaaz noted.

However, he noted that “nothing has been finalised” yet and the changes will hopefully be decided and made public this week.

In a previous article Minivan News explored the Maldivian public’s prodigious appetite for medical care following the inception of the scheme and the subsequent challenges to the health sector.

Aasandha appears to prove the business rule that low prices attract public interest applies even to medical services – many Maldivians talk about being encouraged to go to the hospital simply because treatment is free.

Medical professionals have also commented on what they describe as the population’s reflexive hypochondria.

Dr Ahmed Jamsheed, Chief Operating Officer at Male’s ADK hospital at the time and currently the Minister of Health, observed in a personal blog entry, that ‘the launching of Aasandha has challenged the two hospitals in Male’, pushing them to their limits with frenzied ‘patients’ (or should I call them customers?) flooding and packing the hospitals.”

Observing that ADK has seen a 50 percent increase in specialist consultations and a 100 percent increase in demand for basic services, Dr Jamsheed describes the hospital as “overwhelmed.”

“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 said.

He also echoed similar concerns over the financial implications in sustaining the scheme and suggested that a scheme where patients co-shared the cost would be more ‘useful in limiting unnecessary hospital visits and prescription charges.’

He also alleged

Three bills ratified at end of 2011

President Mohamed Nasheed today ratified three bills passed by the People’s Majlis.

The Partnership Bill, stating the guidelines for the formation, registration and operation of business partnerships in the Maldives, categorises partnerships into ‘General’ and ‘Limited Liability’.

The First Amendment Bill to Tax Administration Act (Act number 3/2010) was also  passed during the Parliament’s sitting on 19 December 2011, and ratified today.

The National Health Insurance Scheme Bill passed during its sitting on 21 December 2011, and was ceremoniously signed by the Health Minister at the Artificial Beach. It has been ratified, and the insurance scheme Aasandha will go into effect tomorrow, January 1, 2012.

The bills have been published in the government gazette.


Procedures to include private clinics in Aasandha underway

The government is working to modify the stipulation that private clinics will not be included in the universal health insurance scheme Aasandha, due to become active tomorrow, January 1.

President Mohamed Nasheed this morning announced that the government is trying to set procedural standards for including clinics in the scheme, Haveeru reports.

Health Minister Ibrahim Waheed told local media that, “We haven’t planned to include private clinics in Aasandha in 2012. The government doesn’t want everyone to set up clinics in their houses but rather wants the people to be able to receive treatment from a single place.”

He added that clinics must upgrade their services to hospital standard in order to be included in the Aasandha scheme.

Details have not been revealed.

The Aasandha scheme does include provisions for Maldivians seeking medical treatment abroad, and offers financial support for those in need.