The government remains committed to running the Aasandha universal health insurance programme initiated in January, claiming the scheme “will not collapse” despite the present economic difficulties facing the country.
State Health Minister Thoriq Ali Luthfee told Minivan News that there was “no cause for alarm” about the future of the scheme, following the revelation that it has yet to settle four months of unpaid premium charges it owes to cover medical treatments.
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 will be paid by the government, while claims, billing and public awareness will be handled by the private partner.
Aasandha Managing Director Mohamed Shafaz has claimed that the government had failed to cover weekly premium payments as agreed under the Aasandha contract since March. 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 the wider South Asia region.
Thirty day target
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 such as Aasandha’s management.
“The important factor is the scheme is continuing,” he said. “The country is going through a difficult time economically and ongoing consultations are currently taking place to clear our bills. We are trying to do this right now. The system is not going to collapse.”
Aasandha’s MD Shifaz said that several general meetings had been held with the government about the issue of back payments – charges he claimed were not contested by authorities.
“I’m not sure the reason for the delay, but the outstanding amounts have not been disputed. It appears they are having difficulty in making payments,” he said.
He did not reveal the exact amount of premium charges presently owed by the government.
When questioned on the impact that failure to pay debts might have on the scheme’s stability, Shafaz claimed that Aasandha’s future was directly tied to service providers such as hospitals and pharmacies, particularly smaller enterprises in the outer atolls.
“The difficulties right now are for the service providers. If they can accept the credits terms we are offering right now, then perhaps they can manage,” he said.
Shafaz said that pharmacies and medical centres on smaller islands were more likely to suffer as a result of failure to secure government payments for the scheme. He added that certain hospitals in Sri Lanka and India also affiliated with Aasandha would need to cover expenses accrued under the universal health system.
Privatised concerns
Back in April, Parliament’s Finance Committee proposed ceasing the provision of universal health care in private hospitals, stating that the scheme would not be economically viable unless private hospitals were excluded.
The proposals were made in a report published by the committee, that recommended the Aasandha service only be made available at the state-run Indira Gandhi Memorial Hospital (IGMH) and other government health centres and corporations around the country.
Calls to limit Aassandha have so far proved divisive in the Majlis and the coalition government. Ahmed Thasmeen Ali, head of the government-aligned Dhivehi Rayyithunge Party (DRP), has previously been an outspoken critic of limiting the provision of universal healthcare at private premises.
Thasmeen told local media at the time that the amendments forwarded by the parliamentary Finance Committee were not the “right way to go” to bring about changes to the scheme, alleging they could undermine parliament’s role in holding the government to account in future, Haveeru reported.
He added that should amendments to the scheme need to be made, he did not want to see the cessation of free healthcare to the public.
Both Thasmeen and DRP Deputy Leader Ibrahim Shareef were not responding to calls by Minivan News at the time of press today.
The Aassandha service was initially intended to cover emergency treatment, including treatment overseas if not available locally, along with all inpatient and outpatient services, domestic emergency evacuation, medicine under prescription, and diagnostic and therapeutic services.
However, Aassandha Managing Director Shafaz said that consultations were set to take place over the possibility of amending the main contract signed between the government and the health scheme’s provider to include an extended number of private practices under the project.
He stressed that there remained “huge concern” at present that such an extension would actually serve to exacerbate the present shortfall in government payments.
“Deluge”
Despite these extension talks, one private doctor not affiliated with Aasandha raised concerns that an apparent “deluge” of patients to IMGH and the private ADK hospital in Male’ were overburdening hospitals linked to the universal coverage scheme.
Conversely, the same doctor contended that large numbers of other health centres and laboratories had seen patient numbers plummet, endangering their long-term existence.
Dr Ahmed Razee, a former Director General of IGMH hospital presently serving as an internist with special interest in diabetes and kidney diseases across Male’ , alleged that under the current agreement, Aasandha had served to create a “grossly unfair monopoly”. Dr Razee added that the scheme had created an environment where even established practitioners were losing regular patients to an “inferior behemoth”.
“When ADK and IGMH pharmacies give you free drugs, why would go to any other pharmacy? I am afraid only Aasandha registered prescriptions are honoured,” he said. “These are available only at IGMH and ADK. Who will go any further – and pay also in the bargain – to another pharmacy?”
Dr Razee contended that when the scheme was launched during the administration of former President Mohamed Nasheed, government promises of a fair share of service provision for private health centres saw a number of enterprises – not just ADK – investing millions of rufiya in health provision.
“With the current monopoly that the government has created, these clinics, pharmacies and labs – representing over a thousand jobs – are going bankrupt,” he claimed. “The deluge of patients on ADK and IGMH is creating too much work for staff and is reducing standards and causing mistakes and making the waiting period entirely too long, and thus expensive, for people from the islands.”
Budgetary factors
Beyond the implications for healthcare, the Maldives has also come under increasing pressure from international organisations to make widescale cuts to state funding.
While recent Maldives’ Inland Revenue Authority (MIRA) figures for May showed national revenue had increased f 9.5 percent compared with the corresponding month in 2011, the figures were not substantial enough to shrink the present national budget deficit.
Governor of the MMA Dr Fazeel Najeeb recently stated that the Maldives was “in a dangerous economic situation never before seen in recent history.”
The International Monetary Fund (IMF) has expressed its concern over the country’s dire balance of payments situation which has been estimated by the Majlis’s Financial Committee to be 27 percent of GDP this year.
The 2012 budget was initially estimated to be around 9.7 percent of GDP, but in May was revealed to be much larger after significantly reduced expenditure and increased expenditure was taken into account.
Spending unaccounted for in the 2012 budget following the controversial change of government of February 7 has included the promotion of a third of the police force, lump sum payments to military personnel, Rf100 million (US$6.5 million) in fishing subsidies, reimbursement of Rf443 million (US$28.8 million) in civil servant salaries following cuts by the previous administration, the creation of two new ministries, and the hiring of international PR firms to counter negative publicity.
Former President Mohamed Nasheed had previously criticised President Waheed and his government for attempting to introduce fees for Aasandha, claiming the administration had squandered funds marked for development on the police and military.
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