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

Finance Ministry selects Allied to provide universal health insurance

The Finance Ministry has announced that the government will partner with Allied Insurance to provide all Maldivians with universal health insurance.

The Ministry said that three companies expressed interest in the public-private partnership, but only Allied completed the letter of expression.

“Sri Lanka Insurance and Amana Takaful didn’t complete the letter of expression. So we decided to award it to Allied,” Director General of the Ministry, Saami Ageel, was reported as saying.

Under the proposal, which the government intends to implement in January next year, Allied will own a 60 percent share in the scheme while the government with own the remaining 40 percent. The actual insurance premium will be paid by the government, while claims, billing and public awareness will be handled by the private partner.

The service will cover emergency treatment, including overseas if the treatment is not available locally, inpatient and outpatient services, domestic emergency evacuation, medicine under prescription, and diagnostic and therapeutic services.

Allied Insurance in July claimed to have launched the country’s first international health coverage policy allowing individuals, families and businesses to access hospital services anywhere in the world.

Provision of the services were said to have been made available through a collaboration with London-based international banking organisation Lloyd’s and the US-based Global Assurance Group.

While regional health policies for destinations like Singapore and Sri Lanka have been available for some time in the country, Allied claimed that its premium package now allowed for coverage everywhere in the world including the US and Canada.

Allied said at the time that although it has worked to provide coverage suitable for all types of income, the international coverage have been devised for higher income earners in the country.

Meanwhile, MPs this week proposed almost a hundred amendments to the National Health Insurance Bill, including a call for it to be made compulsory for locals and expatriates alike.

The bill currently requires workers to contribute 3.5 percent of their salaries to the scheme, however an amendment proposed by MP Yusuf Abdul Gafoor would require the government to pay insurance costs for everyone in the country, out of revenue derived from taxing tobacco products.

Haveeru reported that Maldivian Democratic Party (MDP) MP Mohamed ‘Colonel’ Nasheed had proposed a 1.5 percent employee contribution, with three percent paid by the employer. Dhivehi Rayyithunge Party (DRP) MP Rozaina Adam proposed that workers pay only 0.5 percent.