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