The national health insurance system, Aasandha, may soon introduce a co-payment model, as revealed in Parliament on Tuesday. The move is deemed necessary for the scheme’s sustainability, according to Fathimath Zeeniya, the new Managing Director of Aasandha, and it would mark a departure from the current free service offered to all citizens.

During a parliamentary inquiry, Maafannu Central MP Ibrahim Rasheed questioned the economic feasibility of the Aasandha scheme, highlighting the growing costs making it unaffordable. In response, Zeeniya admitted the organisation’s lack of authority to alter the scheme independently, as it operates under the directives of the National Social Protection Agency (NSPA). However, Zeeniya voiced her support for shifting to a model involving co-payments or annual fees.

The sustainability challenge for Aasandha echoes a global trend where nations grapple with balancing healthcare accessibility and financial viability. Unlike comprehensive systems in countries like the UK, Canada, or Germany, where funding through taxation has established robust healthcare frameworks, the Maldives faces unique hurdles. Geographic fragmentation and limited resources contribute to these challenges, making a co-payment scheme a considered step towards maintaining the system’s viability.

Zeeniya highlighted the unregulated access to Aasandha at pharmacies and healthcare providers as a primary cost driver. The programme’s coverage extends to private healthcare facilities, which often have higher treatment costs than sending patients to foreign hospitals. To mitigate these expenses, the government is exploring measures such as grading hospitals and setting limits on the amounts or co-payments for services abroad.

A significant portion of Aasandha’s expenses, around 56%, is attributed to medication costs. Initiatives to curb these expenses include measures like code-based medication withdrawals to prevent fraud, regulating the frequency of medication procurement, and bulk procurement of expensive drugs. Additionally, Zeeniya suggested restricting the number of pharmacies participating in Aasandha to control costs.

These proposed changes in the country’s healthcare system represent a major challenge for the government. It remains to be seen whether the administration will be able to achieve a balance between two key objectives: providing universal healthcare access to the population and ensuring the economic sustainability of the healthcare system.