ASSESSING THE FINANCIAL SUSTAINABILITY OF UNIVERSAL HEALTH INSURANCE SCHEME "AASANDHA' IN THE MALDIVES

Abstract

This study was conducted for ‘Aasandha’, the health insurance scheme in the Maldives to assess the financial sustainability of the scheme. Maldives's universal health insurance scheme “Aasandha” came in to existence after the Parliamentary Act of Social Health Insurance. Aasandha benefits is widespread; it covers services ranging to inpatient and outpatient treatment including drugs and diagnostics, though subject to certain conditions, within an overall cap of MRF 100,000 per person per year. In theory, the entire population of the country, comprising over 3,30,000 citizens, is eligible for scheme benefits without any premium contributions Qualitative approach of study was done to find the data on the Aasandha's administration and the key informant were interviewed to seek the needed information. Secondary data on hospital costs, costs and funds for the scheme from administrators (NSPA) were gathered to make a comparison for 2011 and 2012. The financial sustainability involves forecasting for the future, macroeconomic forecasts provide a mandatory stand for which the health care financing can be thoroughly assessed. For this, projections were done using the macro economic data, population growth and hospital cost to have a clear foreseen for 2014-2018. The research design used in this study was descriptive research. The study result shows that the total cost of the hospital during the year 2011 was Rf 377,485,242.28 and in the year 2012 it was RF 343,431,217.43.The unit cost for the OPD for the year 2011 was Rf 94.79 per visit while in 2012 it was Rf 91.45 per visit. Furthermore, the study shows that the total cost of Aasandha for the year 2012 was Rf 810,810,640 while it increased to Rf 814,740,394 in the 2013. With the changes in the policies regarding the removal of the ceiling, the study was done to assess the financial sustainability of the scheme if the ceiling is removed. And the results shows that the removal of the Rf100, 000 ceiling will affect the financial sustainability of the scheme.