Reimagining Aasandha: proposed reforms to ensure long-term viability and transparency

Although living in the Maldives has several benefits, one of the biggest benefits that many point out that Maldivians receive from the Government is the national insurance coverage from Aasandha. With the introduction of Aasandha, the Maldives’ healthcare became more affordable for citizens, who can claim Aasandha coverage both locally as well as from any medical institute that covers the Aasandha scheme abroad. This has led to easy and affordable access to often expensive healthcare such as major operations which are accessible from both Maldives and countries like India and Sri Lanka. 

While Aasandha provides crucial healthcare services to citizens without any direct financial burden on them, it poses significant challenges for the Government. The cost of funding Aasandha has been steadily increasing, and despite raising the budget every year to keep up with demand, it continues to fall short of what is required. This leads to a situation where the Government is forced to cover expenses that far exceed the initial budget. The gap between allocated funds and actual expenditure has grown over time, creating a persistent financial strain. 

Moreover, with healthcare costs rising globally and more citizens utilizing Aasandha for both local and overseas treatments, the government's financial responsibility becomes even heavier. As a result, maintaining the program at its current level has become an ongoing challenge. The increasing pressure on the national budget raises concerns about the long-term sustainability of Aasandha and the potential need for reforms to ensure its continued viability. 

Thus, while the program remains a vital component of the nation’s healthcare system, its financial implications on government resources cannot be overlooked. With this, the Government has started seeking out measures to manage finances related to Aasandha better - a much-needed step as the Maldives seeks out measures to reduce the country’s debt and increase its revenues. One of the proposed changes to better manage the Aasandha budget is to first deduct the billed amount from any private insurance coverage held by the patient before Aasandha steps in to cover the remaining costs. This approach offers several benefits.

Firstly, it reduces the immediate financial burden on the government, as Aasandha would only cover expenses that exceed the limits of private insurance policies. This allows the government to allocate its resources more efficiently and focus on those who do not have access to additional coverage. By minimizing redundant expenses, this policy could help curb the program’s over-budget expenditures and improve its long-term sustainability. Additionally, this change would also enhance transparency in the healthcare billing process - which had been a recent issue that was raised. With private insurers playing a more active role, there would be stronger oversight of healthcare expenses, reducing the potential for overbilling or unnecessary treatments, which can inflate Aasandha’s overall cost.

In addition to this, the Anti-Corruption Commission (ACC) has also recommended that Aasandha coverage be tailored based on the financial means of patients. This suggestion was made following the release of a report titled "Corruption Risk Assessment of the Health and Welfare System," which identified several practices within the current framework that could lead to corruption and the potential for certain parties to reap undue benefits. 

The ACC advised relevant authorities to explore the feasibility of transitioning Aasandha into a system that could either be contributory or non-contributory, depending on a patient's financial situation. Such an approach would not only help curb corruption but also ensure that Aasandha remains financially sustainable in the long term. By considering financial means, the program could be better targeted to support those who need it most, while encouraging higher-income individuals to contribute more towards their healthcare costs. This would balance the system and prevent misuse of government resources, preserving Aasandha’s core mission of universal healthcare.