The Auditor General has recommended introducing a co‑payment system for Maldivians receiving medical treatment abroad under the Aasandha scheme, requiring patients to contribute a portion of the total bill instead of the state covering all costs.
The recommendation is part of the performance audit of the Social Health Insurance Scheme, released Tuesday. The audit reviewed the period from 2019 onward and found that the government spent MVR 35 billion on medical treatment over six years, an average of MVR 5.9 billion a year.
The report highlights several systemic issues, including the ability of visiting doctors to refer patients overseas and the rapid rise in Aasandha expenditure. According to the audit, spending on overseas treatment has increased steadily, with MVR 1.6 billion spent abroad between 2019 and 2024, averaging 14 percent of total Aasandha spending annually.
Alongside identifying these challenges, the audit recommends several reforms. Chief among them is the introduction of a co‑payment mechanism for overseas treatment, where patients would pay a percentage of the total cost. The report also calls for increasing individual responsibility among patients to ensure more responsible use of the scheme.
Aasandha coverage board outside a pharmacy.
Another key recommendation is strengthening domestic healthcare capacity to reduce reliance on treatment abroad. The audit notes that many cases continue to be referred overseas despite the availability of facilities in the Maldives. This, it says, is likely due to delays in implementing agreements with foreign hospitals to develop local services, as well as a lack of public confidence in treatment available within the country.
Aasandha services have long been available in hospitals across India and the Maldives. President Dr. Mohamed Muizzu has pledged to expand the service to Bangkok and the UAE, while the government has recently added the Philippines to the list of countries where Maldivians can access Aasandha. The scheme is already available to Maldivians living in India, Sri Lanka and Malaysia.