Aasandha costs projected to reach MVR 4bn next year, audit finds

Spending under the national health insurance scheme, Aasandha, is projected to increase by 62 per cent to MVR 4 billion next year, according to an audit report.

The Auditor General’s Office released its performance audit of the Aasandha scheme on Tuesday. The report stated that the increase in expenditure has created challenges for the scheme’s long-term financial management.

The audit highlighted the need for timely settlement of bills to maintain the financial position of the scheme and to sustain the confidence of service providers. It noted that by the end of 2024, outstanding payments under Aasandha exceeded MVR 640 million, with the amount increasing by an average of seven per cent each year.

Private hospitals told auditors that delays in payments within agreed credit periods increase their operating costs.

The report noted that Aasandha was established as a state-funded health financing system covering the entire population rather than a contribution-based scheme. This structure has led to expenditure exceeding budgeted allocations and has affected the management of the scheme.

According to the audit, total spending on Aasandha amounted to MVR 35.6 billion between 2014 and 2019, averaging MVR 5.9 billion per year. Health services under Aasandha account for 45 per cent of state health expenditure.

From 2019 to 2023, the number of beneficiaries using Aasandha services increased by seven per cent, while expenditure under the scheme rose by 32 per cent.

The audit found that between 2019 and 2024, Aasandha spent MVR 5.5 billion on medicines alone, representing 33 per cent of total scheme expenditure during the period. Spending on medicines increased by 45 per cent overall, with an average annual increase of seven per cent.

Expenditure on overseas medical treatment under Aasandha has also increased. From 2019 to 2023, MVR 1.6 billion was spent on treatment abroad. Average annual spending on overseas treatment rose by 14 per cent during the period.

The report identified several factors contributing to this increase, including the expansion of Aasandha service centres outside the Maldives, cases being referred abroad without documentation showing that treatment was unavailable domestically, and use of the referral system for visits to doctors overseas.

To improve sustainability, the audit recommended ensuring that the scheme is designed and operated in line with legal requirements. It also advised measures to reduce repeated diagnostic testing at multiple centres and to address variations in pricing for similar health services across providers.