Aasandha Health Insurance Expenditure Reaches MVR 35.8 Billion Over Five Years, Audit Finds
A performance audit shows MVR 35 billion was spent on health services under Aasandha | Photo: MV+
The Auditor General’s Office has released a performance audit of the Aasandha health insurance scheme, revealing that the state spent more than MVR 35 billion on health services and medical treatment between 2019 and 2024.
This includes both expenditure under the Aasandha scheme and spending outside the scheme, averaging MVR 5.9 billion annually.
The audit found that Aasandha is the second-largest component of the state budget after hospitals, with MVR 16 billion spent under the scheme alone over the five-year period. While the number of people receiving Aasandha services increased by seven per cent, expenditure under the scheme rose by 32 per cent during the same period.
Medicines were identified as the largest cost driver, with the scheme spending an average of MVR 924.8 million per year on drugs, increasing by approximately seven per cent annually. Private healthcare spending totalled MVR 3.1 billion over the five years, with 83 clinics and two hospitals included under Aasandha. Payments to clinics amounted to MVR 779.8 million, rising by 18 per cent annually.
Visiting doctors are allowed to refer patients for overseas treatment, contributing to high foreign medical costs. Overseas treatment expenditure reached MVR 1.6 billion between 2019 and 2024, despite the availability of specialists in the Maldives for many of the conditions commonly treated abroad. Plans to develop local medical specialties through agreements with foreign hospitals have not yet been implemented.
The audit projected that Aasandha expenditure could reach MVR 4 billion by 2027, a 62 per cent increase compared to 2019. It also found that the scheme is not operating fully in line with legislative requirements. The report noted that implementing a premium-based insurance model, as mandated by law, could have reduced 2023 expenditure by MVR 1.6 billion.
To address rising costs, the Auditor General’s Office recommended introducing a Maximum Retail Price system to control medicine prices, a co-payment system for overseas treatment to increase individual responsibility, targeted subsidies for those most in need, and research into common conditions treated abroad to support preventive health measures.
