Dr Niyaf's Online Clinic

It is probably a bit too early to start celebrating the proposed launching of another health insurance scheme in the Maldives. The last time this happened, the scheme did not survive long enough. Nevertheless, in these times of desperation, as the proverbial saying goes, we are indeed willing to make an effort to clutch at even a straw.

Some information on the new NSPA (National Social Protection Agency) insurance scheme is available on their website: www.nspa.gov.mv

I was aware of the new scheme being drawn up but have not had any formal information on the scheme provided to. As a practicing Pediatrician, I believe that all medical practitioners must be provided with sufficient information regarding how the scheme works and what medical care are covered under the scheme. It is my belief, not based on any official information, but an expectation based on common sense, that the administrators of the scheme would ensure that detailed information is provided to health-care providers on their role within the program.

Out of curiosity, I browsed through the “covered” medicine list provided on the  agency website. I expected it and was not surprised to find that the list did not include some commonly prescribed medicines. I hope the agency, like other such agencies across the world, would form a scientific body that would evaluate additional medicines (and treatments) for suitability and eligibility in being included in the covered list.

The list of treatments currently not covered by the scheme is also very long. Some of these treatments, after further evaluation of need, cost-effectiveness and effectiveness (among other things), may need to be included in the scheme in the future.

Lets hope, for the sake of the many thousand needy Maldivians, that the scheme lives long enough itself and helps Maldivians live healthier and longer.

Responses & Discussions:

Yasiph wrote:
Do you think the current information at nspa.gov.mv is lacking? if yes, could you provide me with what (as a visitor who happens to be a doctor) feel is missing so tht I could ask nspa to include them. btw, i happen to be the webmaster 

Niyaf wrote:
I think there is a lot of information on the site, but I mustsay that the information is not packaged very well. For instance the information on what an NSPA insured person needs to do when medical care is required is presented within a large PDF file. I assure you that packaging such information within a file of that size will make it virtually inaccesible.

I am also concerned about the lack of English on the site. As you’d be aware of, a large number of health-care providers are expatriates. Having the information (apart from the PDF file, which itself is linked via a dhivehi link) only in dhivehi would be a barrier.

I would also like the site to provide information on what a private service provider would need to do to join the scheme as a provider! What are the criteria by which a center is recognised as eligible to be a Provider?

I am sure you are already looking at ways in which the aesthetics and presentation of information on the site could be improved. I think a FAQ, links to seperately identifiable information (such as information for clients, doctors…..etc) may be useful on the home page (say in a menu)………….. Multiple search options maybe enabled to serach the site for eligibility (whether registered - as already present  on the site but not on the home page), whether a certain treatment is covered or not………identify and name a complaints handling officer (with contact info and procedure for contact or complaint) on the site too.

As I have said in the main post, it would be a good idea to present the scheme and its mechanisms to the Providers so that problems could be avoided. The prescription system would need to be changed too……the current system does not provide extra copies as the scheme says we must.

On the essential drug list (or covered drug list): it would be worth having an easily searchable drug list either on the website or as a downloadable application that providers could then install on their office computers.

That was just a quick brainstorming session…….I am sure we could come up with more ideas if we could get more heads together and appropriate time  given.

Good luck with the site management.

Faisal wrote:
I had a brief look through the information provided and the first thing that struck me was, much like you mentioned, whether any doctors were informed or consulted regarding this scheme. Such a program requires consultation with the people who will be providing the service. Can a doctor prescribe expensive treatment because it is ‘free’ for the patient? Can everyone get a CT scan? In some places where the treatment and investigations are free ( like in some regional hospitals), doctors aren’t too limiting in the list of investigations requested. Some doctors who would have limited their diagnostic tools because of the expenses to the patient might not see it as much of a constraint now. 

This raises the question as to where the money will come from. The scheme earmarks a total of Mrf 100,000 for each insured person annually. That it a lot of money, and requires justification when the money will come from the public’s pocket. Should a 70 year old with chronic renal failure and a not so good prognosis have equal claim to the 60 instance of dialysis mentioned? 
There are issues of patient confidentiality as well when the NSPA requires the copies of the medical records for the claim procedure. And in one documents its mentioned that the original prescription should be kept with the pharmacist. At a time when there are no provisions made to ensure patient confidentiality, this will raise serious issues. 
it is interesting to note that treatment for psychiatric problems in not covered in the scheme when more than half the patients visiting the OPD have some form of symptom related to psychiatry. 

These were few things that caught my attention and I am curious as to what position MMA has on the scheme

Niyaf wrote:
I too wonder what the medical association thinks about the scheme!
This looks to me like a very hastily “copied” system of insurance. I guess the authors didn’t want to copy everything from the “certain” overseas scheme that they evaluated.