Changes in access to and costs of overseas treatment after the introduction of universal health coverage in the Maldives: Findings from surveys and the analysis of claims data

Abstract

Background

Shortages in resources for health and health service delivery in small island states make it inevitable for islanders to seek medical treatment out of the country. This study aimed to assess the changes in access to treatment overseas and its disparities before and after universal health care was introduced in 2012 in the island state of Maldives.

Methods

Using primary and secondary data, two analyses were performed: 1. Analysis of beneficiary data on public subsidy for medical treatment overseas 2010–2013; 2. A comparative analysis of two independent cross-sectional surveys conducted in 2010 and 2013. Public subsidy, financial protection, usage, and costs of medical treatment overseas were analyzed using descriptive statistics and the concentration curve and index.

Results

Number of beneficiaries subsidized for treatment overseas has increased by 199% and the average expenditure per beneficiary has increased by 49.7% during 2010–2013. Average number of visits abroad in a year has slightly decreased from 1.6 in 2009 to 1.4 visits in 2013, but among travelers who made more than one trip abroad, average visits remained at 2.7 per year. Median medical costs have increased by 26.9% and the proportion of household spending on overseas treatment in annual household spending has remained around 20% over the years. The proportion of travelers belonging to average households (household spending below $650) has increased by 107%, and the concentration index decreased from 0.08 in 2009 to 0.04 in 2013 indicating a change towards a more uniform distribution of MTO use.

Conclusions

Despite the fact that the objectives of the two surveys differed which may have led to differences in measurements, it can be concluded that UHC has narrowed the gap between the rich and poor in utilizing medical treatment overseas. However, median out of pocket spending on MTO has increased over the years indicating the need to broaden the benefit package of the UHC program. Further research is needed on the most deprived populations who have not accessed care abroad despite the change in the health financing system in the country.