Table 5

Description of public schemes for medical travel in Tuvalu and Maldives

Tuvalu modelMaldives model
Is there a national policy to fund medical travel overseas?Tuvalu Medical Treatment Scheme (TMTS): medical referral scheme with Fiji introduced in 200519 and partner of medical treatment scheme with New Zealand.‘Husnuvaa Aasandha’: universal healthcare programme in the Maldives that subsidises for overseas treatment, introduced in 2012.
How the programme works:
 ApproachMultilateral: government-to-government programme. Other countries participating in the medical treatment scheme with New Zealand are Fiji, Kiribati, Tonga and VanuatuBilateral: government-to-foreign provider programme. Participating countries are the Maldives, India and Sri Lanka.
The Aasandha office is established in Sri Lanka to serve Maldivians seeking treatment in Sri Lanka under the government subsidy.
 GoalProvide access to specialist care not available for citizens in Fiji, Kiribati, Tonga, Vanuatu and Tuvalu. Also provides a visiting medical specialist programme.Provide access to services unavailable in the Maldives.
 Management of the schemeEach country maintains an incountry overseas referral committee (ORC) that manages the scheme, handling all aspects of the referral until the patient arrives overseas.The scheme is implemented by an insurance company, Aasandha Private Ltd at a contracted price of 2750 Maldivian Rufiyah (MRFf per person for the first year (2012)
 FinancingParticipating countries make annual contributions for the scheme through bilateral discussions.Paid directly to the contracted providers through the Maldivian government general revenues on a fee for service basis.
 PurchasingHealth specialists/providers are under contract with New Zealand’s International Aid & Development Agency
Specialist teams from New Zealand are sent to partner countries of the scheme.
Through contracted hospitals in India and Sri Lanka on a fee-for-service basis. Contracts are annually renewed.
Scheduled visits by mobile teams of specialists are done on a regular basis.
 Eligibility (clinical/non-clinical)Referrals are made based on appropriate specialist advice and supported by the participating country’s ORC.
There is good prognosis for the patient living and improved quality of life for at least 5 years after treatment according to clinical evidence and advice.
Overseas referrals are prescribed by a public sector physician.
 ExclusionsChronic cardiac failure, chronic renal failure, chronic lung conditions, chronic neurological conditions and conditions requiring heart, renal or bone marrow transplants are excluded.
Patients who have significant medical conditions other than that for which they are being referred (eg, coexisting renal disease) and/or conditions that will incur ongoing costs that are unable to be met by partner government health funds.
Offers a comprehensive package with few exclusions such as cosmetic surgeries, dental, nutritional supplements, treatments for addictions, counselling, weight loss, abortions, infertility and complimentary medicines.
 Expenses coveredTreatment cost, food, accommodation, small allowance and travel expenses.Treatment costs, tickets for patient and one caregiver.
 Coverage statisticsIn 2013 TMTS spent $A 2.1 million, which is 44.5% of the health budget, where 99 patients (approximately 0.9% of the population) were subsidised by the government.In 2013, Aasandha spent US$ 4.8 million on 3456 visits (approximately 0.9% of the population) that were subsidised for medical travel.
 TradeoffsSacrifices half the health budget that could be used for other health services such as primary healthcare. High out-of-pocket expenditure on medical travel by patients who choose to self-fund their treatments.