Mining alternative data: What national health insurance data reveals about diabetes in the Maldives
BY Yuko Oaku | November 7, 2018|Comments 0
An island nation consisting of 1,190 small islands, the Maldives is clustered around 26 ring-like atolls spread across 90,000 square kilometers. For many centuries, the Maldivian economy was entirely based on fishing. Tuna is one of the essential ingredients in the traditional dishes of the archipelago. But between 1980 and 2013, the GDP per capita increased from $275 to $6,666 due to the success of the high-end tourism sector.
With the rapid economic growth and a wave of globalization, there have also been changes in the dietary preferences and lifestyles of Maldivians. A staggering 30 percent of the Maldivians are overweight due to unhealthy diets and lack of physical activity, according to data from the Global Health Observatory.
Consuming sugary beverages is also a big problem among Maldivian youth and young adults. According to a study by the World Health Organization, in 2015, 4.7 million litres of energy drinks were imported to the Maldives, which is a very high volume for such a small population (around 410,000 people live in the Maldives). These unhealthy habits are drivers for the increase in non-communicable diseases, such as cardiovascular, cerebrovascular and hypertensive disease. These diseases are the main causes of death among Maldivians. According to the National Health Statistics from 2014, diabetes is ranked as the ninth overall cause of death in the Maldives.
Analyzing the prevalence of Type II diabetes with Insurance Data
All Maldivian nationals are covered under the Government’s universal health insurance plan called “Aasandha”. Since it began its services in 2012, the plan gives full coverage to all health services from most health care providers and up to a certain amount for some of the private health care providers. The plan also covers care in affiliated hospitals in neighboring India and Sri Lanka in case the treatment is not available in the Maldives.
Aasandha data provides personal data records and insurance data for all Maldivians. Since the usual data source for non-communicable diseases is the Demographic and Health Surveys, which is carried out every 6 years (most recently in 2015 and before that in 2009), we thought we could get more up-to-date data on diabetes if we looked directly at the health insurance data.
Our team assumed that analyzing this data would serve as proxy indicators for the SDG indicators 3.8.1: Coverage of essential health services. Initially, this indicator was labeled as Tier 3 indicator, meaning that no internationally established methodology or standards were yet available for the indicator. As of 11 May 2018, however, 3.8.1 has been upgraded to Tier 2 indicator, which means that the indicator is conceptually clear, has an internationally established methodology and standards are available, but data are not regularly produced by countries.
Our idea was to have an anonymized look at the data from the universal health insurance plan to see what else we could learn about non-communicable diseases. We at the UN Country Team in the Maldives, UNDP and WHO, partnered with the Maldives National University (MNU) research team and with the National Social Protection Agency (NSPA), the custodian of Aasandha service in the Maldives.
What we found out about Type II diabetes in the Maldives:
We dug into the anonymized health care records for 2016, including information about:
1) what diseases the Aasandha coverage is used for
2) the cost
3) where the medical procedures take place
Together with the research team, we decided to focus on Type II diabetes for the scope of this study. We found some interesting facts about the prevalence of Type II diabetes in the Maldives:
- More than 3 out of every 5 people who have diabetes are women. The mean age of patients with Type II diabetes is 57, while the youngest age is 13.
- Females get diagnosed with Type II diabetes at a younger age compared to men and there is a relationship with gestational diabetes.
- Of those seeking care, 79 percent of the people go to private health care providers, whereas only 21 percent seek services from public health care providers.
We also discovered that the Aasandha data was also incomplete. For instance, there were missing records from some of the largest regional hospitals in most populated atolls in the country. This may suggest that data from government hospitals are not entered into the system because patients don’t need to make a claim for the payment, whereas in private hospitals, the data is needed to allow patients to make a claim for their payment. It could be that more people are using public health care providers, but since the data is not entered into the Aasandha system,this information is unavailable to us.
Next frontiers in proof of concept for alternative data
With this pilot study we found some interesting facts about the prevalence of Type II diabetes in the Maldives as well as some possible data gaps in the Aasandha insurance data. We will be sharing our findings and challenges of using Aasandha data with the members of the UN Country Team as well as relevant ministries and agencies, including the Ministry of Health and the National Social Protection Agency.
Reflecting on this pilot study, we will continue to support the country to explore alternative sources of data that will enable us to track more SDG indicators in the Maldives. According to an internal assessment done on data availability for all SDG indicators by the National Bureau of Statistics, there’s currently no mechanism for data generation for 56 indicators and for another 51 indicators, additional efforts will be required to make the data available.
With all this data missing, we’ll need to tap into additional resources to make the data available because if we don’t know where the Maldives stands on Sustainable Development indicators, it’ll be hard to plan to achieve them. There is definitely a need for new data sources and having this data gap in mind, we have another pilot project in the works that’s going to use call detail records data to track population mobility to the urban centers of Male. Stay tuned for more in our work mining alternative data sources for the Maldives!
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- Lars Tushuizen On
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