Contemporary Issues inFree Health Service, Sri Lanka

Ravi KumudeshBSc (Mgt.) /Dip (MLT) PG Dip (Ex.Mgt.)

Organic System

Management

Resource Inputs

Organization

Financial Support

Service Provision

Health Indicators

Life expectancy at birth 73 yearsInfant Mortality Rate 14.35 / 1000 LBHospital beds 3.6/1000 pTotal bed strength 69,501Government Hospitals 1042Private Hospitals 115Doctors: 2,300 p/Doc.Nurses: 826 p/Nurse

Source: WHO/2011

Health Problems

MalnutritionRapid increase in noncommunicable diseasesViolence and injuries Dengue and other Epidemics

The above-mentioned problems are compounded for the poor population, with an estimated 25% of the population

below the ‘national’ poverty line and 7% on less than one dollar/day.

Is Sri Lanka investing enough in health?

NHE/GDP%

• Sri Lanka 3.2%

• Philippines 3.6%

• Thailand 3.7%

• Bangladesh 3.9%

NHE/GDP%

• UK 6.8%

• Canada 9.2%

• Australia 8.3%

• Japan 7.5%

Source: WHO/2011

Free for All

Total Health Expenditure - US$ 632 Mn. (1.92% of GDP)

Per Capita Expenditure on Health - US$ 31.58

Expenditure on Health - 4.1% of total govt. expenditure

Human Development Index (HDI) - 0.751 (2005)

Health Expenditures

Government 49%NGO 4%

Free for All ???

Who pay for this

Its only 53%Left behind 47%

49%44%

4%

1% 2%

Taxes

Employers

Out of pocket

Insurance

NGOs

Who Pays?

Source: Annual Health Accounts, Ministry of Health 2002

Contemporary issue

Expensive drugs - Out of StockLaboratory investigations – from outside labConsultancy – LimitedSurgeries – Waiting lists

Mentality – Free, Free, Free, & Free

Reality – Pay, Pay, Pay, & Pay

Conflict 01

Think of 100% free health care serviceNo personal budget for health No proper system to recover the expenditureSatisfy with what the government offer Ignore the personal responsibilityNeglect the health issues

Belief of the community and the reality

Conflict 02

Policies are to be “free for all”No sufficient budget allocation No proper system to recover the expenditureParalyze the policies and frame work Unorganized dependence on private sectorBoth government and community pay for health with no plan

Basis of health policies and the practice

Conclusion

Either government should allocate

the 44% out of pocket fraction through a sustainable budget

or systematic approach to

manage the 44% out of pocket fraction to achieve the health care goal.

Recommendations

√Categorize and prioritize the free health care services according to the economic status of the community.

√Introduce government health insurance system with turn over to the health beneficially.

√Develop competitive government health institutes with cost effective service for the community who look for conveniences.

√Regulate the private sector to make income serving poor class.

√Approach to change the traditional health aptitude of free health service.

Thank You !