Download - The study on social impact of free health service in Sri Lanka

THE STUDY ON SOCIAL IMPACT OF FREE HEALTH SERVICE IN SRI LANKA

R Kumudesh1 K Mathotaarachchi2

1In-Charge Medical Laboratory TechnologistNational Hospital, Colombo

2 Senior LecturerInstitute of Human Resource Advancement

University of Colombo

International Research Conference 2013 [email protected]/UoC

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Overview • Introduction• Back ground• Research questions• Method and Data Collection• Data Interpretation• Conclusions • Recommendations


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Introduction• Better health is the basis of human happiness and

well-being. • Health services are diagnosis, Treatment and heath

promotion, maintenance and restoration of health. • Primary health care is the most widely concerned

component


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Background• Sri Lanka principally accepts the free health concept

with government allocations• The gap of government health expenditure and the

total health expenditure shows the problem of sustainability of free health

• This indicates several problems at government hospitals for healthcare needs and health development in community


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Research questions• Identify the disparity of the health policy and

obstacles to obtain free healthcare facilities from state sector healthcare institutions

• Identify the Health financing issues • Identify the problems related to this disparity of

health policy and healthcare services


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Method and Data collectionPrimary data collection

• Questioner with 16 questions was the primary data collection instrument of this research.

• Western province was considered • 40 OPD patients from NHSL (Colombo district), BH

Nagoda(Kaluthara district) and BH Gampaha (Gampaha District) with verbal informed consent.

• Estimated sample size was 120 and actual sample size was 105 and incompletely answered (for more than 50% questions) were rejected.

• Over 20 years people with no gender bias.


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• Collected from Annual reports, country reports and statistical reports available in data bases

• Used to interpret the underlying health issues of this problem and results of primary data analysis.

• World Health Organization (WHO)Statistical data and Ministry of Health reports were used to ensure the reliability and responsibility of the resource.

Method and Data collectionSecondary data collection


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Data Presentation• Primary data represents 70% of males and 30% of

females. • 21% of sample population was less than 35 years • 56% was in between 35 and 55 years. • 23% was more than 55 years.• Private sector occupied proportion was 40%.

Government sector occupation was 34% • Majority of sample population represents the sub

urban living style which is standing for the country status.


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• Only 74 respondents (70%) had previous hospitalization experience.

• Out of this, 47% have admitted in government hospital

• 24% have both government and private hospital experiences.

• 29% have private sector experience only.

Data Presentation Count..


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Availability of facilities in hospitals• Less than 20% of

patients are provided all services at the hospital indicating miss match with customer expectation of quality health service.

• More than 40 % move toward private sector as they were unable to fulfill their needs at the time they required , indicating poor quality service in health

Reasons for moving for private sector

Availability of drug and test facilities


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Utility of health sectors by different income levels

Relationship of utility of health sectors for routine health needs

by different income levels of the population

• Lowest income level also totally not utilized free health only about 20% utilizes totally free health. Most of all income levels utilize both private and government health services.

• But hospitalization in government hospitals is considerably high in all income levels

• It is due to hospital charges at an admission is mostly unaffordable


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Utilization of Health Services for NCD The use of preventive

health care services indicates a problem in NCD policy as the utility of NCD preventive services is poor

This indicates only 28% population with NCD move towards government health sector totally which is the area more prioritized.

contribution of health services for NCD

Utilization of health services for NCD


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Out of pocket expenditure• Even the people who are

under 30000 monthly income also spent 80% of income for their health needs

• It shows the failures for quality health service in government hospitals

• Out of the respondents who utilize the private health care services 78% pay their expenditure from out of pocket.

Percentage of out of pocket expenditure in different income levels

Mode of payments for health


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Secondary Data Analysis Public health

expenditure is always less than 50% of total health expenditure during last15 years.

Only 51% of total health expenditure is spent by government funds and NGO/other donations.

44% of the total health expenditure is financed by out-of-pocket payments.

Share of total health expenditure (Source: WHO National Health Accounts, 2002)

Public health expenditure (% of Total Health expenditure)(Source: WHO National Health Account, 2010)


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Government Health expenditureof total health expenditure

General Government Expenditure on Health 2009

(Percentage of Total expenditure of Health)• Cuba - 92.7% (Rank 5)• Japan - 82.3% (Rank 22)• Maldives - 60.7% (Rank 79)• Mongolia - 54.8% (Rank 92)• China - 52.2% (Rank 100)• Sri Lanka - 46.2% (Rank 115)• Singapore - 36.6% (Rank139)• Pakistan - 34.8% (Rank 143)• India - 30.3% (Rank 148)GDP % of total health expenditure (1).pdf

• Sri Lanka is in 115th position According to the ranking of countries by the percentage health expenditure.

• Many countries even without free health policy have become front with percentage health expenditure.

(Source: www.globalhealthfacts.org)


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Conclusion• All income levels of the society utilizes private

sector for their health care needs. • Most of people who utilize the private sector pay

their bills out of pocket. • These evidences indirectly show the disparity of

free health policy and the nature of persisting health care service.

• massive complication in policy decisions with under strengthen economy and community expectation for free health service


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Recommendations• Health financing policy planning, implementation,

management, and analysis requires good knowledge of health financing issues

• In order to improve the health financing system country needs to adapt for the changing situation and rearrange their health financing system.

• Complete understand on this complicated underlying reality of health should be concerned in provision of sustainable health care service through realistic health planning.

• Traditional health system should be replaced with new health policies to utilize resources more effectively.


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Thank you !

Download - The study on social impact of free health service in Sri Lanka

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