Expensive drugs - Out of Stock Laboratory investigations – from outside lab Consultancy – Limited Surgeries – Waiting lists 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. tions

1. Contemporary Issues in
Free Health Service, Sri Lanka
Ravi Kumudesh
BSc (Mgt.) /Dip (MLT) PG Dip (Ex.Mgt.)

2. Organic System
Management Service Provision
Organization
Resource Inputs Financial Support

3. Health Indicators
Life expectancy at birth 73 years
Infant Mortality Rate 14.35 / 1000 LB
Hospital beds 3.6/1000 p
Total bed strength 69,501
Government Hospitals 1042
Private Hospitals 115
Doctors: 2,300 p/Doc.
Nurses: 826 p/Nurse
Source: WHO/2011

4. Health Problems
Malnutrition
Rapid increase in noncommunicable diseases
Violence 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.

5. Is Sri Lanka investing enough in health?
NHE/GDP% NHE/GDP%
• Sri Lanka 3.2% • UK 6.8%
• Philippines 3.6% • Canada 9.2%
• Thailand 3.7% • Australia 8.3%
• Bangladesh 3.9% • Japan 7.5%
Source: WHO/2011

6. Health Expenditures
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)

7. Free for All ???
Government 49% Who pay for this
NGO 4%
Its only 53%
Left behind 47%

8. Who Pays?
1% 2%
Taxes
44%
49% Employers
Out of pocket
Insurance
NGOs
4%
Source: Annual Health Accounts, Ministry of Health 2002

9. Contemporary issue
Expensive drugs - Out of Stock
Laboratory investigations – from outside lab
Consultancy – Limited
Surgeries – Waiting lists
Mentality – Free, Free, Free, & Free
Reality – Pay, Pay, Pay, & Pay

10. Conflict 01
Belief of the community and the reality
Think of 100% free health care service
No personal budget for health
No proper system to recover the expenditure
Satisfy with what the government offer
Ignore the personal responsibility
Neglect the health issues

11. Conflict 02
Basis of health policies and the practice
Policies are to be “free for all”
No sufficient budget allocation
No proper system to recover the expenditure
Paralyze the policies and frame work
Unorganized dependence on private sector
Both government and community pay for
health with no plan

12. 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.

13. 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.

14. Thank You !