Study on social impact of free health service in Sri Lanka Ravi Kumudesh(kumudeshr@gmail.com) Statistical data and the sense of community show a gap of total health expenditure and public health expenditure. This gap shows the problem of sustainability of free health and has created several problems on patients who visit the government hospital for their healthcare needs and health development in community. This study is focused to clear out the disparity of the health policy by identifying the obstacles to obtain free healthcare facilities from state sector healthcare institutions, and to clarify evidently the circulation of additional amount of money in health service other than public health expenditure creating problems of free health service. Questioner was the instrument used in primary data collection. Responses were analyzed with income levels. Availability of hospital facilities, mode of spending, utility of private and government health facilities, aptitude on current health trends and prevention healthcare were surveyed. Secondary data analysis also carried out based on WHO reports, reports of Ministry of Health and other international reports. Primary data indicated inadequate facilities in state hospitals. Out of admitted patients 72% were requested some drugs and laboratory tests from outside. Every respondent spends some amount of money monthly for their health needs, even among low income levels. Only 21% was alert on preventive health care. Out of the respondents who utilize the private health care services 78% pay their expenditure from out of pocket. It includes both people with high income levels as well as low income levels. Secondary data analysis could justify the present situation of the country health. Public health expenditure share of total health expenditure is always less than 50%. The research realized that all income levels utilize private sector for their health care needs. Most of people who utilize the private sector pay their bills out of pocket. These evidences show the disparity of free health policy and the nature of persisting health care service. Complete understand on this complicated underlying reality of health should be concerned in provision of sustainable health care service.

1. THE STUDY ON SOCIAL IMPACT OF FREE
HEALTH SERVICE IN SRI LANKA
R Kumudesh1 K Mathotaarachchi2
1In-Charge Medical Laboratory Technologist
National Hospital, Colombo
2 Senior Lecturer
Institute of Human Resource Advancement
University of Colombo

2. Overview
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Introduction
Back ground
Research questions
Method and Data Collection
Data Interpretation
Conclusions
Recommendations
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3. 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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4. 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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5. 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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6. Method and Data collection
Primary 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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7. Method and Data collection
Secondary data collection
• 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.
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8. 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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9. Data Presentation Count..
• 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.
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10. Availability of facilities in hospitals
Availability of drug and test facilities
• 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
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11. Utility of health sectors by different income levels
• 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
Relationship of utility of health sectors
for routine health needs
at an admission is mostly
by different income levels of the population
unaffordable
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12. Utilization of Health Services for NCD
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
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13. Out of pocket expenditure
Percentage of out of pocket expenditure
in different income levels
• 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.
Mode of payments for health
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14. Secondary Data Analysis
Public health expenditure (% of Total Health expenditure)
(Source: WHO National Health Account, 2010)
 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
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15. Government Health expenditure
of total health expenditure
General Government Expenditure
on Health 2009
(Percentage of Total expenditure of Health)
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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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16. 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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17. 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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18. Thank you !
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