In addition to provincial disparities, inequity also exists in several key domains with regard to allocation of limited financial resources. Disparities in allocation between curative and preventive health care and in allocation to different levels of curative institutions are the main issues in this context. In Sri Lanka, approximately 91% of the CHE was utilized for curative health care while only 4.5% was utilized by the preventive services in 2013. NCDs utilized 35%, while 22% of the CHE was on infectious and parasitic diseases. Nearly 10% of the expenditure was for reproductive health services and 7.7% for injuries (Health Economics Cell, 2016). The most critical gaps identified in the present health-care financing system in Sri Lanka are due to inadequacies of resource mobilization, allocative inefficiencies and weaknesses in financial management. Possible solutions are (i) generate more fiscal space for health through reforming taxation systems, ensuring tax and government revenue as % GDP, and strong political and financial commitment to increase the fiscal space for health (GGHE, as %GGE), (ii) improve allocative efficiency through investment in cost-effective interventions, primary prevention of NCDs such as best buy interventions, effective coverage of key interventions, and (iii) improve effective financial management. The ultimate goal may be to improve equity by enhancing access across all wealth quintiles. To improve access and utilization by upper wealth quintiles, there has to be marked improvement in the “hotel” facilities within government institutions. However, this is a feature that has been compromised in trying to achieve universal access while keeping costs low.
7.3 User experience and equity of access to health care 7.3.1 User experience Sri Lankans can obtain services at any hospital in the country as there is no clear referral policy from primary- or secondary- to the tertiary-care level. The majority of hospitals do not have an appointment system as there is no systematic registration process of patient information with easy retrieval. Patients with acute health care needs are seen by doctors at the outpatient department and they may prescribe medicine/investigations or admit if required (or demanded), regardless of bed status. Any patient with a condition that requires specialist attention is referred to a consultant clinic in the outpatient department and is required to get an appointment from the relevant consultant clinic. Tertiary hospitals have the services of dedicated specialists for the outpatient department, but the majority of the hospital’s clinics are conducted by the specialist and his/her staff attached to a ward.
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