3.3 Overview of the public financing schemes

could be due to the disease profile, number of health-care institutions in the province and the population.

3.3 Overview of the public financing schemes

3.3.1 Coverage

3.3.1.1 Breadth: who is covered?

Sri Lanka holds a unique position in South Asia as one of the first to provide universal health, free education, strong gender equality and a better opportunity for social mobility for its citizens since Independence in 1948 (Samarage, 2006). Sri Lanka has an extensive network of healthcare institutions and patients have the freedom to choose between the state and private sectors. The HIES (2016) reveals that 90% of inpatient visits and approximately 45% of all outpatient visits are to the government sector facilities. While the upper wealth quintiles are seen to opt out and access private health care often, what is notable in the Sri Lankan context is that many persons access both sectors, and that even the lower wealth quintiles access the private sector for outpatient care and the richer quintiles the public sector for inpatient care (Department of Census and Statistics, 2018a). The government health system provides a safety net, but despite the intention to cover all citizens, disparities may arise due to the accessibility and availability of services, medications and investigations. Although health services are universal and therefore entitlement is for all, subnational variation is observed in accessing health services.10 Further, disparities in health-seeking behaviour may exclude certain populations. Attempts to cover all people are seen by the gradual expansion of health-care programmes dedicated to specific target groups, e.g. estate, urban sector, the elderly, youth, adolescents and, more recently, the focus on migrant populations.

Females show better health-seeking behaviour than males and have a larger number of interactions with the health services, some of which can be attributed to a well-organized maternal care service. This difference between males and females is reflected in the percentage of males over 18 years who had never measured their blood sugar level (58.4%) as compared to the percentage of females (43.1%) (World Health Organization, 2015). Similarly, only 65.7% of males previously diagnosed were currently taking medication prescribed for diabetes, as compared to 73.1% of women.

Sri Lanka is still in the process of reorienting health services to cater for the emerging needs of its population due to demographic, epidemiological and social transitions (refer Chapter 6). Strengthening primary care is considered a timely intervention to expand coverage.