3.7 Payment mechanisms

3.6.2 External sources of funds The contribution of external sources is approximately 1% of CHE. This constitutes grants and loans from developmental partners and bilateral agreements.

3.6.3 Other sources of financing Sri Lanka does not receive any other regular financial support of any significance from other sources.

3.7 Payment mechanisms

3.7.1 Paying for health services Line item budgets are allocated for different services, i.e. hospitals, public health programmes, training institutes and administration. Further, these budgets are categorized under recurring and capital, purchase of medicines and supplies, laboratory services and administration and are listed separately in the annual budget.

Budget allocation is based on the allocation of earlier years and incremental calculations, where each year, unless there is a very specific need or item, the previous year’s budget is increased by a percentage without taking into account the actual figures of consumption or the outputs delivered.

The private sector operates on different terms and the payments are generally based on actual outputs to be delivered and on the overall business strategy.

3.7.2 Paying health workers Payment mechanisms for health workers differ between the government and private sectors. The government employees get a fixed salary as per their scheme of recruitment, salary code, educational background, grade and duration of service. The government system also pays staff for working extra duty hours based on the rates applicable to the service category and grade of service.

There are no payments given based on capitation or fee for service as provider incentives and all payments strictly adhere to the well-established government financial regulations.

Private sector employees receive payments based on whether they are working full time, part time or on a fee-for-service basis. The emoluments could vary depending on the demand and supply of the specific category of staff. Further, compensation in the private sector is subject to variation, mostly on the basis of performance.

A significant number of MOs work both in the government and private sectors, the latter being after duty hours. This is known as dual practice or moonlighting. In the private sector, they would work on a fee-for-service basis, i.e. the number of patients seen or procedures performed.