Conclusions and recommendations
This study highlights the complexity of achieving equity even in a country with a fully state-funded universal health coverage. Although the state spends on universal health coverage, Sri Lankan patients incur direct and indirect costs when receiving hospitalized care in government hospitals. Some of these expenses can be avoided if the current system is improved with regards to quality, efficiency and staff training. Health care workers try to minimize the burden of these expenditures in less wealthy patients, but in the process, the patients are deprived of being fully informed about the range of choices in the investigation and treatment of their diseases. The impact of out-of-pocket expenditure is more on pro-poor households, especially among daily paid workers. There was inequity in patient satisfaction and type of care received, which increased the likelihood of the existence of inequity in the overall outcome. Household economic impact of ill-health and hospitalization is seen more in chronic diseases, which are rapidly rising in Sri Lanka.