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.