Withanachchi Nimnath, Uchida Yasuo
Graduate School of International Cooperation Studies, Kobe University, Kobe 6570013, Japan.
Health Policy. 2006 Aug 22;78(1):17-25. doi: 10.1016/j.healthpol.2005.08.009. Epub 2005 Oct 11.
Sri Lanka's tax-financed public health system has played a significant role in achieving high levels of health status for its people. The 21st century brings new challenges in terms of rapidly aging population and increasing prevalence of NCDs. These challenges are expected to place a heavier burden on the government health financing and provision. However, the government expenditure as a proportion of GDP has declined to 1.1-1.2%, the lowest level, since the country's independence in 1948. Available funding is channeled out of the preventive services and primary healthcare to the complex hospitals, contributed by inadequacy of prioritization in resource allocation. Already, there are evidences of high level of under-funding and implicit rationing with higher impacts on the rural poor and the estate poor. Analysis of the government subsidization of healthcare shows shifting of benefits to the urban better-off from the poor. In light of the findings, the paper focuses attention on policy directions the government health sector in Sri Lanka should follow.
斯里兰卡由税收资助的公共卫生系统在为其人民实现较高的健康水平方面发挥了重要作用。21世纪在人口迅速老龄化和非传染性疾病患病率不断上升方面带来了新的挑战。预计这些挑战将给政府卫生筹资和服务带来更沉重的负担。然而，政府支出占国内生产总值的比例已降至1.1%-1.2%，这是该国自1948年独立以来的最低水平。由于资源分配缺乏优先次序，可用资金从预防服务和初级医疗保健流向了综合医院。已经有证据表明资金严重不足和隐性配给，对农村贫困人口和种植园贫困人口的影响更大。对政府医疗补贴的分析表明，福利从穷人转向了城市富裕阶层。鉴于这些研究结果，本文重点关注斯里兰卡政府卫生部门应遵循的政策方向。
