de Silva Amala, Ranasinghe Thushara, Abeykoon Palitha
Department of Economics, University of Colombo, Sri Lanka.
World Health Organization Country Office, Colombo, Sri Lanka.
WHO South East Asia J Public Health. 2016 Sep;5(2):82-88. doi: 10.4103/2224-3151.206257.
With state-funded health care that is free at the point of delivery, a sound primary health-care policy and widespread health-care services, Sri Lanka seems a good example of universal health coverage. Yet, health transition and disparities in provision and financing threaten this situation. Sri Lanka did well on the Millennium Development Goal health indicators, but the Sustainable Development Goal (SDG) for health has a wider purview, which is to "ensure healthy lives and promote well-being for all at all ages". The gender gap in life expectancy and the gap between life expectancy and healthy life expectancy make achievement of the health SDG more challenging. Although women and children do well overall, the comparative health disadvantage for men in Sri Lanka is a cause for concern. From a financing perspective, high out-of-pocket expenditure and high utilization of the private sector, even by those in the lowest income quintile, are concerns, as is the emerging "third tier", where some individuals accessing state health care that is free at the point of delivery actually bear some of the costs of drugs, investigations and surgery. This cost sharing is resulting in catastrophic health expenditure for individuals, and delays in and non-compliance with treatment. These concerns about provision and financing must be addressed, as health transition will intensify the morbidity burden and loss of well-being, and could derail plans to achieve the health SDG.
凭借在提供服务时免费的国家资助医疗保健、完善的初级卫生保健政策以及广泛的医疗保健服务，斯里兰卡似乎是全民健康覆盖的一个良好典范。然而，健康转型以及在服务提供和融资方面的差距正威胁着这种局面。斯里兰卡在千年发展目标的健康指标方面表现出色，但健康领域的可持续发展目标（SDG）涵盖范围更广，即“确保所有人在所有年龄段都享有健康生活并促进福祉”。预期寿命方面的性别差距以及预期寿命与健康预期寿命之间的差距，使得实现健康领域的可持续发展目标更具挑战性。尽管总体而言妇女和儿童情况良好，但斯里兰卡男性在健康方面相对处于劣势，这令人担忧。从融资角度来看，高额的自付费用以及私营部门的高利用率（即使是最低收入五分位数人群）令人担忧，新兴的“第三层”情况同样如此，即一些享受在服务提供时免费的国家医疗保健的个人实际上要承担部分药品、检查和手术费用。这种费用分担导致个人出现灾难性医疗支出，并造成治疗延误和不依从。必须解决这些关于服务提供和融资的问题，因为健康转型将加剧发病负担和幸福感的丧失，并可能使实现健康领域可持续发展目标的计划脱轨。
