Department of Public Administration, University of Sri Jayewardenepura, Gangodawila-Nugegoda, Sri Lanka.
Department of Management, Monash Business School, Monash University, Menzies Building, Level 11, Clayton Campus, Victoria, 3800, Australia.
Soc Sci Med. 2019 Aug;235:112364. doi: 10.1016/j.socscimed.2019.112364. Epub 2019 Jun 11.
Despite the free public healthcare policy in Sri Lanka, households' out-of-pocket healthcare expenditures are steadily increasing. Parallel to this, there is an emerging private healthcare sector based on a user-pays approach. This study, therefore, examines the relationship between healthcare utilization and out-of-pocket healthcare expenses at household level. Using a double-hurdle model with 42,288 household observations drawn from the household income and expenditure survey (2012/2013 and 2016 waves), we find that out- and in-patient care in public hospitals under 'free healthcare policy' is positively associated with household out-of-pocket healthcare expenses, imposing a significant financial burden on the family budget. This relationship is even greater for utilization of private out- and in-patient care. The recent regulatory and fiscal interventions of the government have favourably moderated this relationship for out-patient care but not for in-patient care. The results recommend introducing public policies to further strengthen the monitoring process for private healthcare sector while ensuring the sustainability of free healthcare policy. The paper provides policy implications for richly categorized out-of-pocket healthcare expenditure and healthcare utilization types.
尽管斯里兰卡实行免费公共医疗政策，但家庭的自付医疗支出仍在稳步增加。与此同时，基于自费模式的私立医疗保健部门也在兴起。因此，本研究考察了家庭层面的医疗保健利用与自付医疗保健支出之间的关系。本研究使用双重障碍模型，利用来自家庭收入和支出调查（2012/2013 年和 2016 年两个波次）的 42288 户家庭观察数据，发现公立医院的门诊和住院治疗与家庭自付医疗保健支出呈正相关，给家庭预算带来了重大的经济负担。而私立门诊和住院治疗的利用情况则更为严重。政府最近的监管和财政干预措施对门诊治疗的这种关系起到了有利的缓和作用，但对住院治疗没有起到这种作用。研究结果建议引入公共政策，进一步加强对私立医疗保健部门的监测过程，同时确保免费医疗政策的可持续性。本研究还为自付医疗支出和医疗保健利用类型的丰富分类提供了政策建议。
