Have out‐of‐pocket health care payments risen under free health care policy? The case of<scp>S</scp>ri<scp>L</scp>anka

Pallegedara, Asankha; Grimm, Michael

doi:10.1002/hpm.2535

Cited by 12 publications

(19 citation statements)

References 44 publications

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“…Because of the limited scope and high cost of private sector facilities, government hospitals, clinics and other peripheral services must cater to a larger proportion of the healthcare demand coming from general public (World Bank, 2013). The resource constraints faced by the government sector result in it facing numerous issues such as shortage of medicines, limited access to specialist treatment and inconsistent service standards (Pallegedara and Grimm, 2018).…”

Section: Introductionmentioning

confidence: 99%

Health insurance ownership and its impact on healthcare utilization

Kumara

Samaratunge²

2019

IJSE

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Purpose The purpose of this paper is to explore the determinants of health insurance ownership of individuals in the Sri Lankan labor force and to examine how insurance ownership impacts healthcare utilization. Design/methodology/approach The authors first used logit model to explore determinants of health insurance ownership. The authors then employed propensity score matching method to estimate impact of insurance ownership on healthcare utilization. Data were obtained from national survey of self-reported health in Sri Lanka – 2014 (n=59,276). National survey of self-reported health in Sri Lanka – 2014 was conducted by the Department of Census and Statistics from January to December 2014. Findings Results showed that individuals with higher educational attainments, headed by literate-heads, based in urban sector, employed in formal sector, and with health adversities and higher degree of risk propensity are more inclined to have a health cover. Health insurance ownership reduces the likelihood of utilizing public facilities while increasing the likelihood of utilizing private facilities for non-communicable diseases (NCDs) and acute illnesses. Welfare consequences of expanding insurance ownership are doubtful due to oligopolistic private healthcare market and adverse selection issue faced by insurers in Sri Lanka. Originality/value This is the first study examining health insurance–healthcare utilization nexus based on Sri Lanka-wide microdata. Also, the study applies bias-corrected matching methods to establish causal links between two constructs. Without being so generalized, healthcare utilization is examined in terms of NCD care and Acute illnesses care, which improves robustness of results and leads to evidence-based healthcare policies. Peer review The peer review history for this paper is available at: https//publons.com/publon/10.1108/IJSE-05-2019-0333.

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Section: Introductionmentioning

confidence: 99%

Health insurance ownership and its impact on healthcare utilization

Kumara

Samaratunge²

2019

IJSE

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“…Findings revealed that medical poverty is high among chronic NCDs. In another study, Pallegedara and Grimm [ 43 ] stressed that older persons are more inclined to suffer from chronic diseases. The two-part model based on the 2012/2013 household survey was carried out to examine the association of NCD-prevalence and healthcare utilization with household consumption [ 44 ].…”

Section: Literature Reviewmentioning

confidence: 99%

Do chronic illnesses and poverty go hand in hand?

et al. 2020

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In the global context, the health and quality of life of people are adversely affected by either one or more types of chronic diseases. The chronic pain associated with diagnosed patients may include heavy medical expenditure along with the physical and mental suffering they undergo. Usually, unbearable amounts of medical expenses are incurred, to improve or sustain the health condition of the patient. Consequently, the heavy financial burden tends to push households from a comfortable or secure life, or even from bad to worse, towards the probability of becoming poor. Hence, this study is conducted to identify the impact chronic illnesses have on poverty using data from a national survey referred as the Household Income and Expenditure Survey (HIES), with data gathered by the Department of Census and Statistics (DCS) of Sri Lanka in 2016. As such, this study is the first of its kind in Sri Lanka, declaring the originality of the study based on data collected from the local arena. Accordingly, the study discovered that married females who do not engage in any type of economic activity, in the age category of 40–65, having an educational level of tertiary level or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. Moreover, it was inferred that, if a person is deprived from access to basic education in the level of education, lives in the rural or estate sector, or suffers from a brain disease, cancer, heart disease or kidney disease, he is highly likely to be poor. Some insights concluded from this Sri Lankan case study can also be applied in the context of other developing countries, to minimise chronic illnesses and thereby the probability of falling into poverty.

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“…In Sri Lanka, Pallegedara [ 16 ] examined the effects of chronic NCDs on household’s out-of-pocket health expenditures and found that medical poverty is high among chronic NCDs. Pallegedara and Grimm [ 17 ] further highlight that older persons are more likely to suffer from chronic diseases. In order to examine the association of NCD-prevalence and healthcare utilization with household consumption, Kumara and Samaratunge [ 18 ] employed the two-part model using the 2012/2013 household survey and found private healthcare utilization was negatively related with household consumption.…”

Section: Literature Reviewmentioning

confidence: 99%

Chronic diseases: An added burden to income and expenses of chronically-ill people in Sri Lanka

et al. 2020

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In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40–65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.

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Have out‐of‐pocket health care payments risen under free health care policy? The case ofSriLanka

Cited by 12 publications

References 44 publications

Health insurance ownership and its impact on healthcare utilization

Health insurance ownership and its impact on healthcare utilization

Do chronic illnesses and poverty go hand in hand?

Chronic diseases: An added burden to income and expenses of chronically-ill people in Sri Lanka

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