Free healthcare: Does it have to be?
Around 100,000 patients receive treatment either on outpatient or inpatient basis per day at the National Hospital of Sri Lanka. That is a staggering number for a single institution to bear in a country where healthcare is free of charge. The financial burden on the country to offer its citizens free health is immense. In spite of that great financial burden, we take pride in knowing the fact that we have a free health system in Sri Lanka.
Health indices like the maternal and infant mortality rates are regarded as indicators of the quality of healthcare delivery in a country. Sri Lanka has the lowest rates of maternal and infant mortalities not only in the region but even on par with developed countries like England.
We have attributed the superior health indices in our country to the fact that health is provided completely free, which I feel is a misconception. Giving free drugs and health services does not improve health indices. Superior health indices in Sri Lanka are due to its well planned public health delivery structure starting from the grass-root level of midwives who provide an invaluable service going door to door in rural areas.
Low maternal and infant mortality rates are indicators of the efficiency of that structure. We should not be under the illusion that giving free drugs to people have resulted in world class health indices in our country. If anything, I feel that free health is deleterious to building a healthy nation.
Anything given away free is taken for granted and its value never appreciated. People are not bothered about health risks because they can always get free drugs from a government hospital. A person getting a bypass surgery free (costing millions in the private sector) after a heart attack goes back to smoking after surgery because the value of it is less when it is free of charge.
A young man after a motorbike accident spending a couple of weeks in the Intensive Care Unit (the bill in a private hospital ICU would’ve been in millions) goes back to riding bikes without a helmet, In this background, the critical question is, does healthcare have to be free? I feel the answer is – Not completely. If 10 rupees is charged from a patient who receives treatment at the National Hospital of Sri Lanka per day, the hospital gets one million rupees a day. This could be spent on purchasing essential drugs which are in shortage from time to time. Thus, patients do not have to buy them from outside.
This is what ten rupees can do. Compare that ten rupees with the millions patients have to pay in private hospitals. Intensive care unit (ICU) in a private hospital costs about a Rs.100,000 per day. When we consider all that, ten rupees a day becomes very trivial indeed. Then why aren’t we charging at least Rs.10 from a patient? Is it because we want to keep the “free health” tag and brag about it? Why don’t we go for a much better quality of service for a nominal fee? It’s about time health authorities and legislators take this into serious consideration.
(The writer is a
doctor attached to the National Hospital in Colombo).
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