Public sector hospitals offer better treatment and inpatient care than private hospitals – study
View(s):A study published by the Institute for Health Policy in 2015 concluded that the quality of treatment and management of inpatient care was actually better in the public sector despite being available at a lower cost, according to a study.
According to the same survey, the quality of assessment and investigation was more comparable across the two, the report noted.
Meanwhile an industry report said Sri Lanka’s total healthcare expenditure as a percentage of total GDP is one of the lowest in the world at 3.24 per cent (as of end-2013).
“Only 44 per cent of this was spent by the government despite a free universal health care system. Patients who are treated at state hospitals are still required to obtain certain drugs and medical tests at their own expense, which has resulted in private healthcare spend remaining above government spend,” a Fitch Ratings report on Sri Lanka’s private sector hospitals said. Of the private spend, 83 per cent constituted out-of-pocket spend as medical insurance penetration is still at a very nascent stage in Sri Lanka, according to this report.
Yet healthcare per capita in Sri Lanka is significantly higher than in most other Asian and middle-income countries, the report added. “This is reflected in high hospital bed penetration of 4.0 beds per 1,000 population – much higher than in similar developing countries, and more in line with developed countries where the bed penetration is around 5.0 (2011),” the report said.
“According to data provided by the Central Bank of Sri Lanka, the public sector accounted for 73 per cent of the hospitals and 93 per cent of the available bed capacity in Sri Lanka, while handling over 90 per cent of the total patient admissions and outpatient visits to hospitals as of end 2014.” The private sector consisted mainly of a few leading hospital chains and a large number of small regional players. The capacity concentration was moderate according to the report, with the top five hospitals accounting for some 45 per cent.
The bed penetration is unequal across the country, with 33 per cent of the population having 2 beds per 1,000 people, highlighting the need for expansion in selected densely populated districts such as Gampaha, Kalutara and Kegalle. Most private-sector beds are concentrated in the Western Province due to the higher physician density in the region.
Highlighting some startling numbers, the report said that Sri Lankan hospitals lag against most countries in terms of providers human and technological resources; physician penetration per 1,000 population was 0.9 at end-2014 compared with a world average of 1.49 in 2013; and availability of medical devices such as magnetic resonance imaging (MRI) and computed tomography units (CT scans) was low at 0.4 and 1.7, respectively, per 1,000 population. “Physician distribution is highly skewed towards the Colombo district, while 73 per cent of the population is faced with a physician density much below the national average – highlighting the significant constraint faced by the industry.”
It said that the Sri Lankan hospital sector as a whole – and private hospitals in particular – is strongly positioned to benefit from favourable macro and demographic trends in the country. The administration which came into power in early 2015 has made it a priority to improve the healthcare system, and has allocated 3 per cent of GDP for healthcare in its 2015 budget compared with 1.4 per cent in 2014. “We believe this will provide an incentive for the private sector to boost investment in order to keep pace with the public sector,” the report said.
Sri Lanka has one of the highest and fastest-aging populations in the world. The number of people over 65 years, at 8.7 per cent of the population (2004:6.9%), is expected to almost double by 2030, requiring significant expansion across the board in the healthcare sector, the report said. A special focus is on geriatrics, which most hospitals are not equipped to handle, it said, adding that the private sector would have a large role to play in plugging the demand/supply gap, as government’s capex on healthcare has amounted to only a 4 per cent Compound Annual Growth Rate over the past seven years.
Sri Lanka’s personal care and health expenses have also increased – to 5.3 per cent of total household expenditure in 2013 from 4.3 per cent in 2006 – as people become more health-conscious as income levels rise. Should Sri Lanka continue its current GDP growth trajectory of 6 per cent – 7 per cent annum, it should reach the level of upper-middle-income economies in the next two-three years, the Fitch report said. “Per capita healthcare expenditure has averaged around US$ 465 for these economies (compared with $ 102 for Sri Lanka), highlighting the growth potential for the country’s healthcare sector in the medium term.”