Can markets determine quality healthcare? A Sri Lankan perspective
by Janaka Goonetilleke on 14 Aug 2013 1 Comment

Health care is a basic human right that every citizen must be offered in a civilised society. Can commoditisation of health care be the answer to the failure of a state system? Was the state system a failure? Should healthcare be determined by the amount of money you have? Is this moral? Is the system efficient? Should expensive drugs and investigations be rationalised according to the need of the patient and in keeping with the economic status of the country?


These are very pertinent questions that any society should answer, especially as we are seeing the effects of the IMF-instigated reductions on subsidies on healthcare and education, which is gradually taking a toll on the life of ordinary citizens, mainly the poor.


I was forced to write this article after listening to the dilemma of a patient who was a retired teacher. She first went to an optician to change her spectacles when she was advised to see an ophthalmologist as her eye pressure was slightly raised. The first ophthalmologist told her she had a cataract and needed surgery. She was not satisfied as her sight was still good. The second ophthalmologist said she had raised eye pressure and needed laser treatment.


Contradictory advice made her see a third ophthalmologist, this time personally recommended by a friend who looked at her and said there was nothing wrong with her.  All this happened in the private sector. The question is, who was right? The patient, fortunately, escaped unnecessary surgery at great expense, but had to pay a big price in terms of consultation fees and waste of time. Unfortunately, no one is accountable for this kind of blatant abuse by the health professionals.


Privatisation of Healthcare


At the instigation of the International Monetary Fund and the World Bank, the subsidy on social welfare has been reduced to such a degree that private health care has vastly grown in Sri Lanka. The markets in health care are geared to profit and earning money. This process that encourages greed can never give humanity genuine health care, as health becomes a commodity geared to earning money.


The simple procedure of doctor-patient relationship is further made worse as markets grow. In the health sector it is not unknown that patients will be charged extra if they don’t come within the quota for the day. Commercialised health care makes it more profitable if you see more patients. So a caring profession that needs a very sympathetic ear and careful examination becomes a five-minute consultation.


Recently, a patient went to see a doctor. He gave the first chit and had a short consultation. Then he produced another chit. When the doctor asked what that was for, he said that is for you to talk. This caused mayhem as the doctor refused the patient the due time and felt insulted. This is unfortunately the depth to which the profession has fallen.


Investigations (tests) carried out are another market. This is because one needs to compensate for the shortened consultation, and of course as profit is the motto, more the investigations more the money earned. The cost to the country in terms of unnecessary investigations are immense, as the chemicals and equipment necessary for the investigations are imported. Such investigations must be rationalised and should only be an aid to diagnosis, and not the means of diagnosis.


Drug imports are another scandal. Inferior quality drugs have made poor patients suffer. Privatised drug imports are open to abuse with no proper controls.


State Health care


The reduced subsidy at the instigation of the IMF has run down the state health care system, which is now virtually partially privatised with patients having to buy some of the basic necessities such as drugs, gauze etc. The consultants also work in the private sector, which has undermined their commitment to the state sector. Moreover, the patients have lost confidence in the state sector and not wrongly believe that they get better treatment in the private sector. 


In the 1970s, the late Senator Edward Kennedy claimed that the health care in Sri Lanka was better than in certain areas in the USA. At the time Sri Lanka was fortunate, it had a committed set of professionals who were caring and worked long hours for no extra pay. The state did its best to finance the system. Today the state is not committed; the professionals are not committed and are more interested in how much money they could earn; hence the parlous state of the public health care system.


Coordinating public health needs is a near impossibility because of the multitude of privatised institutions that have arisen. There is no unitary system that makes statistics easier that helps in health planning.


Economy and healthcare


The markets have created new challenges to the healthcare system, which, of course, is never taken into account by the economists in their false endeavours to asses progress in terms of GDP. Rapid urbanisation and increase in food outlets have disrupted society, from disruption of the social support systems enhancing mental diseases, changes in biodiversity causing new vector-controlled diseases, to obesity and increase in diabetes, hypertension and cancers.


These are long-term expenses which poor countries can ill-afford, not forgetting of course, the infrastructure expenses. An added burden to the country is the cost of treatment abroad as the health care system fails the elite.




In the eyes of the ordinary citizen, health care is inefficient, immoral and is a general abdication by the state of the needs of the citizens at the instigation of the IMF which is based on profits for the corporates and the banks that bankroll the extra activity. Health care should never be absolutely determined by the amount of money one has. This is immoral as health is a universal human right.

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