Evolving healthcare

This week Sri Lanka has enjoyed the limelight for the right reasons. Against the backdrop of a World Health Organization (WHO) summit, the country has been declared malaria-free and been praised for its strong dedication to universal health standards. However, as public investment in healthcare shrinks and health needs shift, the public health system will have to adapt rapidly to meet public needs. 

Sri Lanka is now transforming into middle income country status. Improving economic status and urbanisation generates both positive and negative outcomes. On the positive side, it increases educational status and peoples’ expectations, which in turn results in greater demand for quality health care. Concurrently, on the negative side, changing lifestyles, consuming more fast food and unhealthy diets, the tendency for consumption of more alcohol and tobacco, living in polluted environments, and trauma due to occupational exposure, are drivers of enhanced health risks. Consequently, more financial resources will be required to meet this rising demand for easily accessible and affordable quality healthcare.

Sri Lanka is also experiencing a demographic transition, reflected in the increased population of those aged 60-plus. Population forecasts predict a doubling of the country’s ageing population by 2040 (24.4%) compared to 2010 (12.1%) as life expectancy increases (due to improved island-wide preventive and curative health services) and fertility rates decline rapidly. Accordingly, the heightened fiscal cost for long-term care of this ageing population is an emerging challenge, along with the heightened burden of old-age pension provision.

The epidemiological transition referred to earlier is the emerging shift from communicable diseases, which have largely been well contained, to a rise of non-communicable diseases (NCDs), for example, cardiovascular disease, diabetes, cancer, asthma/chronic obstructive disease and mental illness. 

Currently, treatment for NCDs accounts for nearly 90% of the total ‘disease burden’, while curative treatment for infectious diseases and preventive treatment for maternal and child health account for only around 10%. Furthermore, diabetes and asthma are also on the rise: 10% and 15%-20% respectively, per 10,000 people. 

Whilst mortality rates due to infectious diseases have been declining, from 42% in 1945 to 20% in 2003, mortality rates attributable to NCDs are rising. Death due to diseases of the circulatory system was 23.8% of all deaths in 2003, a dramatic increase from 2.8% in 1945. International comparisons show that such deaths in Sri Lanka are as much as 20-50% higher vis-a-vis developed countries.

But the country is also struggling because of an excess of dependency in public funded healthcare. Only 4% of the private healthcare spend was attributable to insurance in 2013. A meaningful increase in medical insurance coverage would result in more patients opting for paid healthcare by shifting away from state-run hospitals.

Sri Lanka has enjoyed exceptional health outcomes, with strong maternal and child health and low prevalence of infectious diseases, at low cost, in the past two decades. However, there are visible gaps or disparities in health outcomes with regard to NCDs and elderly care. 

Empirical data shows that the country needs sufficient investment in health to avoid the resultant socioeconomic consequences, such as a withdrawal from the workforce early due to ill health in the case of NCDs, and the rising fiscal costs for pensions and long-term care in the case of the ageing population.