Sunday, September 4, 2016

Is free health really free to everybody?

Is free health really free to everybody?
We boast of having free health system that provides health care for our citizens cradle to grave . in fact the courtesy is extended to  non citizens as well , who happen to be in sri lanka when they fell sick. But there is old adage that tells us that there is no free lunch.
The "free lunch" in the saying refers to the nineteenth-century practice in American bars of offering a "free lunch" in order to entice drinking customers.
The phrase is  central to Robert Heinlien's 1966 science fiction  novel The Moon Is a Harsh mistress which helped popularize it. The free market economist Milton friedman also popularized the phrase by using it as the title of a 1975 book.
So as the adage say we will not get anything for free, we will have to pay for whatever service or goods that we consume. Likewise for free health somebody must pay , otherwise it cannot sustain by itself. Hospitals have to be built and maintained ,equipment has to be bought and health workers have to be trained and maintained .All these prerequisite s are extremely costly and will become even more costlier in future with advances in medical science and people living longer.
Although we claim that we have a absolutely free healthcare system what we don’t say is that we have imposed many restrictions on the system by making it very difficult to access the so called free healthcare. And many alternative facilities are allowed to spring up which are very convenient for access , clean and much user friendly outside the free system so that only poorest will come to the free hospitals.
For example the city suburb that I live  I have noticed about more than 10 fee charging roadside health care facilities within two kilometers radius. These places with just a wash basin and inspection bed are open mostly at 0700 to 0900 and then again at 1700 to 1900. Though I cannot be certain I am sure that more than 80% of the population in cities and suburbs use these facilities rather than going to hospitals because of the conveniences they offer. And probably of this 80% about 50% will go to hospitals only if they suffer from a major illness like a heart condition or a cancer. The balance will continue to go to private sector for the treatments.
The per capita health care spending in Srilanka is around 170 $ per person per year.   And bulk of the spending, about 80% should be for treatments of minor illnesses because ratio must be more 100:1 in favour of minor illnesses, of the patients reporting for treatments. So if cost of treating minor illnesses is 80% of the total healthcare cost and 80% of people don’t avail so called free care  in effect 80%x80% of potential patients obtain treatments from outside the free healthcare system. That is 64% of the total population . and in case of major illnesses that we assumed is about 20% of the total spending on healthcare the percentage that will go to free healthcare only in case of major illnesses will be about 40% of total population but about 8% of the total spending.
This takes us to the resource allocation. So the total allocation of 170$ per capita , is spent only on about 40% of the population making our real per capita health spending to 170x100/40 , that is 425$ per person. 425$ is 60000 Rs per person per year , that’s the approximate amount we spend on a person who avails free healthcare , that’s without the investment in land and without paying any taxes
every one of us pay 23400 Rs a year for a health insurance and even when we fall sick we dont go to the insurer but somebody else who charges us full without  any concern for our insurance that we have paid full premium. 

Do people who go to state hospitals receive healthcare to this tune? I am not too sure 

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