Health care systems compared – developing country like Sri Lanka & a developed country like Australia – Written by Dr Harold Gunatillake-Health writer

Health care systems compared – developing country like Sri Lanka & a developed country like Australia – Written by Dr Harold Gunatillake-Health writer


There is no similarity the way the two health systems have evolved, but the socio-economic factor is key to the dissimilarity.

Sri Lanka has no planned universal health scheme, except for free government hospital care, and Australia on the contrary has a most efficient universal public health care plan to cover health-care of all citizens. The Australian Government’s funding contributions include a universal public health insurance scheme, Medicare. Medicare was introduced in 1984 to provide free or subsidized access to public hospital services and to treatment by health professionals (including doctors, optometrists and some other health professionals) Both countries have public hospital delivery systems rendering a free medical system – preventative and curative to the needy public.

In Sri Lanka, in most General and base hospitals in the provinces the casualty and outpatient departments are over-crowded: May have to wait in the queue for a few hours to be attended by a doctor. This distraction fills the private hospital outpatient’s department, too and waiting is the game. In Australia generally, they go to their respective medical practitioners first and then may be referred to a specialist to be consulted privately or through the public hospital out-patients by the junior doctors, and the waiting time would be much shorter.

Most general practitioners and specialists in Australia, accept Medicare levy as payment, others insist on a gap payment.

In 2013–14, there were 1,359 hospitals—747 public and 612 private in Australia for a population of 20 million. In Sri Lanka total number of health institutions was increased from 608 to 615 between 2005 and 2007 for the same population. The private sector consisted mainly of a few leading hospital chains and a large number of small regional institutions.

Most families in Sri Lanka couldn’t afford to seek treatment for chronic noncommunicable diseases through the private hospital-care system, but their state of mind would be that path, even at the expense of selling a property to settle massive hospital bills.

Certain procedures like open heart surgery, in Sri Lanka is subsidised by the government from a special President fund for those who cannot afford, when treated through the private hospital stream. In the public hospitals the waiting list would extend to over a year and they prefer to seek private health care.

Government-provided healthcare is free for all citizens and accounts for almost all preventive care and most in-patient treatment. However, the public health sector has inadequate capacity, limited access to specialist treatment and inconsistent service standards. The availability of complex surgical procedures and specialist care in the public sector is limited to the National Hospital of Sri Lanka in Colombo, the capital, and a few other large hospitals in
major cities.

Private hospitals in the major cities are better equipped for investigations and the specialists also would prefer to see patients with confidence in that environment. Sri Lanka’s expenditure on health (both public and private) was around 3.2% of GDP, or US$89 per head, in 2012, according to estimates by the World Health Organization.

Despite this low expenditure, the health of the population has made great strides, with life expectancy rising from around 60 in 1960 to 74 in 2012, according to the World Bank. The mortality rate for children under five has fallen from 98 per 1,000 live births to 9.6 per 1,000 births in 2013. Many of its health indicators rival those of more developed countries in the region, such as Thailand and Malaysia. Thailand, for example, has a higher mortality rate for children under five and a similar life expectancy, but spends more than twice as much per head on health.

Medicare system in Australia

Universal Medicare system is funded by the government and though it is a free service, tax payers subsidises the system by paying taxes (2%) by those whose annual income is over $80,000 per annum. High income earners past a certain threshold must also pay an extra 1% -1.5% surcharge (depending on income) if they do not have private health insurance.

That covers doctors, specialist’s fees, optometrists, and at times, Dentists and other allied health professionals, investigations such as blood tests and specialised ones like the X-rays and scans, lower cost prescriptions and a free care as a public patient in a public hospital.

You can also get a 75% rebate of the Medicare Schedule fee for services and procedures you have as a private patient. This can be in a public or private hospital.

This doesn’t include hospital accommodation and items such as theatre fees and medicines. Public hospitals are funded by the state, territory and Australian governments, and managed by state and territory governments. Private hospitals are owned and operated by the private sector but licensed and regulated by government.

Private health insurance offers several advantages over the public system: you have the option of being treated by your own physician, you have more control over when and where you receive medical care and the waiting times for elective surgery tend to be considerably shorter When compared to the health systems of most other developed nations, the Aussie version stacks up pretty well and enjoy impressive life expectancy rates, while national
spending on health is similar to that of other prosperous nations.

Over-servicing:
In the Sri Lankan scenario people don’t go for regular visits to the doctors for blood tests as preventative measures. People do not go for a routine cholesterol test, and most people wouldn’t know its significance. A single test will cost over Rs 500, when they could buy a packet of rice and curry for Rs. 150 to feed their hunger.

So, when they are well, they do not go to there doctors for a check-up. Only when they fall ill they visit the GP quit rightly and may be sent to a specialist for further care.

It is a different scenario in Australia. Every six months all unnecessary blood tests are done at the request of the client who is well and fit and then
arrange for a specialist consultation, if required Because, it is a free scheme the incentive is to carry out frequent unnecessary tests that are not relevant and people are turned into ‘hypochondriacs’.

Expat pensioners settled down in Sri Lanka do visit Australia annually to fulfil government regulations, and lot of unnecessary blood investigations are done through the Medicare system, when they are healthy and not sick. No wonder, Health costs in Australia are rising and the government has no control.

Modified over-servicing:
Another scenario developing in the system will have a negative impact on a wonderful health model the Australians enjoy and even the Americans wanted to copy. A few decades back, when a person was not well, the GP would examine carefully, come to a clinical diagnosis, do the relevant investigations and treat. If there is no improvement, GP would then refer to a specialist in that field with a referral note.

The specialist will examine, clinch a diagnosis after further investigations, prescribe medication and refer to the respective GP with a report giving instructions regarding further management. The GP then continue further management as advised by the specialist and refer to the specialist, if required only.

Today, the system has changed drastically. The specialist may send a report to the respective GP, but the patient will be requested to make an appoint with the girl at the desk to review in six months. This review system goes on every six months and the patient will re-visit the referring doctor for repeat prescriptions, referral letters, and for any other new ailment.

This system of streaming applies only to medical patients, and not surgical cases. The consequence of this new system is that the specialist’s appointments get filled up by this ‘recycling’ technique, and that a new patient finds it difficult to squeeze in to consult the specialist -may take months. This new pattern is a different modified over servicing system and drains much of the health allocations. In 2013–14, health spending was estimated at $155 billion.

Most expatriates in Australia would love to return home after their retirement to lead a relaxed less stressful life, having domestics to care for and for household responsibilities. For most retired people that would be only a dream, because leaving Australia having such a wonderful health care system and fit in to a different system of health-care could be frightening, and expensive, too.

Many expats have returned to Australian soil to enjoy the free health-care system and visit home for holidays. Private health care could be very expensive when you visit Sri Lanka, unless you have a private travel health insurance cover.

I know of a case, a friend of mine took him one evening to ‘Raja Bojun’ a popular restaurant in Colpetty to taste hoppers/ pittus/ rotties among others with hot chilies curries and sambols to enjoy which you never get in Australia.The same night, he got a sever colic in the hotel room, with vomiting. Hotel doctor was summoned. He said, that my friend was dehydrated and needs hospital admission immediately. He acceded and was taken to the closest private hospital. The doctor’s fee was rupees ten thousand. He was hospitalized for two nights and was treated by a specialist. The only treatment he received was intra-venous saline drip. The specialist came the next morning, peeped through the door and asked, “How are you today” and as my friend said okay, he disappeared. Next morning the same thing happened, and he was discharged. The hospital and the specialist fees were over fifty thousand rupees. Fortunately, my friend was covered privately. This happened ten years back, and a firsthand true story.

So, be aware, get health insurance cover when you next visit, “Paradise”.


Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of
Cosmetic Surgery. Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic
Surgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US),
Australian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the
International Society of Aesthetic Surgery, Member of the American Academy of Aesthetic & restorative Surgery, Life
Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey): Government scholar to UK for higher
studies.

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