{"id":25268,"date":"2018-04-21T14:08:12","date_gmt":"2018-04-21T14:08:12","guid":{"rendered":"https:\/\/websitedesigns.com.au\/elankanew\/?p=25268"},"modified":"2023-06-26T15:40:05","modified_gmt":"2023-06-26T15:40:05","slug":"health-care-systems-compared-developing-country-like-sri-lanka-a-developed-country-like-australia-written-by-dr-harold-gunatillake-health-writer","status":"publish","type":"post","link":"https:\/\/websitedesigns.com.au\/elankanew\/health-care-systems-compared-developing-country-like-sri-lanka-a-developed-country-like-australia-written-by-dr-harold-gunatillake-health-writer\/","title":{"rendered":"Health care systems compared – developing country like Sri Lanka & a developed country like Australia – Written by Dr Harold Gunatillake-Health writer"},"content":{"rendered":"

Health care systems compared – developing country like Sri Lanka & a developed country like Australia – Written by Dr Harold Gunatillake-Health writer<\/span><\/strong><\/span><\/h1>\n

There is no similarity the way the two health\u00a0<\/span>systems have evolved, but the socio-economic\u00a0<\/span>factor is key to the dissimilarity.
\n<\/span>
\nSri Lanka has no planned universal health scheme,\u00a0<\/span>except for free government hospital care, and Australia on the contrary has a most\u00a0<\/span>efficient universal public health care plan to cover health-care of all citizens. The\u00a0<\/span>Australian Government\u2019s funding contributions include a universal public health\u00a0<\/span>insurance scheme, Medicare. Medicare was introduced in 1984 to provide free or\u00a0<\/span>subsidized access to public hospital services and to treatment by health professionals\u00a0<\/span>(including doctors, optometrists and some other health professionals) Both countries\u00a0<\/span>have public hospital delivery systems rendering a free medical system \u2013 preventative\u00a0<\/span>and curative to the needy public.<\/span><\/p>\n

In Sri Lanka, in most General and base hospitals in the provinces the casualty and\u00a0<\/span>outpatient departments are over-crowded: May have to wait in the queue for a few\u00a0<\/span>hours to be attended by a doctor. This distraction fills the private hospital outpatient\u2019s\u00a0<\/span>department, too and waiting is the game. In Australia generally, they go to their\u00a0<\/span>respective medical practitioners first and then may be referred to a specialist to be\u00a0<\/span>consulted privately or through the public hospital out-patients by the junior doctors, and\u00a0<\/span>the waiting time would be much shorter.
\n<\/span>
\nMost general practitioners and specialists in Australia, accept Medicare levy as payment,\u00a0<\/span>others insist on a gap payment.
\n<\/span>
\nIn 2013\u201314, there were 1,359 hospitals\u2014747 public and 612 private in Australia for a\u00a0<\/span>population of 20 million. In Sri Lanka total number of health institutions was increased\u00a0<\/span>from 608 to 615 between 2005 and 2007 for the same population. The private sector\u00a0<\/span>consisted mainly of a few leading hospital chains and a large number of small\u00a0<\/span>regional institutions.
\n<\/span>
\nMost families in Sri Lanka couldn\u2019t afford to seek treatment for chronic noncommunicable\u00a0<\/span>diseases through the private hospital-care system, but their state of\u00a0<\/span>mind would be that path, even at the expense of selling a property to settle massive\u00a0<\/span>hospital bills.
\n<\/span>
\nCertain procedures like open heart surgery, in Sri Lanka is subsidised by the\u00a0<\/span>government from a special President fund for those who cannot afford, when treated\u00a0<\/span>through the private hospital stream. In the public hospitals the waiting list would extend\u00a0<\/span>to over a year and they prefer to seek private health care.<\/span><\/p>\n

Government-provided\u00a0healthcare is free for all citizens and accounts for almost all preventive care and most\u00a0<\/span>in-patient treatment. However, the public health sector has inadequate capacity, limited\u00a0<\/span>access to specialist treatment and inconsistent service standards. The availability of\u00a0<\/span>complex surgical procedures and specialist care in the public sector is limited to the\u00a0<\/span>National Hospital of Sri Lanka in Colombo, the capital, and a few other large hospitals in<\/span>
\nmajor cities.
\n<\/span>
\nPrivate hospitals in the major cities are better equipped for investigations and the\u00a0<\/span>specialists also would prefer to see patients with confidence in that environment.\u00a0<\/span>Sri Lanka’s expenditure on health (both public and private) was around 3.2% of GDP, or\u00a0<\/span>US$89 per head, in 2012, according to estimates by the World Health Organization.
\n<\/span>
\nDespite this low expenditure, the health of the population has made great strides, with\u00a0<\/span>life expectancy rising from around 60 in 1960 to 74 in 2012, according to the World\u00a0<\/span>Bank. The mortality rate for children under five has fallen from 98 per 1,000 live births\u00a0<\/span>to 9.6 per 1,000 births in 2013. Many of its health indicators rival those of more\u00a0<\/span>developed countries in the region, such as Thailand and Malaysia. Thailand, for\u00a0<\/span>example, has a higher mortality rate for children under five and a similar life\u00a0<\/span>expectancy, but spends more than twice as much per head on health.
\n<\/span>
\nMedicare system in Australia<\/strong>
\n<\/span>
\nUniversal Medicare system is funded by the government and though it is a free service,\u00a0<\/span>tax payers subsidises the system by paying taxes (2%) by those whose annual income\u00a0<\/span>is over $80,000 per annum. High income earners past a certain threshold must also\u00a0<\/span>pay an extra 1% -1.5% surcharge (depending on income) if they do not have private\u00a0<\/span>health insurance.
\n<\/span>
\nThat covers doctors, specialist\u2019s fees, optometrists, and at times, Dentists and other\u00a0<\/span>allied health professionals, investigations such as blood tests and specialised ones like\u00a0<\/span>the X-rays and scans, lower cost prescriptions and a free care as a public patient in a\u00a0<\/span>public hospital.
\n<\/span>
\nYou can also get a 75% rebate of the Medicare Schedule fee for services and\u00a0<\/span>procedures you have as a private patient. This can be in a public or private hospital.
\n<\/span>
\nThis doesn\u2019t include hospital accommodation and items such as theatre fees and\u00a0<\/span>medicines.\u00a0<\/span>Public hospitals are funded by the state, territory and Australian governments, and\u00a0<\/span>managed by state and territory governments. Private hospitals are owned and operated\u00a0<\/span>by the private sector but licensed and regulated by government.
\n<\/span>
\nPrivate health insurance offers several advantages over the public system: you have the\u00a0<\/span>option of being treated by your own physician, you have more control over when and\u00a0<\/span>where you receive medical care and the waiting times for elective surgery tend to be\u00a0<\/span>considerably shorter\u00a0<\/span>When compared to the health systems of most other developed nations, the Aussie\u00a0<\/span>version stacks up pretty well and enjoy impressive life expectancy rates, while national<\/span>
\nspending on health is similar to that of other prosperous nations.
\n<\/span>
\nOver-servicing:<\/span>
\nIn the Sri Lankan scenario people don\u2019t go for regular visits to the doctors for blood\u00a0<\/span>tests as preventative measures. People do not go for a routine cholesterol test, and\u00a0<\/span>most people wouldn\u2019t know its significance. A single test will cost over Rs 500, when\u00a0<\/span>they could buy a packet of rice and curry for Rs. 150 to feed their hunger.
\n<\/span>
\nSo, when they are well, they do not go to there doctors for a check-up. Only when they\u00a0<\/span>fall ill they visit the GP quit rightly and may be sent to a specialist for further care.
\n<\/span>
\nIt is a different scenario in Australia. Every six months all unnecessary blood\u00a0<\/span>tests are done at the request of the client who is well and fit and then<\/span>
\narrange for a specialist consultation, if required\u00a0<\/span>Because, it is a free scheme the incentive is to carry out frequent unnecessary tests\u00a0<\/span>that are not relevant and people are turned into \u2018hypochondriacs\u2019.
\n<\/span>
\nExpat pensioners settled down in Sri Lanka do visit Australia annually to fulfil\u00a0<\/span>government regulations, and lot of unnecessary blood investigations are done through\u00a0<\/span>the Medicare system, when they are healthy and not sick.\u00a0<\/span>No wonder, Health costs in Australia are rising and the government has no control.
\n<\/span>
\nModified over-servicing:<\/span>
\nAnother scenario developing in the system will have a negative impact on a wonderful\u00a0<\/span>health model the Australians enjoy and even the Americans wanted to copy.\u00a0<\/span>A few decades back, when a person was not well, the GP would examine carefully,\u00a0<\/span>come to a clinical diagnosis, do the relevant investigations and treat. If there is no\u00a0<\/span>improvement, GP would then refer to a specialist in that field with a referral note.
\n<\/span>
\nThe specialist will examine, clinch a diagnosis after further investigations, prescribe\u00a0<\/span>medication and refer to the respective GP with a report giving instructions regarding\u00a0<\/span>further management.\u00a0<\/span>The GP then continue further management as advised by the specialist and refer to the\u00a0<\/span>specialist, if required only.
\n<\/span>
\nToday, the system has changed drastically. The specialist may send a report to the\u00a0<\/span>respective GP, but the patient will be requested to make an appoint with the girl at the\u00a0<\/span>desk to review in six months.\u00a0<\/span>This review system goes on every six months and the patient will re-visit the referring\u00a0<\/span>doctor for repeat prescriptions, referral letters, and for any other new ailment.
\n<\/span>
\nThis system of streaming applies only to medical patients, and not surgical cases.\u00a0<\/span>The consequence of this new system is that the specialist\u2019s appointments get filled up\u00a0<\/span>by this \u2018recycling\u2019 technique, and that a new patient finds it difficult to squeeze in to\u00a0<\/span>consult the specialist -may take months.\u00a0<\/span>This new pattern is a different modified over servicing system and drains much of the\u00a0<\/span>health allocations. In 2013\u201314, health spending was estimated at $155 billion.
\n<\/span>
\nMost expatriates in Australia would love to return home after their retirement to lead a\u00a0<\/span>relaxed less stressful life, having domestics to care for and for household\u00a0<\/span>responsibilities. For most retired people that would be only a dream, because leaving\u00a0<\/span>Australia having such a wonderful health care system and fit in to a different system of\u00a0<\/span>health-care could be frightening, and expensive, too.
\n<\/span>
\nMany expats have returned to Australian soil to enjoy the free health-care system and\u00a0<\/span>visit home for holidays.\u00a0<\/span>Private health care could be very expensive when you visit Sri Lanka, unless you have a\u00a0<\/span>private travel health insurance cover.
\n<\/span>
\nI know of a case, a friend of mine took him one evening to \u2018Raja Bojun\u2019 a popular\u00a0<\/span>restaurant in Colpetty to taste hoppers\/ pittus\/ rotties among others with hot chilies\u00a0<\/span>curries and sambols to enjoy which you never get in Australia.<\/span>The same night, he got a sever colic in the hotel room, with vomiting. Hotel doctor was\u00a0<\/span>summoned. He said, that my friend was dehydrated and needs hospital admission\u00a0<\/span>immediately. He acceded and was taken to the closest private hospital. The doctor\u2019s fee\u00a0<\/span>was rupees ten thousand. He was hospitalized for two nights and was treated by a\u00a0<\/span>specialist. The only treatment he received was intra-venous saline drip. The specialist\u00a0<\/span>came the next morning, peeped through the door and asked, \u201cHow are you today\u201d and\u00a0<\/span>as my friend said okay, he disappeared. Next morning the same thing happened, and\u00a0<\/span>he was discharged. The hospital and the specialist fees were over fifty thousand rupees.\u00a0<\/span>Fortunately, my friend was covered privately.\u00a0<\/span>This happened ten years back, and a firsthand true story.<\/span><\/p>\n

So, be aware, get health insurance cover when you next visit, \u201cParadise\u201d.
\n<\/span>
\n\"\"
\nDr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of<\/span>
\nCosmetic Surgery. Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic<\/span>
\nSurgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US),<\/span>
\nAustralian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the<\/span>
\nInternational Society of Aesthetic Surgery, Member of the American Academy of Aesthetic & restorative Surgery, Life<\/span>
\nMember of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey): Government scholar to UK for higher<\/span>
\nstudies.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

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\u00a0systems have evolved, but the socio-economic\u00a0factor is key to the dissimilarity. 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