Kanchana Sajeeva Narangoda’s research while affiliated with University of Montana Western and other places

Background / Objectives: The Sri Lankan healthcare system consists of public and private sectors. In terms of capacity, the public sector dominates the provision of care across curative, preventive and outpatient care. The private sector, too, has grown rapidly in recent years but was mainly confined to providing curative, diagnostic and outpatient care. Since, there are little or no studies conducted in Sri Lanka thus far, the objective of this study was to understand the current approaches adopted in determining the base of healthcare payments. This study also investigated the economic and administrative processes involved in determining the level of healthcare pricing in the private sector healthcare industry in Sri Lanka. Method: This qualitative study investigated the rationales adopted in healthcare pricing by healthcare administrators in the private sector. Structured interviews were conducted and thematic analysis were applied to interview data collected and analysis. Results: Five key themes, which influenced pricing, were identified from the interviews. These themes included influence from medical practitioners/clinicians, competitor pricing, price adjustment/profit margins, consumables and staff, and economic demands. There was a consensus that competitor pricing and seniority of the practicing clinicians had an impact on pricing. Conclusion: This study revealed that the base of payment in private sector healthcare is fee for service (FFS). Adopting popular international approaches such as Diagnostic Related Groups (DRGS) was not shown in this study. Further, it was evident that the Sri Lankan private healthcare sector administrators unilaterally fix pricing based on the identified key themes without adequately consulting the healthcare payers and users.

Demand for private sector healthcare services in Sri Lanka is on the rise. This is very evident from the increase in the number of registered private healthcare institutions from 1990 to 2017. [1,2] With the increasing utilization of private sector healthcare services, various qualitative factors, and service-related issues associated with the healthcare delivery system have become common debates. A major concern, patients have expressed, is about the fees charged by doctors and hospitals. Principle aim of this study was to investigate the perceptions of patients on healthcare pricing within the private healthcare sector in Sri Lanka. The target population of the study was defined as Sri Lankans who have been inpatients in private hospitals within the past year. The focus districts were Colombo, Kandy, and Galle. These 3 districts represented nearly 60% of the total private sector bed capacity. From each district, three main private hospitals were selected. Over 700 patients were invited to participate, 246 surveys were completed, and 215 were retained as 31 had excessive missing and/or unclear data. In all 3 districts the majority of patients were either dissatisfied with or remained neutral (69%) on the hospital fees,(66%) on doctor’s fees,(74%) on the overall price they ended up paying,(76%) on whether they think the healthcare services they received are value for money. This study did not investigate the reasons or the factors that may affect the satisfaction or dissatisfaction of patients towards the fees they paid Multiple factors can affect patient’s perception on the fees they paid. With negative perception on the above it can be concluded that there is sufficient evidence to challenge private sector healthcare satisfaction level vs price/fees equilibrium in Sri Lanka.