Are health services protecting the livelihoods the urban poor in Sri Lanka? Findings from two low-income areas of Colombo

Soc Sci Med. 2006 Oct;63(7):1732-44. doi: 10.1016/j.socscimed.2006.04.017.


Investing in pro-poor health services is central to poverty reduction and achievement of the Millennium Development Goals. As health care financing mechanisms have an important influence over access and treatment costs they are central to the debates over health systems and their impact on poverty. This paper examines people's utilisation of health care services and illness cost burdens in a setting of free public provision, Sri Lanka. It assesses whether and how free health care protected poor and vulnerable households from illness costs and illness-induced impoverishment, using data from a cross-sectional survey (423 households) and longitudinal case study household research (16 households). The findings inform policy debates about how to improve protection levels, including the contribution of free health care services to poverty reduction. Assessment of policy options that can improve health system performance must start from a better understanding of the demand-side influences over performance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost of Illness*
  • Cross-Sectional Studies
  • Delivery of Health Care / organization & administration*
  • Female
  • Health Expenditures / statistics & numerical data
  • Health Services Needs and Demand
  • Humans
  • Interviews as Topic
  • Male
  • Patient Acceptance of Health Care
  • Poverty*
  • Sri Lanka
  • State Medicine
  • Uncompensated Care*
  • Universal Health Insurance
  • Urban Health*