Death knell of free medical services?

| by Milinda Rajasekera

( February 02, Colombo, Sri Lanka Guardian) It is widely believed that the performances of most state services in this country fall below required standards. While some of these institutions function efficiently, the majority of them fail to provide the expected services to the people efficiently. The fact that Sri Lanka’s public service was efficient and exemplary in the past and that it was receiving commendations even from prominent foreign leaders is well known.

The deterioration of the service set in as the country began tasting and enjoying the fruits of freedom gained from colonial rulers. The reasons for the decline in standards of our public service are many and varied. This situation notwithstanding, governments that claimed to pursue socialist policies proceeded to expand the public service. The nationalisation process was initiated and some private sector enterprises were taken over and new state ventures were set up. The determining factor was the socialist concept which advocates that production, distribution and exchange of goods should be in the hands of the state. The desire for crippling opposition forces was another motive that spurred the authorities on to pursue the take-over policy of the ruling party.

Thus greater burdens were heaped on the state sector. A series of corporations were created for commercial and other purposes. Some of those new institutions did well at the start. The Ceylon Transport Board, for example, did well as one of those pioneer corporations created in the first flush of the nationalization spree. But as time passed their efficiency diminished and most of them became burdens on the country without any satisfactory service being rendered to the people. The main reasons for their deterioration were; policies of successive governments that rejected socialism, packing those institutions with unqualified, incompetent and unsuitable persons with political patronage, lack of dedication, corruption, activities of political party controlled trade unions and indiscipline.

Some of these institutions continuously failed to deliver the goods and burdened the treasury. The situation was so bad that Senior Minister Dr.Sarath Amunugama was once constrained to identify some of them as monsters gobbling up state revenue. The successive governments attempted to privatise or restructure them. They succeeded in respect of some but failed in others as objections and obstacles were irrepressible. Most of these objections came from ideologically motivated sections. Giving in to these objections attempts were made to revive ailing enterprises. But most of these exercises were abortive and the unsuccessful institutions still continue to be burdens on the country.

Whatever the criticisms levelled, today, the government seems bent on proceeding with certain pragmatic policies – devoid of ideological concerns - with a view to solving some of the intricate problems plaguing state enterprises. Although many defects could be observed in the methods adopted, the government appears to be acting with a sense of urgency to solve these problems. The occurrence of periodic upheavals in institutions of higher education has been a common problem. Today, the unrest in universities has arisen over the attempt to create private sector universities. Some sections in the student community are up in arms against the proposed measures levelling the usual charge that the move is to destroy the systems that offer free education. While this controversy rages on the proposal to open paying wards in state hospitals has come to the fore.

Health Ministry has given some reasons for setting up paying wards in state hospitals. It said that the present decision had been taken by Health Minister Maithripala Sirisena to earn the income which is being diverted to private hospitals due to the absence of paying wards in government hospitals. The ministry sources also added that public servants who are entitled to the Agrahara Insurance Scheme select private hospitals for residential treatment, since paying wards are not available in most government hospitals. It was also disclosed that a new 25-storey building has been constructed for the OPD of the Colombo National Hospital and that the 17th floor of this new building, is to be allocated for paying wards.

This proposal is now pounced upon by certain sections, particularly the trade union sector. They point out that this move amounts to the denial of the people’s right to free medical services. All Ceylon Health Services Union (ACHSU) has stated that it is in an atmosphere where free health service is broken down so badly that patients have to bring in equipment necessary for treatment that should have been made available in hospitals that the attempt by the government is made to establish paying wards in government hospitals, which move should be defeated.

Explaining possible consequences of this move, the president of this union Gamini Kumarasinghe says by establishing paying wards in government hospitals patients who come for treatment are divided into two classes and patients who pay for their treatment will definitely get better treatment and others would be neglected. He states that the fundamental rights of patients would be violated owing to the proposed programme. He reveals that last year there was a shortage of 71 essential drugs in hospitals and more than 100 kinds of substandard drugs were identified. This attempt of the government, he charges, is to destroy the free health services and change to a system where patients will have to pay for health services.

He also warns that if the government fails to listen to their objections his union would rally with masses in the country and take action to prevent the destruction of free health services. Some of these objections seem to be valid. It is the duty of the government to consider them and take whatever steps necessary to prevent the occurrence of feared ill effects that would occur in the implementation this scheme. The contention that this move marks the destruction of free health services is, however, not tenable.

Today, the vast majority of our people depend on state medical institutions for getting their ailments cured. And most state hospitals evidently provide a satisfactory service although some of them experience shortages of drugs, equipment and personnel. The system of free services permits them to obtain the required treatment from these hospitals and walk away without the need for making any payments. They claim this free service as a right because these institutions are maintained by taxes paid by them. This reasoning is indeed plausible but what they fail to consider is the fact that whatever contributions they make would come back to them in the form of improved facilities in these institutions.

A scheme was recently introduced in hospitals for those willing to make contributions after obtaining treatment. Tills are kept in hospital wards for this purpose. While some with a sense of gratitude respond and make voluntary contributions, most people seem to ignore this provision and leave after getting treatment at great expense to the state. On the contrary, when they get treatment at private hospitals they pay whatever charges imposed without hesitation.

As such is the situation, it seems prudent and reasonable to set up paying wards in state hospitals. However, it is incumbent on the authorities to ensure that the attention to paying wards patients will not in any manner affect the services offered to those in other wards.