Surangi Perera, a 37-year-old resident of Kottawa, had just stepped out of a pawning centre in Malabe. She was standing on the bustling street, waiting for a trishaw to take her to Narahenpita. In her hand she held a few crumpled notes, thinking they would cover the trishaw fare.

As she waited, growing increasingly impatient, Surangi began counting her money repeatedly. The hot sun beat down on her, adding to her discomfort. Her thoughts wandered to her mother, who was in a private hospital in Colombo, battling an illness. The hospital bills had drained Surangi’s savings, leaving her struggling.

Desperation pushed her to approach the writer who was nearby, waiting for another trishaw. With a shaky voice, she asked: “Do you have change for Rs. 500?” The writer, touched by her distress, offered a few notes, which Surangi accepted with gratitude.

With newfound hope, Surangi shared her story. She explained: “My mother is in a private hospital and we’ve been handed a massive bill. We had to spend a lot on medicines from external pharmacies. I used to be able to afford private healthcare with my decent salary, avoiding Government hospitals due to long queues. But now, this is becoming unaffordable. You need to be very rich to access these facilities.”

Her words hung in the air, highlighting the harsh reality of healthcare costs and the challenges many faced in affording proper medical care.

Surangi’s story is not an isolated case in Sri Lanka, as many find themselves facing a similar predicament due to ever-increasing medical costs.

A 43-year-old farmer from Kekirawa shared a distressing tale, illustrating the financial burden that healthcare expenses had become for ordinary Sri Lankans. The farmer had to undertake a daunting journey to Colombo with his pregnant wife, who had been five months along, due to complications that required consultation with a specialist. 

He recounted his ordeal, saying: “I’m a farmer and this visit cost me around Rs. 35,000, which is my entire monthly income. Channelling fees have now reached unthinkable heights. I never imagined I would have to spend so much money just to see a doctor.” 

The channelling fee of Rs. 4,600 and the additional cost of medicines amounting to Rs. 12,000 had left the farmer in dire straits. The doctor had also recommended scans, which seemed financially out of reach. He spoke with a sense of desperation, concluding: “This is a burden we simply cannot bear. Not at all.”  

These stories paint a bleak picture of the healthcare landscape in Sri Lanka today, where the rising costs of medical treatment and consultation fees have left many grappling with impossible choices between their health and their financial stability. They are a stark reminder that access to quality healthcare should be a fundamental right, not a luxury afforded only to the affluent.

Govt. facilities inadequate 

The dire situations faced by Surangi and the farmer from Kekirawa shed light on a troubling issue plaguing Sri Lanka’s healthcare system. According to information gathered by The Sunday Morning, it is evident that Government healthcare facilities are struggling to meet the needs of these patients, further aggravating their difficulties.

In Surangi’s case, her mother’s doctor had taken the extraordinary step of recommending treatment at a private hospital. This decision was prompted by a shortage of essential medicines in the Government healthcare system, highlighting a glaring deficiency in the availability of crucial medical supplies.

The doctor’s recommendation to opt for a private hospital highlights the severity of the situation, where even medical professionals acknowledge the limitations of Government facilities.

Similarly, the farmer from Kekirawa had no choice but to seek consultation with a specialised consultant in Colombo due to complications during his wife’s pregnancy. The absence of such expertise in the Local Government healthcare infrastructure left him with no alternative.

This emphasises the pressing need for improved access to specialised medical care in rural areas, ensuring that patients do not have to endure exorbitant expenses and long journeys for essential treatments.

These cases serve as distressing reminders that the healthcare system in Sri Lanka requires urgent attention and reform to bridge the gaps in access to medical care, availability of medicines, and the provision of specialised services. The challenges faced by Surangi, the farmer, and countless others are a call to action for policymakers to prioritise and enhance the country’s healthcare infrastructure for the welfare of all citizens.

Private healthcare

In response to the pressing issue of rising healthcare costs and accessibility in Sri Lanka, The Sunday Morning reached out to Association of Private Hospitals and Nursing Homes (APHNH) Spokesman Mahanil Perera for insights into the situation.

Perera emphasised that larger healthcare organisations were committed to complying with all Government rules and regulations, and that they had taken steps to reduce prices in accordance with these guidelines.

Elaborating on the fee structure, he said: “Professional fees are decided by the consultant themselves, taking into consideration their experience and expertise. Hospital fees fall within a specific range, with the maximum being around Rs. 1,500.”

Furthermore, Perera highlighted the challenges faced by private healthcare providers, with operational costs, including staff management and electricity prices, having increased significantly.

However, he noted that there were no immediate plans for a price hike.

He also pointed out that the healthcare sector had been cautious about raising prices, even in the face of fluctuations in the value of the currency. The sector had strived to keep price increases to a minimum, recognising its essential role in providing healthcare services to the public.

Price revisions

The Sri Lankan healthcare landscape saw significant changes in June as the Ministry of Health issued a new gazette that revised the Maximum Retail Prices (MRPs) of 60 different types of medicines, including common ones such as paracetamol.

Effective from 26 June, these revised prices reflect a 16% reduction compared to the previous rates. The gazette outlines strict regulations regarding the pricing of scheduled medicines. Manufacturers or importers are not allowed to sell any scheduled medicine at a price exceeding the MRP specified in the schedule, as per the Medicines (Ceilings on Prices) Regulations of 2019, last amended in 2022.

Moreover, if a manufacturer or importer chooses to sell any scheduled medicine at a revised retail price lower than the MRP stated in the 2019 regulations, they are obliged to proportionally reduce that revised price by a total of 16%, as stipulated in the recent gazette.

These revisions were necessitated by the exchange rate fluctuations by that time, which had a significant impact on medicine prices.

Since 2021, there have been three rounds of price revisions: 9%, 29%, and 40%, respectively.

In 2021, a 9% increase in medicine prices was implemented. Then in 2022, local pharmaceutical prices had to be adjusted twice due to the substantial devaluation of the Sri Lankan Rupee in 2021. In March 2022, an extraordinary gazette notification raised the prices of 60 essential medicines by 29%, reflecting the challenges faced by both consumers and the pharmaceutical industry in adapting to economic shifts.

These changes, while addressing some of the cost concerns related to essential medicines, highlight the ongoing struggle to balance healthcare affordability with economic realities in Sri Lanka. The recent adjustments offer a degree of relief to consumers but also underscore the need for continued efforts to ensure access to essential medications for all citizens.