Estate populations have received considerable attention. In the past, health services were provided by the estate management; however, a policy decision was taken in 1996 to deliver government services to this group. Currently, all preventive health services of the estate sector are provided by the provincial health authority and curative health services are progressively being absorbed into the state sector. Within the estate sector, problems of physical access to health services due to the difficult terrain, distance and limited transport facilities may affect timely availability of specialized services. Also, women and young people in the plantation sector face significant barriers in timely access to sexual and reproductive health services (Periyasamy, 2018). Non-Sri Lankans are able to access health services at private health institutions through payment for services, or through state institutions at a nominal fee. Resident visa holders have outpatient and emergency health services covered by the government sector through a health protection plan, which includes a mandatory health assessment introduced recently.
3.3.1.2 Utilization of health services by income category Analysis of the OOPE on health by expenditure deciles reveals that nearly 57% of the total spending on OOPE had been borne by the wealthiest quintile (deciles 9 and 10). This indicates a drop from 63%, the corresponding value given in HIES 2012–2013. Figure 3.8 demonstrates the OOPE spending by expenditure deciles for 2016. Figure 3.8
OOP spending on health by expenditure deciles, 2016 42.8
45 40 35 30 25 20
14.7
15 10 5 0
1.7
2.8
3.6
4.4
5.1
6.4
8.4
10.2
Exp D1 Exp D2 Exp D3 Exp D4 Exp D5 Exp D6 Exp D7 Exp D8 Exp D9 Exp D10
Source: De Silva SHP, De Silva A, Chandrarathna NA, Nieveras O, Kumara R, Amarasinghe S, 2018. Chapter 4
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