2023-09-28 14:46:10 +00:00
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abstract: 'Universal health coverage (UHC), a target of the United Nations'' third
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Sustainable Development Goal on health, refers to people having access
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to essential healthcare services without suffering financial hardship.
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The World Bank and other leading global health actors champion mixed
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health systems-in which government and privately-financed market
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delivery coexist-as a sustainable model for UHC. Yet, little is known
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about what these public-private arrangements mean for women, a crucial
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partaker of UHC in low- and middle-income countries (LMICs). Using a
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critical feminist approach, this study explores how women negotiate
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access to public and private healthcare services within Sri Lanka''s
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state-dominant mixed health system. Data were generated through focus
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group discussions and interviews with women residents of an urban
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division in Kandy, a city seeing rapid private healthcare expansion in
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central Sri Lanka. Notwithstanding policies of universality guiding
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public sector delivery, out-of-pocket payments burden socially and
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economically disadvantaged women. They use private services to fill gaps
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in the public system, and consult dual practitioners privately, to pave
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way for better (public) care. By contrast, wealthier women opt for
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private outpatient care, but capitalize on the dual practitioners to
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obtain priority access to oversubscribed services at public hospitals.
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Most women, regardless of social location, combine public with private,
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albeit to varying degrees, to save on household expenses. Relying on
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women''s invisible care work, these public-private ``hybrid `` routes of
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access within Sri Lanka''s poorly regulated mixed health system,
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reinforce social inequalities and individualize the responsibility for
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healthcare. The article throws light on the messiness of access within
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mixed systems and demands closer scrutiny of calls for private sector
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engagement in the quest for UHC in LMICs.'
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affiliation: 'Kumar, R (Corresponding Author), Univ Jaffna, Fac Med, Dept Community
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\& Family Med, Jaffna 40000, Sri Lanka.
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Kumar, Ramya, Univ Toronto, Dalla Lana Sch Publ Hlth, 155 Coll St,6th Floor, Toronto,
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ON M5T 3M7, Canada.
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Birn, Anne-Emanuelle, Univ Toronto, Scarborough Campus \& Dalla Lana Sch, Toronto,
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ON M1C 1A4, Canada.
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Birn, Anne-Emanuelle, Univ Toronto, Dalla Lana Sch Publ Hlth, 1265 Mil Trail, Toronto,
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ON M1C 1A4, Canada.
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Bhuyan, Rupaleem, Univ Toronto, Factor Inwentash Fac Social Work, 246 Bloor St W,
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Toronto, ON M5S 1V4, Canada.
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Wong, Josephine Pui-Hing, Ryerson Univ, Daphne Cockwell Sch Nursing, 350 Victoria
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St, Toronto, ON M5B 2K3, Canada.'
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article-number: '114777'
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author: Kumar, Ramya and Birn, Anne-Emanuelle and Bhuyan, Rupaleem and Wong, Josephine
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Pui-Hing
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author-email: 'ramyak@univ.jfn.ac.lk
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ae.birn@utoronto.ca
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r.bhuyan@utoronto.ca
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jph.wong@ryerson.ca'
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author_list:
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- family: Kumar
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given: Ramya
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- family: Birn
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given: Anne-Emanuelle
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- family: Bhuyan
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given: Rupaleem
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- family: Wong
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given: Josephine Pui-Hing
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da: '2023-09-28'
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doi: 10.1016/j.socscimed.2022.114777
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eissn: 1873-5347
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files: []
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issn: 0277-9536
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journal: SOCIAL SCIENCE \& MEDICINE
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keywords: 'Mixed health systems; Access to healthcare; Care work; Low- and
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middle-income countries; Sri Lanka'
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language: English
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month: MAR
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number-of-cited-references: '73'
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orcid-numbers: Birn, Anne-Emanuelle/0000-0002-0314-5913
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papis_id: 0fe5ee1a4fb075591dda9bb17c60eed6
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ref: Kumar2022universalhealth
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times-cited: '0'
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title: 'Universal health coverage and public-private arrangements within Sri Lanka''s
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mixed health system: Perspectives from women seeking healthcare'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000805791200012
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usage-count-last-180-days: '1'
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usage-count-since-2013: '3'
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volume: '296'
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web-of-science-categories: 'Public, Environmental \& Occupational Health; Social Sciences,
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Biomedical'
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year: '2022'
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