abstract: 'Universal health coverage (UHC), a target of the United Nations'' third

  Sustainable Development Goal on health, refers to people having access

  to essential healthcare services without suffering financial hardship.

  The World Bank and other leading global health actors champion mixed

  health systems-in which government and privately-financed market

  delivery coexist-as a sustainable model for UHC. Yet, little is known

  about what these public-private arrangements mean for women, a crucial

  partaker of UHC in low- and middle-income countries (LMICs). Using a

  critical feminist approach, this study explores how women negotiate

  access to public and private healthcare services within Sri Lanka''s

  state-dominant mixed health system. Data were generated through focus

  group discussions and interviews with women residents of an urban

  division in Kandy, a city seeing rapid private healthcare expansion in

  central Sri Lanka. Notwithstanding policies of universality guiding

  public sector delivery, out-of-pocket payments burden socially and

  economically disadvantaged women. They use private services to fill gaps

  in the public system, and consult dual practitioners privately, to pave

  way for better (public) care. By contrast, wealthier women opt for

  private outpatient care, but capitalize on the dual practitioners to

  obtain priority access to oversubscribed services at public hospitals.

  Most women, regardless of social location, combine public with private,

  albeit to varying degrees, to save on household expenses. Relying on

  women''s invisible care work, these public-private ``hybrid `` routes of

  access within Sri Lanka''s poorly regulated mixed health system,

  reinforce social inequalities and individualize the responsibility for

  healthcare. The article throws light on the messiness of access within

  mixed systems and demands closer scrutiny of calls for private sector

  engagement in the quest for UHC in LMICs.'
affiliation: 'Kumar, R (Corresponding Author), Univ Jaffna, Fac Med, Dept Community
  \& Family Med, Jaffna 40000, Sri Lanka.

  Kumar, Ramya, Univ Toronto, Dalla Lana Sch Publ Hlth, 155 Coll St,6th Floor, Toronto,
  ON M5T 3M7, Canada.

  Birn, Anne-Emanuelle, Univ Toronto, Scarborough Campus \& Dalla Lana Sch, Toronto,
  ON M1C 1A4, Canada.

  Birn, Anne-Emanuelle, Univ Toronto, Dalla Lana Sch Publ Hlth, 1265 Mil Trail, Toronto,
  ON M1C 1A4, Canada.

  Bhuyan, Rupaleem, Univ Toronto, Factor Inwentash Fac Social Work, 246 Bloor St W,
  Toronto, ON M5S 1V4, Canada.

  Wong, Josephine Pui-Hing, Ryerson Univ, Daphne Cockwell Sch Nursing, 350 Victoria
  St, Toronto, ON M5B 2K3, Canada.'
article-number: '114777'
author: Kumar, Ramya and Birn, Anne-Emanuelle and Bhuyan, Rupaleem and Wong, Josephine
  Pui-Hing
author-email: 'ramyak@univ.jfn.ac.lk

  ae.birn@utoronto.ca

  r.bhuyan@utoronto.ca

  jph.wong@ryerson.ca'
author_list:
- family: Kumar
  given: Ramya
- family: Birn
  given: Anne-Emanuelle
- family: Bhuyan
  given: Rupaleem
- family: Wong
  given: Josephine Pui-Hing
da: '2023-09-28'
doi: 10.1016/j.socscimed.2022.114777
eissn: 1873-5347
files: []
issn: 0277-9536
journal: SOCIAL SCIENCE \& MEDICINE
keywords: 'Mixed health systems; Access to healthcare; Care work; Low- and

  middle-income countries; Sri Lanka'
language: English
month: MAR
number-of-cited-references: '73'
orcid-numbers: Birn, Anne-Emanuelle/0000-0002-0314-5913
papis_id: 0fe5ee1a4fb075591dda9bb17c60eed6
ref: Kumar2022universalhealth
times-cited: '0'
title: 'Universal health coverage and public-private arrangements within Sri Lanka''s
  mixed health system: Perspectives from women seeking healthcare'
type: Article
unique-id: WOS:000805791200012
usage-count-last-180-days: '1'
usage-count-since-2013: '3'
volume: '296'
web-of-science-categories: 'Public, Environmental \& Occupational Health; Social Sciences,

  Biomedical'
year: '2022'