Commodification of Health in Sri Lanka: The rise of Out-of Pocket Expenditure and the Push for Voluntary Private Health Insurance under Neoliberal Health Reforms

Abstract

analyzing the rise in out-of-pocket expenditures (OOPE) and the growing emphasis on Voluntary Private Health Insurance (VPHI) within the context of neoliberal policy reforms. Employing a mixed-methods approach, the study combines quantitative trend analysis (2000–2022) using Sri Lanka’s health expenditure data from the World Health Organization’s Global Health Expenditure Database (GHED) with qualitative thematic analysis of health policy documents and reports from international financial institutions (IFIs). The findings indicate a consistent increase in OOPE, driven by limited public health investment, expanding privatization, and the indirect influence of international financial policies on national budgets and healthcare frameworks. The study highlights a shift from a universal public health model to a market-driven system, where individuals are increasingly treated as consumers rather than citizens. While proponents of VPHI argue that it enhances efficiency and financial sustainability, the study questions whether these reforms genuinely improve healthcare access or lead to structural inequalities. The findings underscore the need for stronger government regulation of VPHI, increased public awareness of health rights, greater transparency in healthcare financing, and policies that prioritize public welfare over market efficiency.