As far back as 340–368 AD, King Buddhadasa of Anuradhapura - himself a practicing Ayurvedic physician - pioneered the building of many hospitals in the country. He set up a healthcare system with one hospital for ten villages which were funded by tax on the revenue from fields of the villages.

In modern Lanka, there are over 555 government hospitals which practice western medicine. In addition there are several other government hospitals which use the Ayurvedic system of medicine. All of these hospitals do not charge for treatment, hospitalization or for the cost of drugs. 

But the system had its drawbacks, state hospital staff treated patients with disdain, most government expenditure was spent on treatment and little was available for modernization and maintenance. Sanitation at state hospitals was way below par. But medical treatment and equipment was of high standard. Until the opening up of the economy in 1977, private hospitals were very few, far between and expensive.

 
Today, there are over 140 private hospitals which provide in-house patient care and medication at a cost. But people were ready to pay for treatment to avoid the crush and delays at state hospitals, as well as to avoid the long wait for ‘specialist’ treatment and surgeries. Soon even the middle classes who could scarcely afford the high costs, were rushing to the private hospitals. So-much-so entering a private hospital for treatment, soon became a status symbol! Additionally, people also got used to visiting private medical practitioners for even minor ailments. 
The use of local herbs and home remedies for coughs, colds and other minor ailments gave way to purchasing of pharmaceutical drugs and tablets which are freely available.

Today in the face of the ongoing economic crisis, this situation is changing and the state medical services are under strain as more and more people - now unable to afford medical treatment at private hospitals - are forced to seek treatment in state institutions in face of a rising costs and stagnant wages. 

For instance, whereas in 2019, the Lady Ridgeway Hospital treated an average of 1000 patients daily. But in April, doctors at Lady Ridgeway Hospital warned the hospital was running out of essential supplies and bed space. 
With the country importing around 85% of its medical supplies, the depleted treasury is unable to provide sufficient foreign currency to replenish medicaments and supplies. With rising inflation, larger numbers of patients today are seeking treatment at state-run hospitals. The cost of essential drugs and hospitalization are now difficult to meet. 
But Sri Lanka is not the only country whose national medical system is in crisis, as world-wide inflation is on the rise. 

The Bank of England recently revealed increases in energy bills, which are set to be three times more than they were a year ago will drive inflation - the rate at which prices rise - even higher. The increase in the cost of living is putting a squeeze on people’s finances, as wages fail to keep up.

In a separate report the BBC added England faced a shortage of 12,000 hospital doctors and more than 50,000 nurses and midwives. 

The healthcare system in the US (the world’s richest and most powerful country) is best revealed in a Harvard University study which describes the situation thus:  “The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it, but can least afford its high cost. This contributes to avoidable healthcare disparities for people of colour and other disadvantaged groups...”

So far we, the Sri Lankans have been lucky, with free medical care being the norm from ancient times. But debt restructuring is staring us in the face. From the time of the Covid-19 pandemic, most employees suffered salary cuts, wage freeze in addition to a loss of other facilities.

Can we cope with the growing costs? Will we have to go back to age-old home remedies? If so, can the ayurvedic system meet the challenges posed by the new viruses etc.? 

Can the medical fraternity which closely protects its members’ rights, come up with plans to meet possible subsidy cuts which may be imposed via the debt restructuring process?

The poorest of the poor need to be protected from the worst effects of subsidy cuts. Or will we emulate the US policy of denying quality treatment to most needy sections of our society? That is the million dollar question. 
The answer is short and definite. We cannot let this happen. We need to protect the poorer sections of society from the crimes of the robber barons.