Financial risk protection in receiving healthcare services among residents of Kalutara District

Introduction: Sri Lankan healthcare system includes public and private sectors, with rising private care reliance funded mainly by out-of-pocket expenses (OOPE). Over half of outpatients use private care, exposing households to financial risks and catastrophic health spending.  
Objectives: To describe financial strain, indirect costs and barriers to Universal Health Coverage (UHC) in view of financial risk protection in Kalutara District 
Methods: A community-based cross-sectional study with an analytical component was conducted in Kalutara District from May to October 2019, inviting 2000 households. Data on household income, expenditure and healthcare costs were collected through an interviewer-administered questionnaire. Scenario-based modelling was done to assess healthcare preferences, accessibility, affordability and financial coping strategies, using retrospective data for comparative household health expenditure analysis. Financial risk protection and associations with catastrophic health expenditure (CHE) were analysed using Mann Whitney U test and chi-squared test. Multiple logistic regression was applied subsequently. 
Results: There were 7747 individuals in the 2000 households selected with nearly equal sex distribution. Most participants were over 50 years of age (28.3%) and 26.8% of households had at least one member with a disease, mainly diabetes (12.9%) and hypertension (10.8%). Median monthly income was LKR 68,625 (IQR: LKR 47,125-104,125) with significant spending on food and healthcare. A majority used LP gas for cooking and had electricity. The CHE affected 8.41% of households, with impoverishment rising from 4.8% to 6.7% due to OOPE. Cancer, heart disease, diabetes and arthritis were most strongly linked to CHE. 
Conclusions & Recommendations: Notable financial challenges are present among residents of Kalutara District, with 8.41% of households meeting the CHE threshold. Non-communicable diseases like cancer, heart disease and diabetes significantly increase CHE risk, emphasizing the need for stronger financial protection and better healthcare affordability.