In common with most British colonies, govern
-
ment hospitals charged user fees prior to the 1930s.
However, a means-tested exemption was provided
to those considered poor, and the income limit
was set so high that most rural patients did not
pay. Yet in the electoral scenario that emerged af-
ter 1931, even these limited fees were considered
unreasonable. User fees were abolished in 1951
by the UNP government in power at the time but
were reintroduced in 1971 by a Trotskyite finance
minister. Demand for health services, especially
by the poor, immediately plummeted, and the
fees were again abolished by the next UNP gov
-
ernment in 1977. Consequently, in Sri Lanka user
charges have never been a barrier to access by the
poor, and the national policy of free care has been
firmly supported by all major political parties and,
in fact, was instigated by the most promarket of
them.