In 1949 S.W.R.D. Bandaranaike, the Minister of Health for the newly independent nation of Sri Lanka,1 declared his government’s acceptance as a fundamental human right of the World Health Organization’s (WHO) concept of health defined as ‘a state of complete physical, mental and social well-being’. This declaration looked back to the colonial legacy which had seen the gradual establishment of a system of free health care for all and it confirmed that this policy would remain the basis of the health care system for the future. In turn, the 2007-2016 Health Master Plan (Health and Shining Island in the 21st Century) reiterated for the twenty-first century the Sri Lankan government’s continuing commitment to ‘providing basic health care free of cost to the individual at the point of delivery, in State sector institutions’ (bold in original) (Ministry of Healthcare and Nutrition 2009: 1). Sri Lanka, defined as a lower middle income country with a GDP per capita in 2008 of US$2014 (Central Bank of Sri Lanka 2009b: IV) is deemed an example of how a poor country can deliver good health care to its citizens at low cost, as evidenced by its inclusion as one of nine country case studies in the World Bank publication Good Practices in Health Financing (Fleisher et al. 2008: 3-8). This chapter first explores the development of Sri Lanka’s exemplary health care system in the colonial and immediate post-colonial period. Second, it analyses the acute problems now challenging that system: can Sri Lanka continue to provide successful health care for its citizens given demographic transition and the double disease burden?