KOCHI: At a time when Kerala is witnessing a debate over the availability and effectiveness of healthcare facilities in the government sector, data with the directorate of health services shows that the number of people visiting government hospitals in the state has risen over the years. Even so, the number of inpatients or those seeking treatment for serious illnesses has come down significantly over the past eight years.
In 2023-24, as many as 11.29 crore people visited government hospitals, including primary health centres, community health centres, taluk hospitals, and district hospitals. Affordability, better facilities, and awareness about the services provided there have resulted in the trend.
“Increased morbidity is one of the reasons why out-of-pocket expenditure and treatment-seeking are high in Kerala,” Dr B Ekbal, a public health expert, told TNIE.
“Also, the number of people with healthcare-seeking behaviour is high the state. So is the case with people who can afford healthcare costs and have insurance claims.”
He said the high demand for treatment at private hospitals reflects the rising number of hospitals. Public and private hospitals are evenly distributed in rural and urban areas in the state, he pointed out.
The data reveals that the number of inpatients at government healthcare facilities has come down to 7.56 lakh in 2023-24 from 14.18 lakh in 2014-15. Also, there is a significant dip in the number of major surgeries performed at government hospitals -- dropping from 1,01,953 in 2015-16 to 89,775 in 2023-24.
According to Hussain Koya Thangal, president of the Kerala Private Hospitals Association, there is an increase in patients overall, which is reflected in the number of people seeking treatment at government hospitals.
“The number of people approaching private hospitals has also increased,” he said, emphasising that there are several contributing factors.
On the rise in patients in the government sector, health economist Dr D Narayana said: “The improvement in government facilities over the past ten years and the rising costs in the private sector have contributed to the trend.”
A study ‘Kerala’s Progress Towards Universal Health Coverage: The Road Travelled and Beyond’, published in the International Journal for Equity in Health in 2024, has found that public healthcare utilisation has increased in the state.
“Overall public healthcare utilisation in Kerala increased from 33.9% in 2014 to 37.3% in 2017-18 for inpatient (IP) care. Under private healthcare utilisation, in 2017-18, for-profit formal private sector utilisation was 59.1%, whereas for NGOs and trust hospitals, it was 3.6%. Public healthcare utilisation was higher in rural areas (38.7%) compared to urban areas (35.2%),” the study stated.
Over the years, the improved facilities, services, and infrastructure at government hospitals, from public health centres to district hospitals and general hospitals, have made the common people choose the sector, Hussain stressed.
“More departments are functional at government hospitals, with more doctors and healthcare staff. The public healthcare system in the state has improved,” he said.
According to Dr Ekbal, while celebrating these achievements, it is crucial not to overlook the challenges confronting Kerala’s health sector, as neglecting them could have far-reaching consequences.
“The rising prevalence of communicable, non-communicable and mental diseases, unique health issues faced by the elderly, and the specific health crises experienced by marginalised communities are all significant challenges today. Despite the strengthening of public health systems, the uncontrolled increase in Out-of-Pocket Health Expenditure (OOPE) borne directly by the public continues to be a major crisis,” Dr Ekbal emphasised.