Kerala’s famed health indices are being challenged by a rise in incidence of lifestyle diseases and an allied increase in cost of healthcare. A recent survey revealed that out-of-pocket healthcare expenses in Kerala are the highest among states, and more than double the national average.Out-of-pocket expenses are the costs one pays for medical care not covered by health insurance, but these figures also underline the higher cost of medical care in the state. The Comprehensive Annual Modular Survey 2022-23, conducted by the National Sample Survey Office, revealed that Kerala’s out-of-pocket expenditure for hospitalised treatment per household per year is Rs 8,655 in rural areas and Rs 10,341 in urban areas. In comparison, the national average is Rs 4,129 (rural) and Rs 5,290 (urban). According to another report, Kerala’s per capita health expenditure was Rs 13,343 in 2021-22—almost four times the national average.
While one factor in the rising healthcare costs could be the growing elderly population, the major contributor is the high prevalence of lifestyle diseases, most of which require lifelong treatment. These—coupled with high cost of diagnostic tests and treatments, the disappearance of not-for-profit hospitals, and a general reluctance to take treatment in government institutions—have pushed up costs significantly. The closure of small hospitals and the emergence of corporate hospitals through acquisitions have adversely impacted costs for people.
Lifestyles diseases should be a worry for a state that boasts of health indicators on a par with the Western world. The second phase of the Kerala government’s lifestyle diseases screening programme, found 46.7 percent were susceptible to lifestyle diseases. While 13.15 percent had hypertension, 8.68 percent had diabetes and 5.42 percent had both. Lifestyle diseases are a leading cause of death, accounting for more than 52 percent of deaths in the 30–59 age group, says another report.
The acclaimed ‘Kerala model of health’ is said to be suffering from what is called “low mortality high morbidity syndrome”, where mortality may be low but morbidity, on account of a large proportion of sick population, is high. Dealing with the situation requires a three-pronged approach. One, create awareness about lifestyle diseases and changes required to reduce risks. Two, rationalise prices of treatments and tests in the private sector and establish a monitoring mechanism. Three, encourage people to opt for treatments in government hospitals. Kerala must wake up to the reality and adopt changes to remain healthy and avoid spending disproportionately on medical care.