Kerala’s celebrated healthcare story has a downside too. A recent study revealed that around 88% of people in rural Kerala and 75% in urban areas die in hospitals, which is nearly double the European average.
While this could be an indication of wider access to healthcare facilities, the argument is that the trend underlines increasing end-of-life healthcare expenses and raises questions about the quality of death.
To put it in context, the proportion of the population dying in hospitals in the European Union is 44%, while in the UK it’s 47%. The policymakers in the EU and the UK are so worried about the higher proportion of hospital deaths that experts are studying the reasons and how it can be tackled.
The all-India average for deaths in hospitals is 44.6% in rural and 61.5% in urban areas.
The study by economist D Narayana argues that Kerala is "more medicine-centric than even the USA," where 80% of deaths occur in hospitals. Sure, there are counterarguments supporting Kerala’s case.
One, Kerala’s hospital penetration is far deeper than any other state. Two, given the large number of fatalities in road accidents in the state, it’s natural that these numbers add to the deaths in hospitals. And, the data also needs to be analysed in terms of age categories and causes to understand better the increased hospitalisation and the allied increase in spending. Yet, one thing is sure hospitalisation doesn’t universally translate into better care.
People who die in hospitals suffer more as they undergo more intensive tests and procedures. Though it remains a fact that hospitals are not good at caring for dying people, the terminally ill and those dying of old age still end up there because of various reasons, including social factors. This not only affects their quality of life but also the quality of death.
While factors like the growing elderly population, high prevalence of lifestyle diseases, and higher cost of diagnostic tests and treatments have already pushed up the cost of healthcare in Kerala, what can be avoided is adding to the burden through unnecessary hospitalisation that does more harm than good.
The solution lies in providing proper nursing care at homes and creating more non-hospital health facilities that are equipped to ensure that the last days of those dying are free of suffering. It’s far more comforting for people to breathe their last in the company of their loved ones than suffer a miserable death in intensive care units, cold and lonely.