KOCHI: Increased incidence of lifestyle diseases and high cost of diagnostic tests, coupled with the disappearance of not-for-profit hospitals and people’s reluctance to opt for government medical institutions have pushed Kerala’s out-of-pocket expenses in healthcare to the highest among states, a recent survey has revealed.
Out-of-pocket expenses are costs a patient pays for medical care not covered by their health insurance. As per the Comprehensive Annual Modular Survey 2022-23 by the National Sample Survey Office under the Ministry of Statistics and Programme Implementation, Kerala’s out-of-pocket expenditure for hospitalised treatment per household is Rs 8,655 in rural and Rs 10,341 in urban areas, while per person, it is Rs 2,368 and Rs 2,939, respectively. The national average per household is Rs 4,129 (rural) and Rs 5,290 (urban) and per person is Rs 950 and Rs 1,446, respectively.
The out-of-pocket expenditure for non-hospitalised treatment is also high in Kerala with each household in rural and urban areas spending Rs 1,177 and Rs 1,163, respectively, and a person spending Rs 322 and Rs 330, respectively. Though the state’s growing elderly population is a reason, experts argue that prevalence of lifestyle diseases among the working group is a major contributor to the rise in spending. “Incidence of lifestyle diseases among people aged between 19 and 69 years is a major factor contributing to the increase in hospital care expense,” said M M Abbas, a Kochi-based health activist.
Dr D Narayana, an economist and statistician, said Kerala also has a high percentage of people with non-communicable diseases.
High individual expense on healthcare worrisome: Expert
“Hospital stay and expenses would be higher here for treatments just before death. The proportion of people who visit hospitals is higher in Kerala. Patients diagnosed with a lifestyle disease will have to take lifelong treatment,” he said. Narayana emphasised that outpatient visits are not covered under health insurance, burdening patients.
Kerala allocates maximum money for healthcare. Hence, the high individual out of pocket expense is worrisome, he said. “Kerala has improved the infrastructure and quality of services at government hospitals, but the number of people visiting private hospitals is high. Considering their social status, most people visit private hospitals,” Narayana said.
Emergence of corporates is another reason behind the rising healthcare burden, opined experts.
Dr Bhaskar Rao, head of Krishna Institute of Medical Sciences (KIMS), which began operations in Kerala recently after acquiring Sreechand Hospital in Kannur and Westfort Hospital in Thrissur, said hospitals make transplants and other procedures available.
“Primary and secondary hospitals should continue to function. They are less expensive for common people, who can visit for fever or other issues,” Rao said, adding that primary and secondary healthcare institutions and tertiary and quaternary establishments have to be complementary to each other.
When small-scale hospitals are closed down or merged and large-scale hospitals become prominent, it affects treatment cost. Abbas said the cost of medicines and diagnosis is also high. “There were several mission hospitals in Kerala, but most have gone extinct. We have many corporate hospitals. This will definitely affect treatment cost and accessibility to healthcare,” he said.
Dr Bhaskar said the healthcare expenditure, with advanced technologies and better-diagnostic facilities, will be higher.