
KOCHI: Around 88% of people in rural Kerala and 75% in urban Kerala spend their final moments in hospitals, as per a new study. This is nearly double the European average and points to the alarming rise in end-of-life healthcare expenses in the state. In sharp contrast, only 40% die in hospitals in other states.
“Kerala seems to be more medicine-centric than the US, where 80% of deaths occur in hospitals,” said D Narayana, economist and former director of Gulati Institute of Finance and Taxation (GIFT), who is now professor of eminence of School of Social Sciences, M S Ramaiah University of Applied Sciences, Bengaluru.
He collated the numbers on hospital deaths from the Sample Registration System Statistical Report 2020 by the Office of Census Commissioner 2024. The figure does not ensure quality of death even as it would see a massive rise in healthcare expenditure.
“Most people wish to die at home. However, due to several reasons, they are not allowed to. Hospital stay before death cannot ensure quality end of life. It also adds to healthcare expenditure,” Narayana said, adding that the number of corporate hospitals in the state also contributes to the situation.
The all-India average for hospital deaths in rural areas is 44.6% while that in urban areas is 61.5%.
Experts for promoting living will to reduce unnecessary treatment
Dr Joy Elamon, former director general of the Kerala Institute of Local Administration (KILA), and a distinguished doctor, said the increased healthcare awareness has contributed to the situation in Kerala.
“Healthcare awareness among Keralites is high. Also, our health-seeking behaviour is advanced. This, along with the availability and universal and uniform distribution of healthcare facilities, leads to a situation where relatives tend to seek medical help or ICU and ventilator support even if they know there is no hope,” he said, adding that age groups of the persons dying in Kerala hospitals would give a clearer picture on the trend.
Another reason cited by Dr Elamon is that Kerala has a strong public health system that enables even people from poor financial backgrounds to approach medical colleges or general hospitals.
M M Abbas, general secretary of the Organic Kerala Charitable Trust, said it is evident from the Census Commissioner’s report that healthcare is high towards the last year or the last quarter of one’s life.
“Especially high is the spending when death takes place in hospital. Does Kerala fall into this category of high bed and physician supply leading to a high proportion of death in hospitals,” he asked.
Added Narayana, “We need to create awareness among healthcare professionals to be more ethical in such situations. The proportion of ageing people and people with comorbidities in the state is high. Thus, a living will, where the patient can decide if they need medical aid before death, with the consent of relatives should be promoted. Such practices can help prevent unnecessary treatments.”
Dr Elamon said Kerala needs to consider the bond between the patient and the relatives. “Relatives may not be emotionally willing to provide medical attention. There would be questions from others too, forcing them to opt for hospital care,” added Dr Joy.
47% in UK
Narayana says the European average hospital death rate is 44%, lower than the UK’s 47%. And these countries implement more social care, he said.