Health care system of Kerala has made tremendous progress over the past 60 years with large number of trained doctors, nurses and other technicians together with an extensive network of hospitals. The basis for Kerala’s impressive records on health standards is the state wide distribution of primary health centers. There are both public and private sector health care institutions in Kerala. Successive democratic governments in Kerala over the past 60 years had shown priority for health sector. This emphasis on health system is reflected in the greater budgetary allocation as well as the rapid growth of facilities from 1956 when the state was formed till the early 1990s. By 1990, Kerala had about 36,000 beds in the public sector and 49,000 beds in private sector. From 1990 onwards, private sector began to show an explosive rate of growth. By 1996, the difference in the availability of public and private health facilities assumed new proportions. The ratio of bed availability in public to private sector was 38,000 to 70,000 in 1996.
Kerala has one of the most extensive networks of government health facilities in India. There is one government health institution in every Panchayat or village. More over, this coverage is not confined to modern medical sector alone. In many places, there are representations of other medical systems such as ayurveda, homeopathy, nature cure, siddha, unani etc.
There was a rapid expansion of health care facilities under public sector in the state during the period between 1960 and 1970. However, thereafter, the mounting fiscal constraints prevented the government to make capital investments on large scales in the health sector. Consequently, capital spending began to stagnate since the 1980s. In addition to this, during the 1990s, there was a steady decline in the revenue spending as well on the non-salary items. The net result was the deterioration of the quality of services rendered by the government institutions. It was in this context that, private medical care institutions began to sprout on a large scale during the 1990s.
The proliferation of private institutions have enhanced the cost of health care considerably. The cost of medical care has been on the rise for the past several years. For many of the middleclass households , rate of increase in the medical care costs is much in excess of general household expenditure. Medical bills account for large share in most homes now. It is not unusual among the poorer sections to find families that have fallen in to debt trying to cover costs for treatments for serious illnesses. The marginal segments of the society such as the fishermen and agricultural labourers are the worst sufferers of this phenomenon.
Scholars point out different reasons for increasing health care costs in the private sector. Heavy increase in the drug prices is one of the important cause. Besides that, a number of sophisticated technology oriented treatments like organ transplants, coronary bypass graft, MRI scans, balloon angiography, joint replacements and infertility treatments etc. are getting established in Kerala’s health care systems. While they offer better quality diagnosis and treatment to the afflicted, they are expensive and beyond the reach of most middleclass families. But the availability of such interventions and the sufferings of the loved ones prompted many to seek such treatments that can ill-afford. Yet another factor promoting cost increase is the popular demand for specialist care. Specialist care adds to medical bills by way of larger fees, more expensive medical investigations and often much more expensive interventions thereafter.
Recently, there has been raised severe doubts about the efficacy of Kerala model of health system. While there are several positive indicators such as high rates of average life expectancy, low infant mortality and better nutritional standards, there are several fresh challenges popping up before the Kerala health care system. Malayalis seem to be under the double burden of communicable as well as chronic degenerative diseases. Many ailments which were thought to be eradicated such as the typhoid and malaria made a fresh reappearance during the 1990s. Leptospirosis, a fatal infectious disease caused by bacteria growing in dirty waters takes many lives during monsoons. Dengue and Japanese fevers, viral fevers spread by mosquitoes etc. are regular occurrences. Along with these communicable diseases, we see steady increase in such non- communicable diseases such as type 2 diabetes, heart diseases, hypertension and cancer. Malayalis also have higher levels of cholesterol as compared to communities living in other Indian states. Thus, Kerala’s disease profile is fast changing to one where the infectious and degenerative diseases contribute on an increasing scale to morbidity. Apart from that, the recent reports about the tribal deaths due to malnutrition and lack of medical care facilities point fingers to the things to be improved in Kerala’s health system