Industry Voice

Situational Analysis of Healthcare in Kerala

The easy accessibility and coverage of medical care facilities has played a dominant role to shape the health status of Kerala

Kerala has a long history of organised healthcare and by the time the state was formed in 1956, the foundation for a medical care system accessible to all citizens was already laid. The proof of the same is the existence of some of the hospitals that are more than 50-year-old. Health had been a major area of spending in the budget from early years in Kerala.

The annual growth rate of Government healthcare expenditure during its first three decades was 13.04 per cent, even surpassing the growth of State Domestic Product (9.81 per cent) during the same period. But the budgetary share of health has been slashed gradually from the 1980's from 6.95 per cent to around five per cent in 2000-2001. While capital spending stagnated by mid-1980's, revenue expenditure started declining after early 1990's. Continued growth of salary component in revenue expenditure led to reduction on supplies and maintenance.

India's first ever Human Development Report published in 2002, placed the Southern state of Kerala on top of all the other states in India, because of easy accessibility and coverage of medical care facilities.

An analysis of development expenditure of Kerala, which consists of medical and public health and family planning shows fluctuations in budget allocation. There has been a steady increase from 1990-1991 onwards till the dip in 2000-01 and 2001-02. The reasons attributed could be political and social changes in the state during that period and a shift in emphasis to family welfare schemes coupled with fiscal crisis.

The Private hospital Sector

Prof Radha Thevannoor

Kerala is one state where private health sector, both indigenous and Western systems of medicine, have played a crucial role. The Ayurvedic system of treatment practised in Kerala dates back to centuries. In the field of Allopathic system, missionary hospitals have contributed profusely by even going into the interiors of the state. It is believed that Portuguese settlers in old Malabar established one of the first hospitals in India.

High level of education especially among women and greater health consciousness have played a key role in the attainment of good health standards in Kerala. Since it is not possible for any Government to cater to the needs of the entire population, many private hospitals came into being. There has been a 40 per cent growth in the private sector as against a 5.5 per cent in the public sector. And now, the state has reached a stage where only about 25 per cent of lower income group uses facilities offered by Government hospitals.

The graph shows the dominance of private hospitals in Kerala when compared with other states. The dominance is seen in the number of hospitals, doctors and even beds. When there are only 1,317 (23.3 per cent) hospitals that are owned by the state, there are around 4,288 hospitals in the private sector. Similarly, it was estimated that in the year 2000, there were about 70,000 beds in the private sector as against 45,684 in the Government sector. During the year, the number of doctors in the Government sector was less than 6,000, while the private sector employed over 12,000 doctors.

Source : M Uplekar, A George, 1995 & 1996

With easy access and willingness to pay, the general public now prefers private services. Many are seen to borrow from various private banking services for treatment in private hospitals even when similar treatments are available in Government hospitals. The belief among the public about quality medical treatment being synonymous with private hospitals have deeply set in. But whether quality is assured is a question.

Especially in India and very much so in Kerala, there is no agency to determine the quality of standard of hospitals. The Credit Rating Information Services of India (CRISL), was assigned to grade Government hospitals in three states in 2002. As opined by CRISIL’s Managing Director, R Ravi Mohan, "Our grading for institutions is an opinion on the relative quality of healthcare delivered by them. A hospital graded higher would have better facilities, superior quality levels and greater consistency in services delivery compared to lower graded ones."

Investment Information and Credit Rating Agency of India Limited (ICRA) also suggested grading of hospitals in 2003. Their grading system suggested looking into technical and inter-personal parameters and conferring highest grades of H1 to hospitals with resources and processes consistent with those required for delivering highest quality of care. This would be followed by H2, H3 and H4 in the descending order.

Though some efforts were initiated in Kerala, it seems to remain on paper even now. Definitely public will resort to private sector more and Government will have to accept the initiatives taken by the private sector. There is no serious effort to regulate the private sector, so that it can be used as an effective means of healthcare delivery. It is high time that the Government wakes up and formulates policies to grade the Government and private hospitals for the benefit of the public. Since there are lesser initiatives from government to add more quality hospitals, it would be most appropriate if proper grading is ensured and public made aware of the same.

E-mail: radha@scmsgroup.org
The writer is Director SCMS School of Technology and Management Kochi