Foundation For Social Health

Kerala

Kerala has a long history of organized health care measures starting from late Nineteenth century. The State has pursued a health development strategy where by the medical needs of common people were largely met by the public sector during the period 1956-1981 . However, the economic reform measures have changed this situation as the state has been reluctant to invest more on public health care services (Ramankutty, V, 1995, 1999). Social scientists should address the emerging issue as to whether the increased privatization in medical care after 1980, might deny the poor and middle income groups access to basic quality health services at affordable cost.

In this context, we can identify the following principal barriers to access to health for the poor people.

• Lack of information on the availability and location of services.
• Lack of funds to avail quality care.
• Insensitive/unreliable treatment provided in the Govt hospitals.
• Irrational drug policy.
• Prohibitive costs in private sector.

From the foregoing analysis, it is clear that Malayalees face the following problems that demand urgent attention of all concerned organizations and health activists.

• More than 25 percent of people suffer from respiratory infections.
• More than 8% of adult population suffers from diabetes.
• Hypertension and heart diseases has increased in the state recently.
• In the case of mental diseases, the State has the highest share. Yet, the mental healthcare facilities are grossly inadequate.
• Diseases like Dengue Fever and Leptospirsis are increasing with alarming rate.
• The share of overweight and obese people in Kerala has increased phenomenally. It is generally observed that probability for heart attacks and strokes increased for these persons.
• The number of HIV positive cases has been estimated to be around one lakh. (Economic Review, 2004, Chap 12,301-05)

The share of old people in the population has increased faster rate than other states. It is projected that the share of 60+ population may cross 32 percent by 2051.This naturally calls forth the need for more geriatric nurses, more psychological counselors and more physicians to attend to degenerative diseases like arthritis and cancer .

Though infrastructural facilities in Kerala public healthcare are good, the service provided by them is woefully low due to the lack of complementarities like medicines, chemical reagents. Government of Kerala spends about 90% of health expenditure for the payment of salaries of public health servants. In this connection, the costs and benefits of introducing user charges may also be analyzed. The government of Kerala has experimented with the introduction of user charges earlier but was forced to withdraw because of the stiff opposition from the public.

In all modern markets, it is generally assumed that both the consumers and sellers/producers are aware of the quality/quantity of services/goods offered for sale. Consumers have a rough idea as to the market price of the good or service he is going to purchase though he may not be conscious of all the intricacies of the market .In health care market, the patients have neither any notion of the gravity of the disease nor do they have any knowledge about the clinical methods available to confirm the disease or the type of drugs they have to take for the complete cure of the problem.

In Kerala, very few doctors appraise the patient or her relatives about the medical problem or the drugs prescribed or the clinical methods required for identifying and confirming the disease. This type of market is popularly known as information asymmetrical market where the doctor can refer her to any clinical diagnostic centres for unnecessary tests for getting monetary gain from these centres or can prescribe any type of drugs for increasing the market of certain drug companies for a quid-pro-quo. The information asymmetries prevailing in the health care sector naturally led to the large scale exploitation of the patients.

The 1980s witnessed a massive expansion of private hospitals/clinics in the state which altered the health care from a service industry to a lucrative business activity with high technology diagnostic centres and irrational prescription of drugs promoted by drug transnationals. Patients coming for treatment may not be aware of the unholy alliances between the doctors and the private investors in drug companies/diagnostic centres. Doctors are ‘educated by the medical journals’ financed by the TNCs /giant national firms extolling the efficacy of their drug formulations. Corporates in Health care are attempting to reduce the controls enjoyed by the State in respect of health products.