Should Health Come with a Price Tag?

Kerala’s health system has for decades been celebrated as one of the finest in the country — robust, accessible, and nearly on par with the private sector. Yet today, we face a fundamental shift: healthcare is slowly moving from being a right to being treated as a commodity. This transformation, where access to care increasingly depends on one’s ability to pay, is among the biggest challenges confronting Kerala’s health sector.

The privatization of hospitals has sharply driven up treatment costs, resulting in a steep rise in per capita health expenditure. Despite these pressures, the state has made sincere efforts to mitigate the burden on citizens. Through programmes such as the Aardram Mission, the government has taken direct responsibility for the procurement and distribution of essential medicines. Even amid financial constraints, these welfare-oriented interventions have continued — a testament to Kerala’s enduring commitment to public health.

One of the state’s greatest strengths has been its decentralized governance. Local self-government institutions now play a key role in health delivery and management, which was crucial in Kerala’s effective response to the COVID-19 crisis. Another distinctive achievement is the state’s palliative care network, widely recognized as a global model of community-based compassion and care.

From the time of Independence, Kerala envisioned a three-tier public health structure — with primary health centres (PHCs) forming the base, taluk and district hospitals as the intermediate layer, and medical colleges at the top. This design, if effectively used, would make it unnecessary for patients with minor ailments to crowd medical colleges. PHCs are meant to provide frontline care and guide referrals further up the chain only when needed.

However, the absence of a family doctor system has distorted this balance. Today, even for minor illnesses, patients tend to consult super-specialists directly. Kerala lacks a well-defined, decentralized referral mechanism in which a PHC doctor functions as the first point of contact. We must also evaluate whether hospital development committees, which include elected representatives, are functioning as genuinely participatory and responsive forums.

Another issue that demands urgent attention is gender justice in healthcare. Our system continues to rely heavily on the underpaid labour of essential workers — nurses, ASHAs, and other community health staff — whose contributions are critical but undervalued. Their work, often delivered at unsustainably low wages, represents a form of systemic exploitation. As these workers become more aware of their rights, Kerala must prepare for the inevitable correction in service costs that will follow — and ensure that this transition happens fairly and sustainably.

The absence of a strong regulatory framework for private hospitals and clinical practices is another major shortcoming. Kerala urgently needs comprehensive legislation — perhaps through an updated Clinical Establishments Act — to ensure accountability, transparency, and standardization across the private sector. High costs for services such as abortion and infertility treatment are just two examples of where regulation is needed to protect patients from commercial exploitation.

Kerala’s acclaimed health model stands today at a crossroads. To preserve what we have built, we must reaffirm our collective commitment to the principle of health as a public right, not a purchasable commodity. Only through stronger regulation, equitable labour practices, and a renewed focus on public responsibility can we sustain and strengthen the promise of healthcare for all.