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Last Updated Tuesday September 26 2017 07:53 PM IST

Health at any cost; the changing face of healthcare in Kerala

Shalini Anna Dominic
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In last moments of life, women less likely to get medical attention Affordable healthcare of good quality was the hallmark of the Kerala model. Representational image

The rooms come with with a view, there are smartly uniformed staff in color coordinated attire and the advertising is world class; if it wasn't for the throbbing head, the aching stomach or the creaking knee you might be forgiven for thinking that you were headed to one of the resorts in Gods Own Country instead of to a hospital.

Kerala has always been a pioneer in providing healthcare for its people. The Kerala healthcare model of the past 50 years has been much lauded world over for providing primary healthcare services which rate far higher than those offered by other developing countries. The reasons for this unique standing can be attributed in large measure to Christian missionaries as well as the communist movement which spearheaded initiatives to make education and healthcare available to all. Affordable healthcare of good quality was the hallmark of the Kerala model .

Today the situation is changing rapidly with large private multi specialty hospitals mushrooming across Kerala bringing with them the latest treatments and the best diagnostic tools. With a massive spike in lifestyle diseases seen across the board, this influx of private healthcare seems to meet the need of the hour. And the crowds flocking to these new hospitals give credence to the view that government hospitals and smaller healthcare providers are no longer the people's preferred choice.

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But what happens in the longterm once smaller and cheaper healthcare providers have fallen by the wayside? Are we heading toward a scenario where medical services become unaffordable for the common man? Should essential services like healthcare be heavily privatized and should profit be the only driver? And when profit is the sole driver how do we define the relationship between hospitals, diagnostic laboratories, pharmaceutical companies and the insurance services?

Of course it would be economically naive to expect hospitals to function as non-profit centers particularly as many that do so currently are finding it difficult to survive in this new corporatized world of healthcare. Yet we need to strike a balance between the old and new.

Medical tourism an important feature of the new system while currently beneficial to the state can also be construed as an early warning to us about the dangers of over corporatizing healthcare. The steady rise in medical tourists -- some come for treatments which are unavailable to them at home but many others come because the cost of treatment at home has spiralled out of their reach -- should lead us to question whether in future the people of Kerala will themselves have to travel to receive affordable healthcare.

With health and the providing of healthcare being such a vital issue, there will always be questions about conflicts of interest in the healthcare system. For as long as medicine has been practiced the question of ethics has been closely bound to it. All societies without a doubt seek improved health for their populations and good hospitals with well-trained medical staff as well as good diagnostic and research and development facilities are key to providing it. Quality service requires large investments of time, effort and resources on the part of those involved and it is only right that their efforts are rewarded within reason. And yet the question remains ... in a society where insurance coverage is relatively low, who is to bear the bulk of this financial burden? Should it be the already heavily burdened patient or should it be the government? Should there be some degree of regulation or should medical services be left to follow an unfettered market-driven path?

These are difficult questions and not all of them apply to our immediate situation, but they are certainly worth pondering over now. To borrow from medical parlance, prevention is certainly better than cure and if required doctors recommend early intervention to reverse a developing health situation.

(Shalini Anna Dominic is a writer based in Kochi. The views are personal.)

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