As a first–rate, nonprofit and holistic health care institution, Amala Hospital and Research Center stands out as exemplary in Kerala’s fast–changing and increasingly inequitable health care system.
Since the mid–20th century, when the state’s Marxist–led government implemented sweeping social reforms, including universal health care, Kerala has consistently ranked ahead of other Indian states in education and health care. Today, the state’s health–related human development indicators, such as infant mortality rate and life expectancy, rival those in developed nations. For decades, Indians as well as international health care specialists have heralded Kerala’s health care system for its affordability and wide accessibility to all residents — rich and poor.
However, in recent years, cracks have appeared in Kerala’s long–prized health care model. Though Kerala continues to lead other states in terms of remarkably low rates of poverty–related mortality and illness, its morbidity rate is the highest in the country. That is to say, its population per capita suffers more than in any other state from chronic illnesses associated with unhealthy lifestyle choices, such as obesity and type–2 diabetes, and old age.
In spite of government subsidies, public health care institutions struggle to meet the ever–rising costs of infrastructure, medical equipment and supplies and prescription drugs.
“There are two mafias in Kerala’s health care industry: the pharmaceutical companies and the diagnostic equipment manufacturers,” says Father Paul. “Both have easy access to doctors and influence the system of treatment. They create serious hospital management challenges, especially in the corporate sector.”
In addition, these days Keralites themselves are demanding greater and more immediate specialized care. “Kerala has a high education level and people are more and more health conscious,” continues Father Paul. “People read. People are aware, especially of medical improvements and new treatment options. Just pick up any newspaper and you’ll see news on health and medicine. So when they come to the hospital, they want to see a specialist right away.”
These combined pressures strain all of Kerala’s health care providers — public, private and Catholic.
The promise of high earnings and the availability of advanced medical technologies have prompted many doctors to open their own private, specialized practices. In recent years, countless private practices have cropped up in all corners of the state.
The poor and working class, however, cannot afford these comparatively expensive clinics and hospitals, which cater to an affluent and middle–class clientele. By the same token, this surge in private health care has made it more difficult for the public health care providers — which have always relied on revenue from patients able to pay for treatment — to serve the needy crowding their waiting rooms each day.
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