Kerala continues to record some of the highest healthcare costs and hospital usage in India, according to the latest NSS health survey, despite expanded insurance coverage.
Thiruvananthapuram: Kerala has emerged as a major outlier in India’s latest National Sample Survey (NSS) health data, showing the highest morbidity, highest hospitalisation rates, and among the highest out-of-pocket healthcare expenses in the country.
The findings are part of the NSS 80th round Socio-Economic Survey on household health consumption conducted across 2025.
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High illness reporting and hospitalisation
The survey shows that Kerala recorded a Proportion of People Responded as Ailing (PPRA) of 39.7% in the last 15-day reference period, nearly three times the national average of 13.1%.
This marks a sharp rise from around 24.5% in 2017–18, indicating a significant increase over recent years.
Kerala also recorded the highest hospitalisation rate in India at 92 per 1,000 persons, compared to the national average of 29 per 1,000. Among those aged above 60, the hospitalisation rate stands at 18.6%, more than double the national average.
Elderly health reporting highest in country
Nearly 78% of Kerala’s elderly population reported illness, the highest among all states, compared to the national average of 43.9%. Among elderly women, the figure is even higher at 81.8%.
Experts note that this may reflect higher health awareness and stronger healthcare-seeking behaviour rather than necessarily worse health outcomes.
The data also highlights Kerala’s heavy reliance on the private sector for inpatient care, with 66.5% of hospitalised cases treated in private hospitals, up from around 60% in 2017–18.
Public hospital usage for inpatient care has declined to around 30%, though public facilities still account for nearly half of outpatient care in rural areas.
Rising healthcare costs
Out-of-pocket expenditure remains high in Kerala despite insurance expansion.
Average inpatient expenditure (excluding childbirth) stands at ₹35,338, slightly above the national average of ₹34,064.
Even in government hospitals, patients in Kerala spend ₹9,313 on average, significantly higher than the national average of ₹6,631.
Childbirth costs are also notably high, averaging ₹39,893 in Kerala, more than twice the national average of ₹15,595, with over 70% of deliveries taking place in private hospitals.
The survey highlights a continuing trend of high healthcare spending in Kerala, raising questions about public hospital capacity and quality.
Despite increased investment in the public health system, reliance on private healthcare remains strong, especially for inpatient and maternity services.
The NSS 80th round survey covered nearly 1.4 lakh households across India between January and December 2025.
Published: 27 Apr 2026, 09:25 pm IST
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