A study conducted in rural areas of Kozhikode district has found that 174 people per a population of 1,000 (17.4%) required outpatient (OP) medical treatment within a recall period of 15 days and 19 people per a population of 1,000 required (1.9%) inpatient (IP) medical treatment within a recall period of a year for their various illnesses.
It also revealed that the utilisation of private healthcare facilities was higher for both OP and IP care. Out-of-pocket expenditure (OOPE) was higher in private facilities compared with public facilities for both OP and IP services. A substantial proportion of households were covered under government health insurance schemes. The OOPE, however, remained considerable among both insured and uninsured households.
The study titled ‘Morbidity and out-of-pocket expenditure among rural households of Kozhikode district, Kerala’ was published in Healthline Journal, a peer-reviewed publication of the Indian Association of Social and Preventive Medicine, on July 23, 2026. It was conducted by T. Jayakrishnan, Head of the Department of Community Medicine, P. Sruthi Krishna, Assistant Professor, Community Medicine, and Anjali Lakshman and Ahana Salim junior resident doctors, at KMCT Medical College, Mukkom, Kozhikode.
The community-based cross sectional study was conducted among 700 households and a sample size of 2,371 in a select grama panchayat in the district. Of the total population, 413 illnesses requiring OP treatment were reported over a period of 15 days, corresponding to a rate of 174 per 1,000 population. Most frequently reported cause of OP morbidities were infectious diseases (76.9%) which included viral fever, respiratory tract infections, mumps, chickenpox, and viral hepatitis. Accidents and injuries constituted 7.6%.
As many as 83.1% sought care from any health facilities, while 16.9% managed themselves through self-medication. A total of 53.4% sought care from private facilities, while 46.6% approached public facilities. The median expenditure OOPE for OP care was ₹145 and ₹700 in public and private facilities, respectively. In public facilities, cost of medicines (₹500) accounted for the highest share and in private facilities, it was for investigations (₹1,150).
Over a one-year period, 44 incidents requiring IP treatment were reported with an incident rate of 19 per 1,000 population. Of this, 77% were admitted in private facilities and only 23% were in public facilities. The cause of hospitalisation in 43.1% of the cases were non-communicable diseases and 34.4% were infectious diseases. The median expenditure OOPE for IP care was ₹600 and ₹5,050 in public and private facilities, respectively. In public facilities, cost of medicines accounted for the highest expenditure.
Out of 663 households, 494 were enrolled in any form of health insurance schemes while 25.4% had no such coverage. The most commonly availed scheme was Pradhan Mantri Jan Arogya Yojana, covering 60.3% of the population. The participants who were covered under health insurance schemes, including those belonging to BPL families, had an OOPE of ₹2,625 for IP care, compared to ₹4,250 among those who did not have it. Although the OOPE was relatively lower for the insured belonging to the BPL category, they still incurred substantial expenditure, indicating that they also suffer high financial burden and are not fully protected.
The OOPE for IP care in the private sector was ₹5,050, which was less than that of previous studies, possibly because patients were admitted for minor illnesses or discharged within a day to comply with insurance claim requirements.
The authors of the study said that the preference for private OP care was a sign of increased privatisation in healthcare which may be driven by many causes like increasing health aspirations, reduced waiting times, perceived better quality of care and greater flexibility in service delivery. The lower hospitalisation rate seen in the present study may not reflect a true reduction in morbidity but could be attributed to reduced affordability, where individuals delayed or avoided hospital admission due to financial constraints.
Published – August 04, 2026 09:00 am IST
