Credible findings, misplaced attribution? Declining out-of-pocket health expenditure in Kerala from 2017 to 2020.

Authors

Adhish Kumar Sethi, Shankar Prinja

Published in

Social science & medicine (1982). Volume 412. Pages 120018. Nov 06, 2026. Epub Nov 06, 2026.

Abstract

In their recent article, Menon et al. study household out-of-pocket health expenditure (OOPE) in Kerala from 2017 to 2020. Using data from the Consumer Pyramids Household Survey, they show 32% reduction in OOPE during this period, largely explained by decline in medication spending. They attribute this reduction to Karunya Arogya Suraksha Padhathi (KASP), a publicly financed health insurance scheme in Kerala. In this commentary, we critically question this attribution. We show that the mechanisms of OOPE reduction postulated by Menon et al. are not supported by the findings of the article. In fact, previous rounds of the National Sample Survey show that any hospitalisation-focused insurance scheme such as KASP cannot be expected to produce large declines in OOPE. In our view, strengthening of government primary healthcare in Kerala since 2017 is a much more plausible explanation for the findings. For financial protection of patients in India, government primary healthcare services need to be improved at scale, with a focus on availability of free medications.

PMID:
42998591
Bibliographic data and abstract were imported from PubMed on 08 Nov 2026.

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