Even as medical inflation soars across India, how much you shell out for healthcare may depend on where you live.

Households in Kerala, Andhra Pradesh, Punjab and Tripura incur highest per capita medical expenditure on a monthly basis and those in the north eastern States incur the lowest, the Household Consumption Expenditure Survey 2022-2023 shows.

Among the rural population, people in Kerala spent the highest -average of ₹645 as medical expenses on a monthly basis. This represents 10.8 per cent of their total monthly per capita expense (MPCE). This is almost thrice the amount spent by households in Gujarat, Madhya Pradesh, Bihar and other States.

Andhra Pradesh at ₹452.5 per month (9 per cent of total MPCE) and Punjab at ₹451.2 (8.4 per cent) are the other two among the top three States where rural households spend highest on medical.

In urban India, Kerala at ₹652.2 per month, Tripura (₹589.1) and Andhra Pradesh (₹499.7) are the top three States with maximum monthly medical expenses.

The 2022-23 survey considers hospitalisation expenses in the last one-year period. Non-hospitalisation expenses (such as medicine, doctor fee, lab tests, etc) during the last 30 days are also accounted for. Values are also imputed towards utilisation of Pradhan Mantri Jan Aarogya Yojana (Ayushman Bharat) or any other State-specific public health scheme by households in the last one year.

Nationally, the survey shows that rural households spend more on medical (7.13 per cent of MPCE) compared with those in urban areas (5.9 per cent). Share of medical expenses (hospitalisation and non-hospitalisation) in total consumption expenses rose from average 5.5 per cent in 2011-12 to 5.9 per cent in the 2022-23 for urban areas and for rural India this rose from 6.7 per cent in 2011-12 to 7.13 per cent in 2022-23.

Underlying factors

“Medical inflation is quite high across the board. At least in States where public healthcare is relatively better, people have an option. But more worrying is States like in the north east, where they might not be able to access healthcare as either they are priced out or cannot access physically,” Dr. Abhinav Akhilesh, Partner, Grant Thornton Bharat, said. As per ratings agency, ICRA, the average revenue per occupied bed for listed healthcare enterprises is up from ₹41,800 in FY22 to ₹50,700 in FY24.

Analysts note that a large proportion of household health expenses in India are out-of-pocket and are due to factors such as cost of living, health insurance coverage, quality of public health infrastructure. Health literacy leads to variations across States.

“The average per capita consumption for health reflects the economy, literacy level and standard of living of various states,” Antony KR, Independent Monitor, National Health Mission, Govt of India, said. “Kerala’s highly literate population have a prompt health-seeking behaviour and it reflects a high income-high expenditure pattern economy,” he added.

In Punjab, low public health spending may be making healthcare expensive. Government health spending in Punjab stands at 30 per cent of total health expenditure while out-of-pocket expenses of households makes up 64 per cent, as per National Health Accounts 2019-20. In case of Tripura, only 36 per cent of households have at least one member covered by health insurance, as per the National Family Health Survey 2019-21.

With inputs from Mridula Krishnaraj