Rural Kozhikode residents show higher preference for private healthcare, study finds

A new study conducted in the rural areas of Kozhikode district, Kerala, has revealed that a significant portion of residents prefer private healthcare facilities over public ones for both outpatient (OP) and inpatient (IP) treatment. The study, published in the peer-reviewed Healthline Journal on July 23, 2026, also highlights that out-of-pocket expenditure (OOPE) remains substantial even for households covered under government health insurance schemes.

The community-based cross-sectional study was carried out by researchers from KMCT Medical College, Mukkom, including T. Jayakrishnan, Head of the Department of Community Medicine, P. Sruthi Krishna, Assistant Professor, and junior resident doctors Anjali Lakshman and Ahana Salim. It surveyed 700 households with a sample size of 2,371 individuals in a selected grama panchayat in the district.

The findings show that 174 people per 1,000 population (17.4%) required OP treatment within a 15-day recall period, while 19 per 1,000 (1.9%) required IP treatment over a one-year recall period. Infectious diseases, including viral fever, respiratory tract infections, mumps, chickenpox, and viral hepatitis, accounted for 76.9% of OP morbidities, with accidents and injuries constituting 7.6%.

Among those seeking care, 83.1% approached health facilities, while 16.9% resorted to self-medication. Notably, 53.4% sought care from private facilities, while 46.6% used public facilities. The median OOPE for OP care was ₹145 in public facilities and ₹700 in private facilities. In public settings, medicines accounted for the highest share of costs, while in private settings, investigations were the largest expense component.

For IP care, 77% of hospitalisations occurred in private facilities, with only 23% in public ones. Non-communicable diseases were the leading cause of hospitalisation (43.1%), followed by infectious diseases (34.4%). The median OOPE for IP care was ₹600 in public hospitals and ₹5,050 in private hospitals. As with OP care, medicines constituted the largest expenditure in public facilities.

The study also examined health insurance coverage. Out of 663 households, 494 (74.6%) were enrolled in some form of health insurance, while 25.4% had no coverage. The Pradhan Mantri Jan Arogya Yojana (PMJAY) was the most commonly availed scheme, covering 60.3% of the population. Despite coverage, insured participants incurred an OOPE of ₹2,625 for IP care, compared to ₹4,250 among the uninsured. Even those belonging to Below Poverty Line (BPL) families with insurance faced considerable financial burden, indicating inadequate protection.

The researchers noted that the lower OOPE for IP care in private facilities (₹5,050) compared to previous studies might be due to patients being admitted for minor ailments or discharged within a day to align with insurance claim requirements.

Commenting on the preference for private healthcare, the authors said it reflects increased privatisation in the health sector, potentially driven by factors such as rising health aspirations, shorter waiting times, perceived better quality of care, and greater flexibility in service delivery. The lower hospitalisation rate observed in this study may not fully capture the actual burden of illness, the authors added.

The study underscores the need to strengthen public healthcare infrastructure and enhance financial protection mechanisms to reduce the economic strain on rural households.