Dis-embedding Health Care

Abstract

From the early 1990s, so-called ‘five-star’ hospitals have sprouted up in small towns and cities across the state of Kerala, South India. Equipped with expensive diagnostic technologies and super-specialist consultants, these institutions are now leading players in the vibrant local health care economy. Markets in health are often understood to increase inequalities by creating a two-tier system of provision for the rich and the poor (for example, Johnson 1995). This paper examines how the processes of marketisation have significantly increased the cost of treatment across the public and private health care systems. It contrasts earlier approaches to corruption in medicine that emphasised the over-use or misuse of technologies (Yesudian 1994) to contemporary Kerala, in which technology has become an important value in everyday medical practice. As a result of growing competition and income aspirations, the health care system is gradually being decoupled from local cost considerations, while doctors and private hospitals are increasingly viewed as exploitative and lacking in moral legitimacy.