National household hospitalisation costs average ₹5,290 urban and ₹4,129 rural annually.
Published Aug 02, 2025 | 7:00 AM ⚊ Updated Aug 02, 2025 | 7:00 AM
Hospital bills. (iStock)
Synopsis: Kerala exceeds the national averages by substantial margins. The state’s urban hospitalisation costs per household (₹10,341) represent 95 percent above the national urban average. Rural hospitalisation expenses (₹8,655 per household) exceed the national rural average by 110 percent. Per-person costs show similar patterns, with Kerala’s urban hospitalisation expenses (₹2,939) running 103 percent above the national urban average.
When a Kerala resident visits a doctor for routine care, they spend ₹330 per month on average – one of the highest individual burden for non-hospitalised treatment in urban India.
For hospitalisation, the state’s urban residents pay ₹2,939 per person annually, again topping national charts. In rural areas, Kerala’s healthcare costs remain equally elevated at ₹322 monthly for outpatient care and ₹2,368 yearly for hospital treatment per person.
The household hospital expenses average at ₹10,341 in urban areas, and, ₹8,655 in rural areas.
This pattern places Kerala at the centre of India’s healthcare expenditure landscape, where a person’s medical bills can vary dramatically based on their state of residence. The data from Comprehensive Annual Modular Survey, 2022-23(National Sample Survey 79th round) reveals how healthcare costs across South Indian states create different financial realities for families seeking medical care.
Tamil Nadu follows Kerala in healthcare costs, with urban residents paying ₹2,028 per person annually for hospitalisation – the second-highest rate nationally. Rural hospitalisation costs ₹1,312 per person yearly, ranking seventh among all states.
For household-level expenses, Tamil Nadu families spend ₹6,053 annually in urban areas and ₹4,507 in rural areas for hospital care.
Telangana presents moderate costs compared to its South Indian neighbours. Rural residents pay ₹182 per person monthly for routine care, ranking fourth nationally, while annual hospitalisation costs reach ₹1,298 per person in rural areas and ₹1,246 in urban centres. Household hospital expenses average ₹4,579 rural and ₹4,008 urban annually.
Telangana is followed by Andhra Pradesh. Annual hospitalisation expenses per person reach ₹1,367 in urban areas and ₹1,097 in rural regions. Monthly routine healthcare costs ₹163 per person in urban areas and ₹169 in rural areas. Household hospital expenses total ₹4,238 urban and ₹3,685 rural annually.
Karnataka records the lowest healthcare costs among South Indian states. Urban residents pay ₹88 monthly per person for routine care – ranking 20th nationally – while rural residents spend ₹76 monthly. Annual hospitalisation costs ₹1,069 per person in urban areas and ₹1,074 in rural areas.
Household hospital expenses reach ₹3,462 urban and ₹4,523 rural annually, making Karnataka one of few states where rural hospital costs exceed urban rates.
The all-India averages provide context for South Indian spending patterns. National household hospitalisation costs average ₹5,290 urban and ₹4,129 rural annually. Per-person hospitalisation expenses average ₹1,446 urban and ₹950 rural yearly. Monthly routine healthcare costs average ₹166 per person in urban areas and ₹124 in rural areas nationally.
Kerala exceeds these national averages by substantial margins. The state’s urban hospitalisation costs per household (₹10,341) represent 95 percent above the national urban average. Rural hospitalisation expenses (₹8,655 per household) exceed the national rural average by 110 percent. Per-person costs show similar patterns, with Kerala’s urban hospitalisation expenses (₹2,939) running 103 percent above the national urban average.
Several states demonstrate healthcare costs well above national averages. Punjab households spend ₹7,374 rural and ₹6,963 urban annually on hospitalisation. Maharashtra families pay ₹6,975 rural and ₹6,399 urban yearly for hospital care. Haryana shows ₹8,489 rural and ₹4,258 urban household hospitalisation costs annually.
At the lower end, multiple states record hospital costs well below national averages. Goa households spend ₹907 rural and ₹1,605 urban annually on hospitalisation – the lowest rates nationally. Sikkim families pay ₹2,060 rural and ₹2,123 urban yearly for hospital care. Mizoram households spend ₹1,373 rural and ₹3,985 urban annually on hospitalisation.
Union territories show extreme variations in healthcare costs. Before their exclusion from this analysis, Lakshadweep recorded ₹19,020 urban household hospitalisation costs annually – the highest nationally. Andaman and Nicobar Islands showed ₹16,679 rural household hospital expenses yearly.
Conversely, Ladakh recorded ₹512 rural and ₹637 urban household hospitalisation costs annually – among the lowest nationally.
Kerala’s high healthcare costs can be attributed to several interconnected factors. Kerala has fundamentally higher costs due to its wage structure.
As Dr Rijo M John, a Kerala-based health economist, had explained to South First previously: “Kerala has one of the highest average wages for both men and women in the country. Everything is interconnected here — higher wages, higher expenditures, and higher costs. You cannot view higher healthcare spending in isolation; it’s also a state with relatively high per capita income and a higher cost of living compared to most states.”
This translates directly to healthcare costs, where “Nurses generally earn higher salaries than in other states,” making “the overall human resource cost in Kerala higher, which naturally increases the per capita cost of providing healthcare.”
Kerala has a distinct healthcare consumption pattern, Dr John notes: “Kerala has a significantly higher health-seeking behaviour compared to most other states” and operates as “a consumer-oriented economy, where people tend to spend more.”
Adding that the cultural approach to healthcare differs markedly from other states, Dr John said, “People here tend to seek medical care even for minor health issues. For example, if someone in Kerala has a fever, they are likely to seek formal care and consult a doctor immediately. Contrast this with many parts of North India or other states, where families often delay seeking healthcare until a condition becomes critical.”
Also, Kerala faces a substantial burden of lifestyle diseases:
Dr John further added that, despite Kerala spending 5.2 percent of its GSDP on healthcare, “the reliance on private healthcare remains pervasive.”
Government expenditure represents only 1.7 percent of GSDP while out-of-pocket expenditure accounts for 3 percent. “Private facilities, often costlier than their public counterparts, drive up household costs, overshadowing the benefits of government investment,” he added.
Dr John contextualizes this within broader awareness patterns: “This isn’t just about healthcare; it’s like when you look at crime statistics across the country. Health-consciousness in Kerala leads to higher reporting of illnesses, including outbreaks like flu or viral infections. While other states may experience similar issues, they may go unnoticed simply because people aren’t as aware or health-seeking.”
West Bengal demonstrates unique patterns in routine healthcare spending. The state’s urban residents pay ₹343 monthly per person for non-hospitalized care – the highest rate nationally, exceeding even Kerala’s ₹330. Rural residents spend ₹172 monthly per person, ranking fifth nationally.
However, hospitalisation costs remain moderate at ₹4,743 urban and ₹2,348 rural per household annually.
Punjab maintains high costs across all categories. Rural residents pay ₹259 monthly per person for routine care, while urban residents spend ₹234 monthly. Annual hospitalisation costs reach ₹1,776 per person in urban areas and ₹1,679 in rural areas. These figures place Punjab consistently in the top five nationally for healthcare expenses.
Northeastern states generally record lower healthcare costs. Manipur shows the lowest routine healthcare expenses nationally – ₹24 rural and ₹27 urban monthly per person.
However, the state’s hospitalisation costs reach ₹7,111 urban per household annually, ranking fifth nationally, creating a sharp contrast between routine and emergency care expenses.
Himachal Pradesh shows elevated routine healthcare costs despite moderate hospitalisation expenses. Rural residents pay ₹218 monthly per person for outpatient care, ranking third nationally, while urban residents spend ₹256 monthly. Annual hospitalisation costs remain moderate at ₹3,524 urban and ₹2,936 rural per household.
Most states show higher urban healthcare costs than rural costs, but several exceptions emerge from the data. Karnataka urban households spend ₹3,462 annually on hospitalisation while rural households pay ₹4,523 – a 31 percent difference favoring urban areas.
Haryana shows an even larger gap, with rural households spending ₹8,489 annually compared to urban households’ ₹4,258 – nearly double the urban rate.
Chandigarh, before exclusion, demonstrated extreme urban-rural variations. Rural household hospitalisation costs reached ₹2,427 annually while urban costs dropped to ₹1,277 – a 90 percent difference. This pattern suggests different healthcare infrastructure and accessibility patterns in these regions.
For routine healthcare, urban costs typically exceed rural costs by smaller margins. The national pattern shows urban residents paying ₹166 monthly per person while rural residents spend ₹124 – a 34 percent difference. However, states like Tripura show rural residents paying ₹73 monthly while urban residents spend ₹213 – a 192 percent urban premium.
The data reveals healthcare costs can vary by factors of ten or more between states. Goa’s rural hospitalisation costs (₹907 per household annually) compare to Kerala’s rural costs (₹8,655) – a 954 percent difference between the lowest and highest spending states.
Urban hospitalisation shows similar patterns, with Goa’s ₹1,605 per household annually comparing to Kerala’s ₹10,341 – a 644 percent difference.
Per-person hospitalisation costs show equally large variations. Rural per-person annual hospitalisation costs range from Meghalaya’s ₹311 to Kerala’s ₹2,368 – a 762 percent difference. Urban per-person costs span from Goa’s ₹488 to Kerala’s ₹2,939 – a 602 percent variation.
Routine healthcare expenses demonstrate smaller but significant variations. Monthly per-person rural costs range from Manipur’s ₹24 to Kerala’s ₹322 – a 1,342 percent difference. Urban monthly costs vary from Manipur’s ₹27 to West Bengal’s ₹343 – a 1,270 percent spread.
(Edited by Sumavarsha)
