PurposeThe substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.Design/methodology/approachA systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.FindingsChronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.Research limitations/implicationsThe present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.Originality/valueGiven the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.

COVID-19 has provided an unprecedented opportunity to expand access and coverage to the country's healthcare system via telehealth. Because of the growing need for telemedicine by healthcare providers, the Medical Council of India issued Practice Guidelines in March 2020. Medical specialties like ophthalmology, dermatology, and neurology offered telehealth services during pandemics. Low-middle-income countries like India are highly dependent on out-of-pocket expenses for health services. Thus, there is a need to understand telehealth's accessibility, feasibility and affordability. This review aims to understand trends regarding the access and patient response to telehealth in India during the COVID-19 pandemic. We reviewed published papers to understand better accessibility and patient response to the healthcare delivery systems via telehealth in India. The results of this review showed that patients were satisfied with the use of telehealth. Healthcare providers and patients believe telehealth can be suitable for various healthcare services, including follow-up visits in clinical disciplines and minor health problems. In conclusion, for Telehealth to understand further, quality evidence must be available, and its role in developing integrated parts of the healthcare system to be defined.

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Time management is critical during the acute stage of acute coronary syndrome (ACS) and stroke. To understand the segments of delays and underlying factors which affect the delay, we conducted a questionnaire survey utilizing the segments of delays model, which is still in progress to reach a higher sample size. Variables, including socio-demographic characteristics, diagnosis, symptoms and severity, awareness, and past medical history, are included in the survey. Descriptive analysis and mapping of the delays were conducted to understand the study’s early findings. A comparison of delays during ACS and stroke shows a higher delay in stroke, especially during decision-making of the victim or family members to seek treatment. Also, the socioeconomic difference between ACS and stroke and the severity of symptoms in stroke are associated with delay.