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.

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.

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Early treatment seeking during a stroke or heart attack is critical to prevent mortality and disability. This study has aimed to understand the perceptions of health-care experts in the state regarding the “emergency healthcare-seeking behavior of Kerala population during an acute stroke or heart attack.” An interpretative phenomenological analysis (IPA) was utilized in the study. Semi-structured interviews with health-care experts were conducted, and the data were analyzed linguistically. Later, interpretations were made based on the themes and literature review. We interviewed 7 health experts, and data were analyzed using the IPA method. Major concerns raised by the health experts include health financing issues, the disparity in treatment-seeking response based on socioeconomic status, less awareness regarding stroke in public, and so on.