Life expectancy in Kerala is 73 years — which is comparable with Europe and the U.S. Photo: © World Bank / Curt Carnemark (flickr)

India's southern state of Kerala has received international attention not only for its beaches and temples, but also for statistics that suggest people of limited means can live long, healthy lives. (Its life expectancy of over 73 years puts it on par with some of the world's most advanced countries.)

But Kerala's rising affluence has challenged the stability of a once-thriving public health system. Indications are that wealthy patients are increasingly turning to high-tech, private clinics for care, putting the public health care system at risk.

PRI’s The World reports an emergence of “lifestyle ailments” like diabetes and heart disease in Kerala, a tropical state on India’s southwestern coast with 18 million residents. Kerala's per capita annual income is a mere $300, but like the whole of India, recent economic growth has meant a booming middle class. At the same time, its population, according to the program, has become less active and more prone to obesity.

The demand for specialized care for a new set of health issues has put a strain on Kerala’s public health system. Public hospitals are losing experienced doctors to better-paying jobs at private clinics.

“People no longer see the government health institution as a place where they would go by choice,” explains Dr. V Raman Kutty at Kerala’s Centre for Health Science Studies. “They would go only if there is no other option.”

As the gap between rich and poor widens, is Kerala’s exceptional status sustainable? Academics will wrestle with that question in January, when the state's Centre for Development Studies hosts a conference on Challenges of Human Development in India. "The pervasive social and economic inequalities," reads the conference announcement, "are a matter of concern for India."

In Japan, her overnight hospital stay would only cost her $10. Photo: Hamed Saber (flickr)

“Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem,” according to the National Coalition on Health Care.

The United States spends the most in the world on health care – about $2 trillion annually. Yet, the U.S. ranks 37th in world in terms of the quality and fairness of its health care, according to the World Health Organization (WHO).

The U.S. has no comprehensive national health insurance system. Those who have insurance get it through their employers, government programs, or private suppliers. However,there are 47 million people that are not insured. Furthermore, millions more are underinsured, which has led to a growing epidemic of medical debt and bankruptcy in the United States. A Harvard University report found that about 50 percent of all bankruptcy fillings were partially due medical debt.

In light of this growing problem, correspondent T.R. Reid traveled with Frontline to investigate if other free-market countries were having the same problems with medical-related bankruptcy. What he found was shocking.

Traveling to the United Kingdom, Japan, Germany, Taiwan, and Switzerland, Reid found that health-related bankruptcy is almost unheard of in these countries. Unlike the United States, all five of the visited countries have universal health care and pay a lot less.

Switzerland spends the second-highest amount on health care, but the government still spends 44-percent less per capita than the United States.

The full program, "Sick Around the World," is available online, along with a list of resources and a Q&A with Reid.

All the countries have varying degrees of private, market-based health care, like the United States. They, however, also limit the level of freedom the health care market can have. According to Frontline:

First, insurance companies must accept everyone and can't make a profit on basic care. Second, everybody's mandated to buy insurance, and the government pays the premium for the poor. Third, doctors and hospitals have to accept one standard set of fixed prices.

It's unnecessary for health care costs to send hundreds of thousands of Americans into debt each year. As Reid has learned, it is possible to make health care universal and affordable in a free-market economy.