1,306 clinics shut, as private hospitals rise in Kerala; IMA expresses concern
Villupuram Sees Major Boost in Healthcare Services
Kochi: Kerala’s healthcare system has changed significantly over the last five years. According to data from the Indian Medical Association (IMA), around 1,306 outpatient clinics and 444 small hospitals have shut down during this period. At the same time, the total number of private hospitals has increased from 3,677 in 2021 to 5,402 in 2026.
While the number of hospitals has increased on paper, many small, doctor-run clinics and neighbourhood hospitals, which usually provide affordable, easily accessible care in both urban and rural areas, are disappearing. The growth is largely driven by big corporate hospital chains and private equity-backed institutions expanding their presence across the state.
This shift is concerning, particularly in terms of affordability and access to care for financially weaker sections of society who have traditionally depended on these smaller establishments for treatment.
As reported by The New Indian Express, this transformation is unfolding alongside aggressive corporate mergers in the healthcare sector. For practising doctors, the primary concern is that the decline of small hospitals weakens primary and secondary level care and pushes patients toward higher-cost tertiary centres.
Speaking to The New Indian Express, IMA state president Dr M N Menon said, “These small hospitals are spread across Kerala, especially in rural areas, and provide treatment to the common people at a low cost. It is essential to retain them. Run by doctors, these clinics have better treatment facilities.”
He further added that seeking treatment at privately run corporate hospitals would increase the financial burden on middle-class households.
The pace of closures has accelerated sharply over the past five years. Between 2016 and 2021, only 148 clinics and 262 small hospitals were shut down, far fewer than in the most recent five-year period.
Health economist Dr. D Narayana attributed the trend to broader systemic changes rather than regulatory measures alone. “We cannot claim the rules and guidelines alone have caused the closure of clinics and small hospitals. People now prefer to consult specialist doctors. Also, with migration, the population in rural areas and small towns has decreased. Small hospitals used to benefit largely from delivery cases and the culture of family doctors. Now, even young doctors are not interested in running a small hospital for several reasons,” he said.
Frequent incidents of violence against healthcare professionals are also discouraging young practitioners from opening independent clinics.
In response to the trend, the IMA has urged that small institutions be exempted from certain registration requirements under the Clinical Establishments Act. Dr. Menon emphasized that regulatory compliance must be aligned with the operational realities of small hospitals to ensure their survival.
Public health expert Dr. V. Ramankutty stressed the importance of balancing patient safety with institutional sustainability. He underlined the need for small hospitals, noting that it is not financially viable for the middle class to seek treatment at corporate hospitals. He added that through discussions and negotiations, the issue could be addressed.
“Most of these clinics may not be able to afford the new technology and facilities outlined in the guideline. There should be revisions in the Clinical Establishment Act in such a way that it ensures patient safety and allows the small hospitals to operate,” he said.
At the same time, Kerala is witnessing a substantial number of mergers and acquisitions in the healthcare sector. In 2023, Quality Care, backed by Blackstone, acquired KIMSHealth Management. Subsequently, Caritas Hospital in Kottayam acquired Matha Hospital, while Baby Memorial Hospital in Kozhikode explored acquiring Chazhikattu Multi Super-Speciality Hospital in Thodupuzha.
