International Remittances and Private Healthcare in Kerala, India


  • Mohd Imran Khan Narsee Monji Institute of Management Studies, Mumbai
  • Valatheeswaran C.



international migration, remittances, healthcare expenditure, health care access


The inflow of international remittances to Kerala has been increasing over the last three decades. It has increased the income of recipient households and enabled them to spend more on human capital investment. Using data from the Kerala Migration Survey-2010, this study analyses the impact of remittance receipts on the households’ healthcare expenditure and access to private healthcare in Kerala. This study employs an instrumental variable approach to account for the endogeneity of remittances receipts. The empirical results show that remittance income has a positive and significant impact on households’ healthcare expenditure and access to private healthcare services. After disaggregating the sample into different heterogeneous groups, this study found that remittances have a greater effect on lower-income households and Other Backward Class (OBC) households but not Scheduled Caste (SC) and Scheduled Tribe (ST) households, which remain excluded from reaping the benefit of international migration and remittances.

Author Biography

Mohd Imran Khan, Narsee Monji Institute of Management Studies, Mumbai

Assistant Professor, School of Economics


Agadjanian, V., Arnaldo, C., & Cau, B. (2011). Health Costs of Wealth Gains: Labor Migration and Perceptions of HIV/AIDS Risks in Mozambique. Social Forces, 89(4), 1097–1117.

Ambrosius, C., & Cuecuecha, A. (2013). Are Remittances a Substitute for Credit? Carrying the Financial Burden of Health Shocks in National and Transnational Households. World Development, 46, 143–152.

Amemiya, T. (1979). The Estimation of a Simultaneous Equation Generalized Probit Model. Econometrica.

Amuedo-Dorantes, C., & Pozo, S. (2011). New evidence on the role of remittances on healthcare expenditures by Mexican households. Review of Economics of the Household.

Antón, J. I. (2010). The Impact of Remittances on Nutritional Status of Children in Ecuador. International Migration Review.

Azzarri, C., & Zezza, A. (2011). International migration and nutritional outcomes in Tajikistan. Food Policy.

Bhat, P. N. M. (1990). Demographic Transition in Kerala Revisited. Economic and Political Weekly, 25(35–36), 1957–1980. Retrieved from

Botezat, A., & Pfeiffer, F. (2014). The Impact of Parents Migration on the Well-Being of Children Left Behind--Initial Evidence from Romania. ZEW-Centre for European Economic Research Discussion Paper, (14-029).

Corno, L., & de Walque, D. (2012). Mines, Migration and HIV/AIDS in Southern Africa. Journal of African Economies, 21(3), 465–498.

de Brauw, A., & Mu, R. (2011). Migration and the overweight and underweight status of children in rural China. Food Policy, 36(1), 88–100.

Dilip, T. R. (2010). Utilization of inpatient care from private hospitals: trends emerging from Kerala, India. Health Policy and Planning, 25(5), 437–446.

Drabo, A., & Ebeke, C. (2010). Remittances, Public Health Spending and Foreign Aid in the Access to Health Care Services in Developing Countries. Retrieved from

Garg, C. C., & Karan, A. K. (2009). Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India. Health Policy and Planning, 24(2), 116–128.

George, A V, Nair, S. (2004). An Overview of the Health Scenario of Kerala. In B. A. Prakash (Ed.), Kerala’s Economic Development Performance and Problems in the Post-Liberalization Period. SAGE Publications Pvt. Ltd.

Gertler, P., Levine, D. I., & Moretti, E. (2009). Do microfinance programs help families insure consumption against illness? Health Economics, 18(3), 257–273.

Government of Kerala. (2015). Economic Review 2015, Thiruvananthapuram: State Planning Board, Government of Kerala. Retrieved from

Graham, E., & Jordan, L. P. (2011). Migrant Parents and the Psychological Well-Being of Left-Behind Children in Southeast Asia. Journal of Marriage and Family, 73(4), 763–787.

Hildebrandt, N., & McKenzie, D. J. (2005). The Effects of Migration on Child Health in Mexico. Economía, 6(1), 257–289.

Islam, A., & Maitra, P. (2012). Health shocks and consumption smoothing in rural households: Does microcredit have a role to play? Journal of Development Economics, 97(2), 232–243.

Khan, M. I., & Valatheeswaran, C. (2016). International Migration, Remittances and Labour Force Participation of Left-behind Family Members: A Study of Kerala. Margin.

Kutty, V. R. (2000). Historical analysis of the development of health care facilities in Kerala State, India. Health Policy and Planning, 15(1), 103–109.

Ladusingh, L., & Pandey, A. (2013). Health Expenditure and Impoverishment in India. Journal of Health Management, 15(1), 57–74.

Levesque J, F, Haddad S, Narayana D, F. P. (2006). Outpatient care utilization in urban Kerala, India. Health Policy and Planning, 21(4), 289–301.

Lung-Fei, L. (1992). Amemiya`s generalized least squares and tests of overidentification in simultaneous equation models with qualitative or limited dependent variables. Econometric Reviews, 11(3), 319–328.

Lurie, M. N. (2006). The Epidemiology of Migration and HIV/AIDS in South Africa. Journal of Ethnic and Migration Studies, 32(4), 649–666.

Mazzucato, V., Cebotari, V., Veale, A., White, A., Grassi, M., & Vivet, J. (2015). International parental migration and the psychological well-being of children in Ghana, Nigeria, and Angola. Social Science & Medicine, 132, 215–224.

Mckenzie, D., & Rapoport, H. (2007). Network effects and the dynamics of migration and inequality: Theory and evidence from Mexico. Journal of Development Economics, 84(1), 1–24.

Mendola, M., & Carletto, C. (2012). Migration and gender differences in the home labour market: Evidence from Albania. Labour Economics, 19(6), 870–880.

Mincer, J. (1978). Family Migration Decisions. Journal of Political Economy.

Nag, M. (1989). Political Awareness as a Factor in Accessibility of Health Services-A Case Study of Rural Kerala and West Bengal. Economic and Political Weekly, 24(8), 417–426. Retrieved from

Newey, W. K. (1987). Efficient estimation of limited dependent variable models with endogenous explanatory variables. Journal of Econometrics, 36(3), 231–250.

NSSO. (1998). Morbidity and Treatment of Ailments.In Ministry of Statistics and Programme Implementation, New Delhi.

NSSO. (2015). Key Indicators of Social Consumption in India: Health. In Ministry of Statistics and Programme Implementation, New Delhi.

Ponce, J., Olivié, I., & Onofa, M. (2011). The Role of International Remittances in Health Outcomes in Ecuador: Prevention and Response to Shocks. International Migration Review, 45(3), 727–745.

Sevoyan, A., & Agadjanian, V. (2010). Male Migration, Women Left Behind, and Sexually Transmitted Diseases in Armenia. International Migration Review, 44(2), 354–375.

Shahrawat, R., & Rao, K. D. (2012). Insured yet vulnerable: out-of-pocket payments and India’s poor. Health Policy and Planning, 27(3), 213–221.

Staiger, D., & Stock, J. H. (1997). Instrumental Variables Regression with Weak Instruments. Econometrica, 65(3), 557.

Stark, O., & Bloom, D. E. (1985). The New Economics of Labor Migration. The American Economic Review, 75(2), 173–178. Retrieved from

Taylor, E. J. (1999). The New Economics of Labour Migration and the Role of Remittances in the Migration Process. International Migration, 37(1), 63–88.

Terrelonge, S. C. (2014). For Health, Strength, and Daily Food: The Dual Impact of Remittances and Public Health Expenditure on Household Health Spending and Child Health Outcomes. The Journal of Development Studies, 50(10), 1397–1410.

Thresia, C. U., & Mohindra, K. S. (2011). Public Health Challenges in Kerala and Sri Lanka. Economic and Political Weekly, 46(31), 99–107. Retrieved from

Tumbe, C. (2011). Remittances in India : Facts & Issues. In Indian Institute of management, Research and Publications (No. 331). Retrieved from

Valatheeswaran, C., & Khan, M. I. (2018). International Remittances and Private Schooling: Evidence from Kerala, India. International Migration, 56(1), 127–145.

WorldBank. (2016). Migration and Remittances Fact Book, Third Edition, Washington DC: World Bank Publication.

Zachariah, K. C., & Rajan, S. I. (2007). Migration remittances and employment short-term trends and longterm implications. Retrieved from

Zachariah, K. C., & Rajan, S. I. (2011). Impact of Remittances of Non-resident Keralites on Kerala’s Economy and Society. Indian Journal of Labour Economics, 54(3), 503–526. Retrieved from

Zhunio, M. C., Vishwasrao, S., & Chiang, E. P. (2012). The influence of remittances on education and health outcomes: a cross country study. Applied Economics, 44(35), 4605–4616.



How to Cite

Khan, M. I., & C., V. (2020). International Remittances and Private Healthcare in Kerala, India. Migration Letters, 17(3), 445-460.




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