Kozhikode: Heart procedures under Kerala’s flagship health insurance scheme for government staff have jumped so sharply that doctors and officials are now asking a blunt question: are all of them really needed? Data reported on Monday shows 13,365 angioplasty claims were approved under Medisep between the scheme’s launch in July 2022 and January 2026, at a cost of Rs 120.76 crore to the exchequer.
Medisep, short for Medical Insurance for State Employees and Pensioners, covers around 36 lakh people, including serving employees, pensioners and their dependants. Cashless treatment at empanelled hospitals is the scheme’s biggest draw, and, say health professionals, part of the reason the numbers have climbed so fast.
Angioplasty, which opens a blocked heart artery, often with a stent, was a marginal item in the scheme’s early months. By December 2024 it had entered the ten most frequently availed treatments. The first two and a half years of the scheme accounted for 8,352 claims. Then came a sharp jump: 4,602 claims were registered in 2025 alone, which is 1,261 more than in the previous year. By the end of 2025 the cumulative figure stood at 12,954, rising to 13,365 by January 2026.
Today, angioplasty ranks second among all treatments in total Medisep expenditure, and carries the highest average payout per claim, at Rs 90,360. That combination of high volume and high unit cost has turned a medical trend into a policy debate.
Why the audit demand is growing
The central worry is not the procedure itself. Angioplasty saves lives every day, and many of these patients needed it urgently. The problem is what the available data does not show: it does not separate emergency interventions done after a heart attack from planned procedures that might have been managed with medicines and lifestyle changes.
That gap is exactly what critics want closed. The growing call is for a comprehensive audit comparing how often angiogram patients at government and private empanelled hospitals are then advised to go in for angioplasty. A sharp difference would raise serious questions about how treatment decisions are made.
The concern is familiar in Indian health insurance. When a procedure is fully cashless for the patient and well paid for the hospital, borderline cases can quietly drift towards intervention.
The other side of the story
Health professionals urge caution before reading the rise as proof of over-treatment. A large share of Medisep beneficiaries are above 50, an age group far more prone to cardiac disease, and Kerala carries a high burden of heart disease and diabetes.
There is a second, more positive explanation. Before cashless cover, many patients put off cardiac investigations and stent procedures because of the cost, sometimes until a minor blockage became a major emergency. With the bill covered, people are seeking treatment earlier.
Both explanations can be true at once. An older population with high cardiac risk, plus easier access, would naturally produce more procedures. The audit demand rests on a narrower point: without a split between emergency and elective cases, and without hospital-wise comparisons, the scheme cannot tell how much of the growth is genuine need.
What this means for beneficiaries
For the 36 lakh people covered by Medisep, the debate has practical stakes. The scheme runs on public money, and if an audit finds wide variation in practice, it could lead to stricter pre-authorisation checks or second-opinion requirements for planned procedures.
None of that should worry a patient facing a genuine emergency. Angioplasty after a heart attack remains standard, life-saving care. The focus is squarely on planned procedures, where there is time to ask questions, seek a second opinion and weigh medicines against intervention.
Medisep has faced scrutiny before over claim disputes, and the angioplasty figures add a new dimension: they point to a pattern rather than individual grievances. Whether the pattern reflects better access, an ageing beneficiary base, loose clinical thresholds or a mix of all three is now the question Kerala’s health establishment has to answer with data, not assurance.
FAQs
What is Medisep?
Medisep is Kerala’s health insurance scheme for state government employees, pensioners and their dependants, offering cashless treatment at empanelled hospitals to around 36 lakh beneficiaries.
What is angioplasty?
Angioplasty opens a blocked heart artery, usually with a balloon and stent. It is used both in emergencies, such as during a heart attack, and as a planned treatment.
How much have angioplasty claims under Medisep grown?
Approved claims rose from 8,352 in the first two and a half years to 13,365 by January 2026, with 4,602 in 2025 alone. Total spend: Rs 120.76 crore, averaging Rs 90,360 per claim.
Why is an audit being demanded?
Because the data does not distinguish emergency procedures from planned ones, nor show whether angiogram patients are advised angioplasty at different rates in government and private hospitals. An audit would compare those rates and flag unusual patterns.
What should a patient do before a planned angioplasty?
Ask whether it is urgent or elective, what medicines could achieve, and whether a second opinion is possible. In a heart attack, do not delay emergency treatment.
The numbers, reported on Monday, have put one of Kerala’s most-used treatments under the spotlight. What happens next depends on whether the scheme opens its procedure data to the audit now being demanded.
