Kerala claims near universal utilisation of health care facilities but the affordability of health services needs attention. An analysis, based on NSSO 55th round data, shows that a high percentage of the population spends a substantial amount of its monthly income on health care. This could be compromising expenditure on essential items like food, clothing and fuel. The analysis also reveals that individuals at the lower end of the income ladder spend a disproportionate share of their income on health. Given Kerala's growing unregulated private health sector and the limited coverage by public health care, this calls for a rethink on providing 'good health at low cost'.