Of the 102 patients who were interviewed for their study, who were eligible for AB-ArK, just five — less than five percent — received free treatment. The rest reported spending large amounts out of pocket.
Published May 07, 2025 | 7:00 AM ⚊ Updated May 07, 2025 | 7:00 AM
A scene at the Old General hospital premises on a busy morning, where patients are seen waiting for their Medical Examination in rural Mysuru. (iStock)
Synopsis: Sarvatrika Arogya Andolana – Karnataka noted in a report that many working-class families are left to navigate the confusing and unaccountable pathway to care during serious sickness to get healthcare even when they possess BPL cards and insurance cards.
For three months, the father of an eight-year-old girl in Karnataka’s Davanagere district ran from hospital to hospital, desperate to get treatment for his daughter’s spinal condition. He ended up spending ₹46,000 — nearly three times the average a family in the state spends annually on healthcare — but his daughter remains untreated.
The girl’s mother rolls beedis for a living. Her father is a daily-wage construction worker.
When the child began struggling to walk and her neck tilted to one side, the family rushed her to a private hospital nine km away. Lacking specialists at local government facilities, they spent ₹36,000 on MRI scans, tests and admission. Doctors said she had a spinal mass and needed surgery.
What followed was a maze of referrals, paperwork work and missed wages — all while her condition worsened.
When referred to another private hospital, the family was told that they couldn’t access benefits under Ayushman Bharat – Arogya Karnataka (AB-ArK) because the girl’s name wasn’t on the ration card. A trip to Mangaluru cost them another ₹10,000, only to be turned away again for the same reason.
For weeks, the father tried adding her name to the ration card, but the government portal was reportedly frozen due to enrolments under the Gruhalakshmi scheme. When they finally reached a government hospital for a referral letter — a key document to access AB-ArK benefits — the “referral code” wasn’t available.
None of the hospitals had noted it. A private neurosurgeon eventually wrote down the code, but without the updated ration card, it was useless.
Despite possessing BPL (Below Poverty Line) and insurance cards, the family was left to navigate a confusing and unaccountable pathway.
“Moreover, the father continued to lose several days of daily wages in this paperwork while the child remained ill. The above case story represents just one among many working-class families who are left to navigate the confusing and unaccountable pathway to care during serious sickness to get healthcare even when they possess BPL cards and insurance cards, Sarvatrika Arogya Andolana – Karnataka (SAA-K) — A people’s campaign for universal health systems — noted in a report.
Their findings sharply contrast with official numbers.
According to the National Health Accounts (NHA) report for 2021–22, Karnataka’s average annual per capita out-of-pocket expenditure (OOPE) on healthcare is ₹1,933 — about ₹7,732 for a family of four. This places Karnataka among the states with relatively low OOPE and a balanced public-private health financing model.
However, SAA-K’s ground-level data tells another story.
Of the 102 patients who were interviewed for their study, who were eligible for AB-ArK, just five — less than five percent — received free treatment. The rest reported spending large amounts out of pocket.
In many cases, patients who used insurance paid as much — or even more — than those who didn’t, both in government and private hospitals.
In theory, insurance schemes are meant to reduce financial barriers to care. But in Karnataka, for many families like this one, those schemes appear to be little more than paperwork — with a price.
The study by SAA-K documented 116 case stories from eight districts across Karnataka and analysed the financial burden faced by 102 patients who were admitted to both government and private hospitals.
Despite 94 percent of these patients possessing insurance — either in the form of BPL or ration cards (commonly accepted in government hospitals) or AB-ArK (more widely accepted in private hospitals) — only five individuals (4.9 percent) received completely free treatment. The remaining 97 patients incurred significant OOPE, often amounting to a substantial share of their household income.
Alarmingly, the study found that even when insurance was utilised, patients spent nearly the same — and in some cases, more — than those who were unable to access insurance at all. In government hospitals, 17 percent of patients couldn’t use their insurance, while the figure was as high as 49 percent in private hospitals.
Patients also reported that they were not shown the actual bills or the amount sanctioned under their insurance coverage. In addition, key services such as medicines and diagnostic tests continued to require out-of-pocket payments — undermining the very purpose of the insurance scheme.
“People on average are spending almost a similar (and sometimes more) amount out-of-pocket in both government and private hospitals when they have utilised insurance, as compared to when they are unable to utilise insurance. Insurance is not reducing the out-of-pocket expenditure,” it said in the report.
The study highlighted several sobering lessons about the state of healthcare access and insurance in Karnataka, particularly for marginalised communities. Illnesses that require hospitalisation are pushing already vulnerable populations — such as members of trade unions, rural and tribal communities and other working-class groups — deeper into poverty.
It is clear that out-of-pocket (OOP) expenditure continues to be a major economic burden for these communities.
“The much-touted insurance cards and insurance schemes are hardly making any impact and not serving the purpose of reducing OOP expenses and providing care for marginalised communities. Moreover, the processes involved in utilising insurance — like getting referral codes, approval, breach of privacy/consent in taking patients’ pictures even in government hospitals, are dehumanising and taxing for people who are already sick,” it said in the study.
Even in emergencies, where AB-ArK technically allows treatment in private hospitals, patients often have to travel long distances while unwell to complete administrative procedures, ultimately incurring high OOP costs anyway. The government’s celebratory statistics — such as those on insurance “coverage,” number of “beneficiaries treated,” or the “amount disbursed” — do not reflect the harsh ground realities faced by those who are supposed to benefit from these programmes.
SAA-K added that the government must prioritise strengthening public hospitals and healthcare services by increasing the budget allocation. They demand that the government move away from insurance-based financing for healthcare and instead focus on investing in strengthening public institutions to ensure Universal Healthcare.
The study by SAA-K revealed that government doctors often prescribe medications that patients are required to purchase from private pharmacies.
“This practice must be stopped by implementing a robust state supply of medicines, as already seen in Tamil Nadu, Kerala and Rajasthan. Similarly, patients who seek treatment in government hospitals are often referred to private laboratories for investigations, leading to significant economic strain. The government should ensure that public healthcare facilities are equipped with comprehensive laboratory services,” it added.
Furthermore, it said the empanelment of private hospitals for providing healthcare services under government schemes has proven ineffective and should be discontinued. Instead, the government should use the allocated funds to strengthen public health services.
“Additionally, all forms of Public-Private Partnerships in healthcare should be halted immediately. These insurance models push people toward private healthcare, eroding trust in public institutions. The government’s responsibility is to rebuild public trust by strengthening the public healthcare system,” the organisation noted.
(Edited by Muhammed Fazil.)
