Bengaluru: In a country where a serious illness can wipe out years of household savings, Karnataka has quietly emerged as one of India’s better-performing states in protecting families from medical expenses.According to the latest National Health Accounts (NHA) estimates released last week, out-of-pocket expenditure (OOPE) for 2022-23 accounts for 29.2% of Karnataka’s total health expenditure (THE), well below the national average of 43.4%.Among the 21 states for which the report publishes state-level indicators, only Uttarakhand (28.8%) and Jammu & Kashmir (29.7%) report a comparable or lower out-of-pocket share, placing Karnataka among the best-performing states in limiting the direct burden of healthcare costs on households.But the comparison gets more interesting once govt spending is factored in. Both Uttarakhand and J&K get to their low OOPE shares by leaning heavily on the state: govt expenditure accounts for 64.4% of THE in Uttarakhand and 68.3% in J&K.Karnataka’s govt spend, by contrast, covers just 33.2% of THE, meaning the state manages a similarly low out-of-pocket burden while spending far less, proportionally, from the public purse.Karnataka residents’ OOPE is estimated at Rs 2,049 per person annually. That’s higher in absolute terms than both Uttarakhand (Rs 1,593) and J&K (Rs 1,701), but lower than the national average of Rs 2,767.Karnataka spends Rs 7,024 per person on healthcare overall, more than the national average of Rs 6,373, and well above what either Uttarakhand (Rs 5,523) or J&K (Rs 5,734) spends per person. Yet, Karnataka’s healthcare spending amounts to just 0.7% of GSDP, lower than the national average and lower than comparable states.Taken together, the numbers present a paradox. Karnataka is among the states where families are least exposed to medical expenses, but it is not among the biggest public spenders on health, relative to either its own economy or its peers.Ritvik R Pandey, principal secretary, department of health and family welfare, said: “The state’s long-standing public health initiatives such as Arogya Karnataka and Yashaswini, along with a robust govt healthcare system that provides free medicines and diagnostic services, are a couple of reasons,” he said.Pandey said the availability of CT scans, MRI facilities, dialysis and nearly 900 medicines free of cost had reduced dependence on private providers. “People can access quality government hospitals with facilities like CT scans, MRI, dialysis and free medicines. These expenses reduce significantly,” he said, adding the govt was expanding advanced diagnostic facilities to district and remote hospitals with the aim of bringing down out-of-pocket expenditure further.He also argued that health expenditure routed through local bodies, Zilla and Taluk Panchayats and local area development funds may not always be captured in state spending figures. Besides, he said, health spending as a share of GSDP tends to taper in richer states where investments in infrastructure and institutions have already reached prescribed norms.Public health researcher Dr Sylvia Karpagam cautioned against interpreting the data too broadly. “I think the govt is increasingly relying on public-private partnerships and health insurance schemes with empanelled private hospitals instead of strengthening its own healthcare system,” she said.Karpagam said lower OOPE does not necessarily mean everyone is protected. Outpatient care, medicines, travel and follow-up treatment often remain outside insurance coverage, and studies have shown that families covered under government schemes can still end up spending anywhere between Rs 10,000 and Rs 1 lakh.She pointed to gaps in access. Senior citizens, tribal communities, people in remote areas and those without social support often struggle to benefit fully from existing schemes, she said. Current models, she added, tend to favour surgical procedures over long-term medical management, while private hospitals may prefer straightforward, reimbursable treatments over patients with more complex conditions.“…We need data on how much of the care is actually evidence-based and whether money is being spent either by govt or patients on unnecessary procedures and tests,” she added.
