Out-of-pocket expenditure (OOPE) directly reflects households’ financial burden for healthcare. Despite efforts to enhance accessibility and affordability through government initiatives and insurance schemes, OOPE remains problematic, especially in rural areas with inadequate public healthcare infrastructure. This study examines factors influencing OOPE in Karnataka’s Dakshina Kannada, Udupi, and Shimoga districts, investigating socioeconomic characteristics, healthcare infrastructure, and accessibility to inform policies for equitable healthcare access and reduced household financial strain. Using purposive sampling, 61 semi-structured interviews were conducted in rural and urban South Karnataka, recorded in Kannada after obtaining consent, and thematically analyzed. Results revealed mixed perceptions of healthcare quality, cost, and accessibility between government and private hospitals. Government facilities were lauded for improved infrastructure and affordability, while private hospitals were preferred for quality and personalized care despite higher costs. Health insurance significantly impacted OOPE reduction. Participants emphasized the need for increased awareness of government insurance programs and improved quality in public hospitals. The study concludes that private hospitals are favored for superior care despite expenses, while government hospitals are valued for affordability. Expanding insurance coverage and improving public awareness are crucial for enhancing healthcare accessibility and affordability.

Background: The Ayushman Bharat Digital Mission (ABDM) aims to enhance healthcare delivery in India through digital integration. The ABDM, an essential part of India’s healthcare system, aspires to transform healthcare delivery through digitization, by emphasizing affordability, accessibility, and transparency. This qualitative study investigated the awareness, challenges, and perceptions of the ABDM among postgraduate students in coastal Karnataka, focusing on their experiences and interactions with digital health technologies. Methodology: A qualitative descriptive approach was employed, involving semi-structured interviews with 17 purposively selected participants from a health science university. The interviews were audio-recorded, transcribed, and analyzed using the NVivo 12 software for thematic analysis. Results: This study revealed that, while many students recognized the ABDM’s goal of establishing comprehensive digital health infrastructure to seamlessly integrate healthcare services and information systems, detailed knowledge about its functionalities, implementation processes, and challenges was limited. Participants highlighted the need for improved digital literacy and support to maximize the effective use of the ABDM. Conclusions: The successful implementation of the ABDM depends on overcoming major challenges such as poor awareness and concerns about data security. Addressing these issues will require focused educational campaigns, increased accessibility, and joint efforts by the government, healthcare providers, and technological partners.

Out-of-pocket expenditure (OOPE) comprises 62% of national health expenditure in India. This heavy reliance on direct payments has engendered economic vulnerability and catastrophic financial pressures (typically defined as out-of-pocket spending exceeding a certain threshold of household income, leading to financial hardship) on households in a country where public health spending remains below targeted levels. The onset of the COVID-19 pandemic intensified these financial hardships further, as both total healthcare spending and OOPE experienced significant escalations due to the increased need for emergency care, vaccination efforts, and expanded health infrastructure. A retrospective, single-center study was conducted using data from COVID-19 patients admitted between June 2020 and June 2022. Patient data were collected from the Medical Records, IT, and Finance departments. A validated proforma was used for data extraction. Descriptive statistics were calculated, and the Shapiro–Wilk test was applied to assess normality of billing and OOPE data. Patients were stratified into three groups based on their insurance status, allowing for comparative analysis of OOPE percentages and absolute expenditures. The 2715 COVID-19 patients were categorized into three groups according to their health financing: those covered under AB-PMJAY (42.76%), private health insurance (22.16%), and the uninsured (35%). While the median billing amounts were comparable across these groups (ranging between INR 85,000 and INR 90,000), a substantial disparity was observed in terms of financial burden. All patients covered under AB-PMJAY incurred no OOPE, whereas privately insured patients had a median OOPE that constituted approximately 21% of their total billing amounts, with significant variability among different insurers. The uninsured group represented 35% of the cases and experienced the highest median OOPE, indicating substantial financial risk. The COVID-19 pandemic has revealed critical gaps in India’s health financing framework. This study emphasizes the strong financial protection provided by AB-PMJAY, while also exposing the limitations of private health insurance in shielding patients from substantial healthcare costs. As the country progresses toward universal health coverage, there is a pressing need to expand public health insurance schemes that are inclusive, equitable, and effectively implemented. Additionally, strengthening regulation and accountability in the private insurance sector is essential. The study findings reinforce that AB-PMJAY has been highly successful in reducing OOPE and enhancing financial risk protection. Although private insurance reduced OOPE, patients still faced considerable expenses. The stark difference in OOPE of 100% for uninsured patients, 21.16% for privately insured, and 0% for AB-PMJAY beneficiaries underscores the importance of further expanding AB-PMJAY to reach more vulnerable populations.

Digital health services, health information, and digitally administered health-financing schemes increasingly presuppose that users can get online. In India, women lag behind men in internet use. We tested whether women’s internet use converged across states between the fifth (2019–21) and sixth (2023–24) rounds of the National Family Health Survey. The ecological analysis covered all 35 states and union territories surveyed in both. Mean internet use rose from 43.3% to 69.5% (population-weighted: 33.3% to 64.4%), and the cross-state standard deviation fell from 16.6 to 11.3. Beta-convergence was strong (β = −0.427, p < 0.0001) and survived transformation, adjustment, and sensitivity exclusions. The concentration index across states ranked by multidimensional poverty fell from 0.118 to 0.013. Poverty did not predict gains once the baseline level was held constant. The gender gap in internet use narrowed on average and converged. Two inequalities in a digital determinant of health therefore narrowed: between poorer and less-poor states, and between women and men. This removes one structural barrier to equitable digital health and primary care. It does not show that health inequalities narrowed. Testing that, and whether the gains reach the poorest women within states, requires individual-level data.

Background: Surgical care is being increasingly recognized as a critical component of universal health coverage (UHC), with unmet surgical needs contributing substantially to morbidity, mortality, and financial hardship in low- and middle-income countries. In India, out-of-pocket expenditure (OOPE) remains the dominant mechanism for financing surgical care, raising concerns regarding financial risk protection. Publicly financed health insurance schemes such as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have been introduced to reduce OOPE for inpatient services. Methods: A hospital-based single-center case study with a cross-sectional analytical design was conducted in a tertiary care teaching hospital in coastal Karnataka, India. A total of 150 patients undergoing common general surgical procedures (laparoscopic cholecystectomy, laparoscopic appendicectomy, inguinofemoral hernia repair, and umbilical hernia repair) were enrolled. Patients were categorized into three groups: uninsured, privately insured, and AB-PMJAY beneficiaries. Direct medical expenditure components were captured, and OOPE was compared across groups. Post hoc comparisons were performed following one-way ANOVA. Results: OOPE varied substantially across insurance categories. Uninsured patients incurred the highest mean OOPE, followed by privately insured patients, while AB-PMJAY beneficiaries reported negligible OOPE. Differences across groups were statistically significant (p < 0.001). Conclusions: Uninsured patients incurred a high financial burden for common surgical procedures, while private health insurance offered partial financial protection compared to no insurance. AB-PMJAY substantially reduced point-of-care expenditure for eligible beneficiaries. Expanding financial risk protection for surgical care may be essential for advancing equitable access and achieving UHC in India.