Public funded health insurance and its role in catering to Catastrophic Health Expenditure: A Reflexive Thematic Analysis from Karnataka, India

Abstract Background The negative impact of structural inequalities on the citizens of developing countries' ability to utilise available services is further deteriorated by healthcare systems that provide insufficient services to meet population needs. Many developing countries face severe limitations in healthcare infrastructure. The combination of these structural disadvantages and the need for sustainable solutions for improving health outcomes creates additional pressures on already fragile healthcare systems. Aim This qualitative study aims to explore the role played by the Ayushman Bharat Arogya Karnataka Scheme (AB-Ark) in addressing the CHE, faced by the BPL families of Bengaluru. This study further expands into understanding claim utilization, service provider behaviour and overall lived experience of the households, enrolled into the AB-Ark scheme. Methods This study devises an Interpretative Phenomenological Approach as the overarching umbrella, while following a reflexive thematic analysis by Braun and Clark on the interview transcripts. This study had a sample size of eight. Eight BPL households were selected for this study through purposive sampling across various parts of Urban Bengaluru. Semi-structured interviews were conducted for data collection. Interviews were collected in Kannada, Tamil, Malayalam, Hindi and English. Results It has been observed that households have a reactive enrollment pattern than preventive in case of the AB-Ark scheme. Unfortunate health contingences, long-term treatment needs, and pilling medical debt have been one of the major factors causing enrollment into this public-funded health scheme. The results have also shown the multiple sides of accessing public health care systems, within its existing barriers and challenges. Conclusion Catastrophic health expenditure extends beyond high out-of-pocket spending, encompassing the cumulative financial vulnerability created by chronic illness, costly treatment episodes, medical debt, and depleted household resources. This study demonstrates that public health insurance has the potential to interrupt these pathways by providing financial risk protection and enabling access to essential healthcare. However, persistent hidden costs, administrative barriers, and procedural inefficiencies continue to limit the extent of this protection.