The Karnataka government has changed the referral requirements for some provisions of the Ayushman Bharat–Arogya Karnataka (AB-ArK) health coverage scheme at four private hospitals in Bengaluru. Under this one-year pilot, eligible below-poverty-line (BPL) patients can access free treatment at participating private facilities without obtaining a prior referral from a public hospital.
The decision was approved at a recent state cabinet meeting, and is aimed at reducing barriers to care while public hospital capacity is expanded.
The private hospitals included in this initiative are:
St. John’s Hospital
Ramaiah Memorial Hospital
Kempegowda Institute of Medical Sciences (KIMS)
Dr. B.R. Ambedkar Medical College and Hospital
These facilities are now permitted to offer 1,491 medical and surgical procedures under AB-ArK without the previous requirement of a referral letter from government health facilities. These procedures cover a range of secondary and tertiary care needs that were earlier either referral-restricted or reserved for government hospitals.
As reported by The Hindu,
This is expected to reduce treatment delays for poor patients in Bengaluru by cutting procedural steps and leveraging private medical college infrastructure amid a documented shortage of government hospital beds.Harsh Gupta, Principal Secretary, Health
Patients eligible for free treatment under this policy must qualify under the Ayushman Bharat–Arogya Karnataka scheme. Typically, this includes individuals or families identified as economically vulnerable, such as those holding Below Poverty Line cards.
Under the scheme, beneficiaries can receive cashless treatment for the covered procedures. The empaneled hospitals invoice the state government based on pre-set package rates, and beneficiaries are not charged for covered inpatient care.
This policy adjustment comes against the backdrop of a significant shortage of government hospital beds in Bengaluru. Government health authorities estimate a gap of several thousand beds when compared to national public health standards.
Officials have stated that while additional public facilities are under development, partnering with capable private hospitals can help manage clinical demand and reduce treatment delays. The relaxation is part of a pilot strategy to test whether access improves when administrative steps like referrals are removed.
Under the updated arrangement, the Karnataka government will reimburse participating private hospitals at 75 per cent of the AB-ArK prescribed rates for covered services. This reimbursement mechanism allows empaneled private facilities to participate in delivering care to scheme beneficiaries.
In practice, patients present their eligibility documentation directly at a participating hospital. The hospital processes care without charging the patient for covered procedures, and later bills the state health system based on standard AB-ArK package rates.
While the policy aims to enhance access, independent health sector observers note that out-of-pocket expenses can still occur in private settings, particularly for services not included under the specific procedure packages, such as outpatient consultations or diagnostics.
Additionally, there is a risk that some hospitals might prioritize cases with simpler procedures or those financially feasible within reimbursement levels. Such dynamics could affect equity if not monitored.
The current arrangements are explicitly marked as a pilot for one year. Ongoing monitoring of utilization patterns, patient experience, and financial impact will be necessary to evaluate whether direct access improves overall healthcare delivery under the Ayushman Bharat–Arogya Karnataka framework.
If successful, this approach could influence future policy design on integrating private sector capacity into public health coverage schemes in other urban centers.
(Rh/SS/MSM)