We live in a country where even in the 21st century a man has had to carry his dead wife for 12 kilometers just because the local government hospital refused him transport. India, the world’s second-most populous nation and its sixth-largest economy spends less on healthcare than poorer nations, retarding growth. With 1.6 million Indians dying due to poor quality of healthcare. India ranked 145 out of 195 on 2018 global healthcare quality and access index.
Healthcare has been influencing Indian law makers ever since the establishment of the judicial system. The healthcare in India is basically divided in two: Public and private.
Public V. Private Healthcare
Public healthcare is free and subsidized for those who are below the poverty line. Reports show that the Indian public health sector encompasses 18% of total outpatient care and 44% of total inpatient care. It has also been observed that the middle and upper class individuals living in India tend to use public healthcare less than those with a lower standard of living.
On the other hand, the private sector consists of 58% of the hospitals in the country, 29% of beds in hospitals, and 81% of doctors. According to surveys, the private medical sector remains the primary source of healthcare for 70% of households in urban areas and 63% of households in rural areas. It has also been noted that the use of private healthcare in India has been growing steadily over the past years.
The Constitution and Healthcare
The constitution of India guarantees the right to healthcare to the citizens in the form of Article 21 of the constitution. It incorporates provisions guaranteeing everyone’s right to the highest attainable standard of physical and mental health. The Article 21 talks about the right to life and personal liberty of all citizens. The Supreme Court has also upheld that the right to live with human dignity, enshrined in this article, derives from the directive principles of state policy and therefore includes protection of health. Further, it has also been held that the right to health is integral to the right to life and the government has a constitutional obligation to provide health facilities.
In various cases, verdicts have been passed stating that the citizens have the right to avail timely treatment in government hospitals and failure to do so by the hospitals will result in violation of patient’s right to life. There have been cases filed in order for the state to comply with Article 21 in cases such as for treatment against pollution hazards, against hazardous drugs, against inhuman conditions in after-care homes, on the health rights of mentally ill patients, on the rights of patients in cataract surgery camps, for immediate medical aid to injured persons, on the regulation of blood banks and availability of blood products and in appeals filed by persons with HIV on the rights of HIV/AIDS patients.
Not only Article 21 of the constitution, but also Article 25 of the Universal Declaration of Human Rights and Article 7(b) of the International Covenant on Economic, Social and Cultural Rights have been recognized as relevant for the protection of right to health and for people to avail relief under the same. These have been cited by the Supreme Court while making its decisions in cases of People’s Union for Civil Liberties v. Union of India(1997) and ESC Ltd v. Subhash Chandra Bose(1992).
The Supreme Court, in the case of Paramand Kataria v. Union of India(1989), passed the verdict that according to Constitution of India, 1950: Article 21- It is the obligation on the State to preserve life, every doctor has professional obligation to extend services to protect life, and the obligation of all Government hospitals/Medical institutions to provide immediate medical aid in all cases.
In the case of State of Punjab v. Ram Lubhaya Bagga (1998), it was upheld that the state has an obligation to maintain health services and failure to do so will result in consequences to be faced by the state and the respective institution.
There have been various other cases wherein the Supreme Court and the High Courts passed verdicts stating the obligation of state and the government organizations to provide proper healthcare for public and protection against diseases. Some of the cases are Paschim Banga Khet Mazdoor Samity v. State of West Bengal, Mr X v. Hospital Z(1998), Death of 25 Chained Inmates in Asylum Fire in TN In re v. Union of India (2002) and S. Lal v. State of Bihar.
Healthcare acts in India
Acts and bills for healthcare protection of citizens have been passed by the government and the legislative bodies namely the Surrogacy Bill; the Clinical Establishments Act; the Food and Safety Regulations of 2011 regarding contaminants; toxins and residue; also prohibition and restriction on sales; Mental Health Act, 1987; the Pharmacy Act, 1940; the Transplantation of Human Organs Acts and Rules; Drugs and Cosmetics Act, 1940; the Prevention of Food Adulteration Act, 1954; Narcotic Drugs and Psychotropic Substances Acts and Rules; Medical Termination of Pregnancy Acts and Rules; Acts in Disability, etc.. These acts and rules have been established for the betterment of public health and hygiene, especially the weaker sections of the society and the ones who cannot afford proper healthcare.
Schemes and programs have also been established by the government of India, for eg. In September 2018, Prime Minister Narendra Modi launched a national health-insurance scheme, Ayushman Bharat, officially called the Pradhan Mantri Jan Arogya Yojana, which aims to provide Rs. 5 lakh insurance cover to over 500 million Indians. The government budgeted Rs. 6,400 crore for the scheme in 2019-20, more than three times the Rs. 2,000 crore a year before but no one can tell as to how far these schemes and programs work.
It can be stated based on a number of reports published that healthcare in India has a lot of politics and the namesake acts, regulations, schemes are only theoretical but the scenario is extremely different when there arises a question of practical application of the working of these amends for the citizens by the government and the courts.