Published Feb 06, 2026 | 8:00 AM ⚊ Updated Feb 06, 2026 | 8:00 AM
The draft defined “Eligible patient” as “a patient who is a resident of Karnataka State.” (iStock)
Synopsis: The critics argued that the draft Bill “neither protects the public health system nor citizens’ healthcare rights,” and instead “seems to legitimise large-scale privatisation” by focusing on “empanelling hospitals for emergency medical care and outsourcing ambulance services to any entity that ‘volunteers’ to do so”.
Karnataka’s draft Right to Health and Emergency Medical Services Bill, 2025, opens with a promise: “Free accessible health care for all residents of the State with the progressive reduction in out-of-pocket expenditure in seeking, accessing or receiving health care.”
A critical analysis of the Bill by three public health advocates, however, warned that the draft’s architecture could lead to gatekeeping and outsourcing in the system, and expand contracting with private providers.
The critique, circulated by Karnataka Janaarogya Chaluvali (KJC), a people’s health movement, said the draft was made “without any due process of public consultation” and was “mostly borrowed from the Rajasthan Right to Health Act (2022).”
It argued that the text “neither protects the public health system nor citizens’ healthcare rights,” and instead “seems to legitimise large-scale privatisation” by focusing on “empanelling hospitals for emergency medical care and outsourcing ambulance services to any entity that ‘volunteers’ to do so”.
The authors, Dr Sylvia Karpagam, Dr Akhila Vasan and Tina Xavier, explained what a rights-based public health law must have.
It should “apply universally and predictably under the rule of law” and “must be transparent, publicly debated, and widely understood.” It should embed “autonomy, privacy, transparency, accountability, and least harm,” and include collective rights to social determinants such as “safe drinking water, sanitation, nutrition and housing; provide universal, free healthcare services including diagnostics, treatment and drugs “for all citizens” without exceptions; and prevent any role of private or corporate entities in planning, regulating, monitoring or provisioning public healthcare services,”
The authors argued that laws might be needed when voluntary compliance with public health policies fails, but laws alone were inadequate without a political and moral mandate to protect populations and healthcare systems.
They added that such a law should also regulate unnecessary tests and procedures, bribery, negligence and absenteeism, clarify responsibility for service delivery failures, limit state power during emergencies using Siracusa principles, and cap private-sector costs with standardised government treatment protocols.
The critique said the draft departed from standardised public health definitions, leaving room for interpretation. It called the draft’s definition of public health “not only inadequate but also mischievous” because it leaves out “provisioned,” which, the authors argued, could absolve the State from being the primary provider.
It also flagged the definition of “healthcare,” adopted “verbatim” from the Rajasthan law, for including “participation in a medical research program.” The phrase “government-funded healthcare services,” they argued, could legalise the transfer of public funds to NGOs and private entities.
The authors argued that a rights law should “prevent any role of private/corporate entities in planning, regulating, monitoring or provisioning of public health care services.” They said the Karnataka draft moved in the opposite direction by creating institutional pathways for empanelment and outsourcing, rather than centring on state provisioning and strict regulation.
The sharpest dispute has been over whether the draft makes the right conditional. The Bill defined “Eligible patient” as “A patient who is a resident of Karnataka State” and links eligibility to “Eligible household” under the National Food Security Act, 2013, along with enrolled members of earlier schemes.
It defined “General patient” as a patient who “is a resident of Karnataka state but does not come under the definition of ‘Eligible household’.” The rights clause said: “Every resident in the State of Karnataka shall have the following right,” language that critics said narrowed the scope of a rights law.
The authors argued that once a “Right to Health” framework introduced filters such as “eligible patients” or “eligible individuals/households,” it would resemble a scheme. In their reading, universality was the core of a right; if access depended on eligibility categories, the state risked offering a benefit rather than recognising an enforceable entitlement.
Dr Karpagam, Dr Vasan and Xavier said the risk became serious when eligibility language sits near emergency services. “Further emergencies happen to anyone in the state, visitor or resident. The language of ‘eligible individual and eligible households’ being brought into emergency services is concerning,” they wrote.
Their concern was practical gatekeeping: document checks, disputes over reimbursement, and delays at the point of care.
It added that public health rights must include social determinants of health, such as water, sanitation, nutrition and housing and not be restricted to curative care services.
Senior health department officials, speaking on condition of anonymity, told South First that a state-funded rights law raised a funding question.
“A law promising free services has to specify who the state will financially cover for non-emergency care, because budgets are limited and health competes with other spending,” a senior official said.
The official added that Karnataka being a major treatment destination for patients from neighbouring states, a blanket entitlement for everyone could create an open-ended commitment for planned, high-cost care.
However, public health advocates, not connected to the critical analysis authors, told South First that broad terms such as “eligible patients” could function as a gate at the hospital if the boundary was vague and left to rules and discretion. It would allow the promise to narrow in practice, without any formal amendment.
They also stated that if a residency-linked limit was used, it should be restricted to planned, non-emergency entitlements and clearly defined.
“If Karnataka wants a residency-linked limit, the cleanest place to use it is planned, non-emergency entitlements, not stabilisation and life-saving care. Even then, the boundary must be explicit: who counts as a resident, what proof is acceptable, and what happens when proof is unavailable,” opined other health advocates who did not want to be named.
The critique raised conflict-of-interest concerns around the proposed State Health Authority (SHA) and district/city authorities. It noted the SHA was expected to oversee audits, hear appeals, empanel private establishments, and outsource ambulance services, and asked why a regulator should also perform executive functions like empanelment.
It flagged the choice of the Suvarna Arogya Suraksha Trust (SAST) Executive Director as member-secretary of the SHA, noting SAST has representatives of empanelled private hospitals on its board.
At the district level, it questioned the inclusion of the Indian Medical Association (IMA) as a grievance-hearing authority, asking: “How can legislation allow such a conflict of interest?”
It added that typically, the Director of Health and Family Welfare should be the member-secretary of state-level regulatory bodies. The authors argued that IMA members might have their hospitals in the district.
Dr Sylvia and others described a tiered grievance pathway — from the institution to the District Health Authority and then an appeal to the SHA — but said there were no serious consequences beyond fines.
It cited “a fine up to ₹10,000 for the first contravention, and up to ₹25,000 for the subsequent contraventions,” adding: “Thus, human life is reduced to a few thousand rupees on the pretext of grievance redressal!”
The critique cited provisions stating the SHA would receive ₹100 crore as a token corpus fund, but that the SHA and district/city authorities could receive “donations” from any “individuals or bodies,” and borrow from the open market.
It argued that donations would create a stake in the regulator’s functioning, and questioned how the government could control a body it cannot fund.
They also flagged that auditors were appointed by the agencies themselves, and said the draft did not mention whether accounts would be audited by the Comptroller and Auditor General.
The authors cited the Supreme Court’s observations in Pt. Parmanand Katara vs Union of India & Ors (28 August 1989) to argue that emergency care could not be delayed for payment. They said it was “unclear why this has to be specified separately” in the title, since “there can be no right to health without the intrinsic right to emergency healthcare.”
They also questioned the draft’s proviso on payment and reimbursement. While the Bill promised emergency treatment “without prepayment of requisite fee or charges,” it added that “Provided that after proper emergency care, stabilisation and transfer of patient, if patient does not pay requisite charges, healthcare provider shall be entitled to receive requisite fee and charges or proper reimbursement from State Government…”
The authors argued that the phrase “if the patient does not pay” made payment the first option, with state reimbursement only as a fallback.
They called the definition of emergency medical services “any reasonable measure to render first-aid, advise or assistance,” as alarming, and argued that it could reduce obligations. They also criticised the definition of “stabilise,” which hinged on what was necessary “to assure within reasonable medical probability” that no deterioration will occur during transfer, and flagged the presence of the “eligible individual and eligible households” clause in emergency services.
The authors also questioned the definition of emergency medical services as “any reasonable measure to render first-aid, advice or assistance,” and the definition of “stabilise”. The latter defined “stabilise” as what was necessary “to assure within reasonable medical probability” that no deterioration would occur during transfer.
They added that emergencies could happen to anyone in the state, “visitor or resident”. Bringing “eligible individuals and eligible households” into emergency services was concerning. The authors asked whether people were expected to carry identification documents or money for emergencies.
The critique noted two chapters dedicated to empanelled hospitals and ambulances, in which key phrases such as “life support system,” “limited life support system”, and “pre-hospital care” were unclear.
It argued that empanelled hospitals would set up emergency departments using government funds without clearly stating commitments and accountability mechanisms. It further noted that district/city authorities were expected to ensure ambulance availability while also handing over ambulance services to “persons voluntarily registered”.
The authors argued that Karnataka required sustained direct investment in government health facilities at all levels, strengthened district and government medical colleges as final referral points, a permanent and well-supported workforce, strict regulation of private providers, transparent data reporting, and accessible and enforceable grievance redressal mechanisms.
Instead, they argued, the government “breezes over” them in the draft Bill, undermining citizens’ health rights, public accountability and the core principles of public health.
They also cited Karnataka’s integrated health policy commitments in 2004 and 2017, and argued any law that legalised privatisation through “public-private partnerships, health insurance, contracting” would drain public resources, leaving patients at the mercy of markets. Without revisiting these mandates, a law could become “toothless” and “an ineffective band-aid for optics,” they added.
(Edited by Majnu Babu).
