INTRODUCTION
Imagine a family that cannot afford a private hospital bill. They are standing outside a hospital built on land the government gave away almost for free. Do they have a right to walk in and get treated for free? Indian constitutional law says yes. This piece explains how courts reached that answer and examines a more important question: is this right actually strong, or does it only work when one specific fact—cheap government land—happens to be present? It is important to note that the strongest recognition of this right comes from Delhi, where hospitals received land from the Delhi Development Authority (DDA) and the Land and Development Office (L&DO) at concessional rates. Other states have weaker or different versions. This shows that the legal approach could be applied wherever hospitals receive government land at concessional rates. However, the clearest judicial decisions on this issue have come from Delhi. This blog argues that the courts have protected access to free treatment in private hospitals through a limited legal route rather than by recognising a universal constitutional duty. While this approach has expanded access for many poor patients, it also leaves the right dependent on specific legal and factual circumstances.
HOW THE RIGHT TO LIFE BECAME A RIGHT TO HEALTHCARE
Article 21 of the Constitution says only this: no person shall be deprived of life or personal liberty except by procedure established by law.[1] On its face, this only stops the government from harming you — it does not say the government must give you anything, like free medical care. But from the 1980s, the Supreme Court began reading life to mean a life with dignity, not just staying alive. Healthcare fell naturally into that idea.
In Paschim Banga Khet Mazdoor Samity v State of West Bengal,[2] a labourer fell off a train and was denied treatment by several government hospitals for want of facilities. The Supreme Court held this to be a violation of Article 21 and ordered compensation – lack of funds was no excuse. In Consumer Education & Research Centre v Union of India[3], the Court linked workers’ health to human dignity under Article 21. And in State of Punjab v Mohinder Singh Chawla[4], the Court held that the right to health is part of the right to life, and a person can even be treated outside the government system if that system cannot help them.
But none of those cases alone requires a private hospital to do anything. Fundamental rights, like Article 21, usually bind only the government. So how did courts make private hospitals responsible too?
WHY ARTICLE 21 ALONE CANNOT BIND A PRIVATE HOSPITAL
A private hospital that is run using private funds is generally not considered “State” under the Constitution, even though it performs an important public service. However, there is an exception through the state action doctrine, which was recognised in Ramana Dayaram Shetty v. International Airport Authority of India[5]. According to this doctrine, if a private body is substantially controlled or funded by the government or performs a function that is essentially public in nature, it may be treated as the State for the purpose of enforcing constitutional rights.
Treating a private hospital as the State would mean that almost every issue involving fundamental rights could be brought against it. Since private hospitals are still private organisations in most respects, the courts have been reluctant to take that approach. Instead, they chose a narrower solution by enforcing the contractual obligations between the hospital and the patient. This reflects the courts’ cautious approach. Although the outcome protects patients, especially those from weaker economic backgrounds, the decision is based on principles of contract law rather than expanding the meaning of the State under the Constitution.
Many large private hospitals did not buy land at the market price. Instead, the government allotted land to them free of cost or at a concessional rate, on the condition that they provide free treatment to a certain number of poor patients. This condition creates a link between the government’s duty to provide healthcare and the responsibilities of private hospitals.
THE LAND-DEAL CASES
Social Jurist, A Lawyers Group v. Government of NCT of Delhi[6] is one of the most important cases on this issue. In one such case, an NGO found that many private hospitals in Delhi had been allotted land by the government at concessional rates but had failed to keep their promise of providing free treatment to poor patients. These hospitals were directed by the Delhi High Court to provide free treatment to 25% of the OPD (outdoor) patients and 10% of the IPD (indoor) patients. The Court also made it clear that the benefit should be only for the genuinely poor patients and asked the hospitals to maintain proper records for ensuring compliance.
The important thing is that the Court did not find these private hospitals to be “State” under the Constitution. Instead, it applied the conditions attached to the allotment of government land. The hospitals, having accepted the land on concessional terms, were bound to fulfil the obligations attached to the same. These conditions conformed with the constitutional obligation of the government under Article 21 and Article 47 to safeguard public health.[7]. The Government had passed on some of this responsibility to the hospitals, by allotting land to them at a concessional rate, and the Court saw to it that they could not escape from it later.
The Supreme Court confirmed this principle in Union of India v. Moolchand Kharaiti Ram Trust.[8] The hospital argued that its lease did not require it to provide free treatment to poor patients, but the Court rejected this argument and upheld the government’s order. Even in May 2026, the Supreme Court continued to monitor the issue by directing the authorities and hospitals to develop a system for tracking free-treatment beds.[9] This shows that ensuring compliance with these obligations is still a major challenge.
WHY HOSPITALS’ OBJECTIONS HAVE FAILED
Usually there are two main objections raised by private hospitals. First, they say that the provision of free treatment by only certain hospitals is an infringement of Article 14, which guarantees equality before the law.[10] Second, they argue that requiring them to provide free treatment violates their right to carry on their profession or business under Article 19(1)(g) of the Constitution.[11]
In short, the obligation applies because these hospitals accepted land at a concessional price with certain conditions, not simply because they are private hospitals. This gives the courts a narrower, easier basis to enforce the obligation, even if it leaves the fairness of forty-year-old land prices formally unresolved.
THE CATCH: A RIGHT THAT DEPENDS ON LUCK
It is worth being honest about the limits of this right. It does not create a general rule that any private hospital must treat the poor for free. The obligation applies only to hospitals that received government land at a concessional price. Hospitals that bought land at the full market price are not covered by these cases. As a result, access to free treatment is not the same everywhere. It often depends on whether a hospital was built on subsidised land and where it is located. Enforcement has also been weak. The Social Jurist case itself showed that many hospitals avoided their obligations for years, and even in 2026 the system for tracking free-treatment beds was still being developed. This shows that a right which depends on repeated court intervention is less effective than one that is properly implemented from the beginning. This is why the government’s recent policy has taken a different approach. Instead of old land conditions and court orders, the government pays private hospitals directly for treating poor patients through an insurance-based system under schemes like Ayushman Bharat.[12] This is a change of strategy from previous cases on land. The land cases associated private hospitals with public accountability. The insurance model is a more practical and lasting way to guarantee health care for the poor.
CONCLUSION
The Constitution does not provide for any special provision for the right to free treatment in private hospitals. It has developed through judicial interpretation by linking the expanded meaning of Article 21, the guiding principles of the Directive Principles of State Policy, and the conditions attached to government-allotted land. Thus, this right is based on judicial precedent and not on any legislation enacted by the legislature. Courts have recognised this right in cases concerning hospitals which have benefited from government land schemes, but its scope is limited. It depends on people’s willingness to sue, and the willingness of authorities to enforce these duties. Therefore, the right is relevant, where applicable, but uncertain for many people who require access to affordable healthcare. This shows how judicial creativity can help protect rights, but long-term effectiveness requires clear laws and proper enforcement mechanisms.
Author(s) Name: Shruti Tripathi (CMP Degree College, Law Faculty (Allahabad
University))
References:
[1] The Constitution of India 1950, art 21.
[2] Paschim Banga Khet Mazdoor Samity v State of West Bengal, (1996) 4 SCC 37.
[3] Consumer Education & Research Centre v Union of India, (1995) 3 SCC 42.
[4] State of Punjab v Mohinder Singh Chawla, (1997) 2 SCC 83
[5] Ramana Dayaram Shetty v. International Airport Authority of India, (1979) 3 SCC 489.
[6] Social Jurist, A Lawyers Group v. Government of NCT of Delhi, 2007 SCC OnLine Del 473.
[7] The Constitution of India 1950, art 21 and art 47.
[8] Union of India v. Moolchand Kharaiti Ram Trust, (2018) 8 SCC 321.
[9] Union of India v. Moolchand Kharaiti Ram Trust, (2026) SCC OnLine SC 926.
[10] Constitution of India 1950, art 14.
[11] Constitution of India 1950, art 19(1)(g).
[12] National Health Authority, ‘About Pradhan Mantri Jan Arogya Yojana'< https://nha.gov.in/PM-JAY > accessed 26 July 2026.
