Private hospitals fail EWS quotas, Supreme Court intervenes

Public land misused, poor patients denied free healthcare

Despite receiving subsidised public land, many private hospitals in India such as Apollo at Jasola in South Delhi, have persistently failed to provide mandated free treatment to economically weaker sections, prompting Supreme Court intervention and calls for strict, transparent enforcement.

The issue of non-compliance by Apollo Hospital and several other major institutions with their obligations to provide free treatment to patients from Economically Weaker Sections (EWS) has come under intense scrutiny.

When the hospitals were being built, they signed an agreement with the government to provide free treatment to economically weaker sections of the society,  in exchange for getting large parcels of prime public property either entirely free or at a hefty discount,

This obligation was a condition for receiving prime public land at highly subsidised rates, yet investigations have revealed a persistent failure to meet these commitments. Over a 12-year period, Apollo Hospital, for example, allocated only about 17 pc of its inpatient beds to EWS patients, falling far short of the mandated one-third quota.

This chronic shortfall prompted the Supreme Court to express grave concerns, warning Apollo that its management could be transferred to AIIMS if it failed to honour its commitments and ordering a joint government inspection of its compliance records. The courts have highlighted that the hospital, which was supposed to operate on a “no profit and no loss” basis for the benefit of the poor, has instead evolved into a commercial venture, leaving intended beneficiaries struggling to access care.

“There has been a persistent lack of enforcement by the Delhi government, despite holding a 26 pc stake and being represented on the management board of the hospital. Audit findings and court orders since 2009 highlighted violations, but both the government and hospital appeared to avoid strict compliance, possibly due to mutual interests and dividend earnings from the hospital’s profits,” a Health Ministry official, speaking on the condition of anonymity, tells Media India Group.

Allegations of bureaucratic inertia and connivance have also surfaced, with public interest litigants noting that lease conditions for EWS treatment were never fully implemented. Inspections in 2023 were either inadequate or not rigorously enforced, which allowed the under-provision of EWS services to persist.

“Hospitals, including Apollo, continued to fall short of mandated quotas, with poor record-keeping and discriminatory practices going unchecked,” the official added.

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The Supreme Court’s 2025 threat of transferring hospital management to AIIMS was a direct response to this failure.

This pattern of neglect is not new. A 2015 Rajya Sabha report revealed that out of 43 hospitals in Delhi allotted land at concessional rates with the condition to provide free treatment to EWS patients, only nine were found to be fully complying with the quotas. The remaining 34 hospitals were either not complying or only partially complying. The stipulated requirement was to provide free treatment to at least 25 pc of outpatient department (OPD) and 10 percent of in-patient Department (IPD) patients from EWS categories.

The report noted that despite repeated directions, many hospitals continued to ignore their obligations and government enforcement remained weak. Between 2012 and 2014, only 2,465 EWS patients were treated in OPD and 1,126 in IPD across all these hospitals-numbers far below what would be expected given the total patient load and capacity.

This crisis extends beyond Apollo Hospital or Delhi. Across India, similar patterns of non-compliance, weak enforcement and bureaucratic inertia are evident in cities where private hospitals have received public land or subsidies in exchange for social obligations.

Patients from economically weaker sections throughout India have been denied their rightful treatments repeatedly and are often buried under excessive paperwork and covert barriers that prevent them from accessing the free treatment they are entitled to. The absence of a robust, transparent and enforceable monitoring system has allowed hospitals to circumvent their obligations with impunity.

“I waited at the hospital for hours, but they kept telling me to come back the next day. Even though I had my income certificate, the doctor requested documents I did not have when I eventually saw them. I felt embarrassed and powerless. I have yet to receive the necessary treatment,” Sunita Kumari, a house-help from New Delhi, tells Media India Group, of her experience at Jeevan Anmol hospital in East Delhi.

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Her story echoes hundreds of complaints that have received by authorities, ranging from outright denial to covert strategies like discriminatory behaviour, lengthy wait times and excessive paperwork.

Healthcare activists blame poor monitoring and enforcement by the government for the impunity with which hospitals deny these treatments.

“Successive committees have failed to enforce EWS compliance due to a combination of government inaction, lack of political will and ineffective monitoring mechanisms,” says the representative of a Delhi-based healthcare NGO, who preferred anonymity.

Despite repeated RTIs, public interest litigations, and court orders, both the government and judiciary have struggled or shown unwillingness to hold large private hospitals accountable, allowing managements to operate as they wish and perpetuate violations across multiple institutions.

“No land allotments have ever been cancelled for non-compliance; even the imposition of fines, such as the INR 60 million penalty imposed on five hospitals in Delhi in 2016, has not resolved the issue,” says the representative of the NGO.

Healthcare activists insist that hospital administrators who wilfully violate EWS quotas should face criminal charges, as these actions constitute a breach of public trust and a denial of essential healthcare to the most vulnerable.

The human cost of these systemic failures is profound. For patients like Sunita Kumari and countless others, the promise of free healthcare remains unfulfilled. Many reports being turned away, asked for unnecessary documents, or made to wait endlessly-tactics that effectively deny them care without an outright refusal.

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“In many instances, compliance is superficial and lacks compassion or intent. We recommend a time-bound independent audit of all these institutions, with the findings made public. Those repeatedly found non-compliant should face penalty mechanisms, including the partial or full reallocation of their land-use benefits to community-serving organizations, after a due diligence process,” Dr Rajat Jain, President of Doctors For You, a leading healthcare nationwide NGO, tells Media India Group.

Jain further stressed the need for structured penalties and independent third-party monitoring, possibly through accredited NGOs or health watchdogs.

“Laws must evolve beyond counting beds or OPD visits to address the quality, accessibility, and timeliness of care, and that legal definitions of ‘non-compliance’ should include covert denial practices like excessive delays or bureaucratic barriers,” he adds.

Hospitals violating these standards should not only face financial penalties but also risk losing their land-use benefits to more compliant institutions or social sector partners.

“Hospitals that have benefited from such assets and failed to uphold their end of the social contract must be held accountable-not just with fines but with corrective reallocations that benefit society. Giving such resources to organizations committed to equity in healthcare is not only fair-it is necessary,” Jain says.