On June 20, a five-year-old girl died in Hapur in Uttar Pradesh after a private hospital allegedly refused to treat her. Her parents, who work as daily-wage labourers, claimed that this was because they were unable to immediately pay the Rs 20,000 demanded for their daughter’s treatment.

In Bengaluru in January, a 72-year-old man who suffered from gastric cancer is reported to have died by suicide after being denied the health coverage he was entitled to under the government’s Ayushman Bharat scheme.

Such incidents are part of a grim pattern of rising barriers to healthcare access as patients are being pushed to the brink and refused life-saving care because they cannot pay.

The Indian Supreme Court in 1989 recognised the right to medical care as inseparable from the right to live with dignity, which means the denial of healthcare treatment a constitutional betrayal and a profound moral failure.

Debt and devastation

When health is treated as a commodity rather than a right, even payment for tests or medicines can push a family into crippling debt. The consequences are postponed treatments, depleting savings, jewellery sold and land mortgaged.

In a country where nearly half of all healthcare spending is out-of-pocket rather than covered by government programmes or insurance, around 55 million people are driven below the poverty line every year by medical expenses alone, estimates the World Health Organization.

Unaffordable medical care can create a perpetual cycle of illness, debt and despair that traps the poorest in intergenerational poverty. It can strip families of stability and hope.

For tuberculosis patients, for instance, treatment delays of seven to nine weeks can consume more than a fifth of a family’s annual income – and this is before therapy even begins.

Households of cancer patients pay more than Rs 3 lakh in out of pocket expenses, according to one report.

Even in ostensibly free government clinics, families can face informal charges. They resort to high-interest loans and forgo essential follow-up care, perpetuating disease and impoverishment.

The anticipation of steep bills leads many to “tough it out” at home until the situation is dire. Hypertension or early-stage tuberculosis, easily managed if caught in time, is often detected only when intensive (and far costlier) interventions are required.

Lives are shortened, tertiary hospitals overflow and the costs soar for everyone. Preventable illnesses morph into life-threatening crises, exacting a toll both on the demand side (patients) and the supply side (public health infrastructure).

Preventive care (vaccines, antenatal check-ups, chronic disease screenings) is often the country’s strongest aid to staying healthy. But when these are out of reach, diseases once thought beaten return and maternal and newborn deaths stay stubbornly high.

Without routine screenings, conditions such as cervical cancer or undiagnosed diabetes progress silently to advanced, life-threatening stages.

Inequities are stark: immunisation rates among Scheduled Tribes lag by more than 20 percentage points behind forward castes. Rural children trail their urban peers by similar margins. Those priced out of formal care often turn to informal providers: pharmacists (qualified and otherwise), traditional healers, unlicensed practitioners.

Misdiagnoses, dangerous antibiotic misuse and unsterile procedures are common, fuelling drug resistance and failed treatments. In India and Pakistan, up to 80% of first-contact care happens outside the public sector. The harm goes beyond individuals as resistant infections spread unchecked, threatening communities and regions.

Lower-caste communities, sexual minorities and internal migrants face even greater barriers, including discrimination, language gaps and bureaucratic hurdles.

Even those enrolled in health schemes have to pay hidden “top up” costs for transport or diagnostics that undermine the promised protection. The result is that health indicators for marginalised groups lag national averages, widening societal fissures and eroding the chances of providing equitable care.

Illness also steals livelihoods. In India’s vast informal economy, there is no paid sick leave, no safety net. Caring for a sick family member or recovering from illness means lost wages. Over time, savings run dry, diets worsen, children are pulled from school. These sacrifices erode human capital and stunt economic growth, leading to measurable productivity losses that hold back regional or national progress.

With every incident of care being refused, substandard treatment or an inflated bill, trust in the health system is eroded.

Enforcing the right to health in India is a matter of life and death. It requires investment in infrastructure, transparency and accountability, so that no patient must choose between medical care and financial ruin. Any citizen must be able to walk into a clinic or hospital without the fear that saving their life could destroy their future.

Equally urgent is the need to expand public financing and strengthen universal health coverage mechanisms, so that healthcare is not left to the vagaries of markets or personal savings but guaranteed as a public good.

Rishiraj Bhagawati is a public health researcher based in Bengaluru.

Also read:

Harsh Mander: The plunder and loot by private healthcare in India

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