Punjab & Haryana High Court Calls for Human-Centric Medical Reimbursement Framework

The Punjab and Haryana High Court has called for a human centric approach to medical reimbursement, as access to healthcare and medical treatment is an absolute right to life, guaranteed under Article 21 of the Indian Constitution. It observed that the existing reimbursement policies for government employees and pensioners requires a fresh outlook to ensure that the deserving claimants are not being deprived of their basic right, that too on technical grounds

The observations came while the court was hearing a batch of writ petitions challenging various aspects of the state's medical reimbursement policy amid concerns that reimbursement claims are mostly rejected due to clauses, such as receiving treatment from a non-empanelled hospital or procedural approvals not being secured in advance, among others. These clauses put the families in tight situations during reimbursement.

Justice Sandeep Moudgil noted that medical reimbursement schemes should be approached with a practical and humane approach rather than just with set policies and interpretations. The court stressed that the objective of such policies is to support people who are facing medical emergencies and serious health conditions. Rather than creating endless barriers and clauses for the patient and their family, it is important to be mindful of the conditions and the situation the family is facing.

The High Court pointed out that in situations of life and death, patients and families are more concerned with treatment and saving lives than with compliance with the administrative formalities. Denial of reimbursement in such situations may undermine the constitutional right to health and medical care.

The court highlighted that the state bears a constitutional responsibility under Article 21 to make sure access to healthcare is convenient for government employees and pensioners, so they don’t experience the burden of medical expenses during genuine emergencies.

The court also highlighted that there are plenty of practical challenges that patients face, such as those who seek medical care at government institutions, such as AIIMS and PGIMER. While these institutions offer advanced medical care, they experience heavy footfall of patients and month-long waiting periods. In serious and time-sensitive situations, following such clauses is life-threatening and inhumane on the part of the state.

The court further emphasised that such policies should take ground realities into account rather than just simply restricting or denying claims. Additionally, the court has expressed concerns over the delays in processing the reimbursement claims. It observed that delays in processing reimbursements can cause financial and mental hardships for someone who is already under medical stress.