Over-centralisation threatens federal health policy, Pg 8

Key Highlights

Issue & Context

• Supreme Court ruling in Dr. Tanvi Behl vs Shrey Goyal (2025) struck down domicile-based reservations in postgraduate (PG) medical admissions in State-run medical colleges.
• The ruling upholds meritocracy but disrupts State health planning by removing State control over medical workforce allocation.

Impact on State Health Systems

• States invest in medical education and rely on domicile quotas to ensure a steady supply of doctors in public health systems.
• Removing these quotas reduces incentives for States to fund government medical colleges, affecting long-term workforce stability.
• Mismatch in postings: Many doctors trained in a State move elsewhere, leaving rural & underserved areas short of specialists.

Failure of a One-Size-Fits-All Meritocracy

• NEET-PG results show that wealthier candidates from privileged backgrounds tend to perform better, widening inequalities.
• The National Medical Commission (2023) suggested reforms to ensure regional balance, but centralisation weakens these efforts.

Need for Reconsideration

• The current model fails to consider State-level health challenges, especially in rural areas.
• Instead of eliminating domicile quotas, a balanced policy linking medical education with public service obligations is needed.
• A revised framework should ensure equity in healthcare distribution without disincentivising State investments.

Mains Mock Question:

"The Supreme Court’s recent ruling on domicile-based reservations in medical education raises concerns over federalism and healthcare equity. Critically analyze. (250 words)"