Losing your vote and passport | PE in Kerala hospitals | South Central 82

Does the SIR-related exclusion only affect marginalised classes of people? Will Kerala’s famed healthcare model collapse in quality with the influx of private equity investments? South Central examines.

Published on:

03 Jul 2026, 1:40 pm

In this week's South Central, hosts Dhanya Rajendran and Pooja Prasanna first discuss senior journalist R Rajagopal’s letter regarding the removal of his name from the electoral rolls, denying him renewal of his passport. The hosts are joined by R Rajagopal himself and Shivasundar, a senior activist and researcher who has been studying the election process.

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“I could not find my own name in the 2002 electoral rolls. I was not surprised, because it was a period of moving and we decided to be in West Bengal only later. But my father’s case is really surprising. Even my wife’s mother was in West Bengal. So it is intriguing why the names were removed from the state’s electoral rolls,” Rajagopal explains.

He further says that there should not be a cause for concern even if names are not in the 2002 rolls.

“The adjudication process is quite hazy. There is still a lot of ambiguity about the validity of the Aadhar card and so on. My birth certificate is also not solid in my case because I was born two years before it became an acceptable document of identity. The matriculation certificate is what has been accepted so far, and I have submitted that. Despite, my name was not in the list. No reason has been conveyed to me either. I am learning that they may have employed what is called a logical discrepancy, like a misspelt name or something. I have filed an appeal, and in West Bengal alone, massive numbers of such appeals are currently pending under various government-appointed commissions,” he adds.

Dhanya says that there is a general notion that those being excluded from the SIR process from rolls are from marginalised or financially disadvantaged backgrounds. “Rajagopal’s case exposes that it is not true, and also shows us the kinds of legal hoops he is made to jump through, affecting passport renewals, travel and so on,” she says.

Shivasundar says that the non-acceptance of the Aadhar card is also ambiguous.

“The Supreme Court has now given full autonomy to the Election Commission to suspect it if the case permits. So this whole imbalance is structural, and the state governments have been given no powers to intervene, tilting the whole process in favour of the Union government and the ECI’s discretion,” he points out.

The panel further discusses the concept of logical discrepancy, conflicting stands of courts, and the inherent problems of the whole SIR process.

In the second part of the episode, the hosts discuss the private equity investments in Kerala’s health sector and how they pose the risk of prioritising profit over patient care. They are joined by investigative journalist Jisha Surya, Chairman of KIMS Health, Dr M I Sahadulla, and medical researcher and educator Dr A Althaf.

Jisha explains the findings of her investigation into the inflow of cash from private equity firms in Kerala’s hospitals. “It started in 2023 with the KIMS hospital in Trivandrum. Thereafter, several firms started making big investments. This has a pattern. We have seen PE firms from the US investing in Kerala’s hospitals, including those in tier 3 and 4 cities. Parallely, several small and medium hospitals are being closed down, and the concern is whether this will affect the famed Kerala model of public healthcare,” she says.

Dr A Althaf says that this is a concern.

“Such PE investments in healthcare started as a post-globalisation phenomenon across the globe. They peaked in 2006 in the US. We must also learn from the experiences in these countries. Activists and experts were worried about this, and the general perception is that more investments mean better healthcare. Studies have found that the mortality rates are higher in the US’s PE-funded hospitals, shattering the myth that more investments make healthcare quality better. PE’s are exclusively for profit and are not preoccupied with access, care, quality and the like,” he explains.

He further elaborates on how no new hospitals were started in Kerala, but major hospitals were taken over through a share buyout. “Initially, we feel the infrastructure investment is good. But gradually, they will exercise some kind of value creation and then eventually sell it out, making sure the profit is four to five times what they invested. An example is the 2018 takeover of Max Healthcare by KKR, an investment company. 27% of shares were sold in 2022, for almost ten times the price. In Kerala, we can also speculate on the profit they seek to make when selling out. Morbidity is often the commodity they are trying to harvest,” says Dr Althaf.

Dhanya asks how this is any different from the status quo, because private hospitals always run on profit, she points out.

“Kerala’s famed healthcare model is not solely built on public hospitals. There has definitely been a private sector that has pitched in to make that model efficient. But as in any business, there is always a chance of profit or loss, but the PE principle does not account for loss. They only move ahead focused on profit, and that is the concern,” says Dr Althaf.

He adds that venture capital and IPOs can be alternative avenues to invite investments in the health sector, without the profit motive of the PEs.

Dr M Sahadulla gives an alternative perspective.

“Kerala, in particular, has the best healthcare indices in the country. Therefore, healthcare awareness and demand are much better in the state, attracting more investments than other states. There are benefits and drawbacks as well. For example, those who had the choice to go to other countries for treatments can now avail it in Kerala. Advanced surgeries like liver and heart transplants, among others, are now available even in tier 3 hospitals. This upscaling of facilities and care is a positive outcome of PEs. The talent pool has also improved, owing to the better payment and training,” he says.

He also adds, however, that the costs must be made more affordable. “Healthcare is a fundamental right, and therefore, we should look at a model where the private and public sectors come together to make healthcare accessible. Quality guarantees like accreditation and other checks must be established by the government in the private sector to make sure that in the race for profit, credibility is not compromised,” he further says.

The panel further delves into medical ethics, the dichotomy of doctors being involved in the financial reorganisation of hospitals, and what the government can do to bring a check and balance.

Tune in to the episode here.

Audio timecodes:

00:00:00 - Introduction

00:02:10 - Headlines

00:09:35 - SIR and issues

00:48:53 - PE in Kerala hospitals

1:19:46 - Recommendations

References:

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