Abstract
The provision of public health services is a state core duty by constitution, it is citizens’ health rights
to fair and equitable service delivery. Realizing these rights depends not only on legal recognition but
also on governance, resource allocation, and administrative practices. Structural constraints are evident
in high-cost specialized diagnostic radiology services, such as computed tomography (CT), which require
advanced technology, skilled personnel, and complex financing and service arrangements. This study
examined how administrative discretion of public health service units affected access to emergency CT
scans. Using a public law–informed health systems perspective, it analyzed interactions between legal
entitlements, service organization, and decision-making. A comprehensive literature review and a case
study of disputes over emergency CT access illustrated gaps between policy intent and operational
practice. Findings indicated that limitations in infrastructure, procurement processes, and financial
incentives within insurance schemes and service contracts contributed to unequal access. Restrictions
on emergency CT scans without medical justification reflected administrative discretion rather than
clinical need, undermining equity, continuity of care, and accountability. The study proposes a “public
law architecture for emergency CT services” as a governance framework integrating constitutional
principles, health legislation, administrative regulations, service contracts, and policy oversight. This
framework aims to align legal obligations with health system operations, constrain discretion, strengthen
accountability, and promote equitable and sustainable access to emergency diagnostic radiology services.
