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Public Health News Analysis
Rajasthan Right to Health Bill, 2022: Honest or a Gimmick
Image Credits: Getty Images
Author : Dr. Anubhav Mondal
Updated on :
May 13, 2023
Right to Health, Free Healthcare Services, Quality of Care, Out-of-Pocket Expenditure, Healthcare Expenditure
Rajasthan Right to Health Bill, 2022 was passed by the State Legislative Assembly on 21st March 2023 which is historical for the State. After unprecedented protests, the doctors finally had an agreement with the Government. The intent may be right considering the massive out-of-pocket expenditure that patients undergo. But the sustainability of the act is debatable as the bigger challenge is fund allocation to health. Only time will tell if the Bill is just another election gimmick or an honest public welfare scheme.
Rajasthan Right to Health Bill was introduced in the State Legislative Assembly in September 2022. It was referred to a Select Committee, headed by the Minister of Health and Medical Services. The committee reported its findings and the bill was amended accordingly and was passed by the Assembly on 21st March 2023.
Protests emerged from the doctors against this bill and consensus was finally arrived with the government on 4th April 2023. A delegation of doctors held talks with the government and signed a Memorandum consisting of 8 points.
It included their major demand that private hospitals that have not taken any benefit from the government in the form of land or buildings at subsidized rates should be kept outside the ambit of the Bill. Among other demands that the government has agreed is to bring a single window system for licenses and other approvals for hospitals and the renewal of the fire no objection certificate (NOC) will be done on a 5-yearly basis.
Any further changes in rules will be done after consultation with two representatives of IMA.
Health in Rajasthan
Rajasthan is the largest state in India in terms of area which accommodates approximately 5.6% of the country's total population.
It's health and economic parameters classify it as one of the ‘weak’ states.
The total expenditure on health as a percentage of total state expenditure increased from 5.7% in 2017-18 to 7.4% in 2022-23, which is also lower than the 8% recommended by the National Health Policy, 2017.
The per capita government expenditure on health in Rajasthan was a mere ₹ 1696 compared to ₹ 4470 in India.
About the Bill
Every resident of the state has the right to avail free healthcare services,
Residents will have certain additional rights: free transportation, treatment, and insurance coverage against RTA.
It sets certain obligations on the state government to ensure the right to health and maintain public health.
Health authorities will be set up at the state and district levels and will formulate, implement, monitor, and develop infrastructure for quality delivery of care.
The Bill also provides for a grievance redressal portal for resolving complaints.
Why in the news?
Rajasthan Right to health bill 2022 was passed by the Assembly on 21 March 2023, which led to unprecedented protests by doctors all over the state. Termed as ‘draconian’, rallies were held all over the state by doctors while the government insisted that suggestions from the doctors had already been incorporated in the bill.
The intent of the bill is perhaps in the right place, considering the massive out-of-pocket expenditure patients undergo, especially during emergencies.
Also, in accordance with the Supreme Court Judgement of 1996, the Right to Health is included in Article 21(Right to Life), as a fundamental right in the Constitution.
Drawbacks
But this Act has a fair share of faults. What bothers the most, is the sustainability of this Act.
As funds allocated to health are termed insufficient for the functioning of the already existing public health institutions, this will serve as a massive blow to the health budget.
According to the Financial Memorandum, ₹14.5 cr recurring expenditure was estimated for this Act. However, this does not mention the costs of providing healthcare services to everyone in the state.
Also, existing schemes such as Mukhyamantri Chiranjeevi Swastha Bima Yojana and Ayushman Bharat Scheme already cater to the public health needs and there might be an overlapping of beneficiaries, lowering the cost effectivity of all these schemes.
In 2018-19, Rajasthan’s total expenditure in health was ₹29905 cr, out of which 44.9% was from out-of-pocket expenditures of individuals. Rajasthan in 2022-23 has increased its health budget, though it seems that it won’t be enough to cover the massive cost of implementing this Act. No mention of additional funds allocated for the implementation of this Act has been specified.
The absence of a clause for compensating private healthcare facilities for rendering free medical assistance is a breach of Article 19(1)(g) of the Constitution. This provision secures the right to pursue any profession or occupation, trade, or business.
Another legitimate issue, that the doctors have pointed out is that the term emergency has not been defined in the Act and subjectively the meaning of emergency is quite varied. What might seem to be an emergency such as a headache or stomach aches to the patient might always not seem to be an emergency to an experienced mind of a doctor.
Lastly, another issue that has cropped up is regarding the privacy of the patient data, which would be uploaded by the District Health Authority. The Act is not specific about who will have access to the report and hence could lead to misuse of the patient data.
Way forward
Rajasthan has been historic in becoming the first state in the country to implement the Right to Health and by reaching a consensus with the protesting doctors has restored faith in problem resolution through discussions, which is the core of democracy.
This all could be termed as a step in the right direction but what lies ahead are bigger challenges of fund allocation and political will for proper implementation of this Act.
Also, it should be noted that the prevention of diseases is way more effective and cost-friendly than treating the same disease as an emergency. So, imparting health education and prevention is way more effective among the communities.
Moreover, the government before implementing new acts, should consider fulfilling the existing vacant positions, as is evident in Table 1.
With the implementation of this Act just before the state elections in December, only time will tell whether this is just another election gimmick or an honest public welfare scheme.
Table 1: Shortfall of Healthcare workers in Rural Rajasthan as on March 31, 2022
References
1.“Bills States”, PRS Legislative Research, Available at: https://prsindia.org/bills/states/the-rajasthan-right-to-health-bill-2022 (Accessed: 13 May 2023).
2.“Rajasthan Doctors Call off Stir against Right to Health Bill after Pact with Government”, The Hindu, 4 Apr. 2023, Available at: https://www.thehindu.com/news/national/other-states/rajasthan-doctors-call-off-stir-against-right-to-health-bill-after-pact-with-government/article66698870.ece (Accessed: 13 May 2023).
3. Dutt, A.(2023)“Doctors vs Rajasthan’s Right to Health Bill”, The Indian Express,29 Mar. 2023, Available at: https://www.indianexpress.com/article/explained/explained-health/doctors-vs-rajasthans-right-to-health-bill-8524518/(Accessed 13 May 2023).
4. “Right to Health Bill: Rajasthan Govt, Protesting Doctors Reach Consensus; Protests to Be Called Off”, Business Today, 4 Apr. 2023, Available at: https://www.businesstoday.in/latest/economy/story/right-to-health-bill-rajasthan-govt-protesting-doctors-reach-consensus-protests-to-be-called-off-376035-2023-04-04 (Accessed: 13 May 2023).