Rajasthan’s Right to Health Care Act: Promises and pitfalls

Though the state government has come to a consensus with the doctors over the latter's disagreement with the Rajasthan Right to Health Care Act, 2023, the legislation still fails to address key concerns pertaining to reimbursements at private hospitals.

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THE right to health is a fundamental human right recognised by international law, and enshrined in various instruments such as the Universal Declaration of Human Rights, among others. The World Health Organization's Constitution recognises the right to health as a fundamental right as well.

The primary objective of this wide recognition is to promote the right of every individual to attain the highest standard of physical and mental health. In its essence, the right talks about affordable medical healthcare for everyone.

In March, Rajasthan became the first state in India to pass a right to healthcare legislation. While the Rajasthan Right to Health Care Act, 2023 is a step forward in the sector and makes healthcare more accessible to the residents of the state, doctors working in the state took to the streets to protest against its passage because, according to them, the Act fails to address some of their key concerns relating to reimbursement.

In 2019, the state government had introduced the Right to Health Bill, but it did not make it through the state legislature as stakeholders were not adequately consulted during its drafting. Similar concerns have been raised about the current Act as well, which the state government has tried to address through an eight-point solution. The highlight of the agreement between the doctor community and the state government was addressing the problem of reimbursement as laid out in Sections 3(c) and 3(d) of the Act. Though the state government has come to a consensus with the doctors over the latter's disagreement with the recent Act, the Act still fails to address key concerns pertaining to reimbursements.

Also read: Rajasthan Right to Health Care Act, 2023: What it entails, and how we got there

An umbrella for expanding healthcare coverage

The Act envisions providing access to healthcare services equitably to everyone, which is evident from the provision of free emergency healthcare treatment. This syncs with Articles 21 and 47 of the Constitution of India.

The Act is the latest addition to a plethora of policies and schemes in Rajasthan that seek to secure the right to health for citizens of the state. The Mukhya Mantri Nishulk Dawa Yojana provides free medicines and medical equipment for a variety of treatments. The Chiranjeevi Insurance Scheme extends a medical insurance cover of twenty-five lakh rupees to all families in the state. Other schemes include the Mukhya Mantri Nirogi Rajasthan Scheme and the Mukhya Mantri Nishulk Janch Yojna.

Principally, all of these flagship schemes of the government have the same goal: to provide access to healthcare for everyone who has been systematically deprived of it due to various socio-economic reasons. The Act has the ability to bring all of these schemes under its aegis. The provisions of the Act will refine and increase the legitimacy of the facilities extended by existing schemes.

Furthermore, these schemes contain within themselves a massive database of the people who are accessing their facilities. The data can be systematically used by the government to extend the facilities to deserving people, thus drastically reducing the time for the implementation of the Act at the grassroots level.

Also read: Healthcare as a right: Analysis of the Rajasthan Right to Health Bill, 2022

Ensuring healthcare to all: A case for streamlined reimbursement and income criteria

The government, originally in Section 3(c) and (d) of the Act, mentioned that every resident of the state is entitled to free emergency medical treatment in the state, be it in private or public hospitals. However, the government didn't mention any clear clause pertaining to the reimbursement of the same to private hospitals. This was the primary cause of conflict between doctors and the state government. In order to address the problem, the government categorised hospitals that would fall under the ambit of the Act.

The categories included in the purview of the act are: a) private medical college hospitals, b) hospitals established under public–private partnerships, and c) hospitals running on land or buildings funded by the government. The government has excluded hospitals with less than 50 beds, and hospitals that were built without taking any grant or land from the government, from the Act. So the Act, post the latest agreement between the government and doctors, majorly regulates those hospitals that fall under the direct or indirect control of the government.

The question that the new agreement raises is if the Act actually intends to extend free medical services to everyone through private hospitals. According to a popularly quoted figure, 98 percent of private hospitals in Rajasthan are small facilities hospitals, and the government removed these hospitals from the purview of the Act. The agreement fails the original purpose of the Act, that is, to make the facilities of both private and public hospitals available to people in case of a medical emergency.

Further, a study found that 75 percent of the insurance claims in four years in the state were from private hospitals; thereby exclusion of the private establishments renders the intended relief redundant.

The issue with Section 3(c) and 3(d) is twofold. Firstly, the government has not made it clear as to what can constitute an emergency, and the word, if loosely interpreted, can cover a spectrum of ailments in their varying intensities. Secondly, the Act does not clarify the beneficiaries of the reimbursements. There needs to be a mechanism in place whereby the state government should be liable to reimburse on behalf of bona fide claims laid by the people who actually cannot pay for the services availed by them and filter out people who are capable of paying for the expenses, for the equitable implementation of the Act.

The experience of Colombia shows that affluent people start clogging courts seeking reimbursement for their treatment under a right to health legislation, straining the entire system financially and accruing benefits at the expense of people who genuinely need those services. The seamless implementation of emergency services extended by the Act would further require 6,000 regulators, it is estimated.

Hence, defining emergency medical treatment and setting up income criteria would help in preserving the resources that could be used for those who are really in need. Moreover, it would prioritise the vulnerable population, and would promote equity and fairness in healthcare.

Also read: Analysing Supreme Court's Attempt To Safeguard Right To Health

Final takeaway

While the Act has the potential to revolutionise healthcare in Rajasthan and provide the right to health to its residents in its true sense, it is not the perfect statute at present. Its effective implementation requires it to be harmoniously operationalised with other schemes; this will also ensure that benefits reach those in need. Involving stakeholders and allocating sufficient resources are essential. The government must ensure transparency and accountability by involving healthcare professionals, civil society organisations and community members in the implementation and monitoring of the Act.

Merely drawing out rights is not enough unless proper arrangements are made to ensure that the intended purpose of the existence of those rights is met. The Act envisions the establishment of a foundation for various governmental schemes extending equitable healthcare services across all classes of people. The government should also remain mindful of the reality of the Act fulfilling its intended purpose; if there exists a section of the society that is unable to receive the facilities made for their benefit, then action must be taken to enable everyone to access those facilities.

The right to health is an essential human right, and it is the responsibility of the government that everyone has access to quality healthcare without facing any discrimination or systemic impediments.