The Coming of a New Dawn: Rajasthan Right to Health Care Act 2022
Subhash Bhambu – Academic Associate, Kautilya
In terms of public policy decisions, Rajasthan Right to Health Care Act 2022 is a milestone in the arena of public health policies in India. Very few countries have explicitly constitutionalised the ‘Right to Health’ as a legal entitlement for the citizens. In that sense, it is a historical as well as a bold step. The Act will certainly initiate a debate in the policy circles and encourage people to assert their expectations from the state as a ‘right’. The state too will realize and be compelled to prepare itself for the necessary health care developments.
The medical associations both public and private have protested against the act raising several concerns. The utmost of them is the trust issue with the government. Several of the past laws and schemes show how legal vagueness and government red-tapism result in inefficiency and failure of policy implementation. The concerns are genuine for the following good reasons.
The act mandates the state resident to avail of free Out Patient Department (OPD) services, In-patient Department (IPD) services consultation, drugs, diagnostics, emergency transport, procedure, and emergency care as provided by all public health institutions. The designated private healthcare providers are mandated to provide emergency treatment and care under any emergent circumstances. (in other words free access to out-patient and inpatient service) One of the concerns of the protesters was around the vagueness of the terms ‘designated,’ and ’emergency.’ Any private provider can be designated to provide healthcare under the Right to Healthcare Act, however, the healthcare provider has to be taken into consultation. Similarly, the word emergency is not defined in the act. Once implemented, the private healthcare providers will face challenges such as bureaucratic burden, and delay in reimbursement. The government will reimburse the treatment expense to private clinics on behalf of residents. However, in the absence of a clear mechanism, this may make private healthcare providers commercially unviable and violate Article 19(1)(g) which is the Right to practice any profession or to carry on any occupation, trade, or business to all citizens) of the Constitution. In case of denial of medical service, there is a grievance redressal mechanism to enforce accountability. The District Health Authority shall take appropriate action, which is also concerned for the doctors since there can be involvement of local politics leading to arm twisting of the doctors. Dr. Amit Yadav, former president of the Jaipur Association of Resident Doctors, says, “If I have a tiff with someone, they can complain to impede our functioning. It will just become another machine of corruption.”
However, despite all these ‘genuine’ concerns, The act’s principles are in direct conflict with the market. Shah Alam Khan, professor of Orthopedics, at AIIMS, New Delhi, writes that we live in a world where the invincible power of capitalism has triggered a cascade of health crises. According to the 2020 report, the public hospital comprises 37.2 percent (25,778 public hospitals) as compared to 72.8 percent (43,486 private hospitals). When it comes to private healthcare infrastructure, it comprises 68 percent. If one includes informal healthcare practices, the number will increase in favor of private practitioners. So, one of the agendas of the medical lobby has to do with private interests. Most of the office bearers of the Indian Medical Association (IMA) which led the protest in Rajasthan, are private practitioners.
When it comes to The Rajasthan Health Care System, according to the Healthy States, Progressive India, and the Health Index Round IV Report, Rajasthan is one of the worst performers and compared to 2018-19, the year 2019-20 saw a decline in various health indicators. In terms of the form of neonatal, under five, maternal mortality rates, tuberculosis treatment success rate, institutional deliveries, and immunization, Rajasthan was placed 16th rank among the 19 large states.
Therefore, the Rajasthan government must take decisive policy decisions. We should be skeptical about the implementation of this health policy since the policy was designed poorly in technical terms where the health care community was not taken into trust, in the first place. Hence, implementation of the policy will be the real challenge for the government where various mechanisms such as financial transaction mechanism, State Health Authority (SHA), and District Health Authority (DHA) for redressal mechanism, have to be established within one year
Nevertheless, like The Right To Information Act, and Mahatma Gandhi National Rural Employment Guarantee Act as the right to have information and right to have minimum employment, the Right To Healthcare Act will boost people’s faith in welfare and the state’s responsibility to ensure health security of its population. Hopefully, other states will take similar steps to strengthen their health capacities. Currently, health is subject to the state list. There are voices advocating for transfer of health into the concurrent list. Fifteenth Finance Commission Chairman N.K. Singh suggests increasing health spending to 2.5 percent of the GDP and setting up a Developmental Finance Institution (DFI) which will look after health investments. The Act will also contribute to the ongoing debate on the Central Government to bear more burden of responsibility when it comes to the Health Care Sector.