In today’s Finshots, we explain why Rajasthan’s Right to Health Act ended up being controversial.

The Story

In 1989, the Supreme Court of India passed a landmark ruling. It said:

“Every doctor whether at a Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life.”

If you read between the lines, the court was basically implying that people have a right to health.

And why was this important?

Well, if you remember your civics lessons from school, you’ll know that the Right to Health isn’t one of the 6 fundamental rights guaranteed by our Constitution. Health is still pretty much a state subject in India. But the court’s ruling got people thinking — “Hey, maybe we do need to do something about this health business. After all, over 63 million people fall into poverty each year due to unprecedented healthcare costs.”

Slowly but surely, various government schemes started to pop up to make healthcare more accessible. But most of them focused on insurance schemes for the poor.

And it took nearly 35 years after that Supreme Court judgment for a state to step up and do something big. Enter Rajasthan with its Right To Health Act. The government wanted its residents to be able to walk into any hospital in case of an emergency and not worry about how much it would cost them. So they drafted the bill and passed the law a couple of weeks ago.

It was meant to be a lifesaver — imagine a situation where a labourer suffered a sudden heart attack. Time is of the essence and the only hospital nearby is a private one. But he can’t afford the exorbitant charges. And if he goes there anyway, he’d probably be denied treatment without some sort of a payment guarantee. He could lose his life in this melee.

With the Right to Health, everyone would get free access to emergency medical care. Whether in a private hospital or a public one. People could heave a sigh of relief.

But doctors at private hospitals were miffed. They took to the streets in protest. And for two weeks, private hospitals turned their lights off. It was mayhem.

But why? Why were the doctors so unhappy with guaranteeing treatment to the common folk, you ask?

Well, their problems with the Right to Health were fairly straightforward.

Firstly, they were worried about the definition of what would constitute a medical emergency. What a patient considers to be an emergency may not be construed as such by a doctor. As some doctors point out, while in most cases, the delivery of a baby can be urgent, it may not necessarily qualify as a medical emergency. But what if the patient disagrees with that?

They wanted more clear-cut answers to what can come under the ambit of free and immediate treatment. Otherwise, they believed doctors would be saddled with umpteen cases. And it could even end up in unnecessary disputes with the patients.

Secondly, private hospitals weren’t convinced that they’d be reimbursed by the government for all treatments. It could lead to disputes, delays, and hospitals might end up losing a lot of money in the process.

Take for instance the Central Government Health Services (CGHS) Scheme which provides free healthcare to most central government employees. It was supposed to be a lifesaver but in 2022, private hospitals were struggling to recoup about ₹500 crores from the Central Government to keep the scheme alive. Some healthcare institutions even discontinued services to eligible outpatients simply because payment delays were leading to red lines in their financial statements. They couldn’t function anymore.

And thirdly, they feared that the bureaucracy would be saddled with excessive powers. The state and district health authority would have precedence to handle disputes over a civil court. And this could pave the way for corruption and bribery as hospitals tried to wriggle their way out of penalties and fines.

Seems like quite a valid set of objections, no?

So, the state government finally relented this week. They agreed to tweak the Act. They kept small hospitals out of the Act. And also exempted private hospitals that haven’t taken any concessions or subsidies from the government for land and building.

But here’s the thing. The tweaks have removed 98% of the private hospitals from the list. There’s nothing left. And that means the Act is a shadow of its former self. People have no option but to go to a public hospital anyway. And the problem is twofold here — there aren’t enough of these hospitals peppered across the state and people seem to prefer getting treated at private hospitals over government hospitals when they can.

For instance, take the case of Rajasthan’s state-sponsored health insurance. People could visit a private or public hospital for their ailments and claim it under this scheme. And when Professor Radhika Jain of University College London ran the numbers, she found that 75% of the insurance claims during the first four years of the scheme all came from private hospitals.

So yeah, without private hospitals, the Act loses its teeth.

Either way, the Right to Health Act in Rajasthan is a start. Even if it has been a rough one marred by protests. It could at least spur other states to think about enacting similar legislation.

Or maybe, rather than leaving it to the states, it’s time for the union government to step up. We’ve seen the devastation that the pandemic wreaked on the common folk. And no one should have to suffer from being unable to access good healthcare. Because health isn’t a privilege. It should be a right. And with government committees and the NITI Aayog mentioning the importance of healthcare accessibility in multiple reports, maybe it’s time for India to consider adding a seventh fundamental right — the Right to Health. It’s time for us to join the 50% of the world which have such rights enshrined in their constitutions.

Sure, execution might be hard. But that shouldn’t stop us from trying to make the lives of all Indians better, no?

Until then…

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