From Aspirations to Implementation: The Rajasthan Right to Health Act, 2023

Posted On - 18 January, 2024 • By - King Stubb & Kasiva

Introduction

Within the domain of fundamental human rights, the right to health assumes a prominent position. It is a universally recognized principle in international law via instruments such as the World Health Organization’s Constitution[1] and the Universal Declaration of Human Rights.[2] This right, which seeks to advance the utmost level of physical and mental health, demonstrates the international dedication to providing accessible and affordable medical care for every individual.

Rajasthan, in an unparalleled action, assumed a leading role by introducing the Rajasthan Right to Health Care Act, 2023, thereby becoming the first state in India to codify the right to healthcare through legislation.[3] Although widely regarded as a substantial advancement in improving the accessibility of healthcare for state residents, the Act encountered strong opposition from the medical community, specifically regarding reimbursement concerns. The Act, which is an admirable advancement in health care legislation in India, faces a nuanced landscape.

This article aims to analyze the situation leading up to the introduction of the Act, what it contains, and the loopholes associated in the following manner:

Leading up to the Act: The Need and Journey
Key Provisions of the Act
Critical Analysis of the Act

Leading up to the Act: The Need and Journey

The Rajasthan Right to Health Care Act of 2023, was enacted in response to the critical need to address healthcare challenges in Rajasthan, India’s most populous state, home to more than 80 million people. Faced with adverse health and economic indicators, the state observed the need to enhance healthcare standards and alleviate families’ financial burdens. Despite already existing schemes like the Mukhya Mantri Nishulk Dawa Yojana[4], providing free medicines and medical equipment, the Chiranjeevi Insurance Scheme[5], offering a comprehensive medical insurance cover of ₹25 lakhs to all state families, alongside the Mukhya Mantri Nirogi Rajasthan Scheme[6] and Mukhya Mantri Nishulk Janch Yojna[7], individuals were responsible for roughly 60% of healthcare costs. This resulted in higher poverty rates and a reluctance to seek medical care.

The legislative process, initiated in 2018, faced various challenges, including opposition to an initially deemed radical draft and disruptions caused by the global COVID-19 outbreak. Finally, after extensive debate, referral to a select committee, and discussions, the Rajasthan Right to Health Care Act was passed on March 21, 2023. This act marks the beginning of a paradigm shift in the field of healthcare rights, which will be overseen by district and state health authorities.

Key Provisions of the Act

Preamble: Aims to protect and fulfill health rights under Article 47 and the expanded definition of Article 21 of the Constitution, focusing on equity and the reduction of out-of-pocket expenditures.
Scope of Right to Health: Guarantees emergency treatment without prepayment, covering medical emergencies, critical care, and obstetric care in public health institutions.
Reimbursement Mechanism: Section 3(c) entitles residents to emergency treatment, and in cases where patients do not pay, healthcare establishments are reimbursed by the state government.
Free Healthcare Services: Section 3(d) provides the right for all residents to avail themselves of free healthcare services from public health institutions, healthcare establishments, and designated healthcare centers as per rules.
Other Empowering Features in Section 3: It includes access to patient records, investigation reports, detailed itemized bills, information about healthcare providers, rates, charges, and the freedom to choose medicines or tests.
Accommodating Special Interests: Amendments made to accommodate special interests by specifying “public health institution, healthcare establishment, and designated healthcare centers” instead of private providers.
Coordination and Nutrition: Section 5(j) emphasizes coordination among government departments to ensure nutritionally adequate and safe food for patients, along with safe drinking water and sanitation.
State Health Authorities: Establishes two independent state health authorities—one for logistical grievances and another for treatment protocols—to advise the government, assist in planning, and ensure quality and cost-effective services.
Appeals Mechanism: Grievances are heard by district health authorities within 30 days, with appeals directed to the state authority. Healthcare institutions must resolve complaints in three days.
Budgetary Commitment: Section 5 mandates the state government to mobilize resources and frame plans or policies to fulfill obligations under the Act, indicating a commitment to budgetary support for the right to health.
Coordination Against Epidemics: Section 5(k) provides for effective measures to prevent, treat, and control epidemics and other public health emergencies through coordinated efforts among government departments.

Critical Analysis of the Act

Although the act is a much-welcome step, it suffers from several loopholes that need to be addressed for proper implementation per the legislative intent. Some of these challenges are as follows:

Lack of Distinction Between Healthcare and Public Health: The Act prioritizes healthcare requirements over public health and emergencies. Delegated legislation and executive actions are expected to have an impact on public health vision and implementation; thus, a clear distinction between public health delivery and healthcare regulation is needed.
Undefined Emergencies and Lack of Clarity on Urgent vs. Emergent Care: The Act lacks a comprehensive definition of emergency, resulting in bureaucratic complications and varying interpretations. If there is no separation between urgent and emergent treatment, private hospitals may become flooded with non-emergency situations, jeopardizing healthcare quality and legislative intent.
Clarity on Interaction with Existing Laws and Schemes: The Act makes no mention or coordination with the existing health laws and schemes. A thorough compatibility analysis is required to ensure that the Act is in line with other relevant legislation, such as the Clinical Establishments Act of 2010[8] and the National Health Mission[9] standards.
Ambiguity in the Applicability of Provisions: The Act’s recognized rights are confined to state residents, however, the phrase “resident” is ambiguous. Ideally, all patients and users of health care should be entitled to these rights. To accomplish this, the definitions of health establishments, which do not distinguish between government and non-government institutions, must be defined.
Over-Delegation of Important Issues: Important provisions, such as identifying emergent medical conditions, resolving grievances, and reimbursement mechanisms, are left to potential delegated legislation and executive discretion. Although operational specifics may be delegated, the Act’s ambiguity on fundamental principles and concepts raises concerns about potential abuse or inconsistent application.
Structure and Composition of Authorities: The proposed authorities’ functions and nomenclature are inconsistent, raising questions about their expertise, neutrality, and efficiency. Authorities require tailored frameworks for strategy planning, implementation, standard setting, and grievance redressal. It is critical to include representatives from patient rights organizations, civil society, and public health professionals.

Conclusion

While the Rajasthan Right to Health Care Act, 2023 portrays remarkable progress toward healthcare accessibility, critical analysis of the legislation reveals significant loopholes. Complications arise from ambiguous emergency definitions, excessively delegated provisions, and a lack of conformity with existing laws. The Act’s success depends on how promptly those shortcomings are addressed. Moving forward, a nuanced strategy including the participation of all stakeholders, legal reform, and adherence to constitutional obligations is required to properly achieve the legislative aims and develop equitable and comprehensive healthcare in Rajasthan, thus paving the way for other states to follow.

Frequently Asked Questions (FAQs)

What rights does the Act guarantee regarding emergency treatment?

The Act ensures the right to free emergency treatment without prepayment, covering medical care, critical care, and obstetric care.

How does the Act address reimbursement for healthcare providers?

In cases where patients cannot pay, healthcare establishments are reimbursed by the state government, as stipulated in the Act.

What is the timeframe stipulated for addressing grievances under the Act, and what happens if healthcare institutions fail to resolve complaints?

The Act requires district health authorities to decide on grievances within 30 days, and healthcare institutions must resolve complaints in three days; failure to do so leads to forwarding the complaints to the district health authority.

What obligations does the Act impose on healthcare establishments regarding patient records and information?

The Act mandates healthcare establishments to provide access to patient records, investigation reports, detailed bills, and information on healthcare providers, rates, charges, and the freedom to choose medicines or tests.

What features distinguish the two independent state health authorities proposed by the Act?

The Act proposes two state health authorities, one for logistical grievances and the other for treatment protocols, aiming to strengthen health-building policies and ensure efficient adjudication of grievances.

[1] https://www.who.int/about/accountability/governance/constitution.

[2] https://www.un.org/en/about-us/universal-declaration-of-human-rights.

[3] https://prsindia.org/files/bills_acts/acts_states/rajasthan/2023/Act7of2023Rajasthan.pdf.

[4] https://schemes.rajasthan.gov.in/scheme/detail/411.

[5] https://chiranjeevi.rajasthan.gov.in/#/home.

[6] https://schemes.rajasthan.gov.in/scheme/detail/972.

[7]http://rmsc.health.rajasthan.gov.in/content/raj/medical/rajasthan-medical-services-corporation-ltd-/en/services/MNJY0.html.

[8] https://cbhidghs.mohfw.gov.in/WriteReadData/l892s/The%20Clinical%20Establishment%20Act%202010-2013.pdf.

[9] https://main.mohfw.gov.in/sites/default/files/56987532145632566578.pdf.

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