Last week, the Governor of Rajasthan signed off on the Right to Health Bill (RTH), making it the law — a first in the country.

But in the days running up to this, the State had witnessed doctor protests, leading eventually to an uneasy truce. An agreement was reached keeping private healthcare institutions, that were unaided by the government, outside the ambit of this RTH framework — a development that had health activists questioning if the RTH Bill now gets limited to being a “public sector law”.

The very fact that there was a high-pitched discussion on a Bill that sought to ensure citizens their right to healthcare — a concept as basic and fundamental as that — left several in civil society concerned. Why would the medical fraternity protest a concept germane to their profession?

On the State

The preamble of the Rajasthan Right to Health Care Act (2022) promises to provide protection and fulfillment of rights, equity in relation to health and well being through guaranteed access to quality health care to all residents of the State “without any catastrophic out of pocket expenditure.” The Act seeks to ensure people free treatment and emergency care, with the State picking up the medical tab.

Lauding Rajasthan’s passing of the Bill as a first step, Amulya Nidhi with the National Alliance of People’s Movements (Health subgroup) says, the State government will now have to outline rules that will help actually deliver free healthcare to the people. This will include bringing in clarity on defining emergencies, ensuring reimbursements quickly and transparently, and including civil society representatives in the monitoring and grievance mechanisms, for instance. He expects other States like Odisha, Bihar, Chattisgarh, etc to move in a similar direction, since health is a State subject.

Unable to understand why some doctors have a problem with the Act, Amulya says, the development comes five years after the Centre’s National Health Policy (2017); and the State took note of concerns of key participants who would be involved in implementing this promise. Providing healthcare lies at the core of the oath doctors take, he says, adding that citizens would in fact react with thankfulness (not violence) if doctors address their medical problems and emergencies.

But not everyone is convinced that the matter is as straight forward. Expressing solidarity with the doctors in Rajasthan, the Indian Medical Association protested with black badges on what it called an “anti-people” bill. People’s health was the State’s responsibility, it said.

Pointing to the free emergency care promise in the legislation, several doctors and healthcare representatives said, it had not been thought through or budgeted for, in terms of the financial support to reimburse doctors and hospitals for providing free care; or set-up organisational and infrastructure back-ups. They expressed concern on the penalties they faced, and potential bureaucratic overreach on their clinics.

Dr Vijay Kapoor, secretary with the Private Hospitals and Nursing Homes Society (PHNHS) urged State authorities to adhere to the agreement with doctors on the RTH Act. Otherwise, he cautioned, doctors across the State would boycott the State’s health schemes.

Clarity needed

“The devil lies in the detail,” says Siddhartha Bhattacharya, Secretary General, Nathealth, a platform for healthcare institutions. The promise to provide emergency care, for example, would require the right protocol to be in place, with well equipped ambulances, and hospitals with the doctors and support staff that can provide emergency care. Without having such facilities in place, the promise of free emergency care would raise the expectation of people and with it the potential of violence against doctors (if it did not meet patient expectations). Further, he added, the delivery mechanism, down to the last mile, financing, etc also needed to be clearly outlined.

In fact, a Nathealth paper on healthcare financing outlines multiple models, such as inclusion of cashless OPD benefits (out-patient), health savings accounts and an alignment of treatment costs in line with the “true cost” of the service delivery with flexibilities built-in to provide the same at a fixed price arrived at through discussions with the provider, to keep it viable for them as well.

At the core of the medical profession is to “do no harm”, says Bhattacharya, stressing the importance of having a strong healthcare delivery plan in place, with technical support, rather than a sub-optimal one.

Health activists though are hopeful, now that the first steps have been taken, the RTH juggernaut rolls on into more States.