As Thomas Fuller rightly stated, health is not valued until disease arrives. In Rajasthan, the focus of post-covid policy has been on health services. the Rajasthan Right to Health Bill 2022 in the state assembly on 21 March.
As Thomas Fuller rightly stated, health is not valued until disease arrives. In Rajasthan, the focus of post-covid policy has been on health services. the Rajasthan Right to Health Bill 2022 in the state assembly on 21 March.
Under this law, every resident of the state would be guaranteed access to free health care services, including consultations, medications, diagnostics, emergency transportation, procedures, emergency care, and safe, quality health care at all public health institutions and selected private institutions.
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Under this law, every resident of the state would be guaranteed access to free health care services, including consultations, medications, diagnostics, emergency transportation, procedures, emergency care, and safe, quality health care at all public health institutions and selected private institutions.
The rules have yet to be finalized, so it’s not yet clear whether non-urgent cases will be covered under the warranty. The state health minister told a news conference that the provisions would apply to private hospitals with more than 50 beds.
Healthcare providers are required to provide emergency care and treatment without waiting for prepayment or police clearance, and will be eligible for reimbursements from the state government. Those who violate the law would be fined up to 10,000 for the first violation e 25,000 for subsequent ones.
Under the bill, the state government must make adequate provisions in the budget, increase access to health services, and develop and institutionalize a human resources policy to ensure the availability and fair distribution of health workers at all levels. It must also establish grievance remediation mechanisms and establish state and district health authorities who will formulate, implement and monitor mechanisms for quality health care and management of public health emergencies.
Healthcare schemes in the state
The state government has launched two health schemes in 2021, the Rajasthan Government Health Scheme (RGHS) for civil servants and retirees and the Chiranjeevi Health Insurance Scheme for the general public.
Both schemes provide beneficiaries with cashless medical services in all public and most private hospitals in the state. After their launch, the influx into the public healthcare system decreased as people preferred private healthcare services.
SMS Hospital, the state’s largest multi-specialty public health institution, has seen a decline in surgeries since the launch of these programs, according to senior physicians in the department of surgery. This has reduced the workload for physicians, residents, and medical students at the medical school, which has impacted the rigor of training and the quality of future physicians.
With the introduction of the bill, the state has tried to show its commitment to people’s right to health, but will it become a reality or will it turn out to be just another populist measure, introduced ahead of the state assembly elections scheduled for the end of the year?
Doctors at private institutions have been agitating since September 2022, when the bill was first introduced to the assembly. Here are some of the problems with the bill:
First, it directly affects the financial viability of private healthcare providers, thereby hampering investment in private companies. It gives people the right to get free healthcare from any medical institution, but doesn’t provide clarity on how private healthcare providers will be compensated. If the government fails to reimburse costs efficiently, private establishments will not be commercially viable.
Second, the state could see its financial obligations soar if the right to health is implemented. In 2022-2023, Rajasthan spent 7.3% of its total budget on health which is higher than the national average of 6%. This is due to the increased expenditure on the Chiranjeevi Scheme and RGHS, and the plan to establish medical colleges in every district will further increase it.
According to rural health statistics (2021-22) released by the MoHFW, the state has a shortage of health workers, particularly in community health centers (CHCs) in rural areas, which needs to be corrected for effective implementation of the bill .
According to the National Health Accounts for India (2022) estimates, total expenditure on health in Rajasthan in 2018-19 was 29,905 crores. Of this, 43.7% was spent by the government (both central and state), while 44.9% was spent by private companies, leading the state to pay a considerable part of what is currently expenditure. lives on people.
The state should now push the private sector to spend more on meeting the needs of the right to health due to the increase of IPD/OPD patients in private facilities due to lack of access and lack of quality healthcare. quality in public facilities, and keep repayments pending.
Third, the quality of treatment can be compromised to keep private entities viable. To fulfill their obligations under the Chiranjeevi scheme, private hospitals have set up separate wards which doctors do not visit on a regular basis. Patients here are discharged within one day, the minimum requirement, and then asked to be readmitted with the cash (self-pay) option. If a patient needs to stay in hospital, treatment is chargeable beyond the scope of the insurance scheme.
Healthcare services will most likely be adversely affected by the additional obligations placed on private healthcare providers under the RTH bill. By providing the right to health, the state appears to make it more difficult to obtain quality care.
Fourthly, there is a lack of clarity regarding various forms of emergency care and treatment which may be changed by the State Health Authority from time to time. This has caused apprehension among the medical community and private entities.
Finally, with an expected negative impact on the private healthcare sector, the state may not be able to attract large healthcare conglomerates. This will affect the investment climate in its healthcare sector and possibly other sectors as well, as the state’s willingness to sacrifice the viability of private commercial enterprises to fulfill public service obligations is clear.
The Delhi High Court said in a 2007 ruling that private hospitals getting land concessions should be subject to the state’s commitment to provide healthcare to their residents, but this should be commercially viable. Thus, 10% of patients in OPD and 25% in IPD must receive free treatment at these facilities.
While private healthcare facilities that have acquired land concessions are subject to such obligations, they should not be imposed on facilities that have not obtained concessions. The RTH bill, however, puts all private institutions under one umbrella, threatening their commercial viability.
That’s not to say the initiative isn’t well-intentioned. Achieving the goal of universal health coverage is crucial. But not enough thought has been put into its implementation. Here are some tips:
First, the right to education model could have been replicated, thus distributing the burden of providing quality health care equally between state and private health care providers. Private entities could also have been encouraged to expand health services in the state to make the sector financially viable.
Secondly, a clearly defined mechanism with a one-stop-shop system for the reimbursement of private institutions should have been proposed.
Thirdly, the information asymmetry between patients and private healthcare providers should have been cleared by the government by making them aware of the bill coverage. For example, in the Chiranjeevi program, patients are often unaware of the package limitations and expect full coverage of 10 lakh as advertised by the government.
Fourth, the government should set up a grievance redress system to address complaints from healthcare workers.
Fifth, the government needs to focus on strengthening public hospitals rather than just shifting the burden to private hospitals.
Sixth, how is the state government going to raise the money needed to implement all of this?
While framing the rules, the state should prioritize these issues to allay the fears of all stakeholders. The proposed act should focus on providing quality healthcare rather than free healthcare even for those who can afford it. This should not be a mere populist measure or citizens will end up being the biggest losers.
The author is Assistant Professor, Department of Economics, St. Xavier’s College, Jaipur.
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