Private healthcare workers say the government was shifting responsibility on to them by force. With private hospitals shut, resident doctors in state hospitals on strike and thousands of patients left in the lurch, Rajasthan is teetering on the edge of a terrible health crisis
Strikes by healthcare workers have hit health services across the board in Rajasthan; (Photo: PTI)
The Rajasthan government's landmark Right to health (RTH) law has jeopardised the state's entire healthcare system. Under the law, every resident of the state has the right to get emergency treatment care without the payment of any fee at any healthcare establishment, including private ones. The government would later reimburse the institutions the cost of emergency healthcare and that of transferring the patient to another institution, if so required. Private hospitals allege that instead of improving public healthcare infrastructure, the government is shifting that mammoth responsibility on to the private sector, which they fear would result in a huge drop in quality of healthcare offered. They also allege that the bill, passed on March 21, ignored the amendments that private healthcare stakeholders and doctors had suggested. They now demand a rollback of the bill. To that end, most private hospitals in Rajasthan have shut down their services.
In a latest development, healthcare professionals of private establishments are now being backed by government doctors, especially resident doctors, who have struck work in solidarity. On March 29, teachers in medical colleges also joined the strike. As a result, services in government hospitals are crumbling too. If the situation doesn't improve soon, Rajasthan may find itself in a full-blown healthcare crisis. On March 27, nearly one lakh protesting doctors and support staff took out a procession in Jaipur. They said they wouldn't move from their position unless the law was rescinded.
The Rajasthan government denies that charges leveled by the protestors, saying the doctors' suggestions were taken into account and then submitted to a select committee, which had examined the legislation from all angles. Health minister Parsadi Lal Meena, too, vowed not to revoke the bill.
Other than emergency healthcare, existing provisions under universal healthcare Chiranjeevi allow individuals from Rajasthan free treatment at government healthcare institutions. Under it, a large part of the private sector had agreed to provide cashless treatment up to Rs 25 lakh for indoor patients (who stay in a hospital while undergoing treatment). Now, such participants are questioning the low cost at which they were made to provide treatment. Both the Chiranjeevi and the RTH are applicable to the private sector even if they had not taken any state help in setting up the institution. While the Chiranjeevi scheme is optional for private sector, the RTH is mandatory for it, even if such private institutions had not taken any state help in setting up the institution.
As reason for their protests against the RTH law, private healthcare providers argue thus: Can a right to food or right against hunger law force five-star hotels to provide free food with all services in their expensive restaurants to anyone claiming to be extremely hungry, with the government later on reimbursing the cost at the rate of Rs 8 per head at which it serves food in its own canteens? Furthermore, can hotels be forced to accommodate the homeless at a rate at which the government charges people at its shelter homes? Though a hospital, nursing home or a clinic cannot ever be compared with a hotel, the argument is not without logic.
First promised in the Congress manifesto before the 2018 assembly polls, Chief Minister Ashok Gehlot's Right to Health Act doesn't in any way enjoin the government to provide anything to improve the health of an individual. Such as, a nutritious diet (Rajasthan has been a consistent laggard in health-related social indices), pollution (with sand particles in air and extensive mining, some of the desert state's cities feature in the world's top 100 polluted ones), housing (building laws are violated with impunity) and hygiene (its cities continue to perform dismally when it comes to national cleanliness ratings).
The new law forces any healthcare facility—even a small clinic—to not only provide emergency healthcare but stabilise the patient and then arrange for the further transport of patients to a government facility where adequate treatment could be ensured. This responsibility is binding and violations are punishable by fines. Moreover, district and state health authorities created under the law as grievance redressal bodies have the last say-no doctor or hospital can approach the court against any decision taken by such bodies.
The provisions of the RTH law would force all private health institutions, even small clinics run by a doctor, to invest in infrastructure to take care of emergency cases along with ambulance facilities.
The other important issue is that the treatment would be 'cashless', to be reimbursed by the government later. This could mean doctors or private hospitals would be forced to chase and extract such reimbursements from the government at rates which the government will decide.
This brings into focus the question if such an act was required in the first place when CM Gehlot has claimed that his Chiranjeevi scheme provides free indoor patient care in all state and affiliated private hospitals up to Rs 25 lakhs. Actually, government hospitals also provide all OPD services and tests for free. However, in reality, patients have to negotiate long queues for treatment in state hospitals and are often forced to pay ten to 20 per cent expenses in private set-ups because state-approved health treatment packages often have items and services that are required for treatment but that are not covered under Chiranjeevi.
The RTH law and Chranjeevi scheme have made the private sector raise a vital issue about reimbursements—reimbursements rates are same for government and private hospitals, whereas government hospitals have salaries and infrastructure paid for by government from citizens' taxes. Also, Chiranjeevi does not differentiate between experience, competence and the professional qualification of a doctor. So, charges (to be paid later by the state government) are deemed to be the same both for a resident doctor and a top neurologist.
So, is RTH entirely bad? It might garner more votes for the Congress from the disadvantaged classes, but the way it forces the private hospitals and clinics to provide emergency services, including transport, with only the promise of pre-set flat rates as reimbursement, is deeply problematic.
A better option for Gehlot was to strengthen Chiranjeevi scheme and gradually expand it to OPD and more test facilities in private hospitals, even if patients were to bear part of the cost. But in his rush to be seen as running a welfare government, Gehlot's move, under the pressure of left activists, has made the entire private sector rise up in revolt. In the process, patients are in danger of dying for want of emergency care such as dialysis and trauma care. The resident doctors' strike in government-run hospitals have worsened the situation.
A viral video from march 28 featured a scene from the state's largest healthcare institution—the SMS Hospital in Jaipur. A good Samaritan had brought an accident victim to the hospital, but the injured man was denied a CT scan until his Aadhar card was produced. The alternative: a Rs 1,100 fee.
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Mar 29, 2023