Health Sector and Health Policy - Rajasthan | RPSC Preparation: All subjects - RPSC RAS (Rajasthan) PDF Download

Understanding Health Rights in Rajasthan

• Rajasthan has implemented various health schemes to ensure comprehensive coverage. One such initiative is the Mukhyamantri Chiranjeevi Swasthya Bima Yojana, which extends healthcare benefits to individuals across a network of more than 1,550 public and private hospitals in the state. This scheme offers insurance coverage for specific types of medical treatments, enhancing access to healthcare services for the populace.
• The Rajasthan Right to Health Bill of 2022 was presented in the Rajasthan Assembly on September 22, 2022. The primary aim of this bill is to safeguard and promote equal rights in health and overall well-being. It has been directed to a Select Committee for further review, led by the Minister of Health and Medical Services, Mr. Parsadi Lal Meena.

Overview of Health Rights in Rajasthan

Right to Health

In Rajasthan, individuals are entitled to the following health rights:

• Access free outdoor and indoor patient services, medicines, and diagnostics at public health institutions.
• Receive emergency treatment and care at any healthcare provider without delays for prepayment or police clearance.
• Obtain information about their illness, treatment results, complications, costs, and access related records.
• Provide informed consent before undergoing specific tests or treatments.
• Expect confidentiality and privacy in treatments at all healthcare facilities.
• Receive referral transport.
• Access safe and quality healthcare.
• File grievances for redressal.

Additional Rights for Residents

• Access free healthcare services from any clinical establishment as defined by the Clinical Establishment (Registration and Regulation) Act, 2010.
• Benefit from free transportation, treatment, and insurance coverage for road accidents at all healthcare establishments. Details of these services will be outlined in the Rules.

Obligations of the State Government

• Develop and implement a public health model.
• Allocate appropriate funds in the state budget.
• Ensure healthcare services are available considering distance, geographical area, and population density.
• Set standards for quality and safety at all levels.
• Establish a system to provide safe drinking water, sanitation, and nutritionally adequate food.
• Implement measures to prevent, treat, and control epidemics and public health emergencies.
• Create and enforce a Human Resource Policy for equitable distribution of health workers.

Health Authorities

• Establish the State Health Authority (SHA) and District Health Authority (DHA) to formulate, implement, and monitor quality healthcare and public health emergency management.
• The SHA will be led by an IAS officer of at least Joint Secretary rank, appointed by the state government.
• The District Health Authority will be chaired by the district collector.
• The SHA will provide advisory support to the government on public health matters.

Grievance Redressal

• Set up a web portal and helpline for filing complaints related to service denial and rights violations.
• The concerned officer must address complaints within 24 hours.
• Unresolved complaints beyond this timeframe will be reviewed by the District Health Authority, which must act and post a report on the portal within 30 days.
• If the District Health Authority does not resolve the grievance within 30 days, it will be escalated to the State Health Authority for further action.
• The State Health Authority will handle appeals against the District Authority’s decisions.

Key Issues and Analysis

Obligations on the private sector may violate their right to carry out business

• Under the Bill, Rajasthan residents have the right to free healthcare services from any clinical establishment, including private ones. However, the Bill does not clarify whether the state will reimburse private establishments for providing these free services, which could potentially infringe upon Article 19(1)(g) of the Constitution, guaranteeing the right to practice any profession or carry out any occupation, trade, or business.
• The requirement for private sector establishments to provide free services without government reimbursement might lead to financial strain, possibly causing them to shut down. In 2007, the Delhi High Court mandated that private hospitals receiving concessional land from the state must offer free treatment to 10% of OPD and 25% of IPD patients. However, this obligation does not extend to private establishments that have not received land concessions.
• An example of a similar policy is found in the Right to Education Act, 2009, which requires private schools to reserve 25% of seats for free education to children from weaker sections. The government reimburses these schools up to the per-child amount incurred.

Grievance redressal mechanism may violate the right to privacy

• A web portal and helpline center will be set up for lodging complaints regarding denial of services and rights infringements. An officer must respond to complaints within 24 hours. If unresolved, the District Health Authority will address the complaint, take appropriate action, and upload an action report on the web portal within 30 days. Depending on the complaint, the report may include a patient’s medical information. The Bill does not specify who other than the complainant will have access to this report, which could potentially violate the patient’s privacy rights.
• In 1998, the Supreme Court ruled that doctor-patient relationships are confidential, and public disclosure of such private information might infringe on privacy rights. Additionally, in 2017, the Supreme Court stated that any limitations on the right to privacy must be proportional to the necessity of state intervention.

Implications of mandating free healthcare 

• The Bill allows residents of Rajasthan to access free health services at any clinical establishment, including: (i) free outpatient and inpatient services, consultations, medicines, and diagnostics at public health institutions, (ii) emergency treatment and care without prepayment, and (iii) referral transport from all healthcare establishments. It also covers free transportation, treatment, and insurance against road accidents at all healthcare facilities.
• This raises several issues:
  • The Bill mandates that the state government must allocate appropriate funds for healthcare in the state budget. The Financial Memorandum estimates a recurring expenditure of Rs 14.5 crore annually, covering allowances for members of the State Health Authority (SHA) and District Health Authority (DHA), as well as other human resources expenses.
  • It notes that the implementation of the Bill's provisions will be managed through the existing health budget of Rs 20,111 crore for 2022-23. However, fulfilling the Bill's requirements may necessitate additional funds for human resources, infrastructure development, and public health functions.
  • The Financial Memorandum does not address the costs associated with providing free healthcare services to all residents or any additional financial implications beyond those mentioned.
• In 2018-19, Rajasthan’s total expenditure on health was Rs 29,905 crore. Of this amount, 43.7% was funded by the government (both state and central), while 44.9% was covered by out-of-pocket expenses by individuals, averaging Rs 1,745 per person. In 2017-18, the average expenditure for hospitalization (both public and private) in Rajasthan was Rs 17,435 per capita. Providing free healthcare and emergency services would likely require covering a significant portion of these individual costs, necessitating an increase in the state's health budget.
• For the financial year 2022-23, the expected budget for Health and Family Welfare in Rajasthan is Rs 20,111 crore, representing 7.4% of the overall budget, which is above the national average of 6% across states.
• Additionally, since 2021-22, Rajasthan has provided insurance coverage under the Mukhyamantri Chiranjeevi Swasthya Bima Yojana. This scheme offers eligible families an annual health insurance of Rs 10 lakh and accidental coverage of Rs 5 lakh. The insurance covers inpatient procedures and other identified treatments, with over 1,660 packages available for various diseases. The scheme includes benefits such as bed expenses, anaesthesia, and blood oxygen costs. Coverage extends to beneficiaries under the National Food Security Act, socio-economically marginalized communities, and contract government workers. Families outside these categories can access premium coverage by paying Rs 850. The scheme also covers expenses for tests, medicines, and consultations up to five days before and 15 days after hospitalization. For 2022-23, the state has allocated Rs 2,228 crore to this scheme.
• Additionally, the central government is implementing the Ayushman Bharat Scheme to achieve universal health coverage. The scheme consists of two components:
  • Health and Wellness Centres (HWCs): These centers provide comprehensive primary healthcare services.
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY): This insurance scheme covers secondary and tertiary hospitalizations up to Rs 5 lakh.
• As of January 30, 2023, Rajasthan has 9,611 HWCs, which constitutes 6% of the total HWCs in the country. Under PM-JAY, eligibility is determined by the deprivation and occupational criteria from the Socio-Economic Caste Census of 2011. The scheme covers costs such as registration, bed charges, medicines, and food. PM-JAY allows states to choose their implementation models, including the assurance/trust model, insurance model, or hybrid model. Rajasthan has opted for the insurance model, where claims are paid by insurance companies, and State Health Agencies pay premiums to these insurers.
• As of February 9, 2023, there are 1,098 hospitals in Rajasthan eligible for empanelment under PM-JAY. By October 2020, PM-JAY covered 58.9 lakh families in the state. By March 2022, over 1.3 crore families were eligible for either PM-JAY or the Mukhyamantri Chiranjeevi Swasthya Bima Yojana, though there may be some overlap in beneficiaries due to matching eligibility criteria between the two schemes.

Institutional and health worker shortage  

• The Bill mandates the development and implementation of a Human Resource Policy for Health to ensure the availability and equitable distribution of health workers. To provide free and quality healthcare across all clinical establishments, adequate human resources and infrastructure are crucial. Current data indicates a potential shortage of these resources in Rajasthan, which could impact the effective implementation of the right to health.
• To meet the Sustainable Development Goal targets for universal health coverage by 2030, the World Health Organization recommends a density of 44.5 health workers per 10,000 people. However, as of 2016, Rajasthan had approximately 14.4 health workers per 10,000 people, which is below the national average of 20.1 health workers per 10,000 people. According to the Rural Health Statistics (2022) by the Ministry of Health and Family Welfare, as of March 31, 2022, Rajasthan faces a shortage of 1,939 specialists, including surgeons, obstetricians and gynecologists, physicians, and pediatricians, at Community Health Centres (CHCs) in rural areas.
  
• Rajasthan also faces a shortage of 1,551 pharmacists at Primary Health Centres (PHCs) and Community Health Centres (CHCs). The state has experienced one of the highest increases in Sub Centres (SCs) since 2005, with a total of 3,011, compared to other states like Gujarat (1,858), Madhya Pradesh (1,413), and Chhattisgarh (1,306). Additionally, Rajasthan has significantly increased its number of PHCs, adding 420 new ones, while other states such as Jammu and Kashmir (557), Karnataka (457), and Gujarat (404) have also expanded their PHCs. As of 2022, Rajasthan has reported a surplus of nursing staff at PHCs and CHCs and does not face a shortage of doctors in rural areas at these centres.