Context

The Right to Health Bill was recently approved by the Rajasthan legislative assembly. Rajasthan would become the first state in India to guarantee its citizens’ right to healthcare once the bill is announced.
Being a torch-bearing step in providing better healthcare, this edition of the burning issue will elaborate on this new law and its criticalities. The topic is relevant for the GS-2 mains paper.

The Right to Health

The World Health Organization (WHO) says that everyone has the right to health, which means they should be able to get the health care they need, when and where they need them, without having to worry about money. No one should get sick and die because they can’t get the health care they need or because they don’t have enough money.
RTH is a fundamental human right that guarantees everyone the right to enjoy the highest attainable standard of physical and mental health.
It is recognized as a crucial element of the right to an adequate standard of living and is enshrined in international human rights law.
Other fundamental human rights, such as having access to clean water and sanitation, nutritious food, adequate housing, education, and safe working conditions, clearly determine good health.

Scope of RTH

RTH covers various health-related issues, including-

Access to healthcare services, clean water and sanitation, adequate nutrition, healthy living and working conditions, health education, and disease prevention.
Accessible, affordable, and quality healthcare services,
Eliminating barriers to healthcare access
Informed consent to medical treatment and accessing information about their health.

Right to Health relating to India

Provisions of the Constitution:

The Constitution of India doesn’t explicitly ensure a basic right to well-being. However, the Constitution makes numerous mentions of public health and the state’s role in providing healthcare to citizens.

Under Directive Principles of State Policy:

DPSPs: To a limited extent IV of the Indian Constitution gives a premise to one side of wellbeing.
The State is obligated by Article 39 to ensure the health of workers.
Article 47 imposes a responsibility on the state to raise people’s nutrition levels, the standard of living, and public health. Article 42 requires the state to provide maternity relief and just and humane working conditions.

Under Fundamental rights:

Article 21 The Supreme Court of India in Bandhua Mukti Morcha v. Union of India & Ors. found that the Constitution of India did not explicitly recognize the right to health care. interpreted Article 21’s guarantee of the right to life, which covers the right to health.
In Territory of Punjab and Ors. In the case of Mohinder Singh Chawla, the Supreme Court reiterated that the right to health is essential to the right to life and that the government was obligated by the Constitution to provide health services.

Article 243G: The Role of Panchayats and Municipalities

The Constitution does not just oblige the State to upgrade general well-being, yet additionally blesses the Panchayats and Districts to fortify general well-being under Article 243G.

15th Commission on Finances:

The 15th Finance Commission’s High-Level Group on the Health Sector recommended declaring the right to health a fundamental right in September 2019.
Additionally, it proposed putting health on the Concurrent List rather than the State List.

Genesis of Right to Health

In 1996, the Supreme Court held that the right to life (Article 21) included the right to health within its fold, and also pointed out the obligation of state governments to provide health services.
Under the Constitution, public health and sanitation, including hospitals and dispensaries, come under the State List.
In 2018, the National Commission on Human Rights (NHRC) drafted the Charter of Patient Rights to be implemented by state governments.
Rajasthan runs certain schemes to ensure health coverage, including the Mukhyamantri Chiranjeevi Swasthya Bima Yojana, under which health coverage is provided in over 1,550 private and public hospitals across the state. Under the yojana, insurance coverage is also provided for certain types of treatment.

Features of the Rajasthan Right to Health Bill

Free treatment: RTH gives every resident of the state the right to avail of free Out Patient Department (OPD) services and In-Patient Department (IPD) services at all public health facilities and select private facilities.
Wider scope of healthcare: Free healthcare services will include consultation, drugs, diagnostics, emergency transport, procedures, and emergency care. However, there are conditions specified in the rules that will be formulated.
Free emergency treatment: Residents are entitled to emergency treatment and care without prepayment of fees or charges.
No delay in treatment: Hospitals cannot delay treatment on grounds of police clearance in medico-legal cases.
State reimbursement of charges: After emergency care and stabilization, if patients do not pay requisite charges, healthcare providers can receive proper reimbursement from the state government.

Significance of the Bill

Frees from Unnecessary obligations:

The Bill empowers patients to choose the source of obtaining medicines or tests at all healthcare establishments, which means that hospitals cannot insist on in-house medicines or tests.

Eliminates discriminatory healthcare structures:

Article 15’s right to equality upholds non-discrimination based on religion, race, caste, gender, place of birth, and other factors. However, healthcare has become a privilege for a select few due to decades of inadequate investment in public health.
To end discriminatory structures that will otherwise continue to perpetuate inequality in all spheres of life, including education, opportunity, wealth, and social mobility, the constitutional right to health is essential.

Enhance the health ecosystem as a whole:

By passing a law that makes healthcare a right for everyone, the government would make it easier for people to demand better care and hold the government and healthcare workers accountable if they don’t get it.

Unique regulation and different instruments to fortify medical services:

Special legislation, capable institutions, increased budgets, medical training and research, wellness and prevention, and service outreach will all be made possible by the Constitution’s right to health; thereby enhancing the health ecosystem as a whole.
For instance, before the constitutional amendment that made it a fundamental right in and of itself, the right to education had also been held to be implicit to the right to life. 15 years ago, the primary school enrollment rate was thought to be impossible; today, it is over 95%.

Reduce expenses incurred out of pocket:

The Economic Survey for 2022–23 reveals that patients continue to directly pay for almost half of all healthcare costs in India. The Right to Health aims to increase public spending while decreasing individual healthcare costs.

Challenges with the Right to Health ‘Pill’

Insufficient infrastructure: India’s healthcare system lacks the fundamental infrastructure necessary to meet the needs of a large population. India, for instance, has only 8.5 beds for every 10,000 people. Also, the doctor-to-patient and nurse-to-patient ratios are significantly lower than WHO standards, which are 1/1000 for doctors and 3/1000 for nurses, respectively (1 per 1456 patients).
The existing burden of schemes: Doctors are protesting against the RTH because they question the need for it when there are already schemes like Chiranjeevi that cover most of the population.
Specialization concerns: They are also objecting to certain clauses, such as defining “emergency” and being compelled to treat patients outside their specialty as part of an emergency.
Saving money on health care: India has the lowest public health spending as a percentage of GDP (1.6 percent). Among the BRICS nations, India has the lowest public health spending. Brazil has 3.96 percent, Russia has 3.16 percent, South Africa has 4.46 percent, and China has 3.02 percent.
No detailing of the process: To the charge that there is no detailing of the process, health rights activists have pointed out that it would be a function of the Rules, not the law itself.
Concerns pertaining to compensation: Healthcare providers have a problem with reimbursement delays. Additionally, there are complaints that the predetermined package rates for various medical procedures and treatments are not sufficiently profitable or do not cover the actual cost.
A high rate of disease: Both communicable and non-communicable diseases like malaria, diabetes, and tuberculosis are prevalent in India. Healthcare infrastructure and resources require significant investment to combat these diseases.

Way Forward

A fundamental shift in approach is required: We must fundamentally alter our healthcare approach. We must view it as a high-yield investment that can significantly reduce future out-of-pocket costs and also increase output rather than spending.
Coordination among states and the centre: Without hindering cooperative federalism, which is an essential component of the Indian Constitution, there must be coordination between the center and the states on a crucial subject like health.
More authority and assistance for states: The COVID-19 response by the Center and states reveals that health must remain on the State List, despite the importance of seamless coordination between the centers and states. Therefore, it is necessary to devolve authority and resources to states to improve their respective public health systems.
Boost public spending: By 2025, India must increase its investment in healthcare resources and infrastructure to at least 2.5% of GDP.
Improve transparency and accountability: Additionally, greater efforts could be made to improve transparency and accountability in the healthcare system, with a focus on educating patients about their rights.

Conclusion:

Given the contentious nature of the Bill, all stakeholders need to come to the table and engage in constructive dialogue to resolve the issues at hand. It should involve liaisons between the government, doctors, patient advocacy groups, and other relevant stakeholders to discuss the concerns raised by all parties and identify potential solutions.
This could be followed by a revision of the Bill, incorporating feedback and suggestions from all stakeholders, and a renewed effort to build consensus and support for the legislation.
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic condition, or social status,” as stated in the WHO constitution.