In a country where an inadequate healthcare system imposes catastrophic costs on the people, the newly-enacted Right to Healthcare Act (RHA), 2022 in Rajasthan is a major development. After initial protests over the law, the State government has arrived at a consensus with the agitating doctors. There are lacunae in the law; nevertheless, the significance of RHA should be seen in the national context where Out of Pocket Expenditure (OOPE), or money spent by people on healthcare, is as high as 48.2 per cent of the total health spend (Economic Survey 2022-23).

It is much more in States such as Uttar Pradesh (71.3 per cent), West Bengal (68.7 per cent) and Punjab (65.5 per cent). In Rajasthan, it is 44.9 per cent. Legislating the right at least to emergency healthcare is crucial where, according to a 2016 Parliamentary standing committee, an estimated 63 million people are pushed into poverty every year due to health expenditure. Seven years later, OOPE has fallen (from 60.6 per cent) but the impact of a health emergency remains disastrous.

However, the law could have been drafted with more precision. The government has brought in the private sector as a provider of healthcare but has not clarified how they would be reimbursed. Doctors running private hospitals were up in arms primarily because there is a lack of clarity on how they would be empanelled for payment. In Clause 3(c), which enforces the right of the residents to avail of emergency treatment without payment of requisite fee or charges, the language is confusing where it is implied that the government will reimburse the cost of treatment if the patient cannot pay. The second contentious clause is 3(d) which says people have the right to “avail free healthcare services from public health institutions, healthcare establishment and designated healthcare centres in the prescribed manner and subject to the terms and conditions specified in the rules”. If these designated health centres are to be identified through the rules, where is the line that specifies that their cost will be reimbursed? What constitutes emergency treatment is not clear too. Following the doctors’ agitation, the State government has excluded 50-bedded hospitals from the RHA provisions. All private hospitals established without taking any facilities from the government are also excluded. According to the Association of Healthcare Providers of India, small hospitals with 11-50 beds make up 65 per cent of India’s private hospitals. Those with under ten beds constitute 14 per cent. The State and the district health authorities, required to be set up under the Act, should identify hospitals qualified to provide routine and emergency healthcare.

The experience of Brazil is instructive, where it took a decade for the law to come to fruition, after citizens were given a constitutional right to health in 1988. The Rajasthan law can set a precedent for other States.