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On Monday, 27 March, nearly 20,000 doctors gathered for a rally in Jaipur after the Indian Medical Association called for a nationwide protest against the newly passed Right to Health Act in Rajasthan. This was the biggest protest rally against the law, since the landmark Bill was passed in the Rajasthan Assembly earlier in March.
Their demand since then – 'Roll back the Draconian Act.'
Doctors in Jaipur protest the Right to Health Act.
(Photo: Accessed by the Quint)
Rajasthan became the first state in India to pass this Bill - touted to bring the country one step closer to Universal Health Coverage by making access to healthcare a legal right.
Critics of the Act, however, say it is "nothing but a hogwash" that will bring little benefit for the people, and can do harm to medical professionals, particularly private practitioners.
Why has an Act meant to assure 'healthcare for all' become such a matter of contention? FIT speaks to experts to find out.
In Case of Emergency: What the Bill Says, and Doesn’t Say
Under the Act, neither government, nor private hospitals and clinics can refuse a person seeking emergency treatment. According to the Act, the government is meant to bear the costs of these treatments.
However, this provision hasn't gone down well with private practitioners.
For one, "What constitutes an 'emergency' is not defined properly," says Dr Sohan Khanna, Vice President, Jaipur Association of Resident Doctors who was present at the rally.
Speaking at a forum discussion, neurosurgeon and health economist Dr J Mariano Anto Bruno Mascarenhas elaborates, "If someone has a headache, for instance, how can you say it is not an emergency because that headache could be because of an aneurysm."
Critics also say there is too much ambiguity as far as the procedure for reimbursement is concerned as well, saying it doesn't specify,
Who will settle the bill (for emergency treatment)?
To whom should the hospitals send the bill?
How much will the government cover? Will the cost of transportation, equipment, and diagnostic tests be covered?
When will the bill be settled? How long will the clinics be expected to wait for each payment?
"If a person is coming with a headache or a stomach ache, should the hospital run diagnostic tests like a CT scan or MRI to determine if it is an emergency? After all these tests and scans, if it is found to not be an emergency, who will pay for them? Will they still be reimbursed?"Dr J Mariano Anto Bruno Mascarenhas
Dr Mascarenhas adds, "When everything else in terms of the duties of the doctors and the rights of the patients has been defined very clearly in the Bill, why are details of reimbursement absent?"
To this, proponents of the Act argue that details of everyday operations are likely to be clarified when the rules of the Act are released.
"Operational guidelines (like the amount allocated by the government for the programme, by when the reimbursements will be made, etc) are not meant to be defined in a Bill," explains Public Health Researcher Siddhesh Zadey.
Why Are Doctors Concerned?
A fine line between rights and obligations
“It's called the Right to Health Bill, but the right is only in the name. Because the bill has a fancy list of rights and a list of obligations. But the point of concern is that they don’t match with each other. And if you force implementation, the doctors will end up paying for it in terms of money and other problems.” says Dr Bruno Mascharanus.
Panic among private practitioners has led to a demand for en masse roll back of the Act.
Fear of wrongful prosecution and lawsuits
One of the concerns that the doctors have is, what happens if the clinic is not equipped to handle the emergency case. Will they be prosecuted?
"If I have a small private clinic, will I be expected to keep it open 24/7 for emergencies? Don't I have a right to personal life?" says Dr Amit Yadav, Former President, Jaipur Association of Resident Doctors (SMS hospital) who was at the rally on Monday.
Protesting doctors are also wary of an increased role of bureaucrats in the decision-making stages.
Under the Act, a patient can file a lawsuit against the clinic and doctor that refuses to treat an emergency case or charges for it. Dr Yadav says the worry is that this clause could become a tool for harassment in the hands of bureaucrats. "There is no provision for the doctor to appeal these lawsuits, either."
Aren't government schemes and hospitals enough?
"There is nothing in this Act that is providing a benefit to patients," says Dr Yadav.
"There are already government programmes like the Mukhyamantri Chiranjeevi Swasthya Bima Yojana, and government hospitals that provide healthcare for free, or at a nominal rate, that are meant to make healthcare accessible, why do we need another act like this?"Dr Sohan Khanna, Vice President, JARD
To this, Dr Parth Sharma, Public Health Researcher, and Fellow at Lancet Citizen’s Commission on Reimagining India’s Health System says, "There is a baseline notion that good care is given only in private centres. So people are drawn to private centres. This gives private sectors the liberty to charge whatever they want, under the garb of a promise of quality which is not always delivered. And at the end of the day, if you don't have acts and laws to monitor what patients are getting in these private sectors, we will not progress."
Not Against ‘Right to Health’: Drawbacks That Need to Be Addressed
Many doctors, activists and public health experts have come out in support the spirit of the Act and what it stands to do, but say the glaring gaps need to be filled before it is implemented.
“I find that this Bill, though noble in intension, in its current form is flawed and incomplete and is just a mirage, and if we go ahead with it, it will do more harm than good," says Dr Mascarenhas.
Dr Sharma, on the other hand, is of the view that though the mechanism is not clear yet, "This Act steps in and starts a conversation around the monitoring of services."
"The Indian government is promising Universal Health Coverage, and saying we have to achieve that by 2030. Now, practically it is extremely difficult to get there, but this type of policy is a step towards UHC."Dr Parth Sharma, Fellow at Lancet Citizen’s Commission on Reimagining India’s Health System
He goes on to say, "People are protesting to withdraw the act, and not improve the act, which are two very different things. If you have a problem with the act, you state the points, and you protest for implementation, but for the thing to be implemented, it needs to be there on paper first."
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