Unhealthy controversy

Govt should engage protestors to make Right to Health work

The doctors’ strike in Rajasthan, which has all but paralysed medical services in the state, offers in microcosm an example of the parlous state of health care in India, caught between a grossly inadequate public health infrastructure and a profit-driven private health care industry. The doctors were protesting against the Right to Health Act, passed by the Rajasthan Assembly last week. The principal point of contention is a provision in the law that mandates all hospitals, public and private, must offer emergency treatment without any prepayment. The Act says the state government will reimburse hospitals. But the protesting doctors, who have received support from the all-powerful Indian Medical Association (IMA), point to a lack of clarity on several counts.
 

Doctors are particularly exercised over the fact that although the Act defines emergencies, it includes an ambiguous addendum stipulating the State Health Authority can also define them from time to time. Doctors are also unsure of the mechanism under which hospitals would be reimbursed. The state government has said the details of the reimbursement system would be explained when the rules for the Act are framed and notified. Up to a point, the doctors’ reservations are not invalid. They are right to fear being subject to bureaucratic systems to recover treatment costs, which can be steep in the case of serious emergencies. But their maximalist position of having the law withdrawn appears obstructionist.
 

The ordinary citizen in India with a limited ability to pay suffers for want of access to emergency services. Stories of less affluent people being shunted from hospital to hospital in search of emergency care are too legion to ignore. This, in spite of a landmark Supreme Court judgment that held that denial of emergency medical care is in violation of Article 21 of the Constitution. In other words, it is a fundamental right of the citizen to be provided emergency medical care without any conditions. Against this backdrop, the Consumer Protection Act, 1986, brought doctors within its purview, a provision that was fiercely opposed by the IMA until the apex court overruled its objections. But India has no federal law governing this right, though a Law Commission had proposed that Parliament pass a law that would enable patients to enforce their rights.
 

Given the paucity of government health services — especially quality tertiary hospitals — in India, the private sector needs to step up. Indeed, it is an open secret that many private-sector hospitals renege on their commitment to deliver free treatment to economically weaker sections in return for land from state governments, given either free of cost or at a significant discount. In that sense, the Rajasthan government has taken a progressive step forward by co-opting the private sector. Its record in terms of public health care delivery is only marginally better than the national average; the average population served per government hospital bed is 1,521 for Rajasthan against 1,678 for India. Having passed a law that is good in intent, it is critical that the state makes it work. Involving the protestors in discussions would be a useful way forward.