With Right to Health Act, Ashok Gehlot seeks to build on his healthcare legacy, eyes a fresh term

In his ongoing third term, his focus on healthcare has only grown, especially in the context of Covid-19, prompting him to work towards a “Rajasthan Model of Public Health” that aims to provide free universal healthcare.

Already, free treatment up to Rs 10 lakh is provided under the government’s flagship Chiranjeevi Health Insurance Scheme. This has been raised to Rs 25 lakh in the latest budget and will be implemented from the next financial year. Under this scheme, the government paid as many as 34.77 lakh claims worth Rs 1,940 crore between April 1, 2022, and December 31, 2022. Chiranjeevi is also implemented through empanelled private hospitals.

Second, OPD and IPD services, as well as medicines, are provided for free at government hospitals under the Mukhyamantri Nishulk Nirogi Rajasthan Yojana. From 185 medicines, 32 surgicals and 8 sutures in 2011-12, it now covers 1,226 medicines (same salt of different dosage is counted as one), 174 surgicals and 153 sutures. Between 2011-12 and February 2023, a staggering 111.02 crore individuals have benefitted, at a cost of Rs 6,813 crore to the state.

To put this into perspective, Rajasthan’s population as per census 2011 was 6.85 crore.

Third, the free healthcare framework includes the Nishulk Jaanch (free test) scheme that provides for up to 90 free tests in government hospitals attached with medical colleges, 56 tests in district, sub-district hospitals, and so on. In almost 10 years between March 2013 and February 2023, as many as 21.59 crore persons have had 53.3 crore tests conducted for free at a cost of Rs 2,126 crore to the state.

While these are the core schemes, there are two other complementary flagship schemes, implemented by the health department: Shuddh ke Liye Yuddha and Nirogi Rajasthan Abhiyaan.

Shuddh ke Liye Yuddha is aimed at checking adulterated food, while Nirogi Rajasthan Abhiyaan is aimed at spreading awareness on population control, geriatric care, women health, child health, seasonal diseases, vaccination, etc. As of January 10, 2023, over 97,000 Swasthya Mitras – 83,116 in rural and 14,373 in urban Rajasthan – had been trained for the purpose.

There is also the Rajasthan Government Health Scheme for government employees, which includes ministers and present and former MLAs, etc., though it is not new.

While Chiranjeevi is among the top schemes of the government, its implementation has often been criticised, especially at the end of private hospitals.

Under the Right to Health Bill now, while the promised free health services in government and certain private facilities are already being provided by existing schemes, the main aim is to strengthen and complement these existing schemes and empower patients and their families.

During the debate on the Bill in the Assembly, Health Minister Parsadi Lal said, “It is true that despite having a Chiranjeevi card, they [private hospitals] sometimes ask a patient for money to deposit as advance. When there is a card, what is the need for a hospital empanelled under Chiranjeevi to ask for money? I get a lot of complaints, and we have made hospitals return such money…hence we are bringing this Bill.”

“I can name 10 hospitals in Jaipur alone which cheat the people. We will act on them once this Bill is passed,” he said.

As per the Bill, anyone found in contravention of the Act will be punishable with a fine of up to Rs 10,000 for the first contravention, and up to Rs 25,000 for subsequent contraventions.

But that may not be the sole reason for introducing the legislation. With the Congress and BJP taking turns to rule Rajasthan and accusing each other of renaming and altering schemes, bringing an Act would ensure that subsequent governments in Rajasthan would have to abide by the provisions of the Act and extend free healthcare mandatorily.

Moreover, a patient can get emergency treatment without having to pay anything upfront at a private facility. If the patient leaves without paying, the government will bear the costs. The Right to Health Bill also extends several other rights to patients, empowering them “to choose the source of obtaining medicines or tests at all health care establishments”, which means that hospitals cannot insist on in-house medicines or tests anymore.

If a patient wishes to leave, they will have to be given “treatment summary in case of a patient leaving healthcare establishment against the medical advice,” or “to obtain treatment records and information from the treating healthcare establishments to seek second opinion from another healthcare professional or healthcare establishment”.

Aiming for reelection later this year, Gehlot is betting big on his welfare schemes, with healthcare sitting at the top. But beyond the elections, Gehlot, who turns 72 in a couple of months, would hope to be remembered for his healthcare schemes.

BJP MLA and chief spokesperson Ramlal Sharma said, “Before this [Chiranjeevi], there was Bhamashah health insurance scheme and people were availing benefits under it. But the government shut it down and brought Chiranjeevi. What was the point of shutting Bhamashah down? Second, you are getting all of the money from the Ayushman Bharat Yojana. So, you are merely changing the name here at the point of implementation.”

Before Chiranjeevi, the state had Ayushman Bharat-Mahatma Gandhi Rajasthan Health Insurance Scheme. Those already registered under it don’t have to apply fresh to avail Chiranjeevi. However, government documents show that between March and December 2022, the state government spent Rs 1,144 crore on the scheme, while receiving an additional Rs 348 crore from the Centre for the period.

Sharma said Gehlot won’t benefit from these schemes. “Doctors are protesting, and for the last 10 days, people have been dying at protests. The schemes won’t benefit them (Congress party).”

Be that as it may, it is true that despite the free medicines and test schemes in Gehlot’s previous tenure, in the 2013 Assembly elections, the Congress registered its worst performance in the state since Independence, returning with just 21 seats out of 200.

However, the party claims that those were initial days, and that it takes time for the schemes to percolate and awareness to spread, and that 10 years later, there is a sea of difference.