The Rajasthan Right to Health Act, 2023
Analysis and Recommendations
The Rajasthan Right to Health Act of 2023 (“RTH Act/ the Act”) is a laudable pioneering law in the domain of health rights in India. The public narrative surrounding the Act has been fraught with pushback from many members of the medical community, most of which are based on an erroneous understanding of the law and the scope of the right to emergency care. However, some aspects of the Act require careful re-examination and modification, and should be considered in any subsequent amendment of the Act. They are summarised below:
Need to distinguish between healthcare and public health
The RTH Act currently has provisions pertaining mainly to healthcare, while public health (including public health emergencies) has been mentioned in passing – leaving both its vision and implementation to delegated legislation and executive decision. In order to appropriately address both aspects of health rights, the Act should be divided into two parts, clearly distinguishing the kinds of rights and responsibilities that are expected as a part of public health delivery from the regulatory mechanisms needed to govern healthcare.
Lack of clarity regarding interaction with existing laws & schemes
The RTH Act makes no reference to existing health laws and schemes operating in the state which have direct overlaps with some of the provisions in this Act. There is a need to conduct a thorough compatibility review and harmonise the provisions of all pertinent laws and schemes. For example, comprehensive definitions of health establishments and emergency existing in the Clinical Establishments Act, 2010 should be incorporated in the RTH Act, prevalent understandings of health centres under the National Health Mission should be followed, and overlaps between this Act and state-level health insurance schemes should be clarified – especially in the context of cashless or free treatment.
Lack of clarity regarding applicability of provisions
The rights recognised under the RTH Act are applicable only to residents of the state, and the definition of ‘resident’ is unclear. Ideally, the rights should be recognised for all patients/ users. Further, the current definitions of health establishments are ambiguous – for instance, it is not clear where both government and non-government health establishments are responsible for facilitating the implementation of certain rights. Such provisions should hence be amended in a way that makes the applicability of rights and responsibilities under the RTH Act clearer, distinguishing between government and non-government institutions where required.
Over-delegation of important issues
Some critical substantive provisions in the Act have been left to prospective prescription by delegated legislation, or executive discretion. The determination of a medical condition as emergent, all details of grievance redressal and reimbursement mechanisms, and even the rights and responsibilities of healthcare providers are examples of such provisions. Although the operational details of the same may be left for prescription and discretion, the basic principles and contours must be contained in the parent Act.
Structure and composition of authorities proposed under the Act
There is a mismatch in the nomenclature of the authorities that are proposed under the Act and the scope of functions that they are expected to perform. The composition of the authorities raises concerns about their efficiency, neutrality, and expertise in performing these functions, including the adjudication of grievances. The structure and composition of these authorities should be tailored to fit these different functions-strategic planning, implementation, standard-setting, and grievance redressal. Moreover, the composition of the authorities should include representatives of patient rights groups and civil society organisations, as well as public health experts.
Inaccuracies and ambiguities in the language of the Act
There are some typographical errors in some provisions of the RTH Act, as pointed out in the note, that should be rectified. Further, there are ambiguities/ inconsistencies in the phrasing of certain provisions – such as the definitions of emergency and first aid, as well as the rights to emergency medical care, free health services, and free transportation – which require modification to enable consistent understanding and implementation.