With the ‘Right to Health Act 2023’, the Rajasthan government has made health services for any citizen free in all public hospitals. The ‘right’ also ensures transparency in health care system and has room for appealing for grievance redressal. However, this Act did not go down well with the private doctors and a national level debate ensued.
IAS officer Dr. Prithivi Raj Sankhla, who is an expert in health economics and is pursuing PHD in Health Finance, believes that it is the duty of any government to make healthcare available for everyone at low cost. As Health Secretary of Rajasthan, the 2002-batch IAS officer was instrumental in formulating this Act. He has since been posted as Secretary, Agriculture and Horticulture, but health economics has been, and still is, a passion for this doctor turned civil servant.
In an exclusive interview to Indian Masterminds, Dr. Sankhla spoke about the Rajasthan government’s Right to Health Act, and also addressed apprehensions relating to it.
What does health financing mean?
Health has two aspects. First is ‘care health delivery system’ which includes the workforce, medical schools, nursing schools, government hospitals, medicines, and other. The second and the most important aspect is ‘financing of those health care’. It is is the duty of the government to assure equitable and sustainable health financing to all citizens.
Does the government play a crucial role in health financing in our country?
In our country, ‘out of pocket’ expenditure for health is very high. According to some survey, the average out of pocket expenditure reaches to up to 65%. So, the burden of health directly falls on the people and it pushes them below the poverty line. In such a situation, the role of the government is very important. They can ensure that people get health care financing as per their paying capacity. Those in need should get more subsidies from the government.
What can be the mechanics of health financing?
The government should provide universal health coverage as Rajasthan is doing through the Chiranjeevi Scheme, or the PMJY scheme of the central government. However, that is not enough. An efficient and cost effective procurement system for all kinds of medicines (diabetes to cancer) at low cost and providing bulk diagnostics at every government hospital should be in place. Only a network of good government hospitals can ensure low-cost healthcare delivery for every citizen.
Why health insurance is not so common among Indians?
Majority of our country’s population can’t afford and a good number of people don’t know about it. Besides that, the private players charge very high. It can go up to 8k-10k which is higher than the total income of many families in our country.
Is health coverage through government effective?
The coverage under Aayushman Bharat is very low it covers less than one third of population of Rajasthan, also the premium estimated by the government of India Rs. 1060 per family of which central government only pays 60% (635 Rs per family per year). While actual health insurance premium in Rajasthan is 1960 Rs per family per year. The insurance cap in amount and coverage of family effectively reduces contribution by the central government to less than 20% in case of Rajasthan. If I talk about Rajasthan, only 59 lakh families are covered under Aayushman Bharat who were identified under socio-economic caste census (SECC). While the Rajasthan health scheme covers 1.49 crore families and provides coverage up to 25 lakhs including organ transplant. And, the total expenditure of the Rajasthan government on healthcare is around 7% of their GDP, which is way more than the national figure.
With better healthcare infrastructure, work force, and schemes like Chiranjivi Rajasthan already working aggressively on healthcare, what will change with the Right to Health bill?
Any act or bill is testimony of government’s promise to the public. Under Right to Health 2023 of Rajasthan, the state government has made a legal commitment to provide free health care to each citizen, commitment for transparency in health service delivery and making grievance redressal mechanism available to common man. And, in the last 5-6 years, the state government has improved the infrastructure and good presence of work force. All most every district has a medical college & nursing. Only, the ‘Right base Entitlement’ was missing which has been given by the act. This act is very aspirational or ambitious as it strives to ensure transparency in both public & private hospital.
Many questions have been raised about the sustainability of this Act. What do you have to say about it?
Most people’s and experts’ assumption about the sustainability of this Act was based on their previous knowledge about Rajasthan. Things have changed totally. We have now good network of hospitals. The number of medical students has reached to 3800 which will increase the supply of doctors. And, with schemes like Chiranjeevi, the footprints in government hospitals will also increase. So, we are ready to provide the entitlement.
Right To Health Act created a stir among private hospitals and doctors. What is your take on that?
The issue majorly involves the health economy. With the universal health insurances, the cost of health procedures has come down drastically. After the Act, they need to be transparent, and our question is, why shouldn’t they? Rajasthan government pays INR 3000 crores on insurances and 60% of that goes to private players. So, why shouldn’t be they answerable? Our aim is to provide optimum health care system to every citizen, and to achieve that, our focus can’t be on ensuring the profit margin of private hospitals.
What should be the next step for India to ensure best health care for everyone?
I believe health and education are the best investments for any government. They impact the productivity and efficiency of the people. Currently, India spents only about 1.25% of the GDP on health, whereas countries like USA and UK spend 18% to 11%. We don’t need to spend that much. There are many examples like Vietnam and Cuba who, with 3-4% of GDP, provide healthcare which is as good as in USA. We can take inspiration from their models and do the best we can.
