Ashok Gehlot writes: As Rajasthan CM, I prioritised healthcare
Recently, I saw a video on social media featuring the well-known teacher, Vikas Divyakirti, which shook me. He was sharing the personal story of a poor family. A 30-year-old man was diagnosed with cancer, and doctors informed them that he could live for another 6 months, but the treatment would be very expensive. The family made a harsh and heartbreaking decision: not to pursue treatment. Their reasoning was, “If we go ahead with the treatment, our entire family will ‘die’ under the burden of debt, so we let him die instead.”
This is not just a story, but a document of the economic cruelty with which the poor and middle class of India have struggled for decades. One of the objectives of my political career has been to eliminate this helplessness. For this, I started working from the very first day of becoming the Chief Minister.
In 1998, when I became the Chief Minister for the first time, I took a pledge that no person in Rajasthan should be deprived of treatment due to lack of money. At that time, we launched the “Mukhyamantri BPL Jeevan Raksha Kosh” for BPL (Below Poverty Line) families. This was a time when a poor person was not ready to believe that the government could provide them with free medical treatment.
However, due to a change in government in 2003, this vision was halted. When I got the opportunity to serve again in 2008, we expanded the scope of this scheme. Along with BPL families, we included the elderly, differently-abled, widows, and needy people from 11 categories, making their entire treatment completely free in government hospitals.
In 2011, by launching the “Mukhyamantri Nishulk Dawa Yojana” and in 2013, the “Nishulk Jaanch Yojana,” we ensured that no one had to use their own money even for a paracetamol tablet or a blood test. The World Health Organisation (WHO) also appreciated this model.
When the public gave me the opportunity to serve for the third time in 2018, we accorded the highest priority to health. This began with the resolution of “Nirogi Rajasthan” in 2019, but the COVID-19 pandemic posed a major challenge to healthcare services. Rajasthan saw brilliant COVID management, and the Bhilwara Model was discussed across the country and the world. During this health emergency, we significantly increased the quality and quantity of health services in Rajasthan, and simultaneously began working on Universal Health Care in both the government and private sectors.
We made treatment in government hospitals not just “cashless,” but completely “bill-free.” Under the “Mukhyamantri Nishulk Nirogi Rajasthan Yojana,” all OPD (Outpatient Department) and IPD (Inpatient Department) services — from the registration slip to the operation — were made completely free. Whether it was an MRI or a CT scan, people didn’t have to pay in government hospitals.
Along with government hospitals, we also opened the doors of private hospitals for the poor. Through the “Chiranjeevi Health Insurance Scheme,” an insurance cover of up to ₹25 lakh was provided, which includes treatment facilities for diseases like cancer, making it unique in the world. The Union Government’s Ayushman Bharat scheme is limited only to the families eligible under the Socio-Economic and Caste Census-2011, whereas the Chiranjeevi scheme was made available free of cost for the poor and at a premium of just ₹850 per year for the affluent class. For state government employees and their families, the RGHS scheme was introduced on the lines of CGHS. These schemes instilled a sense of confidence among the people of Rajasthan regarding treatment. People started visiting hospitals when they fell ill, and the common man’s hesitation even for procedures like having stents placed or knee replacements disappeared.
While in UP (Uttar Pradesh) and Bihar, only 15-20 out of 100 families have insurance, in Rajasthan, approximately 88 out of 100 families have health security. The national average is 41. This is the biggest proof of the success of “Universal Health Care” in Rajasthan.
Recently, a person told me that his cancer treatment, costing ₹17 lakh, was done entirely free of cost. I met a labourer in Rawatsar (Hanumangarh) who had gone into a coma after a wall collapsed on his head; his treatment, which cost ₹8.5 lakh, was done for free.
According to several surveys by different agencies, about 39 million people in India fall below the poverty line every year due to expensive treatment, and families spend 20 per cent of their annual income on medical care. The situation is such that 23 per cent of people are forced to pay hospital bills by taking loans, and 6 per cent by selling their assets or jewellery. During the Congress government’s tenure, more than 50 lakh people received free treatment by getting admitted to hospitals under the Chiranjeevi scheme. These are the 50 lakh families who would have perhaps drowned in debt due to the cost of treatment or become victims of the “helplessness” that Divyakirti mentioned. If the number of free medicines and diagnostics is added to this, this figure will reach millions.
The biggest measure of the success of health services is “Out-of-Pocket Expenditure” (OOPE), which means the cost of treatment borne by the patients. In 2018-19, when our government came into power, approximately 44.9 per cent of the total health expenditure in Rajasthan had to be paid by the patient from their own pocket. Due to our policies, this decreased to 37.1 per cent in 2021-22. The figures after that are not yet available, but I am confident that this burden must have reduced in the coming years. This is significantly better than the national average.
Until 2018, there were only a handful of government medical colleges in the state. We envisioned and fulfilled the dream of “a medical college in every district.” Between 2018 and 2023, we sanctioned or started medical colleges in a total of 30 districts, along with a new medical university. The number of MBBS and MD seats more than doubled. We initiated world-class projects like the IPD Tower and established the Institute of Cardiology, the Institute of Neurosciences, and Virology Labs so that people would not have to rush to Delhi or Mumbai for serious diseases.
The Chiranjeevi Insurance Scheme also benefited government hospitals financially. Government hospitals started receiving claims from insurance companies through this scheme, which improved their financial health. District and referral hospitals began earning between ₹50 crore and ₹150 crore annually, and government hospitals were no longer dependent on the government to run their expenses.
In 1999, when I became the Chief Minister for the first time, the state’s health budget was only around ₹600 crore (estimated), which increased to more than ₹20,000 crore in 2023. This historic increase of more than 30 times in the budget is proof that we did not limit health to just an “administrative task,” but made it the state’s highest priority.
To institutionalise all these works together, we brought in the “Right to Health” (RTH) law, so that treatment becomes a legal right, and not a favour from the government. Unfortunately, the current government has put this law on the back burner. The Central Government should also expand the scope of the Ayushman Bharat scheme and implement it for everyone. As the world observes “Universal Health Coverage Day” on December 12, I would say that governments may come and go, but stepping back from the standards of public welfare that we have established would be an injustice to the public. If the decisions made by our government had been continued, Rajasthan would have been a global leader in the field of health today.
The writer is former Chief Minister, Rajasthan
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