UNDOING HEALTH CARE
Costs of medical education and healthcare will sky rocket
The National Medical Commission Bill has been cleared by the Cabinet. It will soon be tabled in Parliament for debate. If passed, this will become an Act, which will replace Medical Council of India (MCI) and regulate the medical education in India. Till date the MCI has been the regulatory body, which decides about the admission process to the undergraduate as well as postgraduate classes; it sets basic minimum standards required to open a medical college and carries out regular inspections of the colleges to check the status of education. The MCI also has the power to derecognise any medical college, which does not fulfill the required standards. The MCI also decides the medical curriculum. It also maintains a registry of doctors, who have to get registered with their respective state medical councils, which in turn send the details to the MCI from time to time. Whereas the government-nominated members form majority in the MCI, it has elected members as well, which gives it a partial democratic structure. Unfortunately, the MCI has lost its reputation as there have been allegations of corruption against the higher-ups in the council.
The Supreme Court of India had taken cognizance of the irregularities in the council and recommended restructuring of the system so as to make it more transparent to do away with corruption and maintain high standards of medical education. The government had some time ago proposed a National Medical Commission instead of the MCI, which was put in public domain for suggestions. As per reports, it has now been cleared by the Cabinet with minor amendments to the original draft. A review of the original draft of the bill clearly indicates that it will not yield the desired result. According to this, NMC has 25 members, all of whom will be nominated by the Central or the state government/ut. This makes the regulatory body totally undemocratic, with only bureaucratic control and no involvement of various stakeholders.
Its most flawed clause is that it will give a free hand to any for-profit organisation to open a medical college. Up till now the medical colleges were permitted to be opened by not for profit organisations. These colleges will be free to fix their tuition fee. The government may exercise control over the tuition fee of only up to 40 per cent of seats, which means tuition fees in 60 per cent plus seats will be at the mercy of private managements. Thus, the cost of medical education, which is already very high in the private sector, will further rise and will be virtually reserved for the rich classes. Since there will be no regular inspections, check on the standard of medical education will be compromised. Already the low standard of education in many medical colleges, which are notoriously known to hire faculty and patients during inspection, will further go down.
There is a proposal to introduce exit exam for the undergraduate students. This is being done because the difference in the standard of education in various medical colleges is glaring. Instead of meeting its responsibility to standardise education, the government is working on an approach to judge the ranking of the colleges by the performance of the students. This will put the future of many students in substandard medical college in the dark. There are several instances where colleges have been closed down and students are running from pillar to post to seek themselves transferred to suitable institutions.
It is obvious that medical education will become totally unregulated and go in the hands of business interests. It would be naïve to expect a person who has spent crores on getting education to have social interest and service attitude towards healthcare. The already over privatised healthcare in our country will further get expensive and go out of reach of the majority of citizens who are already devoid of quality health care due to high cost of out of pocket expenditure.
It is high time that the medical profession and the civil society speak up for positive actions towards raising the standard of medical education and bringing it within the reach of common man. There is a need for strong debate in the country as to how healthcare system should be so as to provide universal healthcare to all. (The author is senior vice President Indian Doctors for Peace and Development, Former Chairman Ethical Committee Punjab Medical Council & Member core committee, Alliance of Doctors on Ethical Healthcare. The views expressed are strictly personal.)