India is seriously crippled with its health infrastructure, and especially rural healthcare. Government health spending now accounts for 80-90% of total health expenditure in most European countries, whereas, it is less than 30% for India. The healthcare spending in India has come down to about 1.2% of the Gross Domestic Product (GDP), the lowest in a decade as against the global average of 5.4%. As provision for public healthcare becomes limited and the quality deteriorates, people are compelled to seek services from private providers. However, around 60 million people become impoverished every year in India through paying healthcare bills and more than a fifth of people do not seek healthcare, despite being unwell, because of their inability to pay for it. As per the Lancet report titled ‘Global Burden of Disease’, which assessed and ranked the quality of healthcare, India ranked 154th among 195 countries and lags behind countries like Nepal, Bhutan and Bangladesh.
With this background, the National Medical Commission Bill, 2017 was introduced by the Minister of Health and Family Welfare, Mr. J. P. Nadda in Lok Sabha on December 29, 2017. The Bill was drafted by a four-member committee. The bill proposes to replace the corrupt and inefficient Medical Council of India (MCI) by the National Medical Commission (NMC). However, in that process, it creates the provisions for more corruption through bureaucracy. Presently, MCI has one representative each from state and practicing doctors, whereas, NMC will consist of 25 members, mainly appointed by the central government. Only five zonal members of NMC will be elected by the vote of doctors. The rest will be nominated members. This will not only make the commission to act as the puppet in the hands of politicians, but will also open doors for corrupt political influence. Such hold is especially problematic given the close ties that private medical colleges have with the existing political system.
As of today, India has the doctor to people ratio of 1:1700, compared to the WHO norm of 1:1000 and most of these doctors are in urban areas. Now, to produce more doctors, the bill proposes to ease regulations to set up more private medical colleges. The bill proposes to increase the percentage of fee to be decided by the private colleges from 15% to more than 60% of seats. This may result in an anarchic fee-hike in private medical colleges and the students can’t even go to court because this bill permits ungovernable fees. Also, the central government vests total control on waiving off penalty, giving permissions, and allowing doctors to practice without fulfilling all norms.
The bill proposes a National Eligibility cum Entrance Test (NEET) to achieve uniform standards in medical training; on the other hand, it allows medical colleges the liberty to increase their intake capacity without the NMC even bothering to ensure beforehand whether or not they possess the requisite manpower or infrastructure. Also, upon passing from medical colleges, the students will be required to take the National Licentiate Examination (NLE) to get the license to practice.
Moreover, there will be a bridge course which will allow non-MBBS doctors to practice modern medicine after undergoing a short term course in allopathy. With this, the government will wash their hands off by providing degraded services for the poor people. This will also increase use of unnecessary and harmful drugs.
The bill will make medical education accessible mainly for the upper class, whereas, the students from middle or lower class background will be under the burden of huge education loan. This will increase the gap between rural and urban as most of those doctors who will pass from the private colleges will try to practice in the urban areas. The actual requirement of the people is more government hospitals with good doctors and infrastructure and not the private ones which are meant to serve the rich and loot the common people.