Healthcare reforms began on a bad note in 2018

New Delhi: The National Medical Commission Bill, 2017 was introduced by the Minister of Health and Family Welfare, Mr J P Nadda in lower house of Indian Parliament on December 29, 2017. The bill attempts to tackle corruption in medical education and shortage of medical professionals. It seeks to repeal the Indian Medical Council Act, 1956 and provide for a medical education system which ensures availability of adequate and high quality medical professionals. It also proposes the adoption of the latest medical research by medical professionals, and periodic assessment of medical institutions, and an effective grievance redressal mechanism.

The NMC bill calls for a 25-member body appointed by the government, and will include representatives from the Indian Council of Medical Research, the Directorate General of Health, and other members, presumably practicing doctors and health experts and institutions. There will be four regulatory bodies under the NMC, one each for undergraduate and postgraduate education, one to oversee medical assessments and ratings of institutions, and a third for supervising ethics and registration of those allowed to practice medicine. Entrance to undergraduate course will be through NEET, the National Eligibility-cum-Entrance Test.

The introduction of bill witnessed organized protests across the country. More than 2.9 lakh doctors had gone on a 12 hour nationwide strike, leaving the patients unattended. Their main concern is that the bill seeks to allow those practicing alternative medicine to practice allopathy after completing a bridge course. Meanwhile, in the wake of passions were running high on the issue, the government swiftly sent off the bill to a Parliamentary standing committee for scrutiny.

Earlier, the Indian Medical Association (IMA) has termed the approval to NMC Bill, 2017 by the Union Cabinet as a blow to the medical profession that will cripple the democratic functioning the medical profession by making it completely answerable to the bureaucracy. According to Mr K.K. Aggarwal, former president of the IMA, “As such these are the flood gates that have been opened up in terms of the statutory provisions for backdoor entry into medical profession entitling practicing modern medicine.”

Many believe that the decision was taken in the haste. As per Dr Dharminder Nagar, Managing Director, Paras Healthcare, “While we recognize the role of the government and its concern for the healthcare industry. There is a huge manpower gap and we appreciate that the same has been recognized and some steps are being taken to bridge the same. The Medical Council of India (MCI) has been working for numerous decades, their inputs in the same are worthy and should be incorporated in any new policy that the government is planning to introduce.”

Dr Nagar feels that before any new structure is introduced, the transparency and flow should be maintained. “We also sincerely hope that each decision fights red-tapism and bureaucracy and is based on fast tacking the aspects for implementation. Corporate Hospitals have been helpful in establishing India as a preferred healthcare destination for international patients. We hope that future legislation shall help support the industry further,” he added.

Contradictions in the bill

There are some confusing terms in the bill as, for example, it contradicts its own definition of ‘medicine’. Medicine itself is defined as “modern scientific medicine in all its branches and includes surgery and obstetrics,” but does not include veterinary medicine and surgery. However, the Bill repeatedly says that the government wants “to enhance the interface between homeopathy, Indian systems of medicine and modern systems of medicine”.

An AYUSH practitioner is defined as a person who is a practitioner of homoeopathy or of Indian medicine. There will be a national register of the AYUSH practitioners who have qualified the bridge course. The Section 49(4) says that a “specific bridge course may be introduced for the practitioners of homeopathy and of Indian systems of medicine to enable them to prescribe such modern medicines”. Also, the Section 54(o) says the government can notify rules for “the modern medicines that the practitioners of homeopathy and of Indian medicine may prescribe”.

Counter arguments

India has one doctor for every 1,674 people whereas the World Health Organization’s norm is one doctor for every 1000 people. Those who support the bill in its current form, argue that the demand-supply dynamic in medical education is an area for concern and hence the “bridge course” for those who have been trained in traditional medicine like Ayurveda as well as homeopathy should be allowed.

To the allegation that this will encourage quacks, the section of bureaucrats point out to the fact that the MBBS doctors refuse to serve in rural areas leaves the poor at the complete mercy of actual quacks. Their counter is that the homoeopathic, Unani and Ayurvedic doctors spend four-and-a-half to five-and-a-half years studying substantially the same physiology, biochemistry, and other subjects that allopathic doctors do, though the emphasis obviously is on traditional knowledge bases, including the medicinal properties of herbs and natural substances. Therefore, it would be arrogance on the part of MCI to dismiss these healthcare practitioners as quacks.

“The bill in any means shouldn’t allow the Ayurvedic doctor to practice the allopathy or high end technology related treatment but I see no harm in them prescribing standard tests and prescriptions for diseases common to the Indian sub-continent. Don’t understand this mindless opposition,” said Dr Durgesh Sharma who is an intern at a renowned hospital of Delhi.

Another argument against the MCI is that it is an elected body of doctors who elect themselves, thus not being truly democratic or under government’s control. Over the top of that, its history of corruption makes it liable for such allegations.

It is a battle between those who want status quo and those who stand for total revamp of healthcare education and medical practice. In the midst of the arguments and counter arguments, the bill has been anyhow been sent for a revision by the select group of Parliamentarians before its re-introduction in the Lok Sabha. Rightly so, the government must address the genuine issues by including the positive suggestions from all sides. However, the pace of reforms that has been initiated at the inception of 2018 must not slow down. The healthcare sector needs to be put on an accelerator and hope the year ahead brings it order and sanity replacing the mess it has been in.

Key features of National Medical Commission Bill 2017

Constitution of the National Medical Commission:  The Bill sets up the National Medical Commission (NMC).  Within three years of the passage of the Bill, state governments will establish State Medical Councils at the state level.  The NMC will consist of 25 members, appointed by the central government.  A Search Committee will recommend names to the central government for the post of Chairperson, and the part time members.  These posts will have a maximum term of four years.

Members of the NMC will include: (i) the Chairperson, (ii) the President of the Under-Graduate Medical Education Board, (iii) the President of the Post-Graduate Medical Education Board, (iv) the Director General of Health Services, Directorate General of Health Services, (v) the Director General, Indian Council of Medical Research, and (vi) five members (part-time) to be elected by the registered medical practitioners from amongst themselves from the prescribed regional constituencies under the Bill.

Functions of the National Medical Commission:  Functions of the NMC include: (i) framing policies for regulating medical institutions and medical professionals, (ii) assessing the requirements of healthcare-related human resources and infrastructure, (iii) ensuring compliance by the State Medical Councils of the regulations made under the Bill, (iv) framing guidelines for determination of fees for up to 40% of the seats in the private medical institutions and deemed universities which are regulated as per the Bill.

Medical Advisory Council: Under the Bill, the central government will constitute a Medical Advisory Council.  The Council will be the primary platform through which the states/union territories can put forth their views and concerns before the NMC.  Further, the Council will advise the NMC on measures to enable equitable access to medical education.

Autonomous boards: The Bill sets up certain autonomous boards under the supervision of the NMC.  Each autonomous board will consist of a President and two members, appointed by the central government.  These boards are: (i) the Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB):  These Boards will be responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the undergraduate and postgraduate levels respectively, (ii) the Medical Assessment and Rating Board (MARB):  The MARB will have the power to levy monetary penalties on medical institutions which fail to maintain the minimum standards as laid down by the UGMEB and the PGMEB.  The MARB will also grant permission for establishing a new medical college, and (iii) the Ethics and Medical Registration Board:  This Board will maintain a National Register of all licensed medical practitioners, and regulate professional conduct.  Only those included in the Register will be allowed to practice medicine.

Entrance examinations: There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate medical education in all medical institutions regulated by the Bill.  The NMC will specify the manner of conducting common counselling for admission in all such medical institutions.