Managing healthcare

There can be no denying that recent efforts to regulate both medical education and practice — from the Karnataka government bringing in a law to curb overcharging to attempting a single medical entrance exam for everyone — are steps in the right direction. In the same vein, a Bill to set up a National Medical Commission to replace the entirely discredited and corrupt Medical Council of India wasintroduced in Parliament in December. The proposed NMC is expected to bring to an end a farcical system where regulators were elected by the regulated. No wonder, a body that was meant to oversee medical education and practice allowed malpractices to thrive. Marking a break from the MCI, the NMC seeks to create a firewall between regulation of medical education in terms of setting curriculum and standards, and actually monitoring the institutions concerned. It has advocated separate bodies for these aspects. In an effort to correct the domination of doctors in the MCI, the NMC allows for a representation of only five doctors in the 25-member central body, the rest being officials from the Indian Council of Medical Research, the Directorate General of Health Services and other bodies. This, apart from the suggestion that AYUSH (practitioners of ayurveda, siddha and homoeopathy) will be allowed to practice allopathy after a bridge course, has incensed a section of the medical community.

That said, the NMC Bill is not without its problems. First, it may replace control by doctors with bureaucrats, with the Centre controlling appointments to over 75 members in various bodies under the NMC umbrella. Civil society and patient representatives too should have a say. Second, it allows medical colleges total freedom to fix fees on 60 per cent of the seats. The latter is an effort to encourage corporates to invest in medical colleges, of which there are about 500 in the country (government and private), with India facing a paucity of doctors.

Seen along with the NITI Aayog’s prescription of PPPs in health, the Centre seems to be pursuing a model of well-regulated private sector healthcare delivery. This is fine so far as it goes, but it cannot work as a solution for quality or cost concerns. Private healthcare is too driven by commercial considerations to be guided by socio-economic needs. On the other hand, the decay in government hospitals (brought to the fore by the spate of child deaths at Gorakhpur last year) is a reminder that public health spending, at 1.5 per cent of GDP, is way below the global norm of over 5 per cent. A greater government role in setting up hospitals and colleges, alongside better governance, can work best to make quality healthcare affordable. Recent reports on the Budget likely to raise the health outlay by 11 per cent are encouraging. However, a sustained increase is called for, if India's health indices are to improve to at least middle-income country levels.

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