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Insights into Editorial: Does the Medical Commission Bill encourage quackery?


Insights into Editorial: Does the Medical Commission Bill encourage quackery?


Context:

President Ram Nath Kovind has given his nod to National Medical Commission Bill 2019.  The move came after Parliament passed the bill in the just-concluded session. The Bill seeks to repeal the Indian Medical Council Act, 1956.

It has provisions to set up the National Medical Commission which will frame policies for regulating medical institutions and medical professionals and assess the requirements of healthcare-related human resources and infrastructure.

Union Health Minister hails the NMC Act as historic and milestone in the medical education sector. The rules will be framed and the NMC will be constituted within six months.

 

About National Medical Commission Bill, 2019:

The Bill aims to provide for a medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high-quality medical professionals in all parts of the country.

Under the Bill, the NMC can grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine.

The bill seeks to establish uniform standards National Exit Test (NEXT) as

  1. i) an entrance test for post-graduate courses ii) a screening test for those who obtained a degree in medicine from abroad and iii) an exam to obtain the MBBS license for practice.

NMC would regulate fees and all other charges for 50% of the seats in private medical colleges and deemed universities.

As per the Bill, of 25 members proposed for the NMC, only five would be elected which means the non-elected members would be either government officials or those nominated by the government.

 

Recent Government Initiatives:

Government invested Rs 10,000 Cr in creating Government seats in the past five years.

Government is also setting up 21 new AIIMS at a cost of over Rs 30,000 Cr to give boost to the medical education sector. 

Prior to the reforms of NEET and Common Counselling, rich students could afford to pay huge and unrecorded capitation fees to secure admission to private medical colleges.

Now, as NEET qualified students only can get admission, this ensures that merit prevails in admissions.

 

Apprehensions about National Medical Commission Bill, 2019:

In the NMC Act Clause 32 provides for limited License to practice at Mid-level as Community Health Providers:

In other words, persons without medical background are becoming eligible to practise modern medicine and prescribe independently.

Reasons mentioned:

  • India as a whole also has a huge shortage of specialists. So, you may have doctors but it does not necessarily mean that they can adequately address certain diseases.
  • The whole question of doctor-population ratio as per the World Health Organisation (WHO) norms doesn’t really have much of a meaning.
  • We don’t have credible data. But estimates show that there could be about eight lakh doctors actively practising, which would mean that we need an additional five lakh doctors, but that’s just a gross estimate.
  • But, the Indian Medical Association has raised concerns over the term ‘Community Health Provider’ as it allows anyone connected with modern medicine to get registered in NMC and be licensed to practise modern medicine.
  • There is no doubt that there is adequate number of doctors in both Kerala and Tamil Nadu, whereas in Bihar and the northern States, there is an acute shortage.
  • There is a differential between the rural and urban areas, as a large number of doctors tend to cluster in urban areas.

 

About uniform standards National Exit Test (NEXT)

Clause 15 facilitates a common final year undergraduate examination (NEXT) with common standards of knowledge and skills for Doctors on a Nation-wide basis.

Regulations operationalizing NEXT would be made in due course of time keeping in mind, both theoretical, as well as clinical skill sets required at the level of Under Graduation.

Composition of NMC includes 75% doctors representing Central and State Institutions/ Councils and Health Universities.

 

Regarding Fee Regulation:

There is criticism that representation of IMC should be more from democratically elected members than nominated.

The IMA demand that there should be capping on the fee charged by the unaided medical institutions.

Refuting allegations that the clause on fees regulation will make the medical education expensive, ministry clarified there was no provision to regulate fees in the Indian Medical Council Act 1956.

In view of the lack of a regulatory mechanism, the Supreme Court had to pass orders for setting up of fees committees in each state to be chaired by retired high court judges.

Regarding Community Health Provider, India has been able to have a proper training programme that really enables young doctors to go and work in rural areas. However, Chhattisgarh and Assam did work on having a three-year-trained physician such as LMPs (Licentiate Medical Practitioners).

 

Conclusion:

By the government’s view, The NMC Act is progressive legislation which will reduce the burden on students and bring down costs of medical education.

The critics major concerns are that six months period is insufficient and there must also be a focus on quality. However, nurses, if trained well along with strong regulations, can be a great asset.

Thus, it would be adequate to have three-year-trained public health practitioners, who would really address all our infectious diseases and public health requirements of the rural poor.

However, there should be a need of continuous redesign, actually having a strong evaluation framework, a strong regulatory governance framework is extremely important.