NATIONAL MEDICAL COMMISSION

WHY IN NEWS:

• The National Medical Commission Act had come to force in August 2019. The Act constituted the National Medical Commission, which shall supersede the Medical Council of India

BACKGROUND:

• Despite having the most number of medical colleges in the world, and currently having approximately 9.29 lakhs doctors enrolled on the Indian Medical Register, India is way behind in achieving the targeted doctor population ratio of 1:1000 as per WHO norms.
• Shortage of doctors, who are the most important cog in the health care delivery system, has derailed both access to and quality of health care, especially to the vulnerable and poorer sections of the country.
• Besides acute shortage of medical doctors, there are serious issues concerning mal-distribution of doctors and imbalanced growth of medical colleges in the country.
• Though there have been substantial improvements in health outcomes over the years, there are  still large gaps in health care accessibility in many parts of the country and Universal Health Care still remains  a distant dream
• This indicates that India has not been able to leverage its economic growth to achieve the desired health outcomes.

NEED FOR A NEW COMMMISSION:

• Failures of Medical Council of India:
  • Failure to create a curriculum that produces doctors suited to working  in  Indian  context especially in the rural health services and poor urban areas
  • Failure to maintain uniform standards of medical education, both undergraduate and post-graduate
  • Devaluation of merit in admission, particularly in private medical institutions due to prevalence  of  capitation  fees,  which  make  medical  education  available  only  to   the rich  and  not  necessarily  to  the  most  deserving
  • Failure  to  instill respect for  a  professional  code of  ethics in  the  medical professionals and take disciplinary action against doctors found violating the code of Ethic
  • Failure  to  create  a  transparent  system  of  medical  college  inspections  and  grant   of recognition  or  de-recognition
  • Failure to guide  setting  up  of  medical  colleges in  the  country as  per  need,  resulting in geographical mal-distribution of medical colleges  with  clustering  in  some  states  and  absence  in  several  other  states  and  the  disparity  in  healthcare  services  across states
  • Further, MCI was alleged of promoting Inspector Raj (that is, inspections carried out by the MCI to ensure the maintenance of required standards by medical colleges) and the malpractices linked with it.
  • Allegations of rampant corruption in the MCI
• Abysmal  doctor-population ratio:
  • India has a doctor-population ratio of 1:1456 as compared with the WHO standards of 1:1000
• Urban-Rural Divide in Healthcare:
  • Healthcare system in India is among the most privatized systems in the world, where most qualified doctors tend to serve in the urban areas, whereas rural areas are at the mercy of poorly functional public healthcare systems.
  • With rapid privatization of medical education and healthcare since the 1980s, around 70% of medical professionals work in the private health sector and around 70% of these are concentrated in urban well-to-do areas
• Shortage of medical teachers:
  • There is 30-40% shortage of medical teachers.
  • In last 3 years, numbers of medical colleges has gone up to 38, thus requiring 4000 more teachers additional to already shortage of medical teachers
• Disconnect between medical education system and health system
• Absence of proper screening and admission procedures in private medical colleges
• Prevalence of capitation fee in private medical colleges in flagrant violation of the law
• Rapid growth private health care system:
  • In 2014, more than 70% of outpatient care (72% in the rural areas and 79% in the urban areas) and more than 60% of inpatient care (58% in rural areas and 68% in urban areas) was in the private sector
  • Private practitioners are now therefore the first point of contact in both rural and urban areas for many ailments
• Skewed distribution of medical colleges:
  • Medical colleges in the country are distributed in a skewed manner, with nearly sixty five per cent medical colleges concentrated in the Southern  and Western States of the country which has resulted in great variation in doctor-population ratio across the States

KEY FEATURES OF NATIONAL MEDICAL COMMISSION ACT

• Constitution of the National Medical Commission:
  • The Act sets up the National Medical Commission (NMC).
  • 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.
• Functions of the National Medical Commission:
  • (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 50% of the seats in private medical institutions and deemed universities which are regulated under the Act
• Medical Advisory Council:
  • Under the Act, 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 determine and maintain minimum standards of medical education.
• Autonomous boards:
  • The Act sets up autonomous boards under the supervision of the NMC.
  • Each autonomous board will consist of a President and four members, appointed by the central government.
  • These boards are:
    • 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 post graduate levels respectively.
    • The Medical Assessment and Rating Board (MARB):
      • 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 PGMEB.
      • The MARB will also grant permission for establishing a new medical college, starting any postgraduate course, or increasing the number of seats.
    • 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.  The Board will also maintain a separate National Register for community health providers.
• Community health providers:
  • Under the Act, the NMC may grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine.
  • These mid-level practitioners may prescribe specified medicines in primary and preventive healthcare.
  • In any other cases, these practitioners may only prescribe medicines under the supervision of a registered medical practitioner.
• Entrance examinations:
  • There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the Act.
  • The NMC will specify the manner of conducting common counselling for admission in all such medical institutions.
• National Exit Test:
  • The Act proposes a common final year undergraduate examination called the National Exit Test for the students graduating from medical institutions to obtain the license for practice.
  • This test will also serve as the basis for admission into post-graduate courses at medical institutions under this Bill.

BENEFIT OF THE ACT:

• A more facilitative environment that will decrease cost of medical training.
• As the demand supply gap will narrow the premiums placed on admissions will ease off.
• The overall standard would be maintained by the common exit examination.
• Dissociation of the laying of standards and approval of the standards (in consonance with global norms)
• Addressing shortage of doctors:
  • NMC may grant limited licence to practice medicine at mid-level as Community Health Provider to such persons connected with a modern scientific medical profession who qualify such criteria as may be specified by the regulations.
  • These Community Health Providers can bridge the shortages of medical professionals in rural areas
  • Since India have shortage of doctors and specialists, the task shifting to Mid- level Provider will relieve the overburdened specialists
  • Countries such as Thailand, United Kingdom, China have permitted Community Health Workers or Nurse Practitioners into mainstream health services, with improved health outcomes.
• Regulation of fees:
  • NMC will determine fees for 50% of the seats in private medical colleges and deemed universities.
  • This move will broaden the opportunity for students from all sections of society to undertake medical education.
• Transparency:
  • Act will help to ensure transparency and accountability in education system and control through NMC.
• Robust grievance redressal system under National Board for Medical Registration will help to restore public faith

CONCERNS:

• Audit by Third Party:
  • The NMC Act proposed to set up a “Medical Assessment and Rating Board” to hire and authorise any other third-party agency or persons for carrying out inspections of medical institutions for assessing and rating such institutions.
  • The authenticity of quality audits by private bodies can be questioned.
• Centralisation of power:
  • Though health is primarily a state subject, the Act empowers the central government to give such directions and the state government shall comply with such directions.
• Issue of Autonomy:
  • The Act provides NMC as a complete subsidiary of the government. From the selection of its office-bearers and members to its finances, its functioning and powers, all being comprehensively controlled by the government.
  • This absolute control of the government of the NMC, threatens its autonomy.
• Legalized Quackery:
  • The Act is silent on the method by which the “commission” will grant “limited licence” to community health providers to practise modern medicine.
  • The absence of clarity on this front, may allow some unqualified personnel to perform duties of a medical practitioner.

WAYFORWARD:

• Medical manpower planning should be bottom- up:
  • Present approach in the matter of healthcare manpower planning is a top-down one.
  • Since health is a State subject and State Governments are major stakeholders in the delivery of healthcare services, medical manpower planning should be bottom- up.
• Term of a Commission member:
  • In line with the recommendation of the Roy Chaudhary Committee that a member of the Council may not have more than two  terms  in office.
  • Such a provision  will  also  bring  a  blend  of experience and fresh thinking in the functioning of the regulatory body. 
• Trained team of auditors:
  • Inspection should be done with doctors’ designated bodies to kep it corruption free.
• More stakeholders involvement:
  • In order to ensure fair decision making all stakeholders should be given the importance and also the role of state should be increased.

PRACTICE QUESTION:

Q. “A consequence of the insufficient reach of the public sector has been the growth of a massive, heterogeneous and mostly unregulated private health-care sector”. Critically Analyse