National Medical Commission Bill: Today’s Talk on Editorials
Significance: Around 2.9 lakh doctors all around in India on Tuesday went on a nationwide strike to protest against the draft National Medical Commission (NMC) Bill 2017. Indian Medical Association (IMA) has strongly opposed the bill and hence announced a 12-hour strike. Such an unprecedented act be the doctors left the fate of patients requiring urgent treatment hanging in the balance.
- To ensure an adequate supply of high-quality medical professionals at both undergraduate and postgraduate levels.
- To encourage medical professionals to incorporate the latest medical research in their work and to contribute to such research.
- To provide for objective periodic assessments of medical institutions.
- to facilitate the maintenance of a medical register for India and enforce high ethical standards in all aspects of medical services.
- to be flexible to adapt to the changing needs of a transforming nation.
Current problems in medical education in India:
- Governance: Medical Council of India performs all the regulatory functions in India with respect to the medical education. However, it is not functioning with the efficiency or effectiveness it was thought to have. Rather, it is slower in discharging all its duties due to the concentration and centralisation of powers in one single body.
- Personnel Issues: The composition of MCI at present does not represent professional excellence nor follows medical ethos. The current composition of the Council reflects that more than half of the members are either from corporate hospitals or in private practice. It makes health care move away from the reach of the people in general and the poor in particular because the elected members of MCI do not have any standards of ethics.
- Nature of regulatory Power: MCI currently has powers to regulate the fees in private colleges. Such regulation of fee by regulatory authorities has encouraged an underground economy for medical education seats with capitation fees in regulated private colleges.
- Ethics in Medical education: MCI is largely concentrated on licensing of professional colleges. It does not focus much on enforcing medical ethics nor it focuses on removing the widespread corruption and conflicts of interest of its members.
Possible solutions suggested by Commissions:
- Separation of Functions: Professional councils like the Medical Council of India should be dispensed with their academic functions and be transferred under an apex body for higher education to be called the National Commission for Higher Education and Research. Ranjit Roy Chaudhury committee recommended structurally reconfiguring the MCI functions and suggested the formation of a National Medical Commission through a new Act.
- Rationalising Appointments: The Niti Aayog Committee recommended that a framework must be set up under which regulators are appointed through an independent selection process instead.
- Ethics in Medical Field: The Niti Aayog Committee recommended that the areas of medical education and medical practice should be separated in terms of enforcement of the appropriate ethics for each of these stages.
- Removing Financial Regulation: The Committee stated that having a fee cap may discourage the entry of private colleges limiting the expansion of medical education in the country.
How National Medical Commission Bill resolves the issues:
- Subsume MCI: The 2017 Bill sets up the National Medical Commission (NMC) as an umbrella regulatory body with certain other bodies under it. The NMC will subsume the MCI and will regulate the medical education and practice in India. Under the Bill, states will establish their respective State Medical Councils within three years. These Councils will have a role similar to the NMC, at the state level.
- Appointing members from the medical field: The NMC will consist of 25 members appointed by the central government. It will include representatives from Indian Council of Medical Research and Directorate General of Health Services.
- Regulatory bodies: The Bill sets up four autonomous boards under the supervision of the NMC, as recommended by various experts. These bodies are namely Under-Graduate Medical Education Board, Post-Graduate Medical Education Board, Medical Assessment and Rating Board and Ethics and Medical Registration Board.
- Exit Examination: There will be a National Licentiate Examination for the students graduating from medical institutions to obtain the license for practice. This examination will also serve as the basis for admission into post-graduate courses at medical institutions. It ensures a better quality standard for the doctors in India.
Functions of the NMC:
(i) laying down policies for regulating medical institutions and medical professionals
(ii) assessing the requirements of human resources and infrastructure in healthcare
(iii) ensuring compliance by the State Medical Councils with the regulations made under the Bill
(iv) framing guidelines for determination of a fee for up to 40% of the seats in the private medical institutions and deemed universities which are governed by the Bill.
Objections to the NMC Bill:
- Cost of medical education: The government can regulate the fee structure of only up to 40% of the seats at a private medical college. The management will fix the fee structure for the remaining 60%. This will definitely make medical education in India highly expensive.
- An unscientific mix of medical practices: Bill provided separate registration and bridge courses for AYUSH practitioners, enabling them to practise modern medicine. Unscientific mixing of different systems of medicine could endanger patients lives.
- Discrepancies in examination pattern: AYUSH graduates would be registered after a crash programme without appearing for the licentiate examination. The system would restrict MBBS students from practising if they do not pass license examination but not so in the case of AYUSH doctors.
- Limit powers of states: Public health is actually a part of state list. But the states are having limited representation in the body formed under NMC bill.