Critical Analysis Of National Medical Commission Bill

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Introduction

The National Medical Commission Bill was introduced in July 2019 and was notified in the Official Gazette in August 2019. The bill seeks to replace and repeal the Indian Medical Council Act, 1956 and establish a new regulatory body, National Medical Commission (NMC) which supersedes the current regulatory body Medical Council of India. NMC will now be the apex body to govern medical education and medical practice in India. The new bill has been brought to reform the medical education and the quality of doctors it produces. There were various allegations of corruption in the Medical Council of India. Therefore, it also aims to address this issue.

The bill was also introduced in the 16th Lok Sabha and had passed the scrutiny of the Parliamentary Standing Committee. However, the bill lapsed with the end of the term. Therefore, it had to be reintroduced in the new term.

Reasons for the reform

The Medical Council of India was established by the Indian Medical Council Act, 1956. Over the years since its inception, it has not been able to deliver the outcome which was expected from it. India is one of the leading countries in fields like pharmaceuticals, medical tourism, information technology, space technology but still our health indicators are worse than countries like Nepal, Bangladesh, and Sri Lanka. In a report published by the World Economic Forum in 2019, India ranked 150th in the healthcare index(1). Let’s discuss one by one the reasons to bring the reform:

  • Over the years, MCI has been facing criticism and allegations regarding its regulatory role, lack of accountability in its functioning, corruption, and its composition. In 2009, Yashpal Committee was set up to bring about the reforms in higher education. One of the primary recommendations of the committee was to separate the medical profession and medical education. National Knowledge Commission also recommended the same.
  • MCI is an elected body and Medical Practitioners themselves elect its members. i.e. regulators are elected by the regulated. This leads to a conflict of interest and therefore criticized.
  • Medical Education is a diverse stream, but it is wholly dominated by doctors only. This creates a monopoly of doctors in its regulation and therefore there’s a lack of transparency in the functioning of MCI. It should include diverse professionals such as social scientists, public health experts, and economists.
  • In its 92nd report which was published in 2016, the Parliamentary committee on health and family welfare assessed the role, composition, and functioning of MCI. The committee, after thoroughly going through each prospect, was scathing in its criticism of MCI. It criticized MCI on several grounds which I discuss below:
    • The committee noted that the primary healthcare centres have only worsened about the matter of vacant positions. According to a claim made by a representative of the Indian Medical Association, even a general practitioner sees around 500 patients per day and on average 6 minutes per patient is allotted. This is barely adequate to treat a patient properly. There is an urgent need for more quality efficient doctors in India.
    • The representative of the MCI wasn’t able to tell the actual number of registered doctors and who were practising and how many had emigrated. The committee concluded in bold letters: “the Indian Medical Register is not a live database and contains names of doctors who may have passed away or retired from active practice, by now, as well as those with a permanent address outside India and that there is no mechanism in place for filtering out such cases… the MCI has been unresponsive to health system needs (of the country)…”(2).
    • The committee also criticized the composition of MCI. More than half of the members were from private corporate hospitals which are highly commercialised. Even the doctors who were nominated to represent state and central governments were from private corporate hospitals. The current composition of MCI is biased against larger public health interest.
    • A country where a vast majority of the population can’t afford private education and healthcare, more than half of the total medical colleges in India are private colleges that charge exorbitant fees.
    • The committee observed that the MCI has not been able to maintain the ethics amongst doctors and unethical practices continue to grow due to which the profession has lost its respect and trust.
    • The committee noted that the compromised individuals have been able to make to the MCI, but the ministry is not empowered to remove or sanction a member even if he has been guilty of corruption.

 

Based on the recommendations of the committee, a similar bill had been introduced in Lok Sabha. It was examined by the Standing Committee on Health and Family Welfare which recommended several changes to it. However, the bill lapsed because of the dissolution of the Lok Sabha. It was again introduced in 2019 with several changes to the 2017 bill.

Provisions of the Bill

The National Medical Commission Bill: The bill mandates the central government to establish a commission, to be known as the National Medical Commission which replaces the current Medical Council of India. According to section 4(1) of the bill, NMC will comprise 25 members including one chairperson, ten ex officio members, and fourteen part-time members.

Out of these 25 members, at least 15(60%) are to be medical practitioners. Notably, the MCI is non-diverse and consists of doctors only who look out for self-interest over the public interest. Therefore, the bill aims to end the monopoly of doctors and includes members from diverse fields like law, economics, social scientists, science and technology, and management. A search committee will be set up to recommend the names of chairperson and part-time members and it will consist of seven members including the Cabinet Secretary and five experts nominated by the central government (of which three will have experience in the medical field).

According to section 10 of the Bill, the following are the functions of the NMC:

  1. (1) The Commission shall perform the following functions, namely:—

(a) lay down policies for maintaining high quality and high standards in medical education and make necessary regulations in this behalf;

(b) lay down policies for regulating medical institutions, medical researches and medical professionals and make necessary regulations in this behalf;

(c) assess the requirements in healthcare, including human resources for health and healthcare infrastructure and develop a road map for meeting such requirements;

(d) promote, co-ordinate and frame guidelines and lay down policies by making necessary regulations for the proper functioning of the Commission, the Autonomous Boards and the State Medical Councils;

(e) ensure coordination among the Autonomous Boards;

(f) take such measures, as may be necessary, to ensure compliance by the State Medical Councils of the guidelines framed and regulations made under this Act for their effective functioning under this Act;

(g) exercise appellate jurisdiction with respect to the decisions of the Autonomous Boards;

(h) lay down policies and codes to ensure observance of professional ethics in the medical profession and to promote ethical conduct during the provision of care by medical practitioners;

(i) frame guidelines for determination of fees and all other charges in respect of fifty per cent of seats in private medical institutions and deemed to be universities which are governed under the provisions of this Act;

(j) exercise such other powers and perform such other functions as may be prescribed.

(2) All orders and decisions of the Commission shall be authenticated by the signature of the Secretary.

(3) The Commission may delegate such of its powers of administrative and financial matters, as it deems fit, to the Secretary.

(4) The Commission may constitute sub-committees and delegate such of its powers to such sub-committees as may be necessary to enable them to accomplish.

The Medical Advisory Council: The bill provides for setting up of a Medical Advisory Council by the central government. It will be comprised of the Chairperson and all members of the NMC (as ex-officio members), the Chairman of the University Grants Commission, the Director of the National Assessment and Accreditation Council, and various other members to be nominated by the State Governments, Ministry of Home Affairs in the Government of India, State Medical Council, and the Central Government.

The functions of the Medical Advisory Council as according to section 12 of the bill are the following:

(1) The Council shall be the primary platform through which the States and Union territories may put forth their views and concerns before the Commission and help in shaping the overall agenda, policy and action relating to medical education and training.

(2) The Council shall advise the Commission on measures to determine and maintain, and to co-ordinate maintenance of, the minimum standards in all matters relating to medical education, training and research.

(3) The Council shall advise the Commission on measures to enhance equitable access to medical education.(3)

National Examination: As provided in section 14 of the NMC act, there will be a uniform National Eligibility-cum-Entrance Test (NEET) for admission to undergraduate and postgraduate super speciality medical education in all medical institutions which are governed by this act. The bill entrusts the NMC with the task of conducting the NEET and regulating the counselling. Further, the bill also introduces a common final year undergraduate examination to be known as National Exit Test (NEXT) to grant licences to practise medicine as medical practitioners and for enrolment in the State Register or the National Register. This test will also be the basis for admission to postgraduate courses at medical institutions governed by this act. The NMC has been given the responsibility of conducting the NEXT.

Autonomous Boards: The bill provides for the Constitution of various autonomous boards by the central government which are to be supervised by NMC:

  • The Undergraduate Medical Education Board (UGMEB)and Postgraduate Medical Education Board(PGMEB): These two boards will be responsible for the formulation of standards, curriculum, and guidelines for medical education and granting recognition to medical qualifications at Undergraduate and Postgraduate levels respectively.
  • The Medical Assessment and Rating Board: This body has been granted the power to levy charges and penalties on the institutions which fail to work on the guidelines of UGMEB and PGMEB. It will have the power to grant permission to establish new medical colleges, starting postgraduate courses, and increasing the number of seats in the college.
  • The Ethics and Medical Registration Board: It will maintain a national register of all the licenced medical practitioners in the country and regulate medical and professional conduct. Only those included in the register will be able to practice as doctors. It will also maintain a register of community health providers.

Community Health Providers: According to a report, the doctor to population ratio in India as of January 2018 was 1:1655 as compared to the World Health Organization Standard of 1:1000. Therefore, to fill this gap of availability of doctors, the Bill provides for the NMC to grant limited license to certain mid-level practitioners called community health providers (CHP). These CHPs may prescribe specified medicine in primary and preventive healthcare. In any other case, they can only prescribe medicine under the supervision of a registered medical practitioner.

Advantages of the Bill

  • Some of the provisions of the bill may help to curb corruption which is prevalent in MCI. Unlike MCI, the members of the NMC will have to declare their assets when they assume office and when they leave.
  • It will help in achieving the WHO’s prescribed doctor to patient ratio of 1:1100. The Current ratio is nowhere near that.
  • It introduces common exams like NEXT and NEET which will help to bring uniformity in the standard of Medical Education and practice. It will also reduce the burden and cost of taking multiple exams.
  • It sets up the State Medical Council which will act as a grievance redressal body for any complaint of professional misconduct against any doctor.
  • It also keeps a check on the commercialization of medical education and services.

Drawbacks of the Bill

  • In regards to the composition of the NMC, the Centre has been given the power to nominate the members. This may lead to favouritism and bureaucratic interference.
  • The Bill gives extensive discretionary power to the government which reduces the accountability in its functioning and virtually makes it an advisory body.
  • The term ‘Community Health Providers’ has been vaguely defined as it provides for non-medical Persons to practice as a doctor.

Way Forward

No way is perfect in itself but it can be made successful if it is interpreted and implemented properly. The NMC bill if implemented correctly can achieve the objective with which it has been brought. India has suffered from the problem of unskilled and inappropriately trained doctors. MCI was established to solve this issue but instead, the problem increased because of the prevailing corruption in the functioning of MCI. The government needs to thoroughly focus on the good implementation of the bill and its provisions to bring the change.

 

By-

 

Abhishek Kumar

Banaras Hindu University, Varanasi

 

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