The National Medical Commission Bill, 2019 has presently invoked multiple reactions from hailing it as revolutionary to rejecting it as obsolete. The most controversial healthcare bill in Indian history is now approved by Lok Sabha and even the Rajya Sabha has approved it with some changes.
On the brink of the National Medical Bill becoming a law amid intensified criticisms from the medical community, here is a critical analysis of what’s what of the bill:
What is the National Medical Commission Bill?
The National Medical Bill Commission, 2019 is was introduced by the Minister of Health and Family Welfare, Dr. Harsh Vardhan in Lok Sabha on July 22, 2019. The Bill seeks to repeal the Indian Medical Council Act, 1956. It seeks to replace the Indian Medical Council with National Medical Commission to regulate medical education and practices in India.
The NMB is also aimed at reducing corruption in the national medical body and incorporate measures to improve the current state of affairs through implementing innovative solutions from other countries. It proposes major structural changes in the present system and has hence seen opposition from various sides.
Need for the National Medical Commission Bill
#1. Scarcity of Doctors – The population doctor ratio in India is currently 1:1665. The WTO recommended ratio is 1:1500. This clearly shows that India has a scarcity of doctors and hence healthcare services, mainly in the rural areas.
It is important to take steps to reform the system to create more primitive and preventive healthcare professionals in order to manage this ratio. Not only does this require fundamental changes in how the current hierarchy is, but also requires policy changes.
#2. Corruption and Black Money – Corruption was in fact the biggest problem with the previous MCI. In 2010, its president Ketan Desai was also accused of corruption by the CBI showing how deep the problem ran. Black money is prevalent in the college fees system and the MCI is often accused of making medical education a monopoly of the rich. All these allegations have not only harmed the reputation of the MCI but also of the system.
#3. Requirement of High Quality Medical Professionals – The current system has no regulatory measure to ensure that only high quality medical professionals are part of the system. In this time when many cases of malpractice have surfaced, it is important to find a common mechanism to ensure quality of doctors. Further, there is also a need to replace the registering procedure with a licensing procedure and set rules for the same.
#4. Composition of the MCI – The Indian Medical Council is an elected body. It is elected by the doctors. The major function of the MCI is to regulate practitioners. Hence it became a case of the regulators being elected by those they are supposed to regulate. Not only did these often stop the MCI from taking up major changes but it also affected the transparency and unbiased working of the MCI.
#5. Failure To Evolve – The MCI has failed to keep up with the new requirements and needs of the medical system. A majority of its practices are criticised as obsolete and unnecessary. It is important for a body to evolve with time and engage in reforms as and when required.
But MCI has witnessed some fundamental issues like the ones mentioned above which has prevented it from doing so. The medical world is progressing at a rapid pace with new technologies and research areas are developed each day. It is significant to have an adaptable body for the same.
Previous Attempts
This is not the first time the bill has been introduced. In 2017, a similar bill was introduced in the Lok Sabha and the Standing Committee on Health and Family Welfare had recommended several changes.
It had evoked responses from the medical fraternity across the country and parts of the bill was heavily criticised mainly the provision of a “bridge course” to allow practitioners of alternative medicines to pursue allopathy. The bill lapsed with the dissolution of the 16th Lok Sabha.
The provision was subsequently omitted and other changes recommended by the Standing Committee were incorporated. These amendments were then approved by the cabinet.
After the BJP formed government for its second term, the bill was freshly introduced. Even after changes were included, doctors across the country have continued to protest against the bill. Currently, the bill has the nod of both the houses and will be sent for president approval shortly.
Provisions
Structure of the NMC: The NMC is all set to replace the MCI and the members will be nominated by the centre government. It will consist of 25 members out of which at least 60% will be medical practitioners. This is done in order to improve transparency and diversity by including social workers, members of local governments and health economists.
The members of the NMC include
- Director Generals of the Directorate General of Health Services and the Indian Council of Medical Research
- Director of any of the AIIMS
- five members (part-time) to be elected by the registered medical practitioners, and
- six members appointed on rotational basis from amongst the nominees of the states in the Medical Advisory Council.
Functions of the NMC: The objective of the NMC is to ensure availability of adequate and high quality medical professionals. Further it also lays down regulations for medical institutions and professionals and frames guidelines for fee determination in private colleges.
It is also the duty of NMC to assess the requirements of human resource and infrastructure in healthcare and ensure that State Medical Councils comply with the new regulations under NMC bill. It also provides an effective redressal mechanism and undertakes periodical assessments of medical institutions.
Autonomous Bodies: The bill sets up formation of four autonomous and regulatory bodies under the NMC. They will be appointed by the central government and will consist of 4 members and a president. The members are chosen based on their qualification and capability to help the body perform its specific function.
The bodies are: The Under-Graduate Medical Education Board (UGMEB) , the Post-Graduate Medical Education Board (PGMEB) , The Medical Assessment and Rating Board, The Ethics and Medical Registration Board.
Community Health Providers: The most debated provision of the bill, creation of Community Health Providers is an attempt to handle the scarcity of availability of medical help, especially in rural areas. It basically deals with creation of a group of practitioners who have some connection with the medicine world and will meet the required qualification to be decided by the Committee after its formation.
They will be allowed to independently undertake primitive and precautionary healthcare facilities including screening for non communicable diseases and prescribe specific mediations.
NEET/NEXT: The NMC is ready to undertake the National Entrance Eligibility Test for admissions into medical institutions. But, over time the MCI has failed to ensure that only high quality gradates enter the system.
Hence the NMC is going to have the NEXT which is athe final exam for all MBBS graduates in order to ensure uniformity and quality. Further, this will also serve as a medium for students to enter post graduate courses and for foreign practitioners to be able to practice in India.
Private Colleges Fee Regulation: To regulate the high fees in medical institutions, the NMC proposes undertaking fees regulation of 50% seats in private institutions under its control. Currently almost 50% seats in government colleges are actually given based on merit at nominal costs and by this measure almost 75% total seats will be regulated by NMC and ensure that MBBS is not the monopoly of the rich. Further seats regulations can be undertaken by state government based on individual MoUs with the institutions.
NMC Bill vs. IMC Bill
- The governing body under the National Medical Commission Act is the National Medical Commission whereas the governing body of the Indian Medical Council Act is the Medical Council of India.
- The members of the NMC will be either appointed or nominated by the Central government. MCI has a majority of members who are elected from amongst the members of the medical faculty in universities and the State Medical Registers.
- Section 5 of the NMC bill provides for the formation of a search committee with 7 members including the presiding officer. There is no such provision in the IMC bill.
- In order to handle the increasing corruption in the IMC, the NMC bill makes it compulsory for all members including the chairperson to declare their assets and liabilities at the time of taking office. Further they are also supposed to declare any professional and commercial engagement or involvement. All this will also be available publicly on the website of the NMC. Such declaration was not compulsory with the IMC.
- In order to promote transparency, the members of the NMC are not allowed to take up any employment for 2 years after leaving office. No such provisions were present in the IMC.
Criticisms
The Community Health Providers is accused by the MCI as a means of legalization of quackery. 3.5 lakhs non medical person will be obtaining liscense to practice medicine if implemented and is expected by opposers to put life of patients in risk and lower the quality of the medical system in India.
The medical fraternity has completely rejected NEXT in its current format. Dr Asokan, the seceratory general of Indian Medical Association says that the two objectives can’t be reconciled since the level of knowledge and training required for both are very different.
Another major objection has been the nature of selecting the members of NMC. The IMA believes that nomination of members is a way of the government exerting control over the NMC and their doctors should have the right to choose their representatives through elections
The IMA claims that instead of making medical education more affordable, the bill does the opposite. It has said that currently state governments regulate 85% seats and the NMC proposal will only lead to regulation of 50% seats thus increasing the number of management seats.
The Way Ahead
The government looks determined to implement the NMC bill whereas the IMA remains salty. In fact it has describes the law as an “A gross breach of medical ethics and utter disregard for the noble profession in the form of the NMC Bill.” It is important for the government to take the medical fraternity into confidence before implementing the bill for the country to reap benefits of its reforms.