The Medical sector in India is in a critical state. There are 3 major issues ailing the Medical sector viz. Quantity of Medical Professionals, Urban-Rural Imbalance in Medical facilities and Quality of Medical Professionals & Equipment.
As per MCI records, as on Dec-31, 2014, there are 9.36 lac registered (MBBS / MD / MS) doctors, 7.9 lac registered AYUSH practitioners, 16.73 lac registered nurses and 7.56 lac auxiliary nurses in the Medical sector in entire India. How many of them are active on the ground is not known yet ! India has 19 health workers per 10000 people when minimum number prescribed by World Health Organisation is 25 per 10000 people. As per another report by Indian Express published in 2013, India has only 1 working doctor per 1700 people whereas WHO prescribes a minimum of 1 working doctor per 1000 people ! Thus, there is clearly a shortage of qualified Medical Professionals across the nation.
2)Urban-Rural Imbalance :
The problem of quantity is not the only one ailing the Health sector. As per a National Health Profile Report 2013, 67% of the doctors are operating in urban areas thereby depriving the rural areas (where 70% of Indian population is) of essential Medical services. The Report stated that only about 30000 doctors of the 1.06 lac Government doctors serve in the rural areas. There is an estimated 82% shortage in rural areas in surgeons and specialist doctors like pediatricians, gynecologists etc. Thus, the state of Medical sector in Rural India which feeds the entire nation via agriculture is in dire straits.
3)Quality of Doctors :
Though it is difficult to make general statements about the quality of doctors and surgeons in any society, it is a matter of fact that the level of faith that the layman had over doctors and surgeons has diminished considerably in the past decade owing to several incidents of malpractice, wrong diagnosis, high expenditure due to (often needless) multiple scanning Tests etc. There are of course very hardworking and dedicated doctors who are genuinely serving society.
But there is a growing unhealthy trend which has emerged amongst certain groups of doctors especially in cash-rich urban areas, who recommend patients to undergo a variety of Medical Tests and consultations which enrich their colleagues but do not benefit the patient. This trend has originated from a desire to recover the expenses made by the doctor’s family in going through his/her Medical Education. Many practising doctors secured admission into a Medical college at the undergraduate or post-graduate level by paying a huge capitation fees (from 25 lacs to 2 crores INR) besides the regular tuition etc. fees. This trend is particularly prevalent amongst those doctors whose parents who are also doctors run a hospital or a clinic. It is true that running a hospital / clinic is both a service to society and also a commercial business. The business instincts of such doctors eclipse the service instincts and society suffers as a consequence. The root cause of this malaise is therefore the erroneous procedure for admissions into Medical colleges in India and the lackluster role of the Government in regulating it.
India has the highest number of Medical colleges in the world. As in 2015, India has 381 Medical colleges which admit about 64000 students every year for undergraduate (MBBS) & postgraduate courses (MD/MS). Out of these, 188 Medical colleges are private colleges catering to 38715 Medical seats. There are about 90 different Entrance Exams conducted by these various colleges all having different syllabus and exam patterns. Many Private Medical Colleges form a group and conduct their own Entrance exam which is the hot-bed of malpractices. There is little transparency in the Admissions procedure and the system is designed to extract huge capitation fees from students. This is the principal source of the vicious sequence of events which is set forth whereby the student who pays capitation fees and secures admission into a Medical college waits for the earliest opportunity to recover the sum when he emerges as a doctor in society. And, the consequences of the actions of such a doctor is borne by common people in society for years. This is indeed unfortunate.
To nip this root cause in the bud, the Central Govt. had proposed a common National Medical Entrance Exam called NEET for all Medical colleges in India which took place in 2013. Unfortunately, due to a Supreme Court split verdict (2:1) in June 2013, the NEET was struck down in response to about 112 petitions (mostly by Private Medical Colleges). The current Union Heath Ministry has initiated efforts to revive the NEET exam from 2017 and has already secured MCI approval for the same. An amendment in the MCI Constitution and approval by the Cabinet and Parliament is needed before NEET becomes a reality in 2017.
Implementation of the NEET in India at UG and PG levels of admission to Medical colleges shall not only set a uniform standard across the nation but shall end all types of malpractices in admission to Medical colleges which constitutes the root cause of poor quality of doctors or the unethical breed of doctors in society. The NEET exam tests conceptual understanding of the Sciences too besides information unlike some State-level exams like MH-CET. Thus, NEET shall ensure better selection of the candidates for Medical education in India.
In summary, the reinstatement of NEET exam across India shall usher in an age of better quality of doctors both in terms of their ethics and also technical abilities.
The solution to the first 2 issues i.e. Quantity and Urban-Rural Imbalance are quite complex and would need strong political will from the Government and infusion of funds by innovative public-private partnership (PPP) models. Revamping the Health Insurance policies and subsidizing Medical Education in all Medical colleges with Government & Corporate efforts would comprise two of the major steps towards addressing the issues. The Health Insurance scheme launched in conjunction with the Jan Dhan Yojana by PM Modi is one step towards making Medical treatment affordable for the poor man and thus helps in solving some aspect of these issues. But a number of coherent steps will be needed for any significant difference to be felt by the common man especially in rural India.
Let’s hope that with right governance, all the 3 major issues ailing the Medical sector in India will get resolved. Let’s also hope that sanity prevails upon our law makers and they make NEET exam a reality in India as soon as possible !!!