Gist of Making Medical Education Affordable | Gist of Rajya Sabha TV / RSTV (now Sansad TV) - UPSC PDF Download

Making Medical Education Affordable: RSTV - Big Picture

Anchor: Teena Jha

Participants:

Context:

Nearly two years after the National Medical Commission Act was passed, the Commission has released draft guidelines for medical colleges in the public domain, seeking feedback from people and various stakeholders.

Background:

National Medical Commission Bill seeks to repeal the Indian Medical Council Act, 1956 and provide for a medical education system that ensures:

• Availability of adequate and high-quality medical professionals
• Adoption of the latest medical research by medical professionals
• Periodic assessment of medical institutions
• An effective grievance redressal mechanism.  

Key features of the Bill include:

• Constitution of the National Medical Commission (NMC) and within three years of the passage of the Bill, state governments will establish State Medical Councils at the state level.
• Functions of the NMC include:
  (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 Bill.
• Under the Bill, 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. 
• Formation of autonomous boards:
  (i) 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 postgraduate levels respectively.
  (ii) 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.
  (iii) 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.
• Community health providers: Under the Bill, the NMC may grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine.  
• The Bill proposes a common final year undergraduate examination called the National Exit Test for the students graduating from medical institutions to obtain the license for the practice.  This test will also serve as the basis for admission into post-graduate courses at medical institutions under this Bill.

Guidelines:

• No institution should charge a capitation fee in any form or manner.
• For the determination of fees for MBBS/PG courses, it needs to be ensured that the principle of education being “not-for-profit”, is strictly adhered to. Therefore, it is necessary that whereas all the operating costs and other expenses for running and maintenance of the institution for imparting medical education on a sustainable basis are covered in the fees, no excessive expense and exorbitant profit component should be allowed to be added to the fees.
• The operating cost should primarily form the basis for the determination of fees for medical education.
• All private teaching institutions should be advised to adopt operation segment reporting in accordance with the Ministry of Corporate Affairs, Government of India-notified Indian Accounting Standard (Ind AS) 108 in respect of expenses pertaining to the medical college and different PG medical courses.
• All hospital expenses are not to be included in computing the cost for providing medical education. Salaries of the teaching staff and other non-teaching staff should be taken into account for the purpose of determination of fees for medical education.
• For calculating the salary expenditure relating to the teaching & non-teaching staff, the State Fee Regulatory Authority may fix a ceiling as per the NMC approved guidelines for the minimum sanctioned numbers of teaching and non-teaching staff based on the approved student strength.
• The determination of fees for individual PG courses could be left to the college, subject to the proviso that the total operating costs for running all postgraduate courses should not exceed the total fees collected in any particular year. Also, stipend paid to the PG students should be a part of the hospital expenses and should not be taken as a cost of the medical college or added to the fees of a PG student.
• Development fees at the rate of 6% to 15% of the operating cost can be added for meeting the development expenditure for the growth and expansion of the medical college. Such surplus should not be allowed to be used for any other purpose and a separate account for the purpose may be maintained.
• The introduction of a rating system of colleges based on multiple parameters is under consideration and in case such a scheme comes through, the specific percentage of the Development Fee for a college may be linked to the rating awarded to a college so that there is an incentive for colleges to improve their performance and generate larger amounts for the development of the institution.
• Fees for 50% MBBS and postgraduate medical seats in these colleges will be regulated. In States where more than 50% of seats in the private medical colleges are already being regulated (i.e. under the relevant State Act by way of government quota and other quotas with concessional fees), such a higher percentage of government quota seats should be maintained.
• The same set of guidelines applicable to the private medical colleges under the purview of the State Fee Regulatory Authorities should be applicable to the Deemed-to-be Universities.

Issues with the guidelines:

• Calculation of operating costs for newer institutions on an ad-hoc basis brings ambiguity.
• The guidelines seem to over-regulate and over interfere in the sector which may slow down organic growth.
• Opposition from private medical colleges due to reduced profit margins and deteriorating autonomy.
• It may lead to the bureaucratization of education.
• Centre regulating a state list subject (health) may damage the federal stasis.

Significance:

• It makes medical education inclusive and affordable (Presently 28% of the seats cost around Rs.10 lakh annually in tuition fee).
• Guidelines also clearly say no to the capitation fee (Donation/Illegal Fees).
• Enhanced transparency in fee structure which cannot be increased on an ad hoc basis.
• Expansion of guidelines to deemed universities brings uniformity in fee structure and standardization of medical education.

Way forward:

• Converting National Health Policy into legislation with:
  (i) Improving health expenditure to 2.5% of GDP.
  (ii) Strengthening existing medical college infrastructure and converting district hospitals to new medical colleges.
  (iii) Creation of a certification program for ASHAs for their preferential selection into ANM, nursing and paramedical courses.
  (iv) Creation of Public Health Management Cadre.
  (v) Using Make in India to upscale the development of health equipment.
• Improving the doctor: population ratio from 1:1600 to 1:1000 as recommended by WHO.
• Using innovative approaches like telemedicine, robotic surgeries, mobile hospitals to bring healthcare to the doorstep of the people.