How medical education became a business, a policy change at the same time
The so-called draft of the National Education Policy to abandon all regulation of fees in professional courses marks the latest in a series of steps that have aggressively promoted the commercialization of the last decade, say public health activists.
Until 2009, the official position was that education could not be for sale or to a for-profit company. So on paper, all private universities were run by trusts or charities. However, the fact that many obtained illegal gains through capitation fees, heavily inflated tuition fees and other charges was an open secret. In February 2010, the then government of the UPA allowed companies registered under the Companies Law to open medical schools, although with the ironic warning that the permit will be withdrawn if the schools resort to commercialization.
Even this fig leaf was removed in August 2016, when health minister JP Nadda approved an amendment to the eligibility criteria to allow companies to establish medical universities for profit. The government argued that no company applied to establish schools because of the nonprofit stipulation. He also argued that, in any case, profits were obtained in a non-transparent manner and that the legally permitted profits would produce at least some income tax for the treasury. There was little or no discussion about how students could pay the huge fees charged at these universities.
After a huge protest over the increase of tariffs in private medical colleges, a constitutional bank of the Supreme Court ordered in 2003 that each state must have an independent fee-setting committee headed by a retired superior court judge. A Supreme Court ruling of July 2018 again confirmed the 2003 sentence.
The mining giant Vedanta was one of the first companies to establish a university in Palghar. In a movement that shocked the medical fraternity, students and activists, the state government gave him a free hand to decide the fees. However, only a couple of months later, the university was found to be deficient and that the Medical Council of India (MCI) refused to allow further admission in July 2018, a decision challenged by the company in the High Court from Bombay.
Allowing the entry of for-profit companies also led management companies or trusts to ask why their own universities could not become for-profit entities. In January 2017, the government consented and notified that any medical school established by an autonomous body, society or trust could become a company, which would end with all pretense that medical education is a non-profit company.
Going one step further, last month, the MCI Board of Governors amended the Medical College Establishment Regulations, 1999 to allow consortiums to establish medical colleges. A consortium, he said, could be a group of two to four eligible organizations, including a partnership, trust, company, university or that have signed a Memorandum of Understanding. The notification stated that the objective was to invite greater participation of the private sector in the establishment of medical colleges and to provide high quality medical education and training facilities ... without compromising the standards of medical education.
However, many health activists consider that this movement is a way in which private entities can use public hospitals to start medical universities through MoE with a consortium. Even before this, in several states, including Maharashtra and Gujarat, private entities had used public facilities to establish medical colleges under the PPP (public-private partnerships) rubric.
All this is just about producing more doctors and not about the quality of the doctors suited to our needs. The shortage of doctors is in rural areas, but without regulation of rates, only the rich will become doctors. Will they serve where the shortage is? , Asked Chhaya Pachauli, a public health activist from Rajasthan.
Dr. T Sundararaman, former dean of the TISS School of Health System Studies, pointed out that the overproduction of doctors will adapt to companies, but not to the country. Doctors will accumulate in urban areas, which will lead to unhealthy competition and try to milk patients as is already happening in Mumbai. We need a policy that makes people meet in the least attended districts of North and Northeast India, he said.
While public health activists worry about the implications of a private sector without fee regulation, there is also the issue of medical education standards. The experience of India has been that the regulation of private universities has failed miserably, as both a parliamentary committee and the Supreme Court have observed. What is the reason to believe that things are going to improve, ask the activists?