Parliament amends ailing National Medical Commission Bill. Will the state of healthcare improve in India?

By Annapurna Sinharay

The Union Cabinet has sanctioned amendments to the National Medical Commission Bill following recently tabled recommendations by a parliamentary committee and a country-wide furore over the draft bill. The amendments take account of stringent punishment for quackery, removal of a bridge course that would have allowed non-allopathic doctors to practice modern medicine, and regulation of fees for 50 percent seats at deemed universities.

Issues surrounding NMC Bill previously

Previously, the draft bill allowed AYUSH graduates to practise modern medicine after completing a bridge course. Further, to facilitate this, the NMC bill sought to do away section 15 of the IMC Act, which says that the basic qualification to practise modern medicine is MBBS. Predictably, this provision was the cause of much ridicule and resentment as it was dreaded to open the floodgates on quackery. Moreover, the bill enabled private medical colleges to charge exorbitant sums of money. This stricture of the bill was touted to be ‘anti-poor’. The draft bill also denied doctors in India to elect their own democratic medical council; in that, it replaced it with a body where the majority would be nominated by the government. This had been viewed as a retrograde step and was feared to “cripple” the functioning of medical professionals by making them completely answerable to the bureaucracy and non-medical administrators. Newly-appointed IMA president Dr Ravi Wankhedkar had reportedly said, “This bill is anti-poor, anti-people, non-representative, undemocratic and anti-federal in character.”

Key amendments to the NMC Bill

  1. Having taken into account the students’ demand to not subject them to an additional licentiate exam, the Cabinet has approved that the final MBBS examination would be held as a common exam throughout the country and would serve as an exit test to be called the National Exit Test (NEXT). NEXT is also to serve as the screening test for doctors with foreign medical qualifications to practice in India.
  2. The notorious provision dealing with a “bridge course” for AYUSH practitioners to practise modern medicine has been deleted.
  3. The maximum limit of 40 percent seats for which fee would be regulated in private medical institutions and deemed universities has been increased to 50 percent. Further, it has been clarified that the fee would also include all other charges taken by the colleges.
  4. Responding to the demands from States to increase their representation in the NMC, the number of nominees of States and UTs in the NMC has been increased from three to six. The NMC will comprise 25 members of which at least 21 will be doctors.
  5. Another major concern gathered during the discussion with stakeholders was the wide range of monetary penalty, ranging from one half to ten times the annual fee recovered from a batch, to be imposed in a graded manner on a medical college non-compliant with the norms. The clause has been replaced with a provision which provides different options for warnings, reasonable monetary penalty, reducing intake, stoppage of admission leading up to the withdrawal of recognition.
  6. The government is concerned about the quality and safety of healthcare being made available to the citizens and the need to act strictly against unqualified practitioners or quacks. The punishment for any unauthorised practice of medicine has been made severe by including a provision for imprisonment of up to one year along with a fine extending up to five lakh rupees.

State government to take care of rural healthcare

The Bill does not make any specific provision for rural health care per se. State governments have been entrusted with the responsibility of taking necessary measures promoting primary health care in rural areas. However, State governments have not been “empowered” in this regard. This has been a significant letdown because the NMC bill held the promise of finally ending the shortage of doctors in far-flung remote areas where medical graduates do not set foot. Initially, the NMC Bill planned to resolve the rural health care crisis by enabling AYUSH graduates to serve poor patients in rural areas after completion of a bridge course. But at present, the deletion of the bridge course provision has left a gaping hole in the legislation.