A high-level committee headed by NITI Aayog vice-chairman Arvind Panagariya has proposed to replace the Medical Council of India (MCI) with a National Medical Commission.
The four-member committee formed in March made its preliminary report public on Wednesday and invited public comments on the National Medical Commission Bill, 2016, till 31 August.
It suggested that the current electoral process of appointing regulators for medical education should be replaced by a broad-based search-cum-selection committee. It also recommended that for-profit organizations be permitted to establish medical colleges as against the present norm where only not-for-profit organizations are permitted to do so.
It suggested the creation of a Medical Advisory Council by the central government, with one nominated member from every state government and two members to represent Union territories, to be nominated by the home ministry. The council will be advisory in nature and shape the overall agenda in medical education and training.
Under the proposed bill, the committee has also suggested forming a National Medical Commission (NMC) as a policy-making body for medical education comprising a chairperson, nine ex-officio members and 10 part-time members.
On the issue of the National Eligibility cum Entrance Test (NEET), the committee recommended a statutory basis for common entrance examinations for admission to undergraduate and postgraduate courses in medical colleges.
The report said, “We must also provide for a statutory basis for a common licentiate examination for practice by medical professionals after completion of the undergraduate medical degree. Central government may also prescribe skill tests as necessary, as part of licentiate examinations to ensure medical professionals have appropriate knowledge, skills and attitudes for providing health care as per societal needs.”
The committee also discussed inserting an additional enabling provision of voluntary recertification/renewal of licence exam once every 10 years, a practice prevalent in many countries, but concluded that while desirable in the long run, this may not be an appropriate time for such a radical step.
On the issue of medical education fees, the committee concluded that the NMC should not engage in fee regulation of private colleges because micro-management can encourage rent-seeking behaviour in the NMC. However, the committee said the commission should fix norms for regulating fees for a proportion of seats (not exceeding 40% of the total seats) in private medical colleges.
“Governance reform in the health sector is a requirement whether you do it via the National Medical Commission or any other body. The issue the government and authorities need to keep in mind is whether there is a process in place to achieve the goal—standard care at standard cost,” said P.K. Hota, former health secretary.
He said that while cost-sharing and responsibility-sharing between the government and private sector is fine, the efforts must be to utilize the MBBS doctors who form the bulk of the professionals but do not get enough credit.
“You have to evolve a process where MBBS doctors are not hijacked by the specialists and super specialists (as support staff) at a time when hinterland India does not have enough doctors. The cost and quality of medical service should be kept in mind while preparing a final bill else it may become another MCI—a white elephant,” he added.
A NITI Aayog official, speaking on condition of anonymity, said, “Before coming up with a concrete MCI replacement, the committee wanted to have a public debate on the system so that all the challenges and crises arising from the current situation are addressed completely. During the last four months the committee members held wide discussions with a lot of stakeholders.”