Make medical education a public good

Sujatha Rao

Sujatha Rao  

When thought leaders like Gurcharan Das and leading newspapers root for commercialising medical education, one has to sit up and take note. The justification for commercialising medical education is that it will incentivise investors to set up medical colleges, increase the supply of doctors, induce competition and reduce the cost of tuition fees and services. Understanding the downside impact of such a policy, as unfolding in the U.S., can be illustrative.

The U.S. crisis

In a hard-hitting article, “How the Financing of Colleges May Lead to Disaster!” Rana Foroohar explains how in the U.S., the logic of “markets know best” resulted in the entry of banks, hedge funds, private equity, venture capital, for establishing colleges. Post 2002, student debt has climbed to $1.2 trillion with 44 per cent of loan defaults among the “working-class students”.

Flawed logic in India

The NITI Aayog recommendations for reforming medical education need to be viewed in this backdrop. The three-point recommendation — allowing private investors to establish medical colleges untrammelled by regulations, freedom to levy fees for 60 per cent of the students to recoup their money, and making the exit examination the marker for quality and for crowding out substandard institutions — is expected to trigger healthy competition, reduce prices and assure quality.

India has 422 medical colleges with 58,000 annual admissions. With the doctor-population ratio at 1:1,500, there is a dire need of doctors. A comprehensive policy framework consisting of a package of innovative approaches such as use of technology, faculty training in pedagogical skills, permitting foreign faculty to teach and so on is required to optimise churning out of doctors appropriate to our needs from existing colleges besides establishing new ones.

It is pertinent to ask which investor is willing to set up colleges in Bundelkhand or Raipur and why doctors from the surplus States of Tamil Nadu or Karnataka do not go to work in Bastar or Adilabad.

Barely 15,000 doctors may be available to work in rural areas, in the public sector or in public health and primary care. Reversing this trend will require government intervention making public heath and primary care financially remunerative. The demand-supply equation in imperfect markets like health does not get smoothened by open door policies.

A zero-sum game

When public policy encourages high cost of production of doctors only to save on initial investment in setting up colleges, it pays for it in the costly services it procures. It’s a zero-sum game with the government losing much more, both in terms of public finance and welfare.

It is necessary to question why Scandinavian, most European and several developing countries like Thailand provide free medical education and highly subsidised loans, cap the amount of fees and so on. If they are woolly headed socialists, so be it, as these countries have certainly demonstrated better social and economic standards of living.

India has a large cohort of youth who need education to produce wealth and cannot afford to mortgage their lives in seeking it. Pragmatism and national interest must determine public policy.

Sujatha Rao is formerSecretary, Union Ministry of Health & Family Welfare.

The demand-supply equation in imperfect markets like health does not get smoothened by open door policies

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