A case for universal medical care

george thomas

george thomas  

The purpose of medical education is to train medical personnel to handle the medical care needs of the country. It is obvious that any democratic government will try to elucidate what these needs are and tailor the education system to fulfil what is required. Right from the Bhore Committee (1946) to the Mudaliar Committee (1962) and the Shrivastav Committee (1975) to the Bajaj Committee (1986) and including the High Level Expert Group on Universal Health Coverage (2011), the question of what type of medical personnel the country should train has been examined. All these committees are unanimous in their opinion that the country needs a large number of basic doctors. It is not sufficient to state what type of doctors should be trained. It is necessary also to define where they will be employed and who will pay the bills. In short, medical education is the beginning of a process to produce a cadre of personnel who need to be deployed rationally to achieve the health goals of the country.

The piecemeal approach to the problem of providing medical care in India, treating medical education as though it can be separated from medical employment, is responsible for the continuing crisis in medical services and admissions to medical colleges. Numerous commentators have remarked upon the skewed distribution of medical personnel with over 75% of doctors in urban areas where only a third of the people live. A large number of post-graduate doctors and super specialists are underemployed. The problem starts right at the stage of medical admission.

Semblance of quality

Every country should seek to train persons with the best aptitude for a particular task. In doctors, intelligence and empathy are highly prized. It is difficult to measure empathy and most democratic countries use a test of intelligence as a screen to admit medical students because everywhere there are more candidates than seats available. In India, one can accept that because of centuries of deprivation, certain communities need affirmative action in the form of reservation. However, it is very difficult to accept that expensive private medical education is useful for the country. Permitting private medical education was clearly a concession to powerful pressure groups who sought to circumvent the difficult entry barriers to medical education by buying their way. These colleges are filled with the children of doctors, bureaucrats, businessmen and others who seek the social recognition that a medical degree bestows. Anybody with money, irrespective of aptitude, gained entry to some of these colleges. Every year the amounts illegally charged rose by leaps and bounds. Governments were complicit. This egregious state of affairs led to several persons approaching courts. Some semblance of quality has been sought to be restored by the National Eligibility cum Entrance Test (NEET). Private colleges can no longer admit whoever pays the highest even if the examination marks are very low. The rule of reservation is applied after the test scores are obtained. Therefore, it satisfies the need for affirmative action. Unlike marks in the twelfth standard, which can be only obtained once, NEET offers a candidate the chance of another attempt. What the syllabus should be and who should conduct the test can be negotiated.

Inequality among qualified doctors is quite high. The economically well-off can aspire to better jobs, training abroad (still much sought after in spite of all nationalist talk), and generally adopt metropolitan lifestyles. Doctors from poorer backgrounds will need to struggle a lot more. All this can be changed if the government abolishes private practice, institutes universal medical care and becomes the employer of all medical graduates, similar to the National Health Service of the U.K. All medical graduates will be on the same level playing field. Patients will benefit a lot. The deprivation of patients in rural areas will vanish. Unhealthy competition for patients in urban areas will disappear too. No Central or State government has shown any interest in this obvious solution which will benefit the ordinary citizen and the vast majority of doctors from humble backgrounds. The opposition to NEET is a smokescreen to hide the real truth, the abysmal level of medical care services and the continued exploitation of poor patients and the doctors who serve them.

George Thomas is an orthopaedic surgeon at St. Isabel’s Hospital, Chennai

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