National Medical Commission Act

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Context: The National Medical Council Bill was passed by the Parliament in August 2019.

Ministry concerned: Ministry of Health and Family Welfare.

Introduction:

The Bill seeks to repeal the Indian Medical Council Act, 1956 because A Parliamentary Standing Committee established on Health and Family Welfare has examined the role of the MCI in its 92nd report (in 2016) and observed that when MCI was tested on the given parameters (of producing competent doctors, ensure adherence to quality standards, etc) has repeatedly been found short of fulfilling its mandated responsibilities. In our country quality of medical education is not good; the current model of medical education is not producing the right type of health professionals that meet the basic health needs of the country.

This Act provides for a medical education system which promotes:

  1. availability of adequate and high-quality medical professionals,
  2. adoption of the latest medical research by medical professionals, 
  3. periodic assessment of medical institutions,
  4. an effective grievance redressal mechanism,
  5. national health goals, and
  6. equitable and universal healthcare that encourages community health perspective and makes services of medical professionals access to all the citizens; 

Let's look at some differences between provisions of Indian Medical Council Act, 1956 and National Medical Commission Act, 2019

Indian Medical Council Act National Medical Commission Act
Under the Act, the Medical Council of India (MCI) was an autonomous body with two-third of its members (160 plus) being directly elected by the medical fraternity.

 

Under the Act, the new National Medical Commission would have 25 members with no directly elected members. The members will be appointed by the Central Government and a Search Committee will recommend names to the central government for the post of Chairperson, and the part-time members. 

All admissions were through the NEET and no licensing is required for practice but a medical practitioner has to register with a state medical council for this. The Bill provides for a uniform National Eligibility-cum-Entrance Test (NEET) for admission to all undergraduate and post-graduate “super-specialty” medical education while providing for another one, National Exit Test (NEXT) for granting “license” to practice and admission to postgraduate “broad-specialty courses”.
The state governments determined fees for 85% of seats in such institutions and the rest are left for the management. The Act provides for the NMC to “frame guidelines for determination of fee and other charges” for 50% of seats in private medical institutions and deemed to be universities.
No provisions for Community Health Providers were made under this Act The Community Health Provider who is granted limited licenses may practice medicine to such extent, in such circumstances and for such period, as may be specified by the regulations

Features:

  • State governments are required to constitute State Medical Commissions within the time period of three years.
  • Members of the NMC will include:
    1. the Chairperson (must be a medical practitioner),
    2. Presidents of the Under-Graduate and Post-Graduate Medical Education Boards, 
    3. the Director-General of Health Services, Directorate General of Health Services, 
    4. the Director-General, Indian Council of Medical Research, and 
    5. five members (part-time) to be elected by the registered medical practitioners from amongst themselves from states and union territories for a period of two years. 
  • Medical Advisory Council:  Under the Bill, the central government will constitute a Medical Advisory Council. The functions of the Council include: 
    1. It will advise the NMC on measures to determine and maintain minimum standards of medical education and,   
    2. the Council will be the primary platform through which the states/union territories can put forth their views and concerns before the NMC.    
  • Autonomous boards:  This Bill sets up autonomous boards which will be supervised by NMC.  Each autonomous board will consist of a President and four members, appointed by the central government. These boards are: 
  1. The Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB): These Boards will be responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the undergraduate and postgraduate level.
  2. The Medical Assessment and Rating Board (MARB): MARB can levy monetary penalties on medical institutions that fail to maintain the minimum standards as laid down by the UGMEB and PGMEB. The MARB will also grant permission for establishing a new medical college, starting any postgraduate course, or increasing the number of seats.
  3. The Ethics and Medical Registration Board: This Board will regulate professional conduct and maintain a National Register of all licensed medical practitioners. 

Functions of the National Medical Commission: 

Functions of the NMC include:

  1. framing policies for regulating medical institutions and medical professionals,
  2. assessing the requirements of healthcare-related human resources and infrastructure, 
  3. ensuring compliance by the State Medical Councils of the regulations made under the Bill, 
  4. framing guidelines for determination of fees for up to 50% of the seats in private medical institutions and deemed universities which are regulated under the Bill.

Concerns: 

Over the past few days, there have been expressions of concern in various fora over a few clauses of the National Medical Commission (NMC) Act. Even medical professionals have protested. According to media reports, there are five primary concerns- the National Eligibility-cum-Entrance Test (NEET)/National Exit Test, empowering of community health providers for limited practice, regulating fees for only 50% seats in private colleges, reducing the number of elected representatives in the Commission, and the overriding powers of the Centre.

  • Examination: This Act consolidates multiple exams at the undergraduate level with a single NEET and in turn avoids multiple counseling processes. NEXT will act as the final year MBBS examination across India, an entrance test to the postgraduate level, and as a licentiate exam before doctors can practice. It aims to reduce disparities in the skill sets of doctors graduating from different institutions. It would also be a single licentiate exam for graduates across the world. Thus, the government has in effect implemented a ‘One-Nation-One-Exam’ in medical education
  • Community Health Providers: Concerns have been expressed over the limited license to practice for community health providers. We have to appreciate that even with about 70% of India’s population residing in the rural areas, the present ratio of doctors in urban and rural areas is 3.8:1; 27,000 doctors serve about 650,000 villages of the country. A recent study by the World Health Organisation shows that nearly 80% of allopathic doctors in rural areas are without medical qualification. The NMC Act attempts to address this gap by effectively utilizing modern medicine professionals, other than doctors in enabling primary and preventive health care. 
  • Fee Structure:  It is an open secret today that private medical colleges are capitation fee-driven, resort to a discretionary management quota and often have charges of corruption leveled against them. The NMC Act removes the discretionary quota by using a transparent fee structure. It empowers the NMC to frame guidelines for determination of not only fees but all other charges in 50% of seats in private colleges to support poor and meritorious students.
    While a cap on fees is necessary, there is also a need for incentives to attract private investors. In any case, the transparency that NEXT provides would lead to fee regulation through market forces. The Act also provides for the rating of colleges. Thus, reducing entry barriers for setting up medical colleges, along with their rating, is expected to benefit students. They would be able to make an informed decision before seeking admission.
  • Composition:  The current electoral process of appointing regulators is inherently saddled with compromises and attracts professionals who may not be best suited for the task at hand. Indeed, there is ample evidence that the process has failed to bring the best in the field in regulatory roles.
    The Act, therefore, provides for a transparent search and selection process with an eclectic mix of elected and nominated representatives, both in the search committee and the commission itself. The government has further addressed the concern of preponderance of selected members in the commission by adding members from State medical councils and universities.
  • Overriding powers of the Centre: The Medical Council of India, even if directed by the government on critical matters, may not always pay heed. In public emergencies, citizens expect the government to address issues. In the current set-up, it may not be possible all the time. Also, the government should be able to give directions so that NMC regulations align with its policy. Hence, these powers. The use of such authority would follow the principle of natural justice: the NMC’s opinion would be sought before giving directions.

Conclusion:

  • There is no denying that medical education needs continuous reforms in order to usher in improvements in health care. There cannot be just one solution.
  • The NMC Act is a serious attempt to meet the primary need for more medical professionals in the country; it is a beginning.
  • The Act establishes the Diplomate of National Board’s equivalence to NMC-recognised degrees – a long-pending demand.
  • It also promotes medical pluralism. 
  • Both the number of doctors and their skill sets are expected to improve.
  • Autonomy to boards and segregation of their functions will avoid a conflict of interest and reduce rent-seeking opportunities. And ‘quacks’ are liable to face imprisonment or be fined or both. 



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