Strict medical-college fee policing will discourage private players even as India needs more doctors; more govt funding the real solution
The National Medical Commission’s (NMC) draft guidelines for fixing fees say upfront that no capitation fees should be charged in any form. ‘Capitation fees’—the byword for sums paid by aspirants who would have otherwise not qualified for a seat in a private medical college—have often been blamed, along with other factors, for poor-quality medical graduates and for being a tool of the flourishing black economy. A 2013 report by the National Institute of Public Finance and Policy, which was never made public, estimated capitation fee for medical and dental education at close to Rs 3,000 crore in 2011-12 alone. So, it is not hard to see why the NMC should seek to end the practice. At the same time, the move to regulate fees to ensure that medical education is run as a “not for profit” venture—the NMC wants fees to be commensurate to operating costs—has to be mindful of the fact that AIIMS, more than a decade ago, had estimated the cost of producing a single medical graduate at Rs 1.7 crore over five-and-half years. To be sure, the cost of subsidised patient-care in the hospital could bring down this figure several notches, but it would still be a big multiple of the minuscule fee the institute charges. Also, this cost relates to AIIMS Delhi, which would incur lower interest and depreciation overheads, factors the NMC conceded are to be kept in mind while setting fees.
Against such costs, it is important to examine if private colleges can even function without discretion in setting fees and charging for admissions. Indeed, most merit-list students would not be able to afford the true costs of medical education. Keeping in mind the costs incurred by the governments, the Supreme Court had, in 2019, upheld the compulsory rural service bond policy enforced by some states, fixing the compulsory service period at two years and the bond-release amount at Rs 20 lakh.
The NMC needs to realise capping fees at private medical college and discouraging private players will only exacerbate the problem of inadequate medical education infrastructure. Last year, the NEET (UG) received 16 lakh applications, against an estimated total of 80,000 MBBS seats across government and private medical education institutions. Surely, not all of the 15 lakh applicants who didn’t make the cut would make poor doctors if they were to get an MBBS seat? This newspaper has repeatedly highlighted the problem of shortage of doctors in the country—against the WHO standard of 1:1,000, we are still at 0.7:1,000. So, even as the NMC is so strident against discretion on fee-setting, to create the number of doctors India needs, the government has to step in, either to subsidise the private players or create more medical colleges; it can, for instance, partner the 330 private/trust-run hospitals in the country with 300-800 beds that already conduct postgraduate medical training for running undergraduate courses as well. There is a lesson or two for India from countries like Cuba that have reached a healthy doctor-population ratio with high-quality of medical graduates—a large part of the cost of medical education can be lowered if the government were to allow similar relaxation in terms of mandatory infrastructure requirements. Eminent cardiologist Dr Devi Shetty has cited the example of 35 medical colleges of under 50,000-sq-ft area training medical graduates for the US. Such measures, as well as greater public investment in medical education are the real solution, not fee regulation.