The Truth About NMC Act
National Medical Commission Act has been notified in the Gazette of India. It aims to replace the MCI Act and constitute the National Medical Commission, which will replace the Medical Council of India. Does the quality of law leave a lot to be desired? A HE report.
As a doctor, Omana prizes her right to prescribe medicines to patients. But, because she lives in a small town, where doctor-patient conflicts are frequent, exercising that right is not always easy. This year, it could get even harder, depending on how fast the government implements the National Medical Commission Act.
The Centre is set to implement the NMC Act as soon as possible-— leaving several members of the medical community fretting and healthcare researchers concerned that the act will legalise quackery. Several doctors associations have conveyed a more cautious outlook in industry conversations. With few details made public about the implementation of the law, many industry watchers worry that the government might be about to upset the stability of the medical education system as well as healthcare system across the country.
What will the NMC Act do to the Indian Healthcare Sector?
Some of the key features of NMC Act are the following.
Within three years of the passage of the legislation, the Bill proposes to establish a medical commission, both at the national and state levels.
There will be a common final year MBBS exam, to be known as the National Exit Test (NEXT), for admission to postgraduate medical courses and for obtaining a licence to practise medicine. It would also act as a screening test for foreign medical graduates.
As a result, the NEET common counselling and NEXT would be applicable for admission to All India Institute of Medical Sciences (AIIMS). That means, admissions to all AIIMS, JIPMER Pondicherry and PGI Chandigarh will be through NEET to ensure uniformity throughout the medical entrance procedure, including examinations to secure seats at premier institutes.
Section 32 provides for the licensing of 350,000 unqualified non-medical persons to practise modern medicine.
A ‘Search Committee' will recommend names to the central government for the post of chairperson, and part-time members.
NMC will be an umbrella regulatory body comprising 25 members appointed by the central government. It will include representatives from the Indian Council of Medical Research and the Directorate General of Health Services.
The commission will oversee organisations that will control undergraduate and postgraduate education and monitor standards in medical colleges and grant permissions for new colleges.
The NMC will have four autonomous boards — Undergraduate Medical Education Board, Postgraduate Medical Education Board, Medical Assessment and Rating Board and Ethical and Medical Registration Board.
NMC's tenure will be for four years. The Medical Council of India meets at least once a year while the National Medical Commission will meet every quarter. The NMC board members need to declare their assets and liabilities at the time of entering and demitting office.
The NMC Will
(i) Frame policies to regulate medical institutions and medical professionals
(ii) Assess the requirements of healthcare-related human resources and infrastructure
(iii) Frame guidelines to regulate fees and all other charges for 50 percent seats in private medical colleges and deemed universities
Even after notification in the gazette, the readiness for implementation of National Medical Commission Act has to await the rules for the Act developed by relevant ministry and tabled in Parliament, though rarely discussed.
According to news reports, the Centre has started its search for a medical professional with at least 20 years of experience and an ability to "inspire, engage and empower the medical workforce" to head the new National Medical Commission (NMC).
With different sets of rules to operationalise NMC Act in place, the health ministry has already put out notifications to form the commission. Apart from the chairman of the commission, the ministry has also begun the process of creating different boards under NMC to advise it on various matters. These comprise medical assessment and rating board, ethics and medical registration board, among others under the panel.
All the committees would be overseen by medical experts and would have renowned medical professionals as part-time members. NMC would supersede the Medical Council of India (MCI). The new law has given the authority to NMC to decide on how to dismantle MCI.
Policymakers vs Stakeholders Who Wins?
Policies are usually made out of clamour and the belief that these are solutions to existing problems. According to Ravi Duggal, an independent researcher and activist, the medical community, especially IMA, is only interested in protecting their rights and do not want any regulatory mechanisms to govern and bind them. "They don't care about patients, and hence they are opposed to any reforms like mid-level health care providers, fee and price regulation," he adds.
So, is it not the solution to present impediments of the healthcare sector?
"The NMC does not address core issues of medical education like adversities caused by private medical education that perpetuates commercialization of medical practice. On the contrary, it has liberalized fee fixation by reducing the proportion of seats on which state governments can fix fee rates. So medical education will become more unaffordable. It also provides freedom to any entity to set up medical colleges which will only lead to further profiteering and reduced quality of medical education. There is very little in the NMC to strengthen transparency and accountability. Given the MCI experience, this should have been at the core of the reforms. The mid-level provider provision is a welcome recommendation, but the removal of the bridge course is not a good thing given that MBBS and MD doctors unwillingness to join the public health system and work in rural areas," Duggal explains.
In a predominantly, underdeveloped country like India, any new policy can be a matter of deep contestation as well as a matter of agreement. However, policymakers have always talked about broader visions to bring well-being to ordinary citizens. Also, the NMC Act is no different; the more comprehensive agreement is to improve the life situation of ordinary citizens by increasing access to quality healthcare.
However, those in the industry aren't sure about the seamless implementation of the Act.
Jagadish Chaturvedi, founder and CEO HiiiH Innovations Pvt LTD, points out that the biggest reason for opposition against NMC Bill is the NEXT exam. "An objective multiple choice based exam like NEET is replaced by NEXT. It is based on vast MBBS Syllabus, which is an examiner-based assessment, which could be subjective, biased and non-uniform."
The Elephant in the Room
Chaturvedi points out that NMC Act is overall positive for the country. The concerns are vagueness with several clauses, which many believe leaves room for abuse of the act. "For instance, who is a mid-level community healthcare worker? If community health workers are given limited license to provide a primary and preventive prescription of medication, what are the limits? Many doctors are worried about the impact on patients if health professionals who haven't undergone formal medication start treating patients. The concern is not that the doctors' jobs will be taken away, and they won't get patient. A doctor undergoes 8-10 years of training to get a license to prescribe certain medicines. The medical fraternity is worried about giving the same license to someone who hasn't undergone formal training," he notes.
Often the entire picture cannot be obtained only by a few measures and indicators. It is necessary to understand the effect the change it had on people's lives in a soft, qualitative and psychological manner and also in the way of hard, measurable outcomes. Nothing speaks louder than data. And not all policies can be analysed statistically. So, interviews from carefully sampled stakeholders or beneficiaries and focused group discussions can supplement the quantitative approaches of the impact of the NMC Act.