Unregulated medical fees playing havoc : The Tribune India

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Unregulated medical fees playing havoc

The medical profession is often in the news for wrong reasons.

Unregulated medical fees playing havoc

High fees: There are 479 medical colleges, offering nearly 70,000 MBBS seats.



Rakesh Kochhar
Professor of Gastroenterology, PGI, Chandigarh

The medical profession is often in the news for wrong reasons. From the Vyapam scandal to unethical practices in joint replacements or laboratory tests to corruption in the NHRM, doctors have often been blamed. A recent report highlights how the high cost of medical education in India generates unethical practices and that the government has asked the MCI to take remedial measures.

Fees of medical colleges

There are 479 medical colleges in India with 227 being run by the state/central government and the rest by trusts/societies/deemed universities. Of the close to 70,000 MBBS seats, approximately 55 per cent are in the private colleges. There are three categories of fees for the Indian nationals: government college seats with nominal fees, state quota seats in private colleges with fees up to Rs 3-4 lakh per year and management quota seats in private colleges with fees up to Rs 8-15 lakh per year. The fees in deemed universities go up to Rs 25 lakh per year.

It was in 2002, in the TMA Pai case, that the Supreme Court ruled that non-aided private institutions could fix their own fees for professional courses. Subsequently, each state was asked to form a fee fixation committee which was authorised to take into account the existing infrastructure, faculty, equipment and expansion plans to fix the fees. The aim was to regulate fees to curb commercialisation, discourage capitation fees and promote merit. However, over the years, the colleges got away by getting the fees escalated year after year, much beyond reasonable limits. A deemed university with Rs 25 lakh fees from 200 students would earn Rs 80 crore only from MBBS fees every year, with a similar amount from postgraduate fees! 

Currently, deemed universities are allowed to fix their own fees and are out of the ambit of state committees. There are close to 40 such universities running the MBBS course. Overall, only 10 per cent of the private colleges charge fees of Rs 5 lakh per year, while more than half charge over Rs 10 lakh per year. Many colleges also require a security deposit of Rs 15-30 lakh. Till 2016, private colleges were mandated by law to run the course on a no-profit basis. However, the present government has done away with this clause, and has allowed up to 10 per cent fee escalation every year. 

With over 38,000 MBBS seats in private colleges, at least 10,000 seats would fall in the category of fees over Rs 40-50 lakh for the whole course, with some costing over a crore of rupees. Adding to this, Rs 2-3 lakh for coaching for NEET and Rs 5-10 lakh for hostel (a college in UP charges Rs 3 lakh per year for a shared room), an MBBS degree in such colleges could cost at least Rs 60 lakh. The cost of a postgraduate degree is even more than this. Thus, one would require more than Rs 1.2 -1.5 crore to become a specialist.

What are the returns of high fees for an MBBS doctor? 

It is Rs 20,000-25,000 per month in a private hospital or Rs 40,000-50,000 in a government hospital. A postgraduate degree gets Rs 50,000-70,000 for the first few years. A loan of Rs 50 lakh carries an EMI of Rs 65,000 for 10 years. 

How does then the spending for medical education pay back? 

To recover the cost of education, there are very few options. 

  • One, is to go to foreign shores, opportunities for which are limited. 
  • Or, open one's own clinic/hospital which requires even greater investment. 
  • Or, resort to unethical practices like kickbacks for referring patients to a lab for CT/MRI scan or blood tests. The kickbacks for referring a patient for a PET scan can be as much as Rs 6,000-7,000. 
  • Many doctors resort to unnecessary surgeries or stent placement. 
  • There also exists a nexus between the referring doctors and specialist surgeons/interventionists in which a "referral fee" is paid to the former. 
  • India has earned a dubious distinction for unethical practices in organ transplantation and joint replacement. 
  • Some years ago, the BMJ had published the account of Dr David Berger, an Australian doctor doing a stint in an Indian hospital (Corruption ruins the doctor-patient relationships in India, BMJ 2014; 348, g3169). He was aghast at every patient of hypertension being referred to a private lab for echocardiography, every three months. He was told by other government doctors that each referral gets them a few thousand rupees. 

He had commented: "The country's doctors live in an 'unvirtuous circle' of referral and kickbacks". This 'cash-for-referral' practice was fiercely debated in the media and in medical journals. Sometime back, MediAngles, a second opinion centre at Navi Mumbai, studied 20,000 consultations over two years and found that 44 per cent of them were advised unnecessary surgeries, including joint replacement, hysterectomy and coronary stenting. 

A couple of years ago, a hoarding put up by a Mumbai hospital proclaiming 'Honest opinion; no commission to doctor' had pricked the conscience of doctors.

The introduction of NEET was thought to usher in transparency. However, it has led to students with ranks as low as 5 lakh to get admission in a deemed university or under management quota in a private college while meritorious students with a rank of 30,000 fail to get in.

Thus, it is obvious that privatisation of medical education with an unregulated fee structure is playing havoc with our society. It is breeding corruption on the one hand and producing doctors whose primary interest would never be welfare of their patients on the other hand. Drastic steps needs to be taken to break the unholy nexus and restore medical education and healthcare services to normalcy.

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