Don’t force doctors to perform charity

 
 

Now that I have read the whole transcript of the Medical Consultancy and Other Services (Rationalisation of Fees) Bill tabled by Congress leader Renuka Chowdhury in the Rajya Sabha on August 8, I have to say I have mixed feelings towards it. I will leave it to the political analysts to examine the timing of this bill and confine myself to its merits and practicalities.

Dr Kamal Mahawar

In principle, I think the idea of a fair, reasonable, transparent “fee range” not simply “fee cap” would be commendable. It will improve transparency and mean that “famous” doctors and hospitals wouldn’t be able to charge too high a fee to act “pricey” and then use the surplus money to give out as commissions to those who would be willing to perpetuate the “famous, best, pricey” myth for them. However, the bill only talks about fee cap without going into the details of it, which will obviously have to be worked out later! There remain several unanswered questions.

How will you differentiate amongst the practitioners of different systems of medicine practiced in India with different specialist qualifications? Will the bill differentiate between practitioners and hospitals operating in different geographical areas where costs of living may vary? Will the bill also ensure that there is a lower cap on the consultation charges as undercutting due to stiff competition is an equally big problem in private healthcare delivery in India? Will the bill also include procedures and operations or is just going to confine itself to the consultation? Will the bill ensure that professionals only get paid for the services they are qualified to give out and not encroach into each other’s territory? Will the bill also ensure that patients get value for money as quality of services offered may vary vastly and patients usually have no means of assessing the quality of healthcare they receive? Many more such practical questions will come up which will make it very difficult to implement the provisions of this bill without a radical overhaul of the system.

The bill talks about constitution of an “expert panel” to implement its provisions. I am not sure if it is such a good idea. We already have a body to guide and monitor medical professionals in India and it is called “Medical Council of India (MCI)”. Is this not a lost opportunity to bring in the much-needed reforms with the MCI? Rather than making it defunct and take powers and resources away from it and give it to some other expert panel, we should be thinking of ways to reform and strengthen the MCI. Some of the suggestions that have been put forward in the past are wider representation from the society on the council and enhanced resources and powers to enable it to perform its tasks better. I hence feel it would be best that such an expert panel is constituted from the considerably more resourced, financed, representative, responsive, and responsible Medical Council of India.

When these fee ranges are decided for consultations, diagnostics, procedures, and operations, the panel must take into consideration the years of hard work that medical professionals put into their career. We know India is a poor country but this poor country seems to be offering handsome rewards to professionals in other walks of life, so why single out doctors? Doctors deserve to earn a decent wage, which will enable them to live a respectable life. Yes, some doctors have amassed obscene amounts of wealth but they are in minority. This is a profession and not a charity; those who wish to carry out charity are already free to do so. Hence, I would challenge the provision in the bill where it forces doctors to carry out mandatory charity by holding “free camps”. Yes, many corporate hospitals are built on free public land but shouldn’t that mean we ask corporate hospitals to behave responsibly rather than penalizing doctors? At the same time, let us not overlook the enormous value that corporate hospitals add to our healthcare. We need to fix this industry and make it more accountable, responsible, and ethical, not kill it.

A further argument given (by some others) is that since medical education in government medical colleges in India is hugely subsidized, doctors should hence pay back for it in some way or form. My answer is that it would be correcting one mistake with the other. There is no reason to keep our educational establishments underfunded by offering free or subsidized education to all. This is neither good for these institutions nor for their students in the long term. There are many ways to tackle the fee barrier for poorer students who can’t afford to pay.

Forcing qualified doctors to perform charity is neither going to work nor is it a democratic solution. Furthermore, we mustn’t forget that healthcare professionals are now in demand all over the world. By making the already difficult job of medical professionals even more difficult in India, we are going to lose even more doctors to richer countries. This will also make it difficult to attract the best and the brightest to medical profession, who are already beginning to show a preference for non-medical fields. Providing healthcare for the impoverished sections of the society is a state responsibility and I am surprised that this bill, instead of using this opportunity to enhance, equip, and enable public healthcare mechanisms and hospitals, puts the blame completely on private medical professionals. Our state run clinics and hospitals are largely not fit for purpose and suffer from lack of funding, corruption, and inefficient management. It is unfair to ask private practitioners to do as a charity what in reality should be done by state.

Finally, if combined with provisions to make the MCI more effective and resourced, generally making doctors’ remunerations fair and at par with others in society, and decoupling charity from profession, this bill could provide a major opportunity for desperately needed change. Otherwise, it will be yet another lost opportunity.

Dr Kamal Mahawar
Senior Consultant in Bariatric and Metabolic Surgery
Indraprastha Apollo Hospitals, New Delhi

Once known for flexing his muscle, Rashtriya Janata Dal (RJD) MP Pappu Yadav has now donned the mantle of a vigilante.

In his latest campaign, the MP issued a diktat to medical practitioners to refrain from fleecing patients in the name of better treatment and conducted surprise raids at various clinics in Saharsa district in Bihar “to detect anomalies”. “I have checked different pathological labs in Saharsa and found several irregularities,” Yadav said, adding, “I have asked all the doctors not to charge irrational fees from patients or prescribe unnecessary tests.”

Yadav reportedly ‘fixed’ consultation fee of doctors in Bihar depending upon their qualifications and experience. Raising their voice against the diktat, doctors said that the MP from Madhepura had no business to prescribe their fee. “Who is Pappu Yadav to fix our fees?” asked a veteran doctor in the state. Yadav has ‘advised’ the doctors not to charge more than Rs.300 as their consultation fee.

The move has evoked sharp reactions from doctors and various political parties. BJP’s Saharsa legislator Alok Ranjan led a team of leaders to the district magistrate, complaining about the way Yadav had raided the clinics and pathological centres.They alleged that the RJD MP had put up his own rate card for pathological tests, which had instilled a sense of fear in the minds of doctors.

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