Gist Of Rajya Sabha TV (RSTV): National Medical Commission Bill 2019

Introduction

The National Medical Commission Bill, 2019 was recently passed by the Parliament. The Bill seeks to repeal the Indian Medical Council Act, 1956 and reform the medical sector in the wake of corruption allegations against the Medical Council of India.  It also looks to regulate admission to medical colleges and provide for a medical education system which ensures:

• availability of adequate and high quality medical professionals
• adoption of the latest medical research by medical professionals
• periodic assessment of medical institutions
• an effective grievance redressal mechanism

The health minister defended the bill, describing it as "historic".

In 2017, a similar Bill had been introduced in Lok Sabha.  It was examined by the Standing Committee on Health and Family Welfare, which recommended several changes to the Bill.  However, the 2017 Bill lapsed with the dissolution of the 16th Lok Sabha. 

In this post, we analyse the 2019 Bill.

EDITED EXCERPTS FROM THE DEBATE

Question:

How is medical education and practice regulated currently?

The Medical Council of India (MCI) is responsible for regulating medical education and practice.

The Medical Council of India was established in 1934 under the Indian Medical Council Act, 1933.To challenges posed by the very fast development and the progress of medical education in the country, the act was repealed in 1956 and further modified. The objectives of the Council are as follows:-

• Maintenance of uniform standards of medical education, both undergraduate and postgraduate.
• Recommendation for recognition/de-recognition of medical qualifications of medical institutions of India or foreign countries.
• Permanent registration/provisional registration of doctors with recognized medical qualifications.
• Reciprocity with foreign countries in the matter of mutual recognition of medical qualifications.
  

Question:

What are the salient features of the bill?

• Constitution of the National Medical Commission:
  
• The Bill sets up the National Medical Commission (NMC) as an umbrella regulatory body with certain other bodies under it.
• The NMC will subsume the MCI and will regulate medical education and practice in India.
• Under the Bill, states will establish their respective State Medical Councils within three years. These Councils will have a role similar to the NMC, at the state level.
  

Medical Advisory Council:

• The central government will constitute a Medical Advisory Council.
• It will be the primary platform through which the states/union territories can put forth their views and concerns before the NMC.
• The Council will advise the NMC on measures to determine and maintain minimum standards of medical education.

Autonomous boards: The Bill sets up autonomous boards under the supervision of the NMC. Each autonomous board will consist of a President and four members, appointed by the central government. These boards are:

1. Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB):
   
   It will be responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the undergraduate and post graduate levels respectively.
   
   
2. Medical Assessment and Rating Board (MARB):

• • It will have the power to levy monetary penalties on medical institutions which fail to maintain the minimum standards as laid down by the UGMEB and PGMEB. 
  • It 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:

• It will maintain a National Register of all licensed medical practitioners, and regulate professional conduct.
• It will also maintain a separate National Register for community health providers.
  

Community health providers:

• NMC may grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine.
• These mid-level practitioners may prescribe specified medicines in primary and preventive healthcare.
• In any other cases, these practitioners may only prescribe medicines under the supervision of a registered medical practitioner.

Entrance and exit examinations:

• There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the Bill.
• The NMC will specify the manner of conducting common counselling for admission in all such medical institutions.
• It proposes a common final year undergraduate examination called the National Exit Test for the students graduating from medical institutions to obtain the license for practice.
• It will also serve as the basis for admission into post-graduate courses at medical institutions under this Bill.

Question:

What are the key roles and responsibilities of the NMC bill?

• Laying down policies for regulating medical institutions and medical professionals
• Assessing the requirements of human resources and infrastructure in healthcare
• Ensuring compliance by the State Medical Councils with the regulations made under the Bill
• Framing guidelines for determination of fee for up to 50% of the seats in the private medical institutions

Question:

How is this improved version of medical regulation?

• The four sub-boards controlled by a governing or advisory body would add diversity to the expertise and would lead to better regulation.

• NMC will be more representative as out of 25 people, 21 will be from medical background. There will be fair representation from state medical colleges and the state governments.
  
  
• It proposes a common final-year MBBS exam, the National Exit Test (NEXT), before an individual starts practising medicine and for seeking admission to post-graduate medical It will also be a screening test for foreign medical graduates.

It is thus a compilation of three systems and includes licentiate exam too. It provides an entrance for the PG.  It is thus trying to create Single measuring tool/uniform standards for the doctor to enter the internship training. Aberration has been done away with the NEXT exam and it eases the total system of regulation.

• Costing of medical education: Private sector has a share around 50-60 % in medical education. It would cap fees on 50% of seats in MBBS and PG courses at private medical colleges. This would ensure the commercial component and achieve parity across all players.
  
  
• The medical colleges will have to conform to standards and guidelines set by NMC. There would be no need for annual renewals if they conform once and are permitted to operate.
  
  
• Community Health Providers – As they have to undergo the courses approved by IGNOU, a bridge course. This would lead to main streaming more professionals through more scientific and standardised manner.

Question:

Why is medical fraternity opposing the bill? What are the issues?

• No second chance - The standing committee had opposed the National Exit Test (NEXT). The Bill has no scope for improvement if a student fails. Earlier, there existed an improvement exam for those who failed the final-year test.
• The committee believed NEXT would result in a population of mismatched and unhappy doctors who have nowhere to go.
• Community Health Provider has been vaguely defined to allow anyone connected with modern medicine to get registered in NMC and be licensed to practise modern medicine.
• It means persons without medical background are becoming eligible to practise modern medicine and prescribe independently
• The NMC will frame guidelines for determination of fees and all other charges in respect of 50% of seats in private medical institutions. There should have been capping on the fee charged by the unaided medical institutions.
• As per the Bill, of 25 members proposed for the NMC, only five would be elected which means the non-elected members would be either government officials or those nominated by the government.
• The system of allopathic health care by qualified MBBS graduates should be governed only by qualified MBBS graduates. And their representation should be more from democratically elected members than nominated.
• The NMC Bill enables the central government to remove the chairperson or any other member of the commission. Earlier this could have been done with MCI only on the direction of court.
  

Question:

Why did we do away with MCI in the first place?

• There have been several issues with the functioning of the MCI with respect to its regulatory role, composition, allegations of corruption, and lack of accountability.
• For instance, MCI is an elected body where its members are elected by medical practitioners themselves, i.e., the regulator is elected by the regulated thereby creating a conflict of interest.
• There has been no nomination based constitution to accommodate representation from Central and State governments.
• No separation of the regulation of medical education and medical practices.

Way forward

• The NMC Bill opens the path to a long-awaited reform of medical education
• Mid-level health workers like Community Health Providers are very much needed but their training programmes, competencies and roles have to be clearly defined to differentiate them from medical graduates.
• Proper infrastructure at Primary Health Centre is must to ensure better facilities.
• The Allied Healthcare Professionals Bill, which is to be examined by the Standing Committee, is the right place to position them.
• A common exit examination is needed for standardisation and postgraduate course selection but must be preceded by a college-level testing of practical clinical skills as a qualifier for the theory-based NEXT (National Exit Test).

  Question:

   Enumerate the salient features of the National Medical Commission Bill 2019. Examine how the changes introduced by National Commission Bill 2019 will help reform the medical sector.

  Question:

   Discuss the issues that plague the National Commission Bill 2019 and explain how National Medical Commission is an improved version of medical regulation over Medical Council of India?