The Hindu Editorial Analysis : Writing out a clean Bill on health -

The bill supersedes the Indian Medical Council Act 1956. It replaces the Medical Council of India (MCI) with a National Medical Commission (NMC).
The National Medical Commission will comprise of 25 members who will be appointed by the central government through a research committee. The fees of 40% of seats in private medical institutions will be decided by the commission.
The bill will set up a Medical Advisory Council which will function as a medium to convey dialogue between the National Medical Commission and states/union territories.
Four autonomous boards will be established under the commission to supervise and assess the undergraduate and postgraduate medical education.
The National Medical Commission will regulate medical education as well as a medical practice.
A National Licentiate Examination will be conducted to get the license for medical practice as well as to get admission into the postgraduate medical course.

The bill provides for a consolidated NEET (National Eligibility-cum-Entrance Test) for admissions in all undergraduate courses by which separate exams and multiple counseling processes for various medical colleges will be avoided.
For admission in postgraduate level, an equivalent NEXT will be conducted. It will also be the Licentiate Exam for obtaining a license to practice.
This provision will erase off the multiplicities of exams and abolish the inequality in the skill set of doctors graduating from all parts of the country.

The doctors will need to qualify the Licentiate exam only once in the lifetime. Considering the continuous developments in medical science and technology, this license system keeps no checks if a doctor’s knowledge and skills are up to date with the changing times.

The old National Medical Council Act has no provision to regulate fees of various medical institutions. The IMC bill offers to cap fee by enabling the commission to frame guideline for profit-driven private institutions.
The IMC can directly determine the fee for up to 50% of the seats in private medical colleges. This will provide impetus to talented and meritious students to avail the education opportunity in best institutions.
On one hand, it is a positive step in the direction of ‘free education for all’, on the other hand, this provision can be proved to be as a discouraging step for private investments in the field of medical education. Thus there is a need to incentivize private entry by reducing barriers to open medical colleges.

A search committee will recommend the names of chairman and members of the National Medical Commission to the government. Two-third of the members of the commission, including the chairperson, will be medical practitioners. This could lead to too much influence of medical practitioners in the field, according to expert committees.
However, the act asserts a transparent process for selecting the members. The NMC, as well as the search committee for NMC, will be a mix of nominated as well as elected members.

The present framework of the bill provides complete autonomy to the National Medical Commission. However we must not forget that the government should have an overriding supervisory power over the National Medical commission so that the regulations formulated by the commission concur with the government policies.
Moreover, the government is expected to address public emergencies. It might not be the best choice for the commission to dispense government’s duties in emergency cases.

The bill offers a bridge to allow AYUSH workers to practice allopathic medicines. Now 3.5 Lakh AYUSH practitioners across India can also add up to the already 11 Lakh registered allopathic practitioners. This provision has both positive and negative sides.
On one hand it can provide an integration of these two medical schools, on the other hand, the AYUSH practitioners are already well qualified so further integration will lead to overqualification of practitioners. At the same time, this step can also prove to hinder the undisturbed growth of AYUSH.

The biggest challenge to the Indian healthcare system in present times is the unequal distribution of doctors between metro cities and rural areas. The current ratio between the number of doctors in metropolitan and rural areas is 3.8 to 1. At a time when more than 70 percent of Indian population lives in villages, such disparity is frightening. The reason behind this discrepancy is Inadequate investment. Furthermore, very few incentive structures in the rural area
The qualification of doctors in the rural area is much lower than those in urban. The requirement in public health in rural areas differs vastly from what is being taught in MBBS schools.
The disparity is also wide in the number of doctors in northern and southern states. Southern states like Kerala and Tamil Nadu have adequate doctors while the states like Bihar and Uttar Pradesh has an acute shortage of doctors.

We are facing an overall shortage of qualified doctors in our country. According to the World Health Organization, the standard population to doctor ratio is 1000:1. In India, the ratio stands at 1456:1. Over 57 percent of the practicing doctors in India are unqualified with a large number of unaccounted quacks in the field.
While the National Medical Commission Act 2019 has brought some critical attention to it, the act brings a paradigm shift in the philosophy of regulation. The number of doctors and their quality is bound to increase with the implementation of this act. The autonomous commission will work as an outcome-focused system.