Does Vardhan have the political will to take on corrupt hospitals and doctors?

New Delhi: It took a sting operation by a TV channel on doctors accepting commissions of up to 50 percent on scans and routine pathological tests from private laboratories and diagnostic centres for Health Minister Harsh Vardhan to “accept that the patient/consumer of the medical economy needs protection from such nefarious practices”. Speaking in Parliament on Tuesday on the doctor-laboratory nexus exposed by the sting operation, Vardhan, a doctor himself, said it had prompted him to write to the Medical Council of India (MCI) “pointing out that the practice of accepting commissions is in clear violation of MCI’s Code of Ethics”.

He added that the ministry felt that it was “time to check the retrogressive tendencies that have crept into sectors of the medical economy” and “to bring under some degree of oversight the trade practices” employed by labs and diagnostic centres. “This is an old practice. It has been going on for ages in India. Everybody knows about it. The minister is quite well-known for making statements without following them up. If he is really going to follow it up with concrete steps, he needs to create a regulatory mechanism for medical institutions in the country. It is not as if only diagnostic centres are doing it. Hospitals are also doing it,” says Amar Jesani, editor, Indian Journal of Medical Ethics.

In a significant acknowledgment of what lies at the core of the rot that has set into India’s health sector, Vardhan told Parliament that “the laissez faire spirit that dominates this business in India works to the disadvantage of the consumer and needs correction”. Not exactly music to the ears of corporate hospital chains notorious for the exorbitant rates they charge for medical tests and equipment and to five-star private hospitals that make no secret of their policy of “incentives to doctors” in return for referrals.

Jesani explains why the healthcare market in India has come to be so exploitative.

“The fundamental problem is that when you allow markets to determine where the health services are going to be, then they will only go to areas where people have the purchasing power. You will find that the doctor-population ratio in rich urban areas is very high compared to poorer or rural areas or in small towns. When there is an over-concentration of services in one area, instead of catering to a person’s healthcare need they try to generate what is called supplier-induced demand. And this happens in healthcare as a norm simply because the consumer doesn’t know what to consume when he is sick. The doctor, who is an intermediary, decides on your behalf what you should be consuming to get alright. Doctors and hospitals are part of the business. It is not just kickbacks but also over-prescriptions, unnecessary surgeries. More and more care is provided when people don’t need it so that they can inflate the bills,” says Jesani. So what does the health minister need to do to end this sort of profiteering by doctors and hospitals at the expense of patients?

“What he has to do is to bring the market of healthcare under control. If you have an open market without any regulation, where the price of the healthcare is not regulated at all, he won’t be able to abolish such practices.They have to go for price control or price regulation, they have create a mechanism for people to make complaints. They will either have to come up with a separate law or in the existing law create ways to address this…The only way to regulate prices is good costing. Specify the prices - how much each service should cost, what should be the appropriate profit for the hospital. So by regulating the price, you bring down the price on one hand and on the other hand you eliminate corruption. The health minister will need guts to do it,” says Jesani.

If there is political will, say doctors, cracking down on offenders will not be difficult.

“Everything today is audited. To catch the culprit is not difficult. All procedures are prescribed. Everyone knows where the problem is, the challenge is how to fix it. Someone has to have the political will. Harsh Vardhan has to understand that he is the health minister now and he should do something about it. Simply talking about it won’t work.The system is corrupt to the core. Let us see what he does to fix it. Otherwise it will remain an empty slogan,“says Puneet Bedi, a leading gynaecologist and consultant at the Indrapastha Apollo hospital.

Slamming the MCI for its total failure to carry out its mandated role of a watchdog, Bedi said, “The MCI is a quasi-legal body that came into being by an Act of Parliament. But it has never used its authority. It has only abused it. It has two roles - to ensure good quality medical education and to ensure ethical practice. Since it was established in 1956, it has never found a doctor worthy of debarring. The point is that in 58 years we have not understood that medical council will not self-regulate. A profession will self-regulate only ifit is faced with an existential crisis. But the medical profession has become so immune to being called a crook.”

Any serious attempt at cleaning up the medical profession, agree doctors, will involve looking beyond the MCI.

“I don’t think the MCI is going to do anything. It has to be an overarching body that the government should appoint,” says Samiran Nundy, emeritus consultant at the department of surgical gastroenterology and liver transplantation at Sir Ganga Ram Hospital.

Nundy recently co-authored an editorial titled Corruption in Indian Medicine in the prestigious British Medical Journal (BMJ). It was the second such editorial on corruption in India’s health sector by Nundy in response to an explosive report published in the BMJby an Australian physician David Berger who had volunteered for a year at a hospital in the Himalayas. Titled Corruption ruins the doctor-patient relationship in India, the report talked about how “kick-backs and bribes oil every part of the healthcare machinery”. Describing the practice of accepting kick-backs and commissions as “illegal, unethical and immoral”, Nundy said, “Regulation must be done. The American medical profession was in a very similar situation a century ago. It was Abraham Flexner who came and cleaned up the system. We need to clean up medical education and medical practice…the movement has to start with doctors. They must stop taking kickbacks and do what is best for patients. Not just individuals but also government hospitals and institutions where there is so much political influence.”