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When thought leaders like Gurcharan Das and leading newspapers root for commercialising medical education, one has to sit up & take note. It is necessary to get engaged in debate as health affects all — rich, poor, old and young.
The justification for commercialising medical education is that it will incentivise investors to set up medical colleges, increase the supply of doctors, induce competition and reduce the cost of tuition fees and services.
In hard-hitting article, “How Financing of Colleges May Lead to Disaster!” Rana Foroohar explains how in U.S., logic of “markets know best” resulted in entry of banks, hedge funds, private equity, venture capital, for establishing colleges.
Loan markets thrive by making student annuities “produce a fat and stable return in the form of tuition fees”. Post 2002, student debt has climbed to $1.2 trillion with 44 per cent of loan defaults among the “working-class students who either couldn’t afford to graduate or, once they did, found their degrees were largely useless in the marketplace”.
In 2009, a review showed that in the 30 leading for-profit universities, “17 percent of their budget was spent on instruction and 42 percent on marketing and paying out existing investors.”
As a critic put it, “Quality education and higher earnings are two masters. You can’t serve both.”
Free markets also widen inequality. While for-profit institutions chase the full-feepaying students for the 30 per cent profit margins, not-for-profit institutions also feel compelled to increase fees when public funding is reduced or withdrawn.
Access, particularly for families with stagnant incomes and reduced capacity to repay loans, then becomes an issue.
These factors are reportedly compelling the U.S. to revert to the pre-neo-liberal era of the 1960s of making higher education a public good.
The NITI Aayog recommendations for reforming medical education need to be viewed in this backdrop.
The three-point recommendation is expected to trigger healthy competition, reduce prices and assure quality.
Allowing private investors to establish medical colleges untrammelled by regulations
Freedom to levy fees for 60 per cent of the students to recoup their money
Making the exit examination the marker for quality and for crowding out substandard institutions
Many have critiqued the policy response to the deep crisis as inadequate and with potential to worsen the situation.
India has 422 medical colleges with 58,000 annual admissions. With the doctorpopulation ratio at 1:1,500, there is a dire need of doctors.
Non-availability of teachers has constrained further expansion, explaining why over half the colleges churn out poor quality doctors.
Since teachers cannot be manufactured overnight, a comprehensive policy framework consisting of a package of innovative approaches such as use of technology, faculty training in pedagogical skills, permitting foreign faculty to teach and so on is required to optimise churning out of doctors appropriate to our needs from existing colleges besides establishing new ones.
Crisis in the health sector is not only about the gross number of doctors but their geographical spread and quality that privatising education or asking foreign universities to set up shop in India cannot address.
Language, culture, payment systems, social conditions and so on are barriers to such free movement of doctors.