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Subsidising Private Medical Colleges - Chap 8 from Dr Nadkarni's book

Posted Aug 28 2010 10:12pm
As pointed out earlier the government has appointed a board to determine the fee structure in private colleges and to see that the fees charged are legitimate. It is not clear what principles they use but it appears that the board merely verifies the expenses incurred during the previous year and sanctions the fee pattern to meet those expenses. There are no criteria to judge the legitimacy of those expenses. Therefore, the fees are as high as two to three lacs per annum as mentioned earlier. Even after paying such high fees, the students in private colleges are greatly handicapped because their attached hospitals have very low occupancy. The patients in these hospitals have to pay for their hospital expenses. The treatment cannot be totally free. Around 50% of the burden of the expenses incurred on the patients is borne by the students and forms part of their fees. Even then, the patient himself has to pay a fair amount towards his treatment compared to the fact that they get free treatment in government hospitals. Coupled with the fact that these institutions may be having relatively poor investigative and operative facilities and less experienced teachers, the result s a great reduction in number of patients coming in these hospitals. Therefore, the number of students admitted in these colleges is very high compared to the patients available in the hospitals and the patients feel more harassed by a large number of students examining each of them. Thus, a vicious circle is established. Ultimately this results in proportionately small number of patients available to the students to observe and learn his clinical medicine. In all technical colleges, the laboratory or workshop with all equipments suffices to give the students adequate training but not so in the medical college. For medical students, a large number of patients in the attached hospital is most essential for getting their clinical experience. The lay people should realize that a medical student does not interfere with the management of the patient. But he is constantly with the teaching staff & other seniors and observes every step in the process of clinical management and even assists them as directed. This actual observation and participation in the management of the patient forms a major part of his clinical studies; I would say nearly 75% of the education in clinical methods. Therefore, the most important need of the medical students is the hospital filled with numerous patients of different kinds of diseases. The Medical Council had recommended a ratio of 1 to 10 initially i.e. 10 patients per student admitted every year. That means if 100 students were admitted per year in the college, the attached hospital must have the facility to admit at least 1000 patients. In order words, there ought to be at least 1000 patients in the hospital on an average every day. That ratio was diluted later and now stands at 1 to 7, 700 bedded attached hospital for 100 admissions per year in the medical college. Many private college hospitals do have the number of beds but not the occupants whereas the government hospitals are full or even overburdened. The total number of patients in private college hospitals could be as low as 150 to 200. it must be realized again that the hospital fully occupied is not only the need for the students but it is a bigger need for the society because the student who passes with inadequate experience because of lack of availability of patients and has only book-knowledge will obtain the same degree and will be fully entitled to treat the people at large as a student who gets adequate clinical experience. Thus the effects of bad / immature doctors coming out of the medical college are borne for the next 35 years by public at large. So also the benefits of mature doctors coming out of the medical colleges will be reaped by the public at large only. Another factor needs to be considered i.e. the government hospitals/ medical college hospitals as well as district hospitals are too overcrowded and there is a vital need to reduce this overcrowding in these hospitals so that each of the patients gets adequate attention and treatment. Besides, overcrowding hampers medical education as much as scanty patients. The best way to disperse the patients to these private medical college hospitals would be to subsidize the cost of the treatment in private hospitals equally as in government owned medical college hospitals. What I am suggesting is that the expenses of the poor patients coming to these medical college hospitals should be subsidized by the government. The subsidy can be calculated as per what is spent for a similar patient AT A DISTRICT HOSPITAL. This amount could be safely considered as the most minimum amount essential for the treatment of the patients, with no other components added.

The expenses incurred by patient in a medical college hospital have added components and could be broadly divided into three parts
(1) the expenses required essentially for his treatment. I have taken it to be equal to the expense incurred by the government on similar patients in a district hospital and, therefore, suggested the abovementioned level of subsidy.
(2) But the expenses of the patient in medical college hospital would rise appreciably because he is a material for the medical student to learn. The stay of the patient is necessarily increased to some extent and some of the investigations are done merely for academic purposes. As this part of expenses is entirely due to the presence of students in that hospital, it is legitimate that these expenses be borne by students.
(3) But in good medical colleges research is an essential activity. Without research there will be no progress in the science of medicine. Since certain investigations or modalities of treatment are carried out purely for the research, it is clearly understood that this component of the expenses must be given either from the institution or recovered from the research grants provided by the private industries like pharmaceuticals or by autonomous government agencies like University Grants Commission (U.G.C.) and Indian Council of Medical Research (ICMR). The interests of the patients / volunteers are safeguarded by Research Council in that the patient must gain advantage or at least must not be harmed at all and that the patient is properly informed that these investigations and treatment are being done as part of research Today the government refuses to give a single paisa to the private medical colleges as a subsidy. "Why should we spend for ‘rich’ private trusts and the ‘rich’ medical students who, in any case, want to make money?" Strangely all experts are emphasizing the role of private public partnership in various other fields, for example in road and bridge construction. Similarly government factories are constructed on the basis of BOT i.e. build, operate and transfer policy. Therefore, there is no reason why there can not be a private public partnership in the field of medical education. It is not being done to benefit the private trust or agency which is running the college. The government and the public would get tremendous advantages by such subsidy. When the poor patient gets treatment at the same cost as in a district hospital but by more qualified medical teachers, the number of patients in the hospital is bound to increase and the experience gained by the students because of availability of wide varieties of patients would go a long way to make him a better doctor. It is in the interest of the society, therefore, that the medical college hospitals are filled with patients by giving them adequate subsidy to cover the treatment expense of the poor patients.
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