Private medical education takes off in India

Abstract

Medical colleges in India were once funded exclusively by the state, but now private medical colleges are becoming an integral part of medical education. Charitable organisations, religious or minority groups, or trusts are largely managing such colleges. Their main source of income is student fees. Until recently, their intake of medical students was regulated strictly by the government. Typically, 50% of students are mandatory merit students, usually selected on the basis of a common entrance test, who pay minimal fees. A further 35% of students pay a higher fee and 15% of medical students pay substantially higher fees than merit students. The government regulates the fee structure for all categories. However, most colleges find it difficult to comply with all staff and infrastructure requirements of the Medical Council of India and subsist on the current fee structure. A judgment of the Supreme Court of India in 2002 is set to radically change the prevailing scenario (T M A Pai Foundation and Others vs State of Karnataka and Others and related judgments).1TMA Pai and others vs State of Karnataka. Writ Petition (Civil) Number 317 of 1995. New Delhi: October, 2002Google Scholar The court ruled that all citizens and religious denominations have a right to establish and maintain educational institutions. This ruling has upheld the right of private professional educational institutions to charge fees higher than those set by government to ensure their viability and generate revenue surplus for development and expansion. The court also observed that many of the students who pay higher fees come from lower socioeconomic groups and, in fact, subsidise the education of the mandatory merit students, contrary to the ideology of the scheme. Further, there is an obvious need for private colleges in India–in the state of Karnataka, for example, there are 19 medical colleges of which only four are governmental. The court observed that maximum autonomy be given to the management of these colleges with respect to admission procedures, fees, and staffing, without disregarding the principle of merit. Such institutions could also devise their own selection methods. The court underlined the importance of autonomy, nonregulation, and excellence of educational standards. The authorities could regulate the educational and academic matters for affiliation and licensing. The ruling allowed greater regulation for government-aided institutions. Minority-run institutions are also given greater freedom, whereas state governments are to regulate and ensure transparency for government-aided institutions. These judgments should radically improve the medical education sector in India and introduce an element of market competition. There seems to be no logic for one student to subsidise the higher education of another student, especially when the student who is being subsidised is from a richer family. The quality of medical teachers and facilities available at various private colleges could now dictate the proportion of fees chargeable and yet receive adequate applicants. All merit students have an opportunity to enrol at government medical colleges with a low fee structure or pay fees for education imparted at private colleges. Since health is a social good essential for the development of a country, it is to be hoped that the increasing commercialisation of medical education in India ultimately improves health care, without having any adverse effect on the charity services provided by many doctors.