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Corrupt system or corrupt profession

Corrupt system or corrupt profession

The problem of corruption in healthcare is of a multidimensional nature. Corruption may be involved, for example, in construction of hospitals, purchase of instruments, supply of medicines and goods, overbilling in insurance claims and even appointment of healthcare professionals. Another aspect of the problem is the involvement of multiple parties, e.g. policy-makers, ministers, economists, engineers, contractors, suppliers, and doctors. All this may give rise to innumerable clandestine transactions of a corrupt nature among various stakeholders. Some people say since corruption has crept into the entire system of society and doctors are being part of the system, cannot be an exception. Can hiding behind the system offer immunity to healthcare providers? Even if the whole system is corrupt, the medical profession cannot take any solace from corrupt practices. Doctors become punching bags for all the evils. People know very little of true medical profession i e dedicated efforts, hard work and devotion to the duty. Every medico has been doing charity, and service to humanity selflessly. They provide service round the clock, give relief from pain, give assurance to people in distress, have brought down death rate. Most of doctors start with great ideals but fall prey to corruption, somewhere down the way. While other professions have seen an increase in level of comfort in the job and the remuneration package, medical profession has seen a decrease in the level of professional comfort due to lack of allocation to the health sector by the state.

Some black sheep do exist

In a letter addressed to Prime Minister of India, the president of the Punjab Medical Council said, “I want to draw your kind attention to the ‘medical corruption’. There are three factors in medical profession that make it unaffordable i) exorbitant price of drugs, ii) commissions to the referring persons and iii) ordering diagnostic tests and medical examinations without the need. Only a strict control can contain this corruption. In India, every year, “three crore people are believed to slip below the Poverty Line after spending their savings or selling off their assets for medical treatment, which may or may not cure them”. There is a massive difference in the cost price of medicines and the Retail Price mentioned on the packet of drugs. The difference is as much as 1000 per cent and at times even more. It emphasizes the need to prescribe generic drugs, regulates prices with 20% profit and weed out those pharma companies which are inferior and not reliable. Only the actual cost plus 20% profit be mentioned on the packet and not 20 times the cost, giving liberty to fleece the customers. Stents and other implants are also disproportionately priced. A heart stent, which is sold to the patient for around Rs 120,000, does not cost more than Rs 20,000 in the international market’. Why not manufacture such a stent under ‘make in India’ at 5000/- The nationwide trend of private hospitals paying cuts to the referring doctors is a shame. Sometimes the referring doctor/para-medic or a quack is paid as much as 50 per cent cut of the medical treatment charges or the cost of tests and imaging diagnostics. This makes the medical treatment unaffordable for the majority of the population. The doctors and others are also given commissions by the drug manufacturers. This is the cause for over- medication as also the high price of drugs. The scare of diseases like dengue can lead to ‘operation loot’ where a test is charged 2000/- to 3900/-, where the fair price is 600/- as fixed by the competent authority.
Doctors’ trust is sin qua non

Medical treatment revolves round faith of the patient in his doctor and vice versa. It is the coming together of two human beings, one who is ill, and comes to seek the advice of another, who is skilled and in whom former has confidence. Unfortunately it stands eroded.

In an emergency situation, there is an element of urgency to intervene by the primary doctor, which may not be appreciated by the reviewing doctor or court, subsequently. This may lead to a conclusion that intervention was un-necessary and hence corruption.  If a doctor charges the patient for his services as permissible by existing laws, one cannot call it corrupt practice just because the charges are high. Will the society expect the doctor to provide services at nominal costs, or a totally uncompensated service, leading the life of an ascetic? If doctor is not able to make his both ends meet he may be tempted to generate income by taking a commission from the pharmaceutical company, then it becomes corruption. Keeping dying (and dead) patients in the intensive care units (ICUs) with tubes stuck into all possible orifices, or wheeling dead patients from operating tables into ICUs, to be kept there for some hours on ventilators before they are declared dead, removing the appendix for every minor pain in the abdomen, abdominal deliveries where normal delivery was feasible etc have been the instances of corruption. These are instances and not a matter of practice. Most doctors work ethically and with dedication.There is a need to avoid hype against doctors in the media to keep good doctors in the profession and to attract bright students to medical colleges.
Need for reforms

Make all medicines, tests, devices and prosthesis available at cost price or absolutely free to all. Make medical education free, based only on merit. Make medical education based on uniform curriculum. Make all admissions and exams transparent. Advent of NEET (national eligibility entrance test) at the time of entry to medical college and uniform examination at the time of exit to check the competence will be good steps.

 

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