December 28, 2007

Get a Doctor in the Village, how!

The recent controversy regarding the village posting of doctors has
put the medical community on one side and the whole world on the
other side. I remember, 35 years ago, when I was selected for
medical college I went to one of my elderly aunts to seek her
blessing. She was not very happy about the issue, no, she was not
jealous, but she expressed her anxiety very eloquently. "You are
such a nice boy, but now you'll become a bad man". That, I think,
sums up the attitude of the society towards the doctors.

The problem possibly lies with the doctors. They work for money,
they do not bother about the society, they can kill female fetuses
for a few bucks more, and they can refuse treatment for want of
money; they are not up-to-date with knowledge, they do unnecessary
tests to get a share of the booty. Most of the complaints are
probably true. I have seen ultra-sonologists giving shamelessly
false report to assist another shameless gynecologist in going for
an unnecessary surgery, and I have seen many more un-parliamentary
linen that I should not wash in public. All are true and more.

My worry is about the ways the society is trying to go about solving
the problem. The society is trying to find a solution without
assistance from doctors. It was the same when the consumer
protection act came. Most of the sane doctors protested, some insane
ones also did. No one listened to us. I remember having told one
gathering of legal experts, that they were putting the patients from
the frying pan to fire; from doctors clutches to lawyers. I asked
them, why did they want consumer protection act for the medical
community, to improve services or getting compensation, or did they
want just to teach a lesson! I assured them none of these would be
possible. People refuse to learn from history. Has the road accident
compensation policy improved the quality of drivers? It has only
raised the insurance rates and probably helped the family of the
dead. If consumer protection act implementation for medical
community was intended for compensation, it was good, but if it was
meant to improve services, it was useless. People gave us funny
looks, thought we were `so bad'.

Now the great thinkers of the nation are again at it. They want
doctors to go to villages, and because the anti-social doctors do
not want to go to villages, they'll have to be forced. I am
surprised at the cerebral quality of the people who rake up such
ideas. Has any one tried to find out why doctors are not interested
in going to the villages! Is it only money! By the way, one of the
lowest paid employees in India is a junior doctor. As a junior
doctor I was paid a princely sum of Rs. 225/- PM, while the ward
boys were paid Rs 400/-. Their duty was 8 hrs, mine 24 hrs; they had
one weekly holiday, I had none. They had time for lunch; I did not.
I survived because the `sisters' were real sisters; I shared their
food. If the barber failed to turn up, I had to `prepare' the
patient for surgery; the ward boy would not even have a nightmare of
doing it. If the ward boy were absent I had to `ensure' that the
patient reached the OT on time, riding on the trolley, guess who
pushed it through the corridors of the hospital! But I tell you; I
enjoyed my stay as a house surgeon. I am still proud of what I did.
Because that was when I learned. That was what prepared me for the
future. That is where I learnt how to give a painless suture, how to
tackle a violent patient, how to tackle grief. I do not think a Lal
Bahadur Institute trained babu will ever understand that, they do
not have the training.
Look at the position of medical education today. MBBS is a five and
a half years course. Already the longest course in the country. But
an MBBS degree is truly nothing today. At one time an MBBS degree
was equivalent to an M Sc degree. One could become a lecturer after
MBBS, could do a Ph D, or D Sc after MBBS. But no more, now MBBS is
equivalent to B Sc. MD was a doctoral degree, Doctor of Medicine,
now a postgraduate degree, a three years postgraduate degree. A two
years postgraduate diploma is not equivalent to M Sc. Even the MCI
is trying its best to degrade the status of medical degrees.

I invite the society to understand the problem first. Force should
come as the last option, not the first. Today an MBBS degree holder
is a pariah in society, to be accepted by the people he has to have
a postgraduate qualification. `Only MBBS', or `simple MBBS', or
worse `plain MBBS' are terms we hear often, but do not understand
the agony of it all. MBBS entrance is one of the toughest in the
country, but let me introduce you to a tougher entrance, the PG
entrance. The number of seats for PG is one third of the total MBBS
seats, so in any case two thirds of the MBBS shall remain `plain and
simple'. This cutthroat competition has prompted the students to
treat MBBS degree as a qualifying benchmark for PG entrance tests.
They prepare for the test rather than trying to become doctors. This
one entrance test would make or break their career. It is better to
be a simple B Sc then to remain a simple MBBS. There are instances
where MBBS students are paying smaller hospitals to get internship
certificate without going to the hospital so that they can utilize
the time studying. What is the result? They do not become a `doctor'
after MBBS; they remain students. One third of them get into PG, two-
thirds fail. No, not because they are stupid, because the know-all
government has put a rationing in the number of seats for PG.
Imagine the fate of these students, they are plain MBBS, did not
spend time learning during internship, now they are out in the open,
no respect, no knowledge, official quacks. This is the most serious
wastage of trained manpower the country is facing today, all because
of our policy makers.

Who is responsible? There was one know-all TV talk show, which said
if you cannot become a doctor in five years, you could never be. So
cerebral! These are the people who control the society, God help us.
One does not become a `doctor' immediately after passing MBBS; it
takes at least 2-3 yrs of fulltime work under supervision to be able
to work independently. That was what house jobs were. Earlier house
jobs were compulsory before MD entrance. After 2 house jobs if one
did not get in to PG one could still practice. Now house job has no
PG entrance value. Practicing medicine without a House job does not
prepare a doctor well.

Is there a solution to the problems in villages? It is there, if our
great parliamentarians bother to listen to us. By the way I have a
few more proposals. I want to make it compulsory for the
parliamentarians to stay in a village for one year as MP and fulfill
all promises made during election campaign otherwise their
Membership would be cancelled. Make it compulsory for IIM graduates
to stay in a village for one year to work for betterment of rural
finances, before they get their degree. I want High Court judges to
stay in villages at least 2 months a year to help solve the pending
cases in the villages to be eligible for promotion to Supreme Court.
I want the IAS officer to be posted in a village for one year before
they are confirmed in their jobs.They can all stay in the excellent
accomodation provided in the villages for the doctors. Sounds funny?
Who started the jokes!

Here is what I suggest.

The entire medical course needs to be revamped. Instead of hundreds
of confusing degrees there should be one degree, MD. It should be a
nine years integrated course, equivalent in status to a Ph D. All
students, after four years, would get a provisional registration to
work as doctors under supervision. They would select their specialty
at this juncture, depending on the merit and other government
policies of the time. Even a surgeon would be MD. All the diploma
courses would be abolished. There would be specialties in family
practice, clinical medicine, hospital based internists, surgeons,
ophthalmologists, and all other specialties that we have today.

One year out of this course will be a village posting where they can
learn the problems of the villages and unlearn some hi-tech
solutions to simple problems. There would never be a shortfall of
doctors in villages, happy doctors and not frustrated ones. I do not
think there would even be a murmur of protest from anywhere. No
forcible "Cultural Revolutionary" tactics would be needed. The GPs
that we get would be trained ones, not untrained ones as we get now.

How does a patient differentiate between a physician MD and a
general practitioner MD. The same way they do now, between MDs in
Medicine, pharmacology, biochemistry and pathology. In any case,
government can recognize certain associations, memberships of which
can be made compulsory. (For example, MD, Member of Indian College
of Pharmacology, or MD Indian College of Surgeons.). This way every
doctor that comes out of the college would have some special skills,
and have worked independently for at the least 4 years before being
released to the society. There is no wastage of doctors as `simple
MBBS'.

The super-specialties should be limited to a few, the brightest
ones. There should be no further confusing degree like M Ch, DM. The
super-specialists would be offered fellowships of the college, e.g.
MD, Fellow of the Indian College of Cardiac Surgeons, equivalent to
postdoctoral degree, D Sc.

By the way this does not solve the problem of the bad guys in the
profession as mentioned in paragraph two of this article. I'll share
a bitter truth with you. The patients are as much responsible for
this situation as the doctors. The ratio of good doctors and bad
doctors is exactly the same as the ratio of good guys and bad guys
in the society, not more, not less. There is something very wrong in
the way patients select their doctors. Name and fame does not depend
on skill, knowledge and sincerity. Sound business tactics, sometimes
not so ethical, makes one doctor more popular than the other.

This article is aimed at sensible people who want a solution, not
revenge. The next doctor could be your son; the next patient could
be your son.

- Dr Ashok Sinha
ashokagt2@yahoo.com.
79 Tilla,Kunjavan, Agartala, Tripura.

Global medical tool makers throng India

Even as a lack of clarity in regulations is preventing Indian medical device manufacturers from making their presence felt in the $2 billion domestic medical equipment market, foreign players, mostly from the United States, are increasingly finding the country a preferred destination.

The tremendous growth projections have also prompted foreign medical equipment makers to float Indian subsidiaries -- 30 of them received import clearances in 2007 alone -- to move away from the earlier practice of indirect operations through authorised agents in India.

Boston Scientific, Abbott, Becton Dickinson, Guidant, Medtronic, B Braun, Johnson & Johnson, DePuy, Advanced Medical Optics and Stryker are among the leading firms, whose Indian subsidiaries received approvals to import medical devices during the year.

Corporate interest in the Indian healthcare segment and the introduction of the product patent regime in 2005 are known to be the prime movers behind India becoming a hot destination for medical device firms across the world.

A recent FICCI-Ernst & Young study had predicted 15-20 per cent growth for the Indian medical equipment market and estimated market size to be about $5 billion by 2012.

“With the kind of attention the government and the corporate world has given to India’s healthcare sector, the growing interest of foreign players in the medical equipment sector is quite expected. I would be surprised if companies are not coming to India,” says Anjan Bose, chairman, medical electronics forum, FICCI.

According to Bose, India has to join hands with the industry to decide on an appropriate monitoring mechanism to ensure the quality of medical devices reaching India.

Ram Sharma, managing director, Becton Dickinson India, and chairman, medical equipment committee, American Chamber of Commerce in India, also highlights the need for regulating the medical equipment sector.

“We strongly recommend that instead of re-inventing the wheel, India learn from the experiences of other countries that have brought in regulation in the medical technology sector. The focus should be on making the regulatory process transparent and geared towards patient safety. It is highly desirable that the government pools resources with the Global Harmonization Task Force to enable shared learning and benefit from their experiences in the field of medical devices regulation worldwide,” said Sharma.

Though the domestic industry shares the same view on the need for clarity in the regulations binding medical equipment, it complains that Indian regulators adopt double standards in giving marketing approvals for medical devices.

“Indian medical device makers are equally quality conscious. While the Central Drugs Standard Control Organisation allows import of medical devices on the basis of the quality certifications these products have received from foreign authorities, they insist upon unrealistic standards for the Indian industry,” Himanshu Baid, managing director, Poly Medicure, said.

Baid says that Indian drug regulators are applying manufacturing standards meant for pharmaceuticals on medical device facilities.

“Our products are exported to 65 countries including developed markets. Even though we have all certifications needed for exports, our regulators find that insufficient. There has to be some clarity on this before Indian players can sell their cost-effective devices in the domestic market,” Baid added.

Domestic players also allege that the absence of pricing norms is allowing bigger players to charge exorbitant prices for their imports.

Incidentally, the growing demand for medical devices and its cost have also found mention in a recent study carried out by the Delhi-based Society for Economic and Social Studies.

The NGO, which reviewed Indian patent applications for a collaborative project that involved the health ministry and WHO India office, found that a large number of patents have been granted in the area of medical devices during the last three years.

“Sixty four patents have been granted for medical devices in India from 2005 to March 2007. This has obvious public health implications as there is evidence that the cost of devices and diagnostics are starting to form a large proportion of treatment costs. It also points to the necessity of patent examiners being judicious while granting such patents, keeping in mind the three main criteria for granting a patent -- novelty, usefulness and application,” the study said.

December 23, 2007

Screening of new born baby to be made mandatory

Goa government is contemplating the possibility of making screening of new born babies mandatory in the state, which will help medicos to track down and diagnose any deformities in the initial stage itself.

"If we are able to do it, then Goa will be the first state in the country to have mandatory baby screening soon after the birth," state Health Minister Vishwajeet Rane said.

The state, with 14 lakh population, has a considerably good health services with low infant mortality rate.

"If we are able to trace deformities at initial stage, we can correct them rather than waiting for the child to grow," Rane said adding that Delhi government is working on a similar lines but Goa wants to be the first state to implement it.

Rane has also got the consent from the state Chief Minister Digamber Kamat who during his Liberation Day speech on December 19 made a special mention about the plan.

The state Health department, which has failed to make HIV testing mandatory following opposition from certain section, is pressing hard for this new concept.

To ensure that every parent get their child screened, the health minister said, "If they don't screen the baby within 48 hours, than they will not be given a birth certificate.

Rane said the mandatory screening is adopted in places like Philippines, Bangladesh, Singapore and Abu Dhabi, and will be implemented in Dubai from first of January.

The health minister also said that the government intend to set up medical city in the state, which will not only increase tourism but also give Goans access to world class medical facilities, Rane said.

December 18, 2007

Indo-Malaysian venture to train doctors

Considered as the first Indo-Malaysian joint venture by a private medical institution, the Bachelor’s of medicine and Bachelor of surgery programme offered by Melaka Manipal Medical College is becoming a favourite among Malaysians.

With 250 students currently enrolled in the programme, the institution is playing a major role in training Malaysian doctors. The college offers a twinning MBBS degree for medical undergraduates. Students undergo two and a half years of basic sciences and introductory clinical training in the Manipal campus in Karnataka and the remaining two and a half years of medical training is completed in the Melaka campus, Malaysia.

According to P Sripathi Rao, dean, Kasturba Medical College, Manipal, the five semesters of the course conducted in Manipal includes basic sciences and pre-clinical subjects with clinical training. “In Malaysia, students continue with their clinical training. In Manipal, each student is assigned a lecturer who act as a guardian,” he added.The medical college was created in 1997 following an agreement between the governments of Malaysia and India.

“The two governments signed an MoU to train Malaysians students in India. Malaysia has a long history of having many of its doctors being trained in India. And Manipal was chosen as the medical partner in India,” said Rao. “In February 2004, Melaka Manipal Medical College was included in the WHO directory of recognised medical colleges. Also, in the international medical education directory of the Educational Commission for Foreign Medical Graduates.

The degree offered by the Melaka Manipal Medical Colleges is also recognised by the Sri Lanka Medical Council,” said Vidya Pratap, director, PR.

Apollo Hospitals to invest Rs 600 cr in tier II cities

Apollo Hospitals has chartered out a massive Rs 600-crore expansion plan to make its presence felt in tier II cities.

Apollo Hospitals MD Preetha Reddy told ET, “We have finalised our decision to enter the tier II cities. Initially, we would come up with 10 hospitals across the nation.”

The company would come up with 150 to 200 bed capacity hospitals in tier II cities across the length and breath of the country and is under the process of identifying locations for the proposed hospitals. Ms Reddy said that the management would invest Rs 50-60 crore in each of its hospital.

Apollo had appointed a US-based consultant company specialised in healthcare projects for drafting the nitty-gritty of its entire plans. “In total, we would be investing Rs 600 crore for our 10 hospitals in the tier II cities,” said Ms Reddy. The funding would be a mix of equity and debt. However, the ratio is still being worked out.

Andhra Pradesh Doctors to get security cover

If you get violent with a doctor in Andhra Pradesh while he or she is on duty hen be prepared for three years of jail.

The Dr Rajasekhara Reddy government has issued an ordinance to ensure safety to doctors. The Ordinance says any act of violence on a doctor, nurse or paramedical staff while on duty in a government or private hospital, will lead to three years in jail.

After the government's decision, the doctors called off their strike and will join work from tomorrow morning.

''So far it was just three months of jail and was a bailable offence. Now if property is damaged or if a doctor is assaulted then he will straight go to jail and only the magistrate will have powers,'' said Mohd Shabbir Ali, Cabinet Minister, Andhra Pradesh.

Doctors in Andhra Pradesh have been protesting against three incidents of assault on them by relatives of patients.

The ordinance cleared by the cabinet says that any damage to property and equipment will also be construed as an offence.

To take care of complaints by patients or their relatives, a Grievance Redressal Authority will be set up in all government hospitals.

''We hope that it will be enforced and implemented. We should feel protected only then will our minds work freely and we can give better service,'' said Dr Janaki, Government Doctor.

Junior doctors or medical students however say they will continue their strike until Special Protection Force is posted to guard all government hospitals. Junior doctors work as an extended arm of the government doctors and mainly take care of out-patients

British NRI docs looking back at India

India is now experiencing a reverse brain-drain with its well resourced hospitals with state-of-the-art facilities wooing back a sizable number of NRI doctors, who worked with the National Health Service of Britain for years.

Quoting the director of one of India's leading private hospital chains, The Sunday Times reported that he was receiving five job applications a week from NHS doctors and that half his 3,000 consultants were from Britain.

"There's a feeling that India's time has come and there's a huge need for these people to come back," Anupam Sibal, director of the Apollo hospital in Delhi said.

Doctors say they are moving to India because of its economy, state of the art equipment, higher standards than the NHS and a better quality of life.

There has been a boom in private hospitals in India that resemble luxury hotels, with marble foyers and corridors mopped by an army of liveried cleaners.

One of those who have made the transition is Mahesh Kulkarni, an orthopaedic surgeon, who left Bristol Royal Infirmary after 10 years in Britain. He is now a consultant at the Aditya Birla Memorial Hospital in Pune.

"The hospitals are better than in Britain. They are spotless and clean compared with the old hospitals in the UK, some of which are more than 100 years old," he said.

Govt to recognise medical degrees of foreign nations

In a decision likely to benefit Indian doctors settled abroad wanting to return to their motherland, the government proposes to recognise the medical degrees of other countries, including the United States and United Kingdom.

Addressing an Indo-US health summit here, Health Minister Anbumani Ramadoss today said the government proposes to recognise the medical degrees given by countries like United States, United Kingdom, Australia, New Zealand and others.

"I want the support of the Medical Council of India (MCI) on this," he said.

"A lot of Indians who have gone there, studied there, want to come back. The government of India has proposed that we need to take a decision so that a lot of doctors who want to come back to India can do that," he said.

Asked on whether New Delhi should wait for these countries to recognise Indian degrees, he said, recognising their degrees first would be a step forward. "It is to our advantage. It is the first stage, eventually they would reciprocate," he added.

Ramadoss also emphasised the importance of changing the curriculum for emergency medicine in the courses being offered in India. "The concept of emergency medicine is not developed in India even though most of such specialists abroad are Indians," the Minister said.

Ramadoss added it was the curriculum at the undergraduate level which needed to be changed. "We need an international and more practical curriculum," he said.

December 15, 2007

US gives parity status to India's medical education

The United States has said India's recognition system for under-graduate medical courses is at par with theirs, an achievement that could facilitate mobility of doctors from here to US.

National Committee on Accreditation in the US, the apex body responsible for foreign accreditation, has granted parity to the recognition system in India for the courses.

"The MCI had sought parity status from the National Committee on Accreditation. It was granted last month, which means quality wise, the under-graduate courses in India are at par with the US," Dr Vedprakash Mishra, Vice-Chancellor, Datta Meghe Institute of Medical Sciences University, who was part of the MCI team to negotiate with the US agency, told reporters at the Indo-US Healthcare Summit here.

The parity has been granted for two years. "During this period, our recognition system will be monitored by them. Then India will get permanent parity status," he said.

December 14, 2007

Medical apex body to be set up on the lines of UGC

The Union Ministry of Health and Family Welfare has come up with a proposal to set up a Medical Grants Commission (MGC) on the lines of the University Grants Commission (UGC) to regulate all medical colleges in the country.

According to Ministry sources, there are about 262 medical colleges in the country at present and the number is growing constantly. "A need was felt for a Commission to support Government medical colleges in the country. The UGC has a mechanism for assisting the colleges but we do not have any such mechanism so far. We thus thought of an apex body on the lines of the UGC," said an official of the Ministry.

As per the plan, the MGC will regulate the growth of substandard medical and dental colleges, and will also help rationalize their fee structure. "The MGC will aim at putting an end to the malpractices associated with running private medical and dental colleges," added the official.

The official further added that for maintenance of a medical college, it needs huge funds which the state Government is unable to support.

In the recent times, there has been a significant rise in the numbers of private medical and dental colleges which are neither having appropriate infrastructure, nor providing quality teaching.

The guidelines for the setting up of MGC are being worked out. Though it will be primarily based on the UGC model, it will not be completely replicated.

The plan is at its initial stage and once finalized, it will be sent to the Parliament for its approval.

At present, the Medical Council of India (MCI) is the statutory body that evaluates the applications for new colleges and also regulates the functioning of colleges to some extent.

India, France to co-operate on basic medical research

India and France have joined hands to explore the possibilities of RNAi (RNA interference) in areas of basic medical research and biotechnology.

Inaugurating a three-day conference at the Centre for Cellular and Molecular Biology here on Wednesday, the scientific and programme officer French Embassy, Bruno Rouot, said that teams of scientists from India and France are jointly working in areas like Chemistry and Biology.

Eight Indo-France lab centres have already been set up and two research institutes are working in Pondicherry and Delhi. To further this programme and encourage scientists, scholarships and fellowships are also being awarded. There are seven scholarships for Indian students to the tune of 1300 Euros for six month duration, Rouot said.

He said joint research cells are working on water and ground water. He said that 250 projects were approved in 2006 as a part of the joint collaboration between India and France.

Participating in the meet, Chantal Vaury INSERM, Clermont Fd, France in Drosophila (fruit fly) said that in the area of basic research it is important to know how the cells work.

One project is already underway and the conference will work to establish connection between scientists from India and France. The ongoing project will analyse expression of genes with nuclei, she said.

Scientist are trying to understand the RNAi interference in positioning the regulation of expression. In medical research it is working in areas of fighting diseases like HIV, virus related diseases or how to cure a genetic programme that is going wrong. In areas of bio-technology, it informs how to silence a gene, she added.

December 12, 2007

Medical evidence more credible than eye witness account: Supreme Court

In an important judgement on medical jurisprudence, the Supreme Court had held that medical evidence will prevail over the eye-witness account if they were contradictory.

"The medical evidence will assume importance while appreciating the evidence led by the prosecution and will have priority over the ocular version and can be used to repel the testimony of the eye-witnesses," a bench comprising Justices P P Naolekar and Justice D K Jain said.

The Bench passed the order while setting aside a lower court's judgement which had sentenced four people to life imprisonment for killing a man in 28 years ago.

In the lower court it was alleged the accused had entered into the house of deceased around midnight and had beaten up his family members which according to prosecution led to death of one member.

All the eye-witnesses, while deposing before the trial court, had categorically stated the deceased was injured by the use of firearms.

But post mortem of the body showed that there were no indication of any firearm injury on the person and no pellets, bullets or any cartridge were found on the body.

Rejecting the eye-witness account, the apex court said, when medical evidence specifically rules out the injury claimed to have been inflicted as per the eye-witness version, then the court can draw adverse inference that the prosecution version is not trustworthy.

December 10, 2007

Govt thinking of single medical authority for PG Education

The government is considering setting up a unified authority for regulating post-graduate medical courses in the country, Health Minister Anbumani Ramadoss said on Friday.

“In India, we have two authorities to regulate post-graduate medical education; the Medical Council of India and the National Board of Examination,” the minister told Rajya Sabha in response to supplementaries during Question Hour.

The minister acknowledged that MCI-regulated post-graduate education has been recognised by many countries except in the neighbourhood. “But as far as National Board of Examination is concerned, there has been wider acceptance internationally because of the standards of education and its quality,” Ramadoss said.

The minister, however, emphasised the government would take a final decision on the recommendation for a unified authority only after consultations with the stakeholders concerned. He also declared the government was going in for a drastic change in the curriculum at both levels. “The curriculum we are following today is a little outdated. Hence, we are going in for a new curriculum change according to modern concepts, modern technology development,” he said.

The minister, who’d been pushing for a mandatory stint for young doctors in rural areas, also said the government was going to allow government hospitals at district headquarters to join hands with private players to start medical colleges. This is to bridge the divide between six states where two-thirds of India’s medical institutions are located and the rest of the country.

Of the 270 medical colleges in India, six states — Tamil Nadu, Kerala, Karnataka, Andhra Pradesh, Gujarat and Maharashtra — account for 180 of them. The remaining 23 states share the rest.

“There is a huge lacuna in the states of Uttar Pradesh, Bihar, etc. Bihar has only eight medical colleges for a population of 110 million. Uttar Pradesh has 16 and Madhya Pradesh has eight. In the Northeast also, there has been a huge lacuna,” he explained.

December 06, 2007

Medicines may get cheaper

In a major blow to chemists charging hefty margins from consumers, the government has decided to limit trade margins on all medicines sold in the country. The move will take away companies’ freedom to decide trade margins for almost three-fourths of the market. Currently, trade margin cap is prescribed for only one-fourth of the Rs 35,000-core domestic pharmaceutical market.

The margin for this three-fourth of the market will be fixed at 10% of the maximum retail price (excluding excise duty and other applicable levies) for wholesalers and 20% for retailers, government sources said. Consequently, the retail prices of medicines may come down. A notification to this effect is likely in the next couple of weeks. The ministry is expected to amend the drug price control order of 1995 soon to introduce the caps.

Sources said margins for a smaller fraction of the market — brands sold by their chemical name, which account for less than about 5% of the market — will be fixed at 15% and 35% respectively.

Reigning in trade margins was a priority for chemicals and fertilisers minister Ram Vilas Paswan, who had earlier asked companies not to charge margins as high as 10-20 times the cost of production on many drugs.

The policy will be enforced by National Pharmaceutical Pricing Authority (NPPA). The chemicals and fertilisers ministry has already said it would be the price watchdog’s responsibility to monitor overcharging of trade margins.
There will, however, be some exemptions for the small scale companies as most of them rely on chemists unlike bigger companies that employ a vast army of salesmen to ‘educate’ doctors about their brands.

Small companies will be allowed to pay an extra fee to the chemist as a support to compete with larger firms. In terms of percentage, it is this segment where margins are the highest. Bringing margins from above 1,000% of production cost to 50% (wholesale and retail together) would benefit the consumer, and at the same time, the extra fee would still give them an edge over bigger rivals.

It is to be noted that for the three-fourth of the market where new margins are being notified, there is no check on the retail price. That is, companies are free to decide a price but have to restrict trade margins to a percentage of that. Earlier it was thought that increasing the retail price would enable companies to give a higher margin in rupee terms, while complying with the percentage ceiling.

However, with the National Pharmaceutical Pricing Authority strictly enforcing the cap on annual price increase — 10% since early this year — on all medicines outside government price control, a cap in percentage terms is considered not prone to abuse.

Medicines may get cheaper

In a major blow to chemists charging hefty margins from consumers, the government has decided to limit trade margins on all medicines sold in the country. The move will take away companies’ freedom to decide trade margins for almost three-fourths of the market. Currently, trade margin cap is prescribed for only one-fourth of the Rs 35,000-core domestic pharmaceutical market.

The margin for this three-fourth of the market will be fixed at 10% of the maximum retail price (excluding excise duty and other applicable levies) for wholesalers and 20% for retailers, government sources said. Consequently, the retail prices of medicines may come down. A notification to this effect is likely in the next couple of weeks. The ministry is expected to amend the drug price control order of 1995 soon to introduce the caps.

Sources said margins for a smaller fraction of the market — brands sold by their chemical name, which account for less than about 5% of the market — will be fixed at 15% and 35% respectively.


Reigning in trade margins was a priority for chemicals and fertilisers minister Ram Vilas Paswan, who had earlier asked companies not to charge margins as high as 10-20 times the cost of production on many drugs.

The policy will be enforced by National Pharmaceutical Pricing Authority (NPPA). The chemicals and fertilisers ministry has already said it would be the price watchdog’s responsibility to monitor overcharging of trade margins.
There will, however, be some exemptions for the small scale companies as most of them rely on chemists unlike bigger companies that employ a vast army of salesmen to ‘educate’ doctors about their brands.

Small companies will be allowed to pay an extra fee to the chemist as a support to compete with larger firms. In terms of percentage, it is this segment where margins are the highest. Bringing margins from above 1,000% of production cost to 50% (wholesale and retail together) would benefit the consumer, and at the same time, the extra fee would still give them an edge over bigger rivals.

It is to be noted that for the three-fourth of the market where new margins are being notified, there is no check on the retail price. That is, companies are free to decide a price but have to restrict trade margins to a percentage of that. Earlier it was thought that increasing the retail price would enable companies to give a higher margin in rupee terms, while complying with the percentage ceiling.

However, with the National Pharmaceutical Pricing Authority strictly enforcing the cap on annual price increase — 10% since early this year — on all medicines outside government price control, a cap in percentage terms is considered not prone to abuse.

December 02, 2007

Health ministry may hive off medical education into new department

In a move that could trigger a major debate among the medical fraternity, the government is reportedly toying with the idea of creating a separate department of medical education in the ministry of health and family welfare under a secretary level officer.

Coming just after the Presidential assent to the AIIMS (Amendment) Bill 2007, said sources familiar to the development, the proposed department is set to strangle the autonomy of Medical Council of India (MCI) and ignite fresh sparks in the ongoing ministry-medical fraternity tussle.

At present, MCI, a statutory body, regulates medical colleges, affiliation, new colleges and doctors registration.

According to the initial plans, the new department will be headed by a non-IAS secretary who may be picked up from the medical fraternity, sources close to the development told SundayET.

The new department is expected to handle regulatory and administration works related to medical education in the country. The sources further said that the creation of the new department was necessitated by the government’s conscious decision to allow more medical institutions on public-private partnership (PPP) mode.

Once the new department is created, the functioning of the country’s medical college-cum-hospitals, including All India Institute of Medical Sciences, Post Graduate Institute of Medical Education and Research and others, will be under two departments. “The health issues will be handled by the health department, and the issues related to the medical education of such hospitals will be administered by the proposed department of medical education,” said the sources.

Understandably, such a technical department — which may also oversee the education content of the medical institutes — will be headed by a health specialist. At present, there are 14 technocrat secretaries or equivalent to secretaries at the Centre who are not from any of the Central administration services.

Experts, however, feel the move could curtail the autonomy of MCI and strangle the autonomy of government institutions. “The idea looks good on paper, but what’s the need of a separate department when you have a fully functional Medical Council of India to look into medical education? Even the proposed appointment of a medical fraternity member as the secretary is of no consequence because eventually he has to report to the minister. I feel the move is one more attempt at curbing the autonomy of statutory bodies,” said Dr Ajay Kumar, president, Indian Medical Association (IMA).

Now, even as the move aims at co-opting the private sector to streamline the education system and meet the rapidly rising demand for medical professionals, the stage looks set for a fresh round of tussle.

December 01, 2007

New IRDA norms soon for health insurers

The Insurance Regulatory and Development Authority (IRDA) plans to soon come out with separate guidelines for health insurance players, aimed at comprehensive medical insurance coverage and redressal of consumer grievances.



“To handle a plethora of issues relating to health insurance with focussed attention, a separate health unit has been set up in the Authority; specialised resources have been inducted to strengthen the role of IRDA in the development and better conduct of health insurance business,” C.S. Rao, Chairman of IRDA, said at a conference organised by FICCI here on Thursday.

He also said that to increase the penetration of health insurance in the country, the Authority has recommended to the Government to bring down the capital requirement for stand-alone health insurance companies from the present Rs 100 crore to Rs 50 crore.

Rao also said that the committee constituted to look into the problems faced by senior citizens had submitted its report. “We are in the process of examining the report and taking further action on the recommendations that have been proposed,” he added.

The Authority, he said, had already taken steps towards standardising the definition of pre-existing diseases, which are now reflected in the health insurance products.

“The General Insurance Council, consisting of all-non life insurers, is also working to build a consensus on the issue,” the IRDA Chairman said.

The premium from health insurance products in non-life companies has grown from Rs 675 crore in 2001-02 to Rs 3,200 crore in 2006-07, while it has the potential to grow up to Rs 30,000 crore by 2015, Rao added.

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