THE SOCIO-ECONOMIC COST OF UNETHICAL

MEDICAL PRACTICES

Recently, the Indian Medical Association has staged a protest

against the Government’s proposal of starting a 3 ½ years’ basic
course for ‘rural doctors’. The protest is not really against any
reduction in quality of medical treatment. The protest is because
their share of the loot will be reduced. Presently, for want of any
doctors in the rural areas, whoever can afford to go to the towns,
perforce goes to the doctors practicing in the urban areas.

The position of the IMA is most illogical. Hardly any MBBS

doctor is prepared to work in the rural areas, forget about the MD
and MS doctors. We know it too well that even government
doctors are found missing from their places in the rural areas.
PHCs hardly even open—if they open, they limp along on the
paramedics. And yet the IMA would not want the government to
create a cadre of doctors who would be obliged to work in the
rural areas.

Even on purely scientific grounds, the opposition has no merit.

By what logic a 3 ½ years course would not enable a man to treat
most of the basic problems that beset the rural population? Do we
really need the present-day MBBS to treat worms, upset stomach,
diarrhea, cough and cold, aches, leucorrhea, menstrual problems,
boils, heat stroke and the like? Won’t these rural doctors be able
to detect tuberculosis and treat it? Would they not be better than
the outright quacks who are treating the rural people now? Is it
not the responsibility of the Government to protect them from the
quacks? How can the IMA deny them the right to better
treatment? The rural folks would not mind getting treated by
regular MBBS doctors, but where are they to be found in rural
areas?

The IMA wants to maintain the status quo because the presence
of rural doctors would mean that fewer patients would then be
forced to go to the towns where the regular MBBS doctors and
hospitals are looting the patients.

Let us face it. We presume that very few Indians have medical
insurance—largely because it does not normally cover OP
treatment. For all those who are not covered by some sort of
system like the CGHS, getting sick and a visit to the hospital is a
harrowing experience.

The entire projection of low-cost medical services in India is

from the point of view of medical tourism. The USP is that
surgeries in India would typically cost 50-75% less than the US
and this significant cost reduction enables the foreigner to
purchase a round trip air ticket, recuperative holidays post-
treatment in a lazy beach location in India and return home
saving money.

Sounds nice for the foreigner, but we should be more concerned

about the aam Indian aadami. The cost of numerous procedures
may be low for an American—is it low for the aam Indian
aadami too? Certainly not.

Can the Indian masses really afford the cost of the unnecessary
caesareans that are imposed upon them? Can the people afford
the cost of the angioplasties that are imposed upon them?

The OP fees varies but even in mofussil areas now it is not less
than Rs. 200/-. Usually, most Indians would go to a private
practitioner where once again the consultation fees would be
about Rs. 200/-. The doctor would order a series of pathological
investigations. They would set him back by another Rs. 1000/-
for blood, urine and stool tests. Specialized tests like ultrasound,
X-ray or CT scan would cost more. Finally the doctor would
write the prescription. The cost of the drugs could be anything
depending on what he has prescribed. Your financial condition is
never taken into account when prescribing the drugs.

Medical treatment in India could have been tolerable but for the
unethical practices of doctors. We are forced into unnecessary
tests, are prescribed unnecessary drugs and frightened into costly
surgical procedures. The cost to the common man is literally
back-breaking. Many people go into debt because of this. You
have one sick man in the family and the monthly budget goes
bust. You have a chronically ill patient, like someone suffering
from asthma or heart disease and you had it.

The Government does not have any regulatory mechanisms

worth their name. On paper we have drug price controls. In
practice, the drugs are beyond the reach of the common man.
Generic drugs are even now not being promoted. The most
problematic area is the private hospitals. They do not have any
control at all. As a result they are completely free to charge at
will, whether for the consultation fees of the doctors or the
charges for the rooms.