Editorial Notes

[Editorial Notes] Writing out a clean Bill on health

Medical education needs continuous reforms; the National Medical Commission Bill could be the first step towards this.
By IASToppers
August 17, 2019


  • Introduction
  • National Eligibility-cum-Entrance Test (NEET)/National Exit Test
  • Empowering of community health providers for limited practice
  • Regulating fees for only 50% seats in private colleges
  • Representation in NMC
  • Overriding powers of the Centre
  • Significance
  • Other Benefits of the Act
  • Conclusion
  • IT’s Input
    • Amendments proposed in National Medical Commission Bill

Writing out a clean Bill on health

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  • Recently, there have been concern over a few clauses of the National Medical Commission (NMC) Bill which is now enacted.


  • There are five primary concerns i) the National Eligibility-cum-Entrance Test (NEET)/National Exit Test, ii) empowering of community health providers for limited practice, iii) regulating fees for only 50% seats in private colleges, iv) reducing the number of elected representatives in the Commission and v) the overriding powers of the Centre.

National Eligibility-cum-Entrance Test (NEET)/National Exit Test

Current Scenario


  • For the past few years, a separate NEET is being conducted for undergraduate and postgraduate courses.
  • In addition, there are different examinations for institutes such as the All India Institute of Medical Sciences and the Jawaharlal Institute of Postgraduate Medical Education and Research.

What the Act did?

  • This Act consolidates multiple exams at the undergraduate level with a single NEET and avoids multiple counselling processes.
  • NEXT will act as the final year MBBS examination across India, an entrance test to the postgraduate level, and as a licentiate exam before doctors can practice.


  • It aims to reduce disparities in the skill sets of doctors graduating from different institutions. It would also be a single licentiate exam for graduates across the world.
  • Thus, the government has in effect implemented a ‘One-Nation-One-Exam’ in medical education.

Empowering of community health providers for limited practice

Current Scenario

medical iastoppers

  • Concerns have been expressed over the limited license to practice for community health providers.
  • A recent study by the World Health Organisation shows that nearly 80% of allopathic doctors in the rural areas are without a medical qualification.
  • However, even with about 70% of India’s population residing in the rural areas, the present ratio of doctors in urban and rural areas is 3.8:1.

What the Act did?

  • The NMC Act attempts to address this gap by effectively utilising modern medicine professionals, other than doctors in enabling primary and preventive health care.


  • Evidence from China, Thailand and the United Kingdom shows such integration results in better health outcomes.
  • Chhattisgarh and Assam have also experimented with community health workers. Further, the Act requires them to qualify various criteria thereby ensuring quality.

Regulating fees for only 50% seats in private colleges

Current Scenario

  • Today, private medical colleges are capitation fee-driven, resort to discretionary management quota and often have charges of corruption against them.
  • The Indian Medical Council Act, 1956 has no provision for fee regulation.
  • Until now, ‘not-for-profit’ organisations were permitted to set up medical colleges which requires enormous investments and a negotiation of cumbersome procedures.

What the Act did?

  • The NMC Act removes the discretionary quota by using a transparent fee structure.
  • It empowers the NMC to frame guidelines for determination of not only fees but all other charges in 50% of seats in private colleges to support poor and meritorious students.


  • Along with the transparency of NEXT exams, the capping of fess would lead to the fee regulation through market forces. The Act also provides for rating of colleges.
  • Thus, reducing entry barriers for setting up medical colleges, along with their rating, is expected to benefit students.
  • They would be able to make an informed decision before seeking admission.


  • While a cap on fees is necessary, there is also a need for incentives to attract private investors.

Representation in NMC

Current Scenario

  • The election process of MCI is based on flawed principle in which MCI was elected by some doctors who, in turn, were regulated by the MCI itself.
  • These results attract professionals who may not be best suited for the task at hand.

What the Act did and its significance

  • The Act provides for a transparent search and selection process compromising of elected as well as nominated representatives, both in the search committee and the commission itself.
  • The government has further addressed the concern of preponderance of selected members in the commission by adding members from State medical councils and universities.

Overriding powers of the Centre

Current Scenario

  • In public emergencies, citizens expect the government to address issues. In the current set-up, it may not be possible all the time.

What the Act did?

  • The Bill allows the government to override any suggestions of the National Medical Commission.


  • The government should be able to give directions so that NMC regulations stick to their policies and powers.
  • The use of such authority would follow the principle of natural justice in which the NMC’s opinion would be sought before giving directions by government.

Other Benefits of the Act

  • The Act establishes the Diplomate of National Board’s equivalence to NMC.
  • It also promotes medical pluralism.
  • The Act brings paradigm shift in the regulatory philosophy from an input-based, entry barrier for education providers without corresponding benefits, to its becoming outcome-focused.
  • Autonomy to boards and segregation of their functions will avoid a conflict of interest and reduce rent-seeking opportunities.


  • The NMC Act is a serious attempt to meet the primary need of more medical professionals in the country.
  • However, there is no denying that medical education needs continuous reforms in order to usher in improvements in health care.

IT’s Input

Amendments proposed in National Medical Commission Bill

Constitution of the National Medical Commission

the National Medical Commission

  • The Bill sets up the National Medical Commission (NMC) by replacing the current Medical Council of India (MCI). Within three years of the passage of the Bill, state governments will establish State Medical Councils at the state level.
  • The NMC will consist of 25 members appointed by the central government.

Functions of the NMC include

  • Framing policies for regulating medical institutions and medical professionals.
  • Assessing the requirements of healthcare related human resources and infrastructure.
  • Framing guidelines for determination of fees for up to 50% of the seats in private medical institutions and deemed universities which are regulated under the Bill.

Medical Advisory Council

  • Under the Bill, the central government will constitute a Medical Advisory Council which will be the primary platform through which the states can put forth their concerns before the NMC.
  • Further, the Council will advise the NMC on measures to determine and maintain minimum standards of medical education.

Autonomous boards

The Bill sets up autonomous boards under the supervision of the NMC. These boards are:


  • The Under-Graduate Medical Education Board (UGMEB):Responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the undergraduate
  • Post-Graduate Medical Education Board (PGMEB):Same work as UGMEB, but at post-graduate level.
  • The Medical Assessment and Rating Board (MARB): MARB will have the power to levy monetary penalties on medical institutions which fail to maintain the minimum standards as laid down by the UGMEB and PGMEB. The MARB will also grant permission for establishing a new medical college, starting any postgraduate course, or increasing the number of seats. 
  • The Ethics and Medical Registration Board: This Board will maintain a National Register of all licensed medical practitioners, and regulate professional conduct.  Only those included in the Register will be allowed to practice medicine.

Entrance examinations: 

  • The Bill proposes a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-specialty medical education.
  • The bill seeks to establish uniform standards for medical education by proposing that the final year of MBBS exam, known as National Exit Test (NEXT), be treated as an
  1. i) An entrance test for post-graduate courses
  2. ii) A screening test for those who obtained a degree in medicine from abroad.
  3. iii) An exam to obtain the MBBS license for practice.


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