A district medical officer from Australia who volunteered to work at a small charitable hospital in India has published an indictment of the Indian health system. David Berger’s paper in the British Medical Journal, titled “Corruption ruins the doctor-patient relationship in India”, is rekindling a debate which is years old in India.
It is a question of life and death but has had unbelievably little impact on public health. Berger has suggested sanctions of a sort — derecognition by medical licencing authorities in the UK, US, Canada, Australia and New Zealand of alumni of Indian private medical colleges practising in their jurisdiction. While a blanket ban would be clearly unfair and untenable, the suggestion does clarify that in a world without borders, Indian corruption is not just India’s business.
The paper draws attention to the “unvirtuous circle” of donations and fees in private institutions generating a debt burden, making doctors more open to corruption. This would be news to readers of a UK journal, but not to the Indian medical community. It also talks about the system of kickbacks and gratifications that flourishes in clinical practice.
Unscrupulous doctors prescribe unnecessary drugs and specific brands at the pecuniary urging of pharmaceutical companies, and order irrelevant tests for kickbacks. Medical organisations secure certification by dodgy means. These, too, are known evils. What surprises is that despite the obvious cost to the nation, there has been little political will to curb such practices, even after the crisis of confidence in the Medical Council of India that came to light in 2010.
While Berger has alluded to the unacceptably high out of pocket health expenses in India, he says nothing about insurance.
Perhaps it was not a factor in the small hospital where he worked. While insurance has increased business volumes, easy money has deepened the problem of unnecessary procedures, surgery and hospital stays. Again, this is an open secret in India. The government and the medical community know that such practices are eroding the public trust in doctors. Did they have to wait for a practitioner from overseas to blow the whistle, yet again?