56.1 Some of problems – tip of the iceberg

Today (aug-2012), the medical education is falling apart and health care costs are rising day by day. Due to rise of self-finance colleges, many brilliant students are not able to get admission and seats are passing to far less studious and intelligent students. So the quality of doctors will degrade rapidly in times to come. Plus, the Ministers\IAS are making cumbersome laws that will reduce the competition in pharmacy business, and thus will drive up the medicine costs. What Gazette Notification drafts can reduce the problems?

56.2 How to improve Medical education and reduce medicine costs?

I at RRP propose following Gazette Notification drafts to improve medical education and reduce medicine costs :

1. Right to Recall National Health Minister, State Health Minister, District Health Officer : This will reduce corruption in apex body as well improve general efficiency and transparency.

2. RTR Medical Council of India Chairman and RTR State Medical Council Chairman : The self

3. Many times doctors deliberately prescribe expensive medicine when cheaper medicine is available. Solution? If patient wants to disclose the medicine he is taking, the pharmacists will enter the list of medicine patient took along with his mobile number and email ID. So that competing companies may send him list of same medicine with cheaper price

4. Many pharmacists are willing to sell medicines at lesser commissions. But the fellow pharmacists hire criminals to stop such pharmacists. Right to Recall Police Commissioner will reduce the strength of criminals and so pharmacists willing to sell medicine at lesser prices will be able to sell medicine at lesser prices

5. Using TCP, remove product patent and re-install process patent law.

6. Using TCP, enact a law that MBBS cannot leave India for 8 years and DM cannot leave for another 2 years and MD cannot leave India for 3 another years.

7. Using TCP, abolish all self finance seats in medicine. All medical colleges will have zero tuition fees, and will carry condition that doctors cannot leave India after MBBS for certain number of years.

8. The Govt will make a website, on which pharmacy companies, registered doctors etc can suggest “equivalent medicines” for a given brand name. This will enable patient to know if the doctor has suggested an expensive medicine or cost-effective medicine.

56.3 Reducing motivated spurious medications

Please note – spurious medication is different from over-cautious medications. Over cautious medication is when doctor in order to rule out even minutest chances is prescribing tests and medicines which are less likely to be needed. This is NOT because doctor is getting commission etc but because doctor is over-cautious.
Spurious medication is when doctor is deliberately recommending more expensive tests\medicines, even when cheaper tests\medicines are available, and recommending tests\medicines which are not even needed to begin with. The main reason is that doctors get commission from testing companies and medicine-making or medicine-selling companies. Please note again : over-cautious medication is different from spurious medications. And only 5% to 10% doctors do such mal-practice. But problem needs to be addressed as this 5% can create suspicion in all 100% cases.

Following are the Gazette Notification drafts I propose to reduce the problem :

1. If Jurors see a serious suspicious that testing-center-owners or medicine-company-owners were paying doctors in anyway, they conduct a narco-test in public. Please note — there will not be narco test of doctors. Only the owners or key managers in medicine companies will be narco-tested.

2. CAG (Comptroller and Audit General) will audit expenses of all pharmaceutical companies with turnover above certain limit. And if that company is paying doctors directly or indirectly large amounts, it can detect it, and bring the case to the Jurors. Right to Recall CAG will reduce the problem of CAG taking bribes and will also improve efficiency of CAG. Such Audit and Jury Trial will reduce the possibility of pharmaceutical companies directly or indirectly paying doctors.

3. The dealers and wholesales of medicine will not get more than a certain % of amount as commission. This is important. Because medicine companies are too large and organized to give bribes to doctors who are scattered all over India. So they give 30% to 50% commission to dealers, with intention that dealers will pass part of it to doctors. Otherwise, no dealer is contributing value that matches 30% of price as commission. Once commission has a lower and upper cap, the ability of dealers to pay doctors will reduce.

4. The medicine cannot be sold above or below the written price. And a medicine-making company must sell one drug at same price to all its buyers on a given date. This is important. If medicine is to be sold at price written, then medicine company will have to charge same from all patients. So if price is too high, sale may reduce and revenue may suffer. And if price is low, then dealer’s commission will be low too and dealer will not be able to bribe doctor

5. Promoting direct purchases from medicine-making companies so that dealership reduces.

6. The Govt will make a website, on which pharmacy companies, registered doctors etc can suggest “equivalent medicines” for a given brand name. This will enable patient to know if the doctor has suggested an expensive medicine or cost-effective medicine. This will expose doctor to a patient , which will enable patient to change doctor. Also, fear of expose will increase if such website is there.

7. Banning all fees in medical colleges :- high admission fees not only reduce talent level in medicine, but also create a need and provide a moral cover to loot patients. So admission should be strictly merit based (reservation should apply) and fees should be zero.

56.4 What can YOU do to improve medical education and reduce medicine costs in India?

Please read chap-13 of this book http://rahulmehta.com/301.htm . It has several steps where-in you can spend 6 hours a week and help to bring TCP draft in Gazette in India. The steps involve distributing pamphlets, informing citizens on motives of leaders such as Congress MPs, BJP MPs, The Anna etc who oppose TCP draft, by giving newspaper ads and contesting elections. Once TCP gets printed in Gazette, using TCP, it will become easy for activists to get citizens’ opinion law-drafts necessary to improve medical education, reduce medicine costs and reduce spurious medicines. With this, activists can ban admission fees, reduce possibility that pharmaceutical companies are paying doctors and so forth. With these laws, quality of medical education will improve and spurious costs will decrease.