Health campaigning group calls for action on corruption in India

The Indian branch of the international People’s Health Movement organisation has expressed serious concerns about the increasing trend of corruption in India’s private medical sector.

In an open letter to India’s health minister, Harsh Vardhan, the movement called on the Indian government to act firmly against corruption in the private health sector. The organisation, which campaigns for equal health for all, said that such corruption can lead to substantial increases in the costs of care, impoverishment, and compromised health outcomes. It recommended that policy initiatives should be drawn up to curb corruption and warned that “private sector corruption is also in danger of becoming the acceptable norm of behaviour, to be universalized by policy.”

In the open letter T Sundararaman, joint convenor of the Indian chapter of the People’s Health Movement, wrote, “The worst aspect of private sector corruption is the all pervasive feature of kickbacks and commissions for referrals. That they secure an unfair market advantage is one of the problems. But the much greater problem is that these are in essence bribes paid to secure unnecessary diagnostics and treatments.”

The letter called for legislation against kickbacks and commissions in the private health sector and emphasised the need for professional councils to outlaw commission payments. It also called for more awareness about the impact of kickbacks among the public and healthcare providers.

After a recent initiative taken up by The BMJ to fight corruption in the healthcare sector, particularly in India, various organisations have come up with specific actions against kickbacks and commissions in Indian healthcare. In a recent editorial The BMJ’s India editor, Anita Jain, and coauthors wrote, “We plan to launch a campaign against corruption in medicine, which will begin with a focus on India. We know that India is not alone, but if we can defeat corruption in India we believe it is possible to tackle it for the benefit of millions of people in other countries with similar health ecosystems.” They added, “We urge an international fight back against kickbacks. Join us.”1

The Maharashtra Medical Council (MMC) has taken action to tackle corruption in the health sector by issuing a “show cause” notice to Kokilaben Dhirubhai Ambani Hospital in Mumbai for “asking doctors to refer patients to the hospital in exchange [for] bribe/commission.”2

Kishor Taori, MMC president, said in June, “In India, the practice of giving bribes/commissions is a major reason for doctors losing their credibility. I agree that it is very dangerous and spoils the doctor–patient relationship. MMC is trying to work on this . . . To begin with, we have written to 300 doctors’ organisations, accredited to the MMC, to spread awareness among their doctors.”2

In Maharashtra the Indian Medical Association has initiated a state-wide campaign to put a stop to referral services and the division of fees. The MMC said that the move aimed to make the profession “noble.”3

However, some organisations have strongly opposed the initiative. Nitin Bhagali, president of the Maharashtra based Association of Nursing Homes and Clinic Owners, told the Pune Mirror newspaper, “Cut practice [the practice of accepting commissions for referring a patient, including to a diagnostic laboratory]—though unethical—can be continued, as it is a question of survival for a freshly graduated doctor. We are forced to become businessmen by society. If others like property dealers and lawyers can charge their percentage, then why can’t we?”3