Health care is among the most corrupt services in India
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7379.10/c (Published 04 January 2003) Cite this as: BMJ 2003;326:10All rapid responses
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Indian medical system is not very clena one.There are corruption at
every level in India.There is corruption in Medical colleges,at
administrtaive levels and MCI-Medical Council of India has been termed by
the Supreme Court the Apex court in India as "Den of Corruption".Thats the
situation in India.Very sad indeed.
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I strongly oppose the message delivered in the article and subsequent
rapid responses. I feel that Indian public health machinery is one of the
oldest and finest machinery throughout the world on which more than 70%
Indian population depends. Indian primary care doctors and para-
professionals are working honestly in adverse conditions- without basic
amenities. The survey highlighted in the news roundup was only taken from
cities where respondents of survey can afford health services from their
pockets to some extent. Nevertheless, the rest of India needs these
primary care doctors. Calling them corrupt and comparing with police is
demeaning the entire medical profession.
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AMost private medical colleges in India are in a bad shape.I know how
they pass their exams.Bribing is so common in most private medical
colleges in India.There are no proper regulating bodies for medical
eductaion.The medical council of india which is supposed to regulate
eductaion in India has been termed by the supreme court of India-as the
"largest bodyof corruption".That itself speaks how corrupt teh system is.
You may be from a Gooverment controlled medical school which may have
better standards.
I have nothing more to say Dr Suja.
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It is with my deepest regrets that I write to say that Dr Sumithra
Josepha unfortunately (and probably unintentionally) appears to have
generalised the untoward practices and experiences of certain medical
students/doctors in India to every medical student and doctor in the Sub-
Continent.
India being a huge country and the second most populous in the world,
produces a number of talented young people many of whom aspire to study
Medicine. However, the ratio of prospective students to the number of
available training places is very high and therefore, competition is
extremely intense. Entry into a Government Medical School is usually
dependent on the ability to obtain the highest possible scores from School
Leaving Public Examinations or specific University Entrance Tests or a
combination of both.
While it is true that coming from an affluent family can bestow one
with an unfair advantage by providing easy access into Private Medical
Schools merely through paying large sums of money, the majority of Indian
Medical School graduates in Government Institutions are typically from
middle class backgrounds. Their strength comes through merit and not
money. They are hardworking and achieve success through fair means. It is
to be noted that doctors from this pool who seek overseas experience in
Western Countries successfully pass standardised Assessment Exams like
PLAB (Professional and Linguistic Assessment Board, UK) and the USMLE
(United States Medical Licensing Exams) often with high scores in their
first attempts.
It is also the case that despite the mode of entry, some Private
Medical Schools do provide good training and produce good doctors. I do
not agree with Dr Sumithra Josepha that the Government of India should ban
all Private Medical Schools. Instead, I suggest that fair entry criteria
are introduced and enforced so that their doors can open to students from
middle class backgrounds as well.
The Indian Medical System like any other medical system in the world
has its advantages and disadvantages. I acknowledge that there is a
certain degree of corruption in the system and this may be increasing.
However, I think it would be fair to say that there are still several
doctors in India both in the Government Sector and in the Private Sector
who voluntarily choose to put the care and welfare of their patients as
their first and foremost priority and concern however hard it may be in an
increasingly difficult and competitive market economy. I agree with Dr
Sumithra Josepha that strong medical regulatory bodies are needed in
India.
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My Medical Undergraduate degree is from a Government Medical School in India
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Indian medical system is very corrupt perhaps one of the most corrupt
in the world.The corruption starts right from their days in med school
where they have to pay huge amount of money to get in and pass out.This
mindset get carried on to their life later where their only aim is to make
more money and nothing else.I feel its high time India ban private medical
colleges whose only aim is to make money!In fact corruption is so common
in India,oen of my freidn who was in private practice once told me that he
charges for blood tests when actually no test is carried out! Absence of
regulating bodies-Medical Council Of India is too weak an organisation and
corrupt makes corruption and unethical practices more easy in India.Its
high time Govemrent of India make strong regulating bodies who will
control private practitiones in India
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Healthcare in Mumbai, India, is distinguished by very high levels of
corruption even in the private sector. Corruption occurs in three forms-
split-fee, pharma-company interference and performance of unnecessary
tests and procedures. In my experience corruption is practiced by almost
all doctors. In fact it is so much a part and parcel of work that I was
asked by a young medical student
how much cut I can offer him, when he returns to start practice in Mumbai
and refers patients to me!
I found it ridiculous when the Indian Medical Association opposed
reservations saying it is anti-merit, while they do not take any stand
against split-fee, when is not only anti-merit but also grossly
psychopathic and predatory.
The most ironical aspects of this are-those who practise split-fee are
guaranteed rapid and stupendous professional success and inspire awe among
their clientele, there is great one-upmanship among doctors who offer
kickbacks and worst of all-there is no method to catch the corrupt folks
red-handed or no punishment for them.
So it will go on.( and get worse, I suppose.)
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Dear Sir,
There seems to be an extremely self-defeating air about the responses
to the article detailing corruption in the Indian health care system. By
blaming the “corrupt system” we justify turning a blind eye as well as
flowing with the tide. After all, who can fight the system?
As far as I can see, corruption boils down to a very personal
question to which each of us must seek an answer: Should I or Shouldn’t I
indulge in unethical and corrupt practices. The answer should be self-
evident.
Blaming others such as the corrupt law enforcement, lack of
accountability, and poor salaries only further entrenches the elements we
seek to remove. It has been estimated that only 20% of the people at the
receiving end of corrupt practices protest – and it’s unlikely that many
doctors form part of that group. All of us have been guilty of choosing
the easy way out rather than the right way, and no amount of hand wringing
can change this reality.
The largest association of doctors in India, the Indian Medical
Association seems more concerned with the recently passed consumer
protection act than doing a serious introspection of its own declining
standards of morality. The heads of the regulatory council of medical
education the Medical Council of India are embroiled in allegations of
payoffs. Surely, they should be at the forefront stemming this tide rather
that providing fresh impetus to the torrent of corruption?
We must believe that each of us can resist and in our own way we must
provide examples others can follow. We are the truly privileged- we have
received a state subsidized medical education, we can maintain a
reasonable lifestyle while discharging our duties to the best of our
abilities, and those of us in Institutions can influence the minds of
prospective doctors. Abdicating our personal responsibility towards this
problem by invoking the “system” makes us weaker than we really are.
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dear sir,
you have dealt with corruption in health services in india going to the
root causes and have suggested remedial measures.
in the final analysis, i think the blame lies solely with the people. the
people select the government to deliver the goods. the politicians are the
masters of the system. corruption starts there and then the poison
permeates into the whole system including the health services. whether
there is a way out of the mess is a matter of debate.
further, corruption is not simply a matter of accepting bribes or penny
pinching.there is a whole gamut of illegal activities. there is connivance
with spurious drug mafia,trade in human organs, wheeling and dealing with
all sorts of illegal activities. in gujarat riots, the doctors for the
first time in indian history participated in mayhem, murder, arson and
loot. also doctors of one community refused to treat patients from another
community.
may be a doctor looses a bit of his concience with accepting his first
bribe. then he gets deeper and deeper into the morass, finally
participating fully in criminal activities.
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Dr. Kumar paper about corruption in health services in India is a
very good point to study similar cases in other undevelopment
countries.Here,in Brazil,the federal government second amount of the
public money go to the healh system,named SUS.However,despite the fact
that Brazil is a large country,the public health system works in very bad
conditions.For many years are proved allegations of corruption in various
levels of the system.About 40.000.000 of brazilian citizens have a private
health secure,but 100.000.000 depends only by the public health system,the
SUS.Health is responsability of the city;the money cames from the central
government,after that to the states and then is distributed to
municipes.Certainly a lot of money "disappeared" in this burocratic
way.Propositions made by the general attorney to sustain surveillance of
this path was ignored by the past government (by January,1,2003 we have a
new president,left-winged),and even the municipal and states authorities
don't let a public and non-governamental approach.In fact,is a lot of
perception of corruption,also in Transparency International surveys,but
not pointed only the health system.I hope that the new authorities of
Brazil take the necessary measures to allow corruption and show
transparency to the citizens.But I have my doubts,the country is very
large,as in India case,and a lot of efforts have to carry out this problem
or,in other words,to give health to the majority of brazilian
people,without financial resources.
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Worried about the well being of my patients.
I have read this article and all I can say is that I agree with
everything that has been said.
I am a General Practitioner in Birmingham (UK)and have been trained
by the excellent system here in England. I have a high Asian Indian
population on my practice list and I see the problems outlined directly.
Patients who are under my care go on holiday to India, often for months at
a time. Due to the fact that a lot of them are elderly with medical
problems that are known of and optimally treated, they inevitably get
unwell and are seen by the 'Private' Hospitals there. Here they have a
number of tests performed, most of which are unnecessary and are given a
range of medications, often which interfere with what they have been
prescribed by myself. I despair when they return with unanswered questions
which I am expected to sort out due to a, often money hungry, negligent
doctor.
As far as I can see, unless there is a governing body like the GMC
here in the UK, in India, this will continue and poor patients will
suffer. The NHS may have its faults but as far as I am concerned, it is
the best healthcare system in the world, fair to both the rich and the
poor.
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