Mushrooming of Private Medical Schools in India, the Present Student Profile and Cost of Medical Education and its Impact on Equity, Health Care Accessibility, Cost and Perceived Quality of Health Care

Rationale: The mushrooming of medical schools in India has primarily occurred because of the large-scale privatization of medical education and the simultaneous loosening of government control over medical education. Private medical colleges that charge capitation fee are indicative of such commercialization of medical education. The term 'capitation' refers to huge sums of money and deposits demanded by private institutions, especially medical and engineering colleges, for granting admission to prospective students. World Health Organization norms state that there should be one doctor per 2,500 people; India approximately has one doctor per 1000 people. According to NSS data, the Indian government's share in overall expenditure on education is declining steadily; from 80 percent in 1983 to 67 percent in 1999. We see that Medical education has grown rapidly in India; from 11,800 admissions per year in 1990 to 24,000 in 2005. Much of this growth can been attributed to the opening of private, for-profit medical schools, which now account for about 42 percent of medical seats in the country. The flow of doctors from these medical schools and its impact on accessibility, cost of health care and perceived quality of medical care has to be explored Objective: The objective of this paper is to analyse the health care impacts such as equity, accessibility, cost and standard of medical care arising out of the opening of private-for-profit medical schools and the affordability of medical education and admission patterns. Methodology: Trivandrum district was chosen as the study area because of the presence of a large number of private-for-profit as well as a government medical college in the district. A pretested interview form, checklist, Focus Group Discussion (FGD) were conducted in each of these medical schools with students, parents of students, faculty and other community leaders as the participants. Convenient sampling was done to select a few health centres (private and public) in the district to assess the education background of the doctors (private-school educated or government school educated), locations of these centres, accessibility of the centre, cost of privately-educated-doctor-run health care facility vis-a-vis a government-educated doctor. Exit interviews were done for every 5th patient coming out of these conveniently selected health centres. Secondary data and literature searches were used to assess the present scenario of private medical education, the students who study in these colleges and the effect on the community of these privately-educated doctors. Results: The average cost of medical education in private medical scholl is Rs 400.0000 ( 88,920$), while in government sector around 400,000 ( 8892$) .The facillities in private sector fall behind the national standards. FGD results, most students said that decision for the admission were took by their parents, in this part of the country the status accrued to the medical doctor is commandable, most parents are bussiness gaints, non resident Indians and doctors.Senior faculties are mainly retired or staff on leave from government medical schools, they said the perfomance and commitment of the students are graded as very poor, but they said the school owners are interferiring with the examination marks. Community leaders belive that the more supply of doctors will solve the existing staff crisis in governmet sector, most of them were doubtful about the quality of doctors from private medical schools, majoriy of them didn't prefer to consult a doctor trained in a private medcal schools for their illnesses. Based on the available secondary data, the establishment of private medical schools has contributed to the rich being able to study more than the poor, has had no significant impact on improving accessibility to health care facilities, has contributed to rising costs of health care, but no significant difference in the standard of medical care provided. Conclusion: The privatisation of medical education in India and its effect of enabling only a few rich people to study has not contributed significantly to the health care of the poor and rural populations nor has it improved accessibility of health care and standard of health care but has contributed indirectly to rising costs of health care.