Corruption in medical care – is the market the cause?

One of the most striking features of medical care in India is the extreme inequality between what it offered to the rich and to the poor. The majority of patients living in villages do not have access to the most basic necessities such as immunisation. The metros are flush with the latest technological marvels several times over, the several magnetic resonance scanners being one example. It is, however, a mistake to think that this metropolitan plenitude necessarily translates into better medical care. Those with money to burn are often subjected to unnecessary and inappropriate investigations. Often, the results of such tests only complicate matters, cause unnecessary anxiety and convert hitherto healthy captains of industry into quivering bundles of neurosis. When such tests are followed by unjustified surgery, the horror is compounded.

Pressures of the market worsen the situation. Let me provide an example. In the town where I live, a few doctors acquired a computerised tomography scanner (CT). It was not long before the need to pay instalments began to worry them. The group cajoled colleagues in practice to refer patients for scanning by ‘extending the indications for a scan’. The ubiquitous practice of offering a financial incentive for such reference – disguised as ‘interpretation fee’ – was already in vogue’.

Examples of unwarranted surgery abound. Recently I saw a patient with tuberculosis of the lumbar spine without neurological abnormality who had been subjected to an operation to fuse the diseased vertebrae. It is standard practice to treat such patients with anti- tuberculous drugs alone as there is seldom any instability. Two months after the operation, the plates and screws came off the bones they were supposed to fuse. She had to undergo another operation to remove the metallic implants. Examples such as these are numerous and each doctor sees only the tip of the iceberg.

lssues in Medical Ethicshas discussed this problem over the past three years. What is the solution ? I am not convinced that appealing to the better instincts of the medical personnel is likely to improve matters. The very organisations set up to ensure ethical practice – the Medical Council of India and the state medical councils – are themselves mired in corruption.

I believe the only answer is removal of the cause, namely the possibility of fleecing patients of huge sums. In other words, we must abolish the market in medicine. This is possible through a system that ensures universal medical coverage to all our citizens and registration, perhaps by the state, of incomes of doctors and other personnel in the health field. A socialised system will not easily lend itself to corruption.