Antidote For Doctors’ ‘Cut Practice’ 

Mahesh Vijapurkar

The billboard by the Asian Heart Institute in Mumbai, proclaiming “No commission to doctors, honest opinion” seems to have done the trick. A government-appointed panel has made recommendations which may emerge as an Act of the legislature in Maharashtra to curb the practice of kickbacks in the profession. But that would be limited to this state.

Reports indicate that the panel, formed a few weeks ago, has suggested that anyone found accepting or giving a kickback should be punished by a fine of Rs5,000 and a jail term of three months. A repeat offence could mean a higher fine – five times the first. If not the fine, a jail term should shame kickback-practioners into the straight and the narrow path.

It is no one’s case that each and every doctor is into this game of getting as kickbacks for referrals but given the size of bills that are generated for a patient, the public may need some convincing. That may not be merely by denying the prevalence of the practice but accepting it and curbing it in a manner people feel it has been given up.

The seriousness of the effort is indicated by the fact that a former police chief of the state, Pravin Dixit heads the panel, and Dr H Bawaskar who has been fighting this ill practice in the profession have found a place on the panel. Dr Bawaskar had been mentioned in The Lancet sometime in 2013 and is perhaps therefore not the angel of the profession which has ignored his pleas to end it.

It was written in Lancet: “When a cheque landed on the desk of 63-year-old doctor Himmatrao Saluba Bawaskar, from a diagnostic centre under the guise of ‘professional fee’, Bawaskar not only returned it, but he also filed a complaint against the center with the Medical Council of India (MCI), the national watchdog for medical education and doctors.”

What happened to that case in terms of the outcome is not clear. It is encouraging is that Bawaskar is on the panel along with a representative of the Medical Council. This lends a direction to the intent though how the machinery works once the law is in place is another matter. That, of course, is the main issue in governance in our country where a good law can be sabotaged by poor implementation.

Had the Medical Council been willing to act about the need to check this blatant means of earning the extra buck in the profession, and taken a cue from Bawaskar’s complaint some half-a- decade ago, billboard may not have gone up at all. It is not that the Council would be unaware of it, especially when the government has been pointing out how hospitals overcharge patients for items including stents.

The reaction to the Asian Heart Institute’s billboard showed that the medical fraternity is divided, with some accusing it of a clever ploy to advertising and others insisting that kickbacks was prevalent among only a few. But, except for Bawaskar, no other person from the profession is known to have ever even let out a peep about the practice. The extent of this corruption is hard to define, but drug companies may be making up with their inducements.

‘Cut-practice’, which is how kickbacks in medical profession are known or described as, does push up the cost of medical care. The simplest illustration could be needless and numerous pathological tests simply because of a financial arrangement between a doctor and a pathology lab. The patient may not need it, the doctor knows it, and the pathology labs may not even be conducting the tests actually not needed but bill for them.