Corruption, an undeniable reality in the health sector, is arguably the most serious ethical crisis in medicine today. However, it remains poorly addressed by professional associations of physicians and government bodies of healthcare.
There have been umpteen number of reported cases in the past of physicians and other healthcare professionals rendering unethical services with a wide variety of abuses such as practising without the proper educational qualifications; practising without required licences and registrations; over-charging; negligence; unwarranted prescriptions, treatments or surgical procedures; supervising or monitoring, sexual misconduct with patients.
There may be unethical disclosure of a patient’s medical history to employers,credit investigators, banks, attorneys and others; and sexual contact may be initiated by the practitioner with his or her patients. Practitioners may accept bribes or excessive fees for expert testimony, and they may make narcotics and other substances that can be misused available to those in their care.They may perform illegal abortions or treat unreported gunshot wounds.
The problems of ageing and incurable terminal conditions and diseases are susceptible to medical fraud. Ineffectual cures may be offered for everything from cancer to baldness.
The state of the medical profession which was once a noble one today seems impure. It calls for medics, the government and the public to act against dishonest doctors and restore the dignity of the profession and work for the welfare of society.
The situation has become so bad that patients today approach the doctor with mixed feelings – of faith and fear, of hope and hostility. It goes without saying that such criminal doctors are in a minority. Unfortunately, their number seems to be increasing.
There have been incidents where hospital authorities have refused to release the bodies of patients who died in their care because the relatives could not afford to pay the medical bills. There are reports of medics amputating the limbs of poor people at the bidding of the begging mafia.This is merely the tip of the iceberg.
Rampant corruption exists at every level, from medical college admissions, getting a degree, to registration with the medical council. Question papers have been leaked and jockeys have written medical examinations on behalf of students.
Medical college managements are known to charge unofficial “donations” in addition to official fees. Students have been reported to bribe faculty to get good reports, and doctors have been reported to pay bribes to get registered with the state medical council.
Though India is a welfare state, the role of the government at the centre and in the states in providing healthcare facilities is deplorable. Against the recommendations of the WHO that the total health expenditure should be 6.5% of the gross national product (GDP), India spends only 4.8% of GDP on health. Further, public health expenditure is just 1.2% of GDP, or barely 25% of the total health expenditure; the rest of the money is paid by patients directly to private doctors and hospitals for whom profits may take precedence over their patient’s interest.
Corruption traps millions of people in poverty, perpetuates the existing inequalities in income and health, drains the available resources undermines people’s access to healthcare, increases the costs of patient care and, by setting up a vicious cycle, contributes to ill health and suffering. No public health programme can succeed in a setting in which scarce resources are siphoned off, depriving the disadvantaged and poor of essential healthcare. Quality care cannot be provided by a healthcare delivery system in which kickbacks and bribery are a part of life.
There is an urgency to make healthcare service and service providers more transparent operationally. This will help ensure people and processes can be made easily accountable to provide better healthcare services. It is only then that the healthcare system can breathe a bit easier.There is a need to engage in public discussions and take a stand – against unethical and corrupt practices in healthcare and medicine for the sake of the individual’s well-being as well as for social good.
Dr Naresh Purohit is Executive Member, Federation of Hospital Administrator. He is also advisor to the National Communicable Disease Control Programme. Dr. Purohit is also Advisor to six other National Health Programmes. He is visiting Professor in five Medical Universities of Southern India including Thrissur based Kerala University of Health Sciences ((The views and opinion expressed in this article are those of the author)