Community Health Providers (Clause 32)
India’s doctor-population ratio stands at 1:1456, below the WHO-recommended ratio of 1:1000, with a significant imbalance between urban and rural healthcare availability. The shortage of qualified medical professionals has left many rural populations dependent on unqualified practitioners, with 57.3% of those practicing allopathic medicine lacking formal medical qualifications.
To support the Ayushman Bharat programme and the proposed 1.5 lakh Health and Wellness Centres, the Bill provides an enabling provision for granting a limited licence to specially trained mid-level healthcare providers. These Community Health Providers would be permitted to deliver only primary and preventive healthcare services under a regulated framework. The provision draws on international models adopted in countries such as Thailand, the United Kingdom, China, and the United States, where community health workers and nurse practitioners play an important role in healthcare delivery.
The government maintains that this measure is intended to address immediate healthcare workforce shortages while medical education capacity continues to expand.
National Exit Test (NEXT) – Clause 15
The Bill proposes the National Exit Test (NEXT), a common final-year examination for medical graduates aimed at establishing uniform national standards of medical education and clinical competence.
The examination is intended to ensure consistency in knowledge and skills among medical graduates across the country. Detailed regulations for implementing NEXT would be framed separately, with due consideration to both theoretical learning and clinical training requirements. A transition period of three years has been provided before the examination becomes operational.
Fee Regulation in Medical Education (Clause 10(1)(i))
The Bill introduces provisions for regulating fees in private medical colleges, addressing a gap that existed under the Indian Medical Council Act, 1956. Under the proposed framework, fee regulation would apply to 50% of seats in private medical institutions.
With nearly half of all MBBS seats already available in government colleges at subsidized fees, the proposed arrangement would make approximately 75% of total medical seats accessible at regulated or affordable fee levels.
State governments would continue to retain flexibility regarding fee structures for the remaining seats through agreements with private institutions. The government has also emphasized the continued availability of scholarship programmes and merit-cum-means assistance to support students from economically weaker backgrounds.
The Bill argues that transparency created through the National Eligibility cum Entrance Test (NEET), common counselling processes, institutional ratings, and quality benchmarks would discourage arbitrary fee increases and promote accountability among medical colleges.
Expanding Medical Education Capacity
The government has highlighted significant investments in medical education infrastructure, including over ₹10,000 crore spent on creating additional government medical seats over the previous five years and more than ₹30,000 crore allocated for establishing 21 new AIIMS institutions.
According to the government, these measures aim to increase access to quality medical education while ensuring that admissions remain merit-based through NEET and common counselling systems.
Merit-Based Admissions
The Bill reinforces the role of NEET as the sole entrance examination for medical admissions. The government argues that the introduction of NEET and centralized counselling has enhanced transparency, reduced the influence of capitation fees, and ensured that admissions are based on merit rather than financial capacity.
Overall, the proposed reforms seek to address healthcare workforce shortages, standardize medical education, improve affordability, and strengthen transparency and accountability in the medical education system.
