The last few weeks have seen countless protests related to the National Eligibility cum Entrance Test (NEET) results. The National Testing Agency (NTA), which conducts the NEET exam, is in the eye of the storm. There are allegations of insiders at the NTA leaking question papers and awarding unscientific grace marks. For those students who have spent sleepless nights in careful preparation what is happening is indeed a travesty. But what is at the root of this issue?
In this article, we attempt to break apart the issue and examine some of the core public policy problems that led to this tragedy.
The Stakes and the Incentives
To begin with, the NEET exam is highly competitive. In 2024, more than 25 lakh students applied for 1 lakh seats, making it one of the most competitive examinations in the country. Among these 1 lakh seats, only 54,278 were available at low fees in government colleges. This means only 2% of the students who take the exam get an opportunity to study in a government college, increasing the stakes for aspirants.
NEET was introduced in 2013 and has been institutionalised since 2016. The National Testing Agency took control of the examination from CBSE in 2019 and continues to run it currently. Before NEET, the AIPMT (All India Pre-Medical Test) and various state-level exams were used for medical college admissions. Since 2019, NEET has been the sole examination for medical college enrollment in India.
In essence, NEET is a highly competitive, high-stakes, centralised examination that occurs once a year. This creates a perfect recipe for corruption. When the stakes are high, the incentive for corruption, such as bribing officials, is also high. And in a centralised system, it only takes a few corrupt officials to create havoc for many.
Following the NEET scam, the Government of India has decided to roll out the Public Examinations (Prevention of Unfair Means) Act, 2024 to counter future paper leaks and cases of cheating. The act brings several exams and personnel under one umbrella and increases the punishment for malpractices. However, instead of addressing the core problems, the act has only raised the stakes of these exams, further increasing the chances of corruption.
But what is the core problem behind the NEET issue?
The Underlying Conundrum
According to recent data from the World Bank, India still has only 0.7 doctors per 1,000 people, far below the global average of 1.7 doctors per 1,000 people. A FICCI-EY report titled "Decoding India's Healthcare Landscape" states that India needs to add nearly 27 lakh doctors to achieve its 2047 healthcare vision. There is no argument against this—India needs more doctors.
Regarding the supply of students aspiring to become doctors, as we discussed earlier, there is an ample number of students applying for medical entrance exams. Therefore, the crux of the matter is this: we need more doctors. We have a significant number of young people aspiring to enter the medical profession, but there are not enough medical seats available.
This is a conundrum of sorts. Why are there not enough medical seats? Usually, when there is a demand-supply mismatch, such as with medical seats, the market typically addresses this by providing more. But this is not happening. Why?
Consider the high cost of a management seat in a medical college, which has risen to Rs. 50 lakh annually in certain colleges - running a medical college in India seems lucrative for entrepreneurs. So why aren't we seeing new ventures despite the financial incentives to increase medical seats or establish new medical colleges?
This is because starting a medical college in India is extremely difficult and costly.
Medical vs Engineering Colleges
Remember the days of the IT boom? There was a demand for engineering jobs, students were interested, and markets responded by setting up new engineering colleges. However, this rapid growth was facilitated by low regulatory burdens and minimal setup costs for engineering colleges, meeting the demand from aspiring students.
Compared to engineering colleges, starting a medical college requires a 300-bed hospital, on-site student housing and library, and specific land requirements, among other regulations. Experts say that the cost of setting up a medical college is close to Rs 200 crore whereas an engineering college can be set up for around Rs 15 crore.
Even after overcoming these hurdles, scaling medical seats is difficult due to another set of regulations prescribing the number of seats that can be added. This is why, despite having a large number of medical colleges, the number of seats still lags behind.
Are Strict Regulations the Only Way?
These strict regulations have been supposedly put in place to prevent low-quality institutions from producing low-quality doctors. But are entry regulations the only way to do this?
First, how do we prevent low-quality services in any sector? India has numerous engineering colleges, and many produce subpar engineers. Yet, instances of significant machine failures due to insufficient engineer expertise are rare. This is because the availability of engineers is large and low-skilled engineers are unlikely to be hired in the first place. Similarly, with a surplus of doctors graduating, low-quality doctors will struggle to find employment. This will encourage students to seek better education and colleges to enhance their standards to attract top students through competition. In other words, fair competition can largely address the doctor quality issue.
Secondly, in the National Medical Commission Bill 2019, the Government of India proposed a National Exit Test for all MBBS students before they receive a license to practice. Such a test can ensure that regardless of where students pursue their MBBS course, they must meet specific minimum requirements to qualify as practitioners. This measure aims to significantly address the issue of doctor quality, which surprisingly persists despite stringent regulations.
Thirdly, colleges and states must be given autonomy in producing quality doctors according to their needs. For this, colleges and states should have the option to either conduct their own exams or opt into NEET. For example, different colleges have different cultures, they should be allowed to select candidates that fit their criteria (while adhering to norms like reservations). Similarly, states capable of conducting their own entrance exams should be allowed to do so. As the NTA enhances its capacity to conduct exams efficiently, colleges and states can gradually adopt it. This also serves as an incentive for the NTA to improve its capabilities.
Way Forward
If regulations are eased, there will be more private medical colleges coming up in our country which will ease the stakes and competitiveness of these exams. More importantly, this will allow more doctors to come out of the system which will have a large impact on our healthcare parameters.
 | A guest post by
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 | A guest post by
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