Prime Minister Narendra Modi has blamed previous governments for the large numbers of Indian students pursuing medical education abroad, but health and education experts say the trend owes heavily to the current government’s actions that have accelerated the commercialisation of medical education.

The Modi government has added several thousand undergraduate medical seats through dozens of new government colleges, but it has also introduced regulatory changes that have or will encourage increased fees at private medical colleges, the experts say.

Indian doctors who earned their degrees abroad have said an inadequate count of government college seats and the high fees charged by private medical colleges in the country for a proportion of their seats are the main reasons Indian students pursue medical studies abroad.

Against this background, Modi has blamed previous governments and asserted that his dispensation had augmented the number of medical colleges in the country.

There were 300 to 400 medical colleges earlier, and now they number nearly 700, Modi said. “Probably, more doctors will be produced in 10 years than the last 70 years,” he said.

The Union cabinet had in 2018 approved a Rs 10,700-crore plan for 24 new medical colleges with 10,000 undergraduate and over 8,000 postgraduate seats. The health ministry had earlier implemented a plan to set up medical colleges attached to 58 district hospitals.

Experts have applauded those investments but criticised other initiatives — including proposed changes to private medical colleges’ fee structure and plans to allow private hospitals to build colleges attached to district hospitals — that they say will only increase the fees.

The National Medical Commission, a new governance structure for medical education and practice established in 2019, has proposed that the fees for only 50 per cent of MBBS seats at private colleges have to be on a par with the fees charged by government medical colleges.

“This suggests that private medical colleges will be able to charge whatever they wish for half their seats,” said a doctor who requested not to be identified. “This effectively means the seats will go only to those who can afford them.”

Under earlier rules, private medical colleges in some states could earmark up to 15 per cent of their seats for the so-called “management quota”. These seats came at high fees or were sold to the highest bidders against the so-called “capitation fees” — a sum paid to buy a seat.

Members of the All India Foreign Medical Graduates Association estimate that between 30,000 and 40,000 students enrol annually in undergraduate medical courses in Belarus, China, Russia, Ukraine and other countries.

Some private colleges in India charge MBBS students Rs 10 lakh to Rs 16 lakh a year across the five-year course. “But the students pay only about Rs 30 lakh for the full MBBS course in China, Russia or Ukraine,” said Najeerul Ameen, the association’s president.

Education sector experts say that while the Manmohan Singh government had signalled its intention to curb capitation fees through a series of bills, the Modi government has not continued those efforts.

Experts have also cited a change the Modi government has made to regulations for educational institutions that now allow profit-making entities to set up medical colleges that may be attached to profit-making hospitals.

Until the rules were amended in 2020, only not-for-profit entities could establish educational institutions. Any surplus earned by such entities was to be used only for institutional expansion.

Under the new rules, a consortium partner with an annual turnover of not less than Rs 500 crore can apply to the government to establish a medical college and another consortium partner can run the hospital.

Abha Dev Habib, a former member of Delhi University’s executive council, said hospitals attached to medical colleges served society by remaining not-for-profit entities. Now, such hospitals set up by consortiums can earn profits.

“This is another example of the commercialisation of higher education in general, and health education in particular,” she said.