(This story originally appeared in on Mar 07, 2021)
About 28% of MBBS seats in India cost over Rs 10 lakh per annum in just tuition fees. The high fees effectively makes these seats a quota for the rich, one that is larger than those for the SC (15%), ST (7.5%) or OBC (27%). And that’s without taking into account the fact that this 28% is of total seats, while the caste-based reservations do not apply to all.
How did we get to this 28%? It’s based on a detailed analysis of fees for the MBBS course in over 530 MBBS colleges. About half the seats in private colleges, excluding deemed universities, are in the management quota or NRI quota. In the NRI quota, the average annual tuition fee is roughly Rs 25 lakh per annum. For the management quota, the average fees are around Rs 11 lakh though it varies from Rs 4 lakh in private colleges in West Bengal, which is uncommon, to Rs 18 lakh to Rs 20 lakh in states like Karnataka and Rajasthan. Besides the tuition fees, almost all colleges collect about Rs 2 lakh a year as charges for hostel, mess, exams, library and so on.
The most expensive seats are in the deemed universities. Over 8,500 seats in these universities constitute about 10% of all MBBS seats. Barely 3% or about 23,000 of the 7.7 lakh who qualified through the combined entrance exam, NEET, applied for these seats. The average annual tuition fees for NRI seats in these colleges are Rs 36 lakh, which is about Rs 1.6 crore for the entire course. The average fees for management seats in them are Rs 18 lakh.
TOI had reported earlier how the higher the fees, the poorer the average NEET score. The high fees leading to a virtual reservation for the rich has led to those with ranks even below 6 lakh in NEET getting admission, though there are only about 83,000 MBBS seats.
Even some government colleges, mostly in Gujarat (11 colleges) and Rajasthan (8 colleges) have management seats (1,350) and NRI seats (580) at an average Rs 18.5 lakh. The management quota seats in these government colleges range from Rs 7.3 lakh to Rs 18 lakh per annum in some of Gujarat’s municipal medical colleges in Gujarat. Others could also be as low as Rs 75,000 in Rajasthan to Rs 1 .3 lakh in Doon Medical College in Uttarakhand.
Most states governments have been pushing up fees in their medical colleges citing the high cost of medical education, though the money collected from increased fees is just a fraction of the budget. In Punjab, the cost of MBBS in government colleges went up from Rs 4.4 lakh to Rs 7.8 lakh, among the highest in the country. Fees in most government colleges in Maharashtra and Madhya Pradesh are about one lakh per year.
Incidentally, according to the latest expenditure survey done by the NSO in 2017-18, before the job loss of millions and economic devastation caused by the pandemic, the monthly expenditure of 80% of Indian families was less than Rs 10,500. Renowned economist Thomas Picketty had estimated that in 2015 about 5% of Indian adults earned over 63,000 a month or over 7.5 lakh a year. He estimated that just 1% (13.8 million) earned over 2 lakh. This is unlikely to have changed much since. What this means is that at best only 5% of families can afford the fees being charged for medical education in most institutions, even government ones.
Fifteen AIIMS accounting for about 1,100 seats offer the cheapest medical education, mostly charging Rs 1,628 or Rs 5,856 per annum. Centrally-funded institutions charge the least fees. West Bengal and Bihar offers the cheapest medical education in the country with the majority of colleges in the former charging Rs 9,000 as tuition fee and Rs 144 as hostel fees and the latter charging about Rs 6,000 as tuition fees and Rs 4,200-20,000 as hostel fees. Even among private colleges, West Bengal has among the lowest fees, mostly well below Rs 5 lakh for management seats and about Rs 15 lakh for NRI seats.
In 2016, the Parliamentary Standing Committee report on the functioning of the Medical Council of India (MCI) and medical education had strongly criticised “admission procedures which are primarily monetary based”. The committee recommended a common entrance test “to ensure that merit and not the ability to pay becomes the criterion for admission to medical colleges”. But with fees remaining unchecked, neither the new National Medical Commission nor the National Eligibility-cum-Entrance Test (NEET) has achieved this.