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Private healthcare providers in India are above the law, leaving patients without protection

BMJ 2015; 350 doi: (Published 24 February 2015) Cite this as: BMJ 2015;350:h675
  1. Sunil Nandraj, senior advisor, health systems, New Delhi, India
  1. sunil.nandraj{at}

Many states have not ratified or do not enforce the central Clinical Establishments (Registration and Regulation) Act 2010, leaving patients exposed to irrational and unethical practice, writes Sunil Nandraj. The objections of private providers and doctors’ associations don’t stand up to scrutiny

Most people in India use private health services and facilities but lack both information about them and any control over them. Many states—including Assam, Goa, Gujarat, Kerala, Meghalaya, Punjab, and Tamil Nadu—don’t have appropriate legislation to regulate private clinical establishments.

Legislation that does exist is outdated, and enforcement is near absent.1 The Bombay Nursing Home Registration Act dates from 1949, the West Bengal Clinical Establishments Act from 1950, and the Delhi Nursing Home Registration Act from 1953. These cover allopathic hospitals but not laboratories, diagnostic centres, government facilities, or ayurvedic hospitals. And minimum standards, treatment protocols, qualification of personnel, and fee structures are unregulated.

The Tamil Nadu Private Clinical Establishment Act came into law in April 1997 but because the state government has not properly framed the rules it cannot be enforced.

Irrational and unethical practices

Poor regulation results in fluctuating standards and irrational and unethical practices, such as unnecessary surgeries and diagnostic tests, commission for referrals, …

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