Activists have called for the immediate capping and regulation of trade margins on all medicines, medical devices, and consumables, as well as ceilings on treatment charges levied by private hospitals.
Jan Swasthya Abhiyan (JSA) and the Working Group on Access to Medicines and Treatment (Working Group) have called for urgent government intervention to regulate healthcare provided by private hospitals, warning that patients continue to face excessive and arbitrary charges for treatment, medicines and medical consumables, with little effective protection or recourse.
The demand comes amid renewed scrutiny of private hospital pricing. The Supreme Court has recently questioned steep mark-ups on medicines sold through hospital pharmacies, including a case in which a cancer medicine supplied at around ₹2,700 carried an MRP of around ₹27,000.
The Court has also questioned practices that require patients to purchase medicines from hospital-linked pharmacies and has asked the government to examine the regulation of trade margins.
The activists note that the problem goes far beyond the price of individual medicines. India lacks an effective nationwide system to regulate what private hospitals can charge patients for procedures, services, medicines and consumables. JSA and the Working Group said leading corporate hospital chains charge an average of ₹60,000 to ₹78,000 per day of treatment. They said they arrived at this figure based on publicly available data from the Ministry of Corporate Affairs.
The organisations said this represents an unacceptably high level of profiteering, with the costs ultimately borne by ordinary patients through exorbitant hospital bills.
While the Clinical Establishments Act, 2010 (CEA) provides a legal framework for regulating clinical establishments and envisages government-determined ranges of charges, the activists noted that its implementation has failed.
Dr Abhay Shukla, Co-convener, JSA, said: “Private healthcare has expanded enormously in India, but regulation has simply not kept pace. There is no regulation of rates of care, and the patient has virtually no bargaining power over what they are charged.”
He added that leading corporate hospital chains have been earning huge surpluses, estimated at between ₹22 lakh and ₹55 lakh per year from each bed, in recent years.
“The CEA was passed more than a decade ago, but its non-implementation has produced zero results on the ground. It is high time that the government starts regulating procedures in private hospitals. A patient should know how much they will be charged before agreeing to a treatment,” he said.
The JSA and the Working Group also said India needs a strong regulatory framework that protects patients, ensures transparency and puts clear limits on what private hospitals can charge. They added that the government already has legal and regulatory tools at its disposal, but what has been missing is the political will to use them effectively.
Medicines and medical consumables are a particularly serious concern. A 2021 study by the Competition Commission of India has previously highlighted the problem of high margins in pharmaceutical sales and the perverse incentives that can arise when hospitals or hospital pharmacies control what patients are required to purchase. JSA and the Working Group noted that hospitals can procure products at substantial discounts while patients are charged prices close to the printed MRP.
K.M. Gopakumar, co-convener, Working Group, said, "When patients are required to buy these products only from the hospital pharmacy, there is no price competition at all. The MRP cannot become a licence to charge patients many times the procurement price. The government must urgently fix the trade margins on all medical products and ensure that patients are free to purchase medicines and consumables from outside wherever clinically possible.”
The groups also warned that the increasing financialisation of healthcare is affecting not only patients but also clinical practice itself.
Dr Gayatri Sharma, Community Health Physician and Researcher, said: “Doctors should be able to make treatment decisions solely based on what is medically necessary for the patient. But in increasingly commercialised hospital settings, doctors face pressure to meet revenue, investigation or procedure targets. Such pressures interfere with rational clinical decision-making and can result in unnecessary tests, procedures or treatment. The National Medical Commission should ban incentive-linked pay for doctors.”
Shishir Chand, Delhi Co-convener of NGO People for Better Treatment (PBT), said that patients often approach the organisation after receiving hospital bills running into lakhs of rupees, without understanding how those amounts were arrived at. “By then, families may have borrowed money, sold assets, or exhausted their savings. When they challenge the bill, they are forced to run from one authority to another. A patient who has just gone through a serious illness should not have to fight another battle simply to find out whether they were fairly charged,” he said.
The activists noted that an effective and accessible grievance-redress mechanism for patients facing excessive or unjustified hospital bills is currently absent.
JSA and the Working Group also called for a major increase in public health spending and the strengthening of public hospitals to provide free and accessible care to wider sections of the population.
In addition, they called for a time-bound investigation by the Competition Commission of India into potentially anti-competitive practices and possible violations of competition law by private hospitals.
