In 1989, a lawyer stood in front of the Supreme Court of India to argue for the rights of road traffic accident victims to receive care, and the duty of medical institutions to provide care. Parmanand Katara’s case turned out to be a landmark case because it established that the right to healthcare is irrevocably linked to Article 21 of the Constitution- the right to life. Not only did the verdict place precedence on life-saving healthcare over legal proceedings in injuries, but it pronounced that the state’s obligation to preserve life is “total, absolute and paramount”. 

Healthcare is a fundamental human right, a non-negotiable for a life of dignity. Most developed societies acknowledge the basic right to health care access as one of the most important achievements of plural and secular societies. 

In India, that right rests on two constitutional foundations: Article 21 guarantees the right to life, which the Court in Katara read to encompass emergency medical treatment that cannot be denied, and Article 47, a Directive Principle of State Policy, which makes the improvement of public health one of the State's primary duties. 

One need not appeal to compassion alone, then, to defend the right to healthcare. Where kindness fails, the Constitution and law still impose a duty to protect life and to ensure access to care. Healthcare is an enforceable obligation, not/ a luxury or a commodity reserved for the privileged.

How India Regulates Healthcare and why Regulation Became Necessary

To ensure that institutions providing healthcare are able to uphold the citizens’ right to health, various states in India enacted laws to regulate hospitals, nursing homes, and other medical facilities. Before the central Clinical Establishments (Registration and Regulation) Act, 2010, was passed, healthcare regulation in India was governed through a mosaic of separate state laws. 

One of the earliest of these was the Bombay Nursing Home Registration Act, 1949, followed by similar statutes in other states. These laws introduced basic registration requirements and minimum standards intended to regulate the quality of facilities.

However, the eighteen different state laws took substantially different approaches and had vastly different scopes, and, as the Planning Commission noted in 2002, they remained largely unimplemented and ineffective in most states. 

In a report prepared for the 11th Five-Year Plan in 2006, the Working Group on Clinical Establishments pointed out that while the for-profit private sector accounted for 50% of inpatient care and 60 to 70% of outpatient care, it remained largely fragmented and uncontrolled, leading to issues such as inadequate treatments, the wasting of scarce resources, and serious medical malpractice. This dissatisfaction with state-level efforts eventually became the driving force behind the introduction of the central Clinical Establishments (Registration and Regulation) Act, 2010 (CEA 2010).

To streamline functions and provision of services, and to ensure the observance of minimal standards by all providers, advocacy groups, the judiciary and the National Human Rights Commission demanded a central regulatory structure, applying to both public and private health care institutions. 

The Statement of Objects and Reasons for the Central Bill (CEA 2010) by the central government to the parliament recorded this demand. By bringing both public and private establishments under a single umbrella of "minimum standards," the Act sought to protect patient safety, ensure quality of care, and improve equitable access to healthcare for all citizens. 

The passage of this Act was supposed to be a watershed moment for Indian healthcare. However, for over 15 years, it has remained a largely hollow promise. While it was officially brought into force in 2012, the Central Government has not yet notified minimum standards for the vast majority of healthcare categories, with the lone exception of medical diagnostic laboratories. 

This regulatory vacuum has allowed for a dangerous divergence: while the public healthcare system in many states is in a state of virtual collapse resulting from insufficient funding, the private sector has grown unfettered.

When Healthcare Becomes a Market without Meaningful Regulation

This uncontrolled growth of the private sector, which now accounts for approximately 50% of inpatient care and 60–70% of outpatient care, has introduced cutting-edge technology and sophisticated medical management to those who can pay. 

Yet, these advantages have come at a catastrophic cost for the average Indian family, as out-of-pocket expenditure (OOPE) has historically accounted for nearly 75% of total health expenditure.  pushing millions of households below the poverty line. Sources indicate that poor and marginalised communities are frequently pushed into private facilities they cannot afford, forced to make payments at the direct expense of essential needs like basic nutrition.

The assumption that expensive care equals better care has proven false. The lack of effective regulation has led to excessive dependence on technology and an overuse of procedures that could be avoided.  The bills in such unregulated hospitals are also inflated using arbitrary charges (with markups of 10-15 times of everyday items billed), and intransparent billing (lump-sum packages, but no publicly available price lists) both of which contribute to unethical care. 

The inherently profit-seeking nature of the private sector has shifted the focus away from patients. Instead, corporatised practices have seeped into smaller private institutes, charitable hospitals, as well as the government sector. One would expect that private healthcare would increase choice and bring in healthy competition, thereby improving quality of care; on the contrary, the health care ‘market’ has been hegemonised by a few large players with regional monopolies, leaving both providers and seekers of care at the mercy of corporate giants and market forces.

When Maharashtra put Patients at the Centre

In 2021, the Maharashtra Nursing Homes Registration (Amendment) Rules, 2021 emerged as a landmark victory for patient rights, born from the harrowing lessons of the COVID-19 pandemic and decades of advocacy by health rights activists and civil society organisations.

The rules mandated that nursing homes could not charge more than the rates "notified by the Government from time to time", that a dead body could never be withheld for non-payment of bills, and it prohibited the detention of living patients over unsettled accounts. 

Every establishment was required to set up a grievance redressal cell with a toll-free number. Most importantly, it mandated a hearing within 24 hours for patients currently under treatment, ensuring that disputes could be resolved before they escalated into life-threatening delays.

The Standard Charter of Patients’ Rights Rule 11-Q shifted the patient from a passive beneficiary to an empowered stakeholder. For the first time, patients in Maharashtra had a legally recognized right to information and transparency (receive estimated costs of treatment beforehand and view itemised bills), autonomy and records (seek a second opinion and have unfettered access to their own clinical records and case papers), and safe and respectful care (ensuring that female patients are examined only in the presence of another female).

The 2026 Bill: Modernisation or Rollback?

This finally brings us to the reason for the historical journey this essay has taken, and why this discussion is so urgent today. After looking at the draft of the 2026 Bill, I found myself asking a single question: Where are my rights? 

Maharashtra has released the draft Clinical Establishments (Registration and Regulation) Bill, 2026, presented as a modern upgrade to bring all clinics and labs under one system. We must acknowledge that the draft Bill increases requirements for transparency, such as Section 11, which mandates that hospitals publish their rates on websites and in three languages. 

Unlike the 1949 Act, which was limited strictly to nursing and maternity homes, the 2026 Bill covers the full spectrum of modern medicine, including diagnostic centres, medical laboratories, and day-care centres. The Bill formally enshrines a Charter of Patients’ Rights within the primary legislation, granting patients legal standing to information regarding diagnosis, estimated costs, and access to medical records.

A close inspection of the draft, however, reveals an unacceptable rollback of patients' rights, either by omission of important mandates from the 2021 amendments, or a deafening silence on other issues that the state cannot afford to remain silent about.

The Right to Affordable Care cannot be left to self-regulation

The 2021 Rules at least gave the state a foothold to cap runaway costs by linking charges to rates notified by the Government. The 2026 Bill abandons this entirely, moving toward "rate self-regulation." Under Section 11(2), a hospital can charge whatever it wishes as long as it displays that price on its wall or website. 

Private hospitals are businesses. Like any business, they are expected to generate revenue, remain profitable, and deliver returns to their owners or investors. In the current environment in India, the massive influx of private equity from foreign investors has shifted focus to quick returns. The omission of capped rates, therefore, specifically favors large corporate chains while threatening the survival of smaller, affordable charitable hospitals. How can we expect a corporate player that runs on the principles of maximising revenue generation to self-regulate charges and keep the patient's interest at the centre? 

A Law for Private Hospitals, but What About the Public Hospitals?

One of the Bill's most fundamental contradictions lies in whom it chooses to regulate.

Perhaps the most damaging provision is Section 2(e), which explicitly exempts all public institutions, including Central, State, and local government hospitals, from the Act. All previous legislative efforts similarly created a double standard by explicitly exempting government-run facilities from the very same standards of transparency and quality they sought to impose on others. By exempting itself from the "minimum standards" it imposes on others, the state risks a double standard that could lead to unchecked poor quality in public care, effectively forcing citizens into the unregulated private sector.

Protections for Dignity and Choice are Disappearing

Inexplicably, the draft Bill deletes two important safeguards that existed in the regulatory framework: the requirement that a female attendant be present during the examination of a woman and the explicit guarantee of the right to treatment for people living with HIV. A regulatory framework cannot claim to protect patients while simultaneously dismantling safeguards that uphold their dignity and rights.

Among the most humane provisions of the 2021 Rules was the explicit prohibition on hospitals withholding the bodies of deceased patients or detaining living patients for non-payment of bills. These safeguards recognised that dignity does not end with death, nor can personal liberty be made contingent on one's ability to pay. Just as we began to see the promise of these protections, the new 2026 draft Bill threatens to dismantle them by dropping them entirely.

The draft Bill also omits a basic patient right recognised in the National Charter of Patients' Rights - the right to purchase medicines or undergo diagnostic tests at a provider of one's choice. The usual justification for limiting this choice is that medicines dispensed through a hospital pharmacy are quality-assured, making it easier to trace problems in the supply chain. 

But this argument raises a more fundamental question. If India has a statutory drug regulatory system responsible for ensuring the quality and safety of medicines, why should patients be expected to rely on a hospital's pharmacy to guarantee what the State is already legally obligated to ensure? Restricting patient choice is not a substitute for effective regulation of medicines.

In addition, the Bill remains dangerously silent on the rights of marginalized communities. A truly modern regulatory framework should set standards for equitable, inclusive and non-discriminatory care. Yet the draft does not attempt to address standards for gender-affirming healthcare, the rights and care of intersex children, or other aspects of healthcare where discrimination and the absence of clear clinical standards continue to cause significant harm.

The Right to Know and the Right to Complain

If you’ve ever stood at a hospital reception desk, clutching a folder of reports and feeling completely overwhelmed, you know that the law is often the last thing on your mind. You just assume that certain basic decencies are guaranteed. You assume that a doctor’s qualifications are verified and that your privacy is protected. 

Under the 2021 Rules (Rule 11-Q), patients were granted specific rights designed to ensure they could verify the expertise of their caregivers and voice concerns immediately. The 2021 Rules explicitly gave patients the right "to write complaints in a complaint register kept in the nursing home at the reception counter". The rules also required that a "list of Medical Practitioners along with their qualifications, MCI/MMC registration number and its validity date shall be displayed at reception zone prominently in nursing homes. 

Analysis of the draft confirms that the requirement to display the list of doctors with their qualifications and registration has been removed. While Section 11 of the 2026 draft Bill mandates the display of registration certificates and rate lists, it is silent on the credentials of the medical staff providing the care. The Charter of Patients’ Rights in Section 13 of the 2026 Bill does not include the right to a physical complaint register at the reception. By removing this requirement, it effectively omits the most accessible point of feedback for a patient, leaving them with no statutory forum to record an immediate grievance while under treatment.

The 2021 Rules mandated a 24-hour grievance hearing for patients under treatment. The 2026 Bill eliminates this time-bound mechanism, providing appeal routes for hospitals that are fined but offering no specific forum for a patient who has been wronged.

In law, the omission of a right is often as good as permitting unethical practice. By deleting the specific, enforceable protections won in 2021, the 2026 Bill tacitly allows the return of predatory practices. 

Lastly, the proposed State Council, which decides the standards for all hospitals, is reserved entirely for officials and medical councils. There is no seat for civil society, patient groups, or public health experts, leading to a regulator that is captured by officialdom. It reeks of a 'public' regulator that doesn't actually involve the public.

If Maharashtra is to honour the constitutional promise of the right to health, the Bill must be substantially revised. It must restore the patient rights guaranteed under the 2021 Rules, reinstate meaningful regulation of healthcare costs, ensure that public hospitals are held to the same standards of safety, quality and dignity as private institutions, and include the most important stakeholder, the public, in the State Council that will shape healthcare policy.

A law that governs that right must be shaped transparently, debated publicly and judged by one simple standard: does it make healthcare more equitable, more accountable and more dignified for every person who seeks it? 

Edited by Radhikaa Sharma and Parth Sharma
Image by Gayatri