The need for a rational and regulated health care has been raised by people’s movements across countries and these have had an impact on evolution of policy. This is amply demonstrated by the passing of the public insurance schemes for the elderly and the poor during the sixties in the US. Similarly the movement for a rational drug policy and health care in Latin America and Asian countries, and also for a national health insurance scheme in Canada are examples of this (Fiedler: 1996; Evans & Law: 1991). In developed countries where the Charter of Patient’s Rights has been adopted, the sheer power of the professionals does not allow patients to assert their rights. Merely enunciating a charter of rights will not automatically result in either the practitioner or the health care system responding to patient needs. However this does not detract from the importance of such initiatives (Tailor & Mayberry: 1995).

The Consumer Protection Act definitely provided the opportunity for raising the need for regulation in the Indian context and the role of consumer organisations has been that of a pressure group, whose interests must get articulated in State policy. Consumer activism can and has raised a number of issues like medial negligence, over medicalization, use of irrational drugs, lack of transparency, lack of medical ethics in medical practice etc. These organisations have been an important pressure group during the last couple of years and have demonstrated the lacunae in the private hospitals. The Consumer Protection Act brought the issue of quality of services in the private sector under public scrutiny and debate. The medical profession however, reacted very negatively and defensively to the issue (Bhat: 1994). In this scenario the issues raised by the consumer groups need to be further strengthened by the government to push for regulation. Another reason that the State needs to play a more pro-active role is that it is evident that the professional bodies have divided interests and are therefore unable to provide a coherent direction to policy.

These developments have definitely influenced policy makers to react but it is important to recognize that there are limitations to such forms of activism. In interacting with the medical professional even the informed consumer may be unable to overcome the unequal relationship that exists between a doctor and a patient. Here one needs some systemic checks and balances, which only the State can initiate in order to protect the welfare of its citizens.

Summary of Recommendations

This paper has provided evidence from a wide range of studies on the private sector which clearly suggests the need for regulation.

It is evident from the international and national studies that the State will have to continue to play an important role in providing services, and also rationalise the existing services in the private sector within the ambit of its planning process.

There is a need for creating an information system on the private providers at various levels of care, medical technology and its use, fiscal concessions, and compliance to conditionalities.

There is a need for developing uniform guidelines for all states.

The regulatory process has to take into account the diversity and address different levels of care.

There is a need to define what is expected of primary, secondary and tertiary levels of care and the minimum norms in respect of manpower, skills, and equipment. These norms may be adapted from the public health care system.

There is also a need for evolving standardized treatment regimens for treating common ailments as well as the major communicable diseases.

Training of private practitioners and evolving reporting systems into the public health monitoring and surveillance systems at the primary, secondary, and tertiary levels of care need to be put in place.

The tertiary corporate sector must not be given more subsidies but must comply with conditionalities, which try to build equity concerns.

Staffing and physical standards must be applicable to both secondary and tertiary levels of care.

Recent initiatives at accreditation must be strengthened but this must not preclude other initiatives for making the private sector play a more socially responsible role in future.

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