Health is a State subject, yet patient protection demands national standards. Critically examine the working of the Clinical Establishments Act, 2010 in this light.

Public health and hospitals fall under Entry 6 of the State List. Parliament could not impose one law on all States. The Clinical Establishments (Registration and Regulation) Act, 2010 therefore uses the consent route. It applied at first to four States and all UTs, and other States can adopt it by passing a resolution [2]. The Act creates a national framework, but in practice national standards have stayed largely on paper.

Strengths: national standards with State consent

• Uniform structure: a National Council chaired by the DGHS sets minimum standards and keeps a national register. District Registering Authorities under the Collector register establishments [2].
• Regular checks: permanent registration lasts 5 years and must then be renewed [2].
• Patient rights in the Rules: Rule 9 of the 2012 Rules makes several duties conditions of registration. These are displaying rates in the local language and English, following Standard Treatment Guidelines and keeping EMR/EHR [3].
• Respects federalism: the Centre advises rather than imposes. In October 2026, the Union Health Secretary urged States to enforce rate display [1].

Weaknesses: gaps in practice

• Uneven coverage: States that have not adopted the Act use their own laws, such as Maharashtra's 2026 Bill [7]. As a result, standards differ across States.
• Centre's unfinished duty: Rule 9(ii) requires the Centre to fix a range of rates. A subcommittee was set up to do this [4], but no range had been fixed by 2022. That year the Supreme Court held that this is the Centre's duty and imposed ₹20,000 in costs [3].
• Displaying a price does not control it: emergency patients cannot compare hospitals. Bills also grow through drugs and consumables, which PM-JAY itself had to price separately [6].
• High financial stakes: out-of-pocket spending fell from 62.6% of health spending (2014-15) to 39.4% (2021-22), but it is still high [5].
• Weak enforcement: the Centre says implementation is the job of States and UTs [4], so enforcement depends on each district authority.

Overall, the Act's federal design is sound, but patients have not yet got national standards in practice. Cooperative federalism is the way forward. The Centre should notify a range of rates with separate bands by city and hospital grade, starting from PM-JAY package prices. States should copy Rule 9's duties into their own laws. This would turn the right to health under Article 21 and SDG 3.8 on universal health coverage into real protection for patients.