Uneven adoption of the Clinical Establishments Act, 2010 by States has weakened patient protection. Examine the federal problems in regulating private healthcare.

Health is a State subject. The Clinical Establishments (Registration and Regulation) Act, 2010 therefore binds only the States that adopt it by resolution under Article 252, and so far that is 12 States and 7 UTs [1]. The result is a patchwork of protection: what a patient is entitled to depends on which State the hospital is in.

How uneven adoption weakens patient protection

• Patchy coverage: Large States such as Maharashtra have not adopted the Act [1]. Even official counts differ: an earlier Health Ministry reply in Parliament listed only 10 adopting States [2].
• Different standards: Karnataka, Gujarat, Tamil Nadu and West Bengal have their own laws. Karnataka and West Bengal require hospitals to display rates, but Gujarat's law does not [1].
• Centre can only advise: In October 2026 the Union Health Secretary asked Chief Secretaries to make hospitals display their rates under the 2012 Central Rules. That duty binds only where the Act applies [3].
• Unequal remedies: West Bengal requires a grievance cell and lets its commission award up to Rs 50 lakh in compensation. Maharashtra's 2026 Bill has no grievance mechanism at all [1].

Federal problems in regulating private healthcare

• Constitutional limits: Under the Seventh Schedule, the Centre can only persuade States through letters and advisories. It cannot enforce compliance [3].
• Enforcement depends on States: State registering authorities have to inspect thousands of small clinics and keep displayed rates current, and their capacity varies widely.
• Public–private double standard: Maharashtra's Bill exempts government hospitals, while the central Act exempts only armed-forces facilities. Poor patients in public hospitals may end up less protected [1].
• Rights left out: State laws leave out parts of the NHRC Charter of Patients' Rights, such as freedom to buy medicines outside the hospital [1].
• Medical tourism: Foreign patients on Medical/Ayush visas need prices they can predict across States, which a patchwork of laws cannot guarantee [3].

Way forward

• A model law that States can adapt, covering rate display, a ban on charging above displayed rates, itemised bills and grievance cells.
• Linking health grants to States' adoption of minimum standards.
• Using the NHRC Charter as a common floor of patient rights [1].

Uneven adoption reflects real tensions in India's federal design, but it need not mean uneven protection. If the Centre and States agree, in the spirit of cooperative federalism, on a common floor of patient rights backed by West Bengal-style redress, regulation of private healthcare can become uniform. That would advance Article 21's right to health and SDG 3.8 on universal health coverage.