Regulatory collapse in all aspects of medical care in India

The new year starts with the health sector staring at regulatory collapse in most facets related to medical care. Bodies meant to regulate healthcare professionals are either nonexistent or in shambles. Several deaths and injuries from contaminated drugs have laid bare the state of drug regulation. Fraud perpetrated on Ayushman beneficiaries has caused several deaths and exposed patients to unnecessary treatment and procedures. There are no regulatory structures for private hospitals that are estimated to account for 80% of medical services.

Let’s start with the National Medical Commission (NMC), the apex regulatory body for doctors. It is functioning with near-empty autonomous boards dealing with undergraduate and postgraduate medical education, ethical and medical registration and medical college assessment, as the government has failed to make timely appointments.

The NMC’s attempt to update and organise the Indian Medical Registry has failed miserably. With no proper registry to check against, we’ve had several cases of fake or inadequately qualified doctors causing deaths and injuries. Despite a government-appointed committee finding doctors guilty of being bribed by pharma companies, the commission is yet to act against them. What’s worse, the NMC continues to reject all appeals filed by patients or their families, claiming only doctors have the right to appeal before the commission.

The commission and the health ministry were rocked by the scandal of medical colleges being tipped off by insiders about impending inspections. The CBI revealed that colleges had arranged fake patients and ghost faculty for inspections and were given approval in exchange for hefty bribes. Ragging and suicides in medical colleges continue unabated as the NMC failed to address either crisis. It also failed to ensure that MBBS interns and postgraduate medical trainees are paid a stipend by all colleges. The commission was unable to respond to the demands of trainee doctors to regulate duty hours and frame to patient-to-nurse ratio (nurses already have this) to ensure better care for patients and to prevent exploitation of doctors and burnout.

Moving on, the National Nursing and Midwifery Commission Act and the National Dental Commission Act came into force in August 2023. More than two years later, neither commission has been constituted. The Madhya Pradesh scandal of fake nursing colleges has not triggered a scan of private nursing colleges mushrooming across several states. Regulation of nursing education hangs in limbo, with the old council working like a stopgap arrangement. Registries of nurses and dentists are in as poor a state, if not worse, as the registry for doctors.

The National Commission for Allied and Healthcare Professions Act was passed in 2021, and the commission was constituted only in January 2024. It was meant to regulate physiotherapists, speech-language pathologists, radiologic technologists, medical lab technologists, and others who play vital roles in modern healthcare delivery. But the non-implementation of the act forced the Indian Association of Physiotherapists to file a public interest petition in the Supreme Court in 2025 seeking a comprehensive regulatory framework for accreditation, registration and licensing of allied healthcare professionals and for a framework to prevent the unchecked proliferation of illegal allied healthcare institutions. The petition remains pending.

This year also saw several cases of serious fraud under the Ayushman scheme by hospitals. Fake bills generated against fake Ayushman cards surfaced in several states, along with cases of patients with Ayushman cards being forced to pay out of pocket. While some hospitals were removed from the Ayushman panel, patients were not adequately compensated. However, the most horrific was the deaths caused by unnecessary angioplasty done by doctors in a hospital in Gujarat. Though the Ayushman scheme is said to use an AI-enabled fraud detection mechanism, this only detects fraud already committed. With no protection to prevent such abuse, the scheme is a Rs 5 lakh bait on every Ayushman beneficiary’s head that makes them the target of various kinds of fraud.

The diagnostics sector is estimated to be worth Rs 1.5 lakh crore, most of it spent from patients’ pockets. The Clinical Establishments Act sets down the manpower and infrastructure requirements for labs, but implementation is poor, with even registration of labs not being strictly followed. The SC ordered that all lab reports must be signed by pathologists, but with more than one lakh labs and roughly 5,000 pathologists, most labs are run by unqualified manpower using scanned signatures of pathologists.

The government is yet to frame a policy on online health service aggregators, even as several such aggregator companies offering diagnostic services have sprung up. Despite the government talking about a hub and spoke model for improved access to diagnostics, it has not framed standards for sample collection even after the Delhi High Court ordered it to do so in 2024.

The cough syrup deaths in Madhya Pradesh in October 2025 exposed the state of drug regulation. Despite hundreds of deaths reported in India and other countries from contaminated cough syrup manufactured in India since 2019, drug regulators have failed to stop them. Data on who’s been inspected, by whom, and what the inspections showed continue to be hidden from public scrutiny. The list of drug samples found substandard, put up on the website of the central drug regulator, shows that several companies are repeat offenders. However, there is no information on what action was taken against such companies.

Now consider this state of little or no regulation in the light of where we are heading. Hundreds of public health facilities are being handed over to private entities in the name of public-private partnerships to start medical colleges, even as complaints of inadequate infrastructure and faculty in hastily opening medical colleges have been pouring in. With accreditation by the National Accreditation Board for Hospitals and Healthcare Providers being voluntary, it is estimated to cover barely 2% of hospitals with more than 50 beds. Though the Clinical Establishments Act (CEA) 2010 was adopted by 19 states and all union territories barring Delhi, the private sector remains largely unregulated as the law is hardly ever implemented.

India has the dubious distinction of recording the highest medical inflation of 12-14% in Asia-Pacific, and arguably the world, even as the expansion of the for-profit health sector is on steroids. Without the government stepping in to regulate with an iron hand, citizens could end up spending astronomical amounts of money on unnecessary or even harmful medical treatment of dubious quality.

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