States responsible for diagnostic centre pricing, referral practices: MoS Health tells Rajya Sabha

The questions asked whether Government is aware that diagnostic centres, including pathology labs, X-ray, CT scan, and MRI facilities, charge excessively and allegedly offer refferal commissions to doctors, increasing treatment costs for poor patients; whether any national regulartory mechanism exists to monitor and control pricing of diagnostic tests; if so, the details thereof and the extent of enforcement; whether Government proposes to prsecribe standard rates or bring diagnostics under a uniform pricing framework; and the steps taken to curb unetical referral practices and ensure affordable diagnostic services?

In her reply, the Minister stated that the Government of India enacted the Clinical Establishments (Registration and Regulation) Act, 2010 (CE Act), along with the Clinical Establishments (Central Government) Rules, 2012, subsequently amended in 2018 and 2020, to regulate both government and private clinical establishments. The Act mandates that clinical establishments adhere to prescribed minimum standards of services.

The CE Act is currently applicable in 19 States and Union Territories, including Arunachal Pradesh, Assam, Bihar, Jharkhand, Haryana, Himachal Pradesh, Mizoram, Rajasthan, Sikkim, Telangana, Uttarakhand, Uttar Pradesh, and UTs such as Andaman & Nicobar Islands, Chandigarh, Dadra & Nagar Haveli and Daman & Diu, Jammu & Kashmir, Ladakh, Lakshadweep, and Puducherry.

Under the CE Rules, clinical establishments are required to prominently display the rates charged for various services in both the local language and English, and to charge within the prescribed range of rates. However, the issue of determining the range of rates is currently sub-judice before the Supreme Court of India.

The Minister further clarified that States and UTs that have adopted the CE Act are responsible for its enforcement. The Act empowers district-level registering authorities, chaired by the District Collector or District Magistrate, to take action against violations, including imposing penalties and cancelling registrations. In States that have not adopted the CE Act, clinical establishments are regulated under respective State laws.

On the issue of referral commissions, the government pointed to the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, which prohibit physicians from giving or receiving any commission, gift, or bonus in exchange for referring patients or diagnostic specimens. The regulations also require that diagnostic investigations be prescribed judiciously and not routinely.

Additionally, under the Free Diagnostics Service Initiative, the Centre provides financial support to States and UTs to ensure that essential pathological and radiological diagnostic services are made available free of cost at public health facilities. The response indicates that while regulatory mechanisms exist at both central and state levels, enforcement and pricing control largely remain within the domain of States and UTs.