The human right to health means that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions, and a clean environment.

  • The human right to health guarantees a system of health protection for all.
  • Everyone has the right to the health care they need, and to living conditions that enable us to be healthy, such as adequate food, housing, and a healthy environment.
  • Health care must be provided as a public good for all, financed publicly and equitably.

The human right to health care means that hospitals, clinics, medicines, and doctors’ services must be accessible, available, acceptable, and of good quality for everyone, on an equitable basis, where and when needed. The design of a health care system must be guided by the following key human rights standards:

Universal Access: Access to health care must be universal, guaranteed for all on an equitable basis. Health care must be affordable and comprehensive for everyone, and physically accessible where and when needed.

Availability: Adequate health care infrastructure (e.g. hospitals, community health facilities, trained health care professionals), goods (e.g. drugs, equipment), and services (e.g. primary care, mental health) must be available in all geographical areas and to all communities.

Acceptability and Dignity: Health care institutions and providers must respect dignity, provide culturally appropriate care, be responsive to needs based on gender, age, culture, language, and different ways of life and abilities. They must respect medical ethics and protect confidentiality.

Quality: All health care must be medically appropriate and of good quality, guided by quality standards and control mechanisms, and provided in a timely, safe, and patient-centered manner.

The human right to health also entails the following procedural principles, which apply to all human rights:

Non-Discrimination: Health care must be accessible and provided without discrimination (in intent or effect) based on health status, race, ethnicity, age, sex, sexuality, disability, language, religion, national origin, income, or social status.

Transparency: Health information must be easily accessible for everyone, enabling people to protect their health and claim quality health services. Institutions that organize, finance or deliver health care must operate in a transparent way.

Participation: Individuals and communities must be able to take an active role in decisions that affect their health, including in the organization and implementation of health care services.

Accountability: Private companies and public agencies must be held accountable for protecting the right to health care through enforceable standards, regulations, and independent compliance monitoring. ISSUES OF CONCERN IN THIS CHAPTER ARE:

  1. Right to life
  2. Right to health
  3. Universal access to treatment
  4. Free access to treatment
  5. Universal access to essential drugs
  6. Right to informed consent
  7. Medical negligence
  8. Reasonable care

Public authorities must take steps to protect an individual’s life, in almost all circumstances, and must not take away a persons life except in very limited circumstances. For example, when lawfully defending someone from violence.
This protection requires that there should be an official investigation into deaths resulting from the states failure to protect life or use of force.

The human right to health is recognized in Article 25 of the Universal Declaration of Human Rights (UDHR) and in numerous other international instruments. Prime among them being the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR), the 1965 International Convention on the Elimination of All Forms of Racial Discrimination (ICERD), the 1979 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the 1989 Convention on the Rights of the Child (CRC). No government hospital shall deny the treatment of patient at any cost whatsoever. According to a report by the IMS Institute for Healthcare Informatics titled “Understanding Healthcare Access in India”, rural areas remain significantly underdeveloped in terms of health infrastructure, with about half the people in India and over three-fifths of those who live in rural areas forced to travel beyond 5 kms to reach the nearest healthcare centre. It clearly shows that physical accessibility of public and private healthcare facilities is a major challenge in rural areas. The report also shows that availability of healthcare services is skewed towards urban centers with these residents, who make up only 28 per cent of the country’s population, enjoying access to 66 per cent of India’s available hospital beds, while the remaining 72 per cent, who live in rural areas, have access to just one-third of the beds. Similarly, the distribution of healthcare workers, including doctors, nurses and pharmacists, is highly concentrated in urban areas and the private sector. The National Human Rights Commission’s core group on health has observed rights perspective is missing from the draft National Health Policy, 2015.
The aim is to support better understanding of human rights law for health and social care professionals and explain how it can be used to ensure that patients and care recipients receive a service based on fairness, dignity and respect.

The physical accessibility of pubic or private healthcare facilities is a challenge in rural areas. 

  • The implication of traveling large distances to access a healthcare facility in rural areas is that an individual potentially loses their day’s worth of earning and may also select facilities that may not be the most cost effective for the treatment they seek.
  • A larger proportion (+10%) of people traveled less than 5km to access private healthcare facilities for OPD (out-patient department) services as compared to public facilities.
  • Similar differences were observed across urban and rural segments, and also across acute and chronic segments.

Increasing proportion of people are using private healthcare facilities over public facilities for both IPD (in-patient department) and OPD (out-patient department) treatment.

There has been a steady increase in the usage of private healthcare facilities over the last 25 years for both OPD and IPD treatment, across urban and rural areas.

Over one million HIV/AIDS patients in India are without access to the much-needed anti-retroviral (ARV) treatment, a new international report said today, suggesting that India should consider issuing compulsory licensing for increasing availability of drugs.

The joint report issued by the World Health Organisation, UNAIDS, and UNICEF said India had made progress in scaling up access over the years, but said given its robust generic drug industry it could have done better.

“India has done well in scaling up access to the ARV therapy over the last seven years,” says a senior WHO official, suggesting there is still a huge gap to address.

The universal gap between those needing urgent ARV treatment for HIV/AIDS the world over and those unable to have any access climbed to over 15 million people and there is an urgent need for funds to the tune of USD 10 billion, says Rifat Atun, a senior official of the Global Fund which is the main provider of assistance to countries afflicted with HIV/AIDS, Tuberculosis, and Malaria.

India now ranks third in scaling up access, after South Africa and Kenya during the last five years.

However, it needs to cross some distance for ensuring universal access for all its HIV/AIDS patients.

Around 3,20,074 have received ARV therapy in India at the end of last year as compared to 2,34,581 patients to the previous year. Between 1.1 and 1.4 million HIV/AIDS patients have no access for ARV therapy in India.

Given the number of health professionals and the state of the art generic drug industry in India, the performance on the HIV/AIDS front could be far better in comparison with other low-income countries in Southern Africa.

India must consider issuing compulsory licenses for ensuring free access to second and third-line treatment for all patients.

Compulsory licensing enables a national government to revoke a license issued to a patent holder and thereby, allow other parties to produce and sell a patented product for non-commercial purposes.

Several industrialised nations resorted to compulsory licensing to enable their national health departments to procure medicines at low prices so as to provide free of cost in government hospitals.

India is yet issue a compulsory license despite its rising HIV/AIDS patients who now need second and third-line treatment.

In 2006, Thailand issued compulsory license for the production of patented drugs for for its HIV-infected population. Later, Brazil also issued compulsory license for the production of patent-drugs produced by an American pharmaceutical company despite enormous pressure from the US.

Heart disease is particularly endemic in India, where a genetic trait renders Indians three times more vulnerable than Americans or Europeans. While the average age for a heart attack in London is 65, in India it is 45 years. One in four Indians gets a heart attack before retirement and about 25 percent of all heart-disease deaths happen to those under the age of 40. As a result of this higher prevalence, the Indian subcontinent alone accounts for 45 percent of coronary artery disease worldwide.

In the face of such high demand, India’s healthcare system faces great difficulties in serving people’s needs. On average, there is one doctor per 2000 people, 70 percent of which live in urban areas. Thus, access to care is determined by the convenience and affordability of travel. Even when people can get to a hospital, 50 percent of patients seeking cardiac care at a district hospital before 2001 would die before they could get specialist help.

Like many other countries, cost is the biggest barrier to medical treatment in India. Of the 22.5 million Indians in need of heart surgery annually, less than 3.5 percent can afford it. The ripple effects are enormous: when a poor family loses its primary breadwinner, the whole family is made destitute. In other words, affordability of healthcare is a pre-requisite for emerging out of poverty. But less than 15 percent of Indians have access to health insurance, including the 2 percent that can afford private insurance.

Furthermore, led by developed economies, the trend in healthcare has been moving away from large hospitals to smaller clinics that provide a more tailored and unique experience, in addition to a stronger focus on new technologies, vaccines, and “wonder drugs”. While it is an exciting time in global healthcare since most diseases are curable, treatment remains prohibitively expensive, excluding most poor people from the healthcare system. In fact, 100 years after the first heart surgery, only 8 percent of the world’s population can afford one.

India is among the countries with the highest Out Of Pocket expenses on health care. Expenditure on drugs constitutes over 67% of out of pocket expenditure on health care. High Level Expert Group Report on Universal Health Coverage for India recommended that an increase in the public procurement of medicines from around 0.1% to 0.5% of GDP would ensure universal access to essential drugs, greatly reduce the burden of out-of-pocket expenditures and increase the financial protection for households. As per WHO study estimates, about 65% of the Indian population lacks regular access to essential medicines. This is a paradox given that India is one of the largest manufacturers and suppliers of generic drugs to the world, the reach of the essential drugs are out of the reach of big population in India, the essential drugs are life saving drugs and shall be available to all in India to meet the right to life requirements.

Informed consent is an ethical and legal requirement for research involving human participants. It is the process where a participant is informed about all aspects of the trial, which are important for the participant to make a decision and after studying all aspects of the trial the participant voluntarily confirms his or her willingness to participate in a particular clinical trial and significance of the research for advancement of medical knowledge and social welfare. The concept of informed consent is embedded in the principles of Nuremberg Code, The Declaration of Helsinki and The Belmont Report. Informed consent is an inevitable requirement prior to every research involving human being as subjects for study. Obtaining consent involves informing the subject about his or her rights, the purpose of the study, procedures to be undertaken, potential risks and benefits of participation, expected duration of study, extent of confidentiality of personal identification and demographic data, so that the participation of subjects in the study is entirely voluntary.

For a drug to get approved and enter into the market it has to prove its safety and efficacy in clinical trials. Clinical trial is a term used to describe all research related activities, which use human being as subjects. As no individual has right to infract fundamental rights of another person for the sake of fulfilling his own purpose, so an important tool called “informed consent” came into existence.

The informed consent is described in ethical codes and regulations for human subject’s research. The goal of the informed consent process is to provide sufficient information to a potential participant, in a language which is easily understood by him/her, so that he/she can make the voluntary decision regarding “to” or “not to” participate in the research study.

Conventionally informed consent is thought to be in terms of the documents signed and dated by participants, setting forth the purpose, benefits, risks and other study information necessary to allow the participants to make an informed and voluntary decision to participate in the clinical study. In reality, informed consent is the process that applies to each communication to participants, commencing with the subject recruitment material and the initial telephone screening of potential subjects through the conclusion of the study. It also describes the obligation of the investigator to inform the subject about personal benefits and risk, individual faces in study.

Informed consent is not only required for clinical trials but is an essential prerequisite before enrolling each and every participant in any type of research involving human subjects including; diagnostic, therapeutic, interventional, bioequivalence, social and behavioral studies and for all research conducted domestically or abroad. Obtaining consent involves informing the subject about his or her rights, the purpose of the study, the procedures to be undergone, the potential risks and/or benefits of participation and alternative treatments available if any. Subjects in the study must participate willingly only after consenting based on the information given

BASIC ELEMENTS FOR WRITTEN INFORMED CONSENT DOCUMENTS

  1. A statement that the study involves research;
  2. An explanation of the purpose of research and the expected duration of the subject’s participation;
  3. A description of the procedures to be followed and identification of any procedures that are experimental;
  4. A description of any foreseeable risks or discomforts to the subject, an estimate of their likelihood and a description of what steps will be taken to prevent or minimize them;
  5. A description of any benefits to the subject or to others that may reasonably be expected from the research. Monetary compensation is not a benefit;
  6. A disclosure of any appropriate alternative procedures or courses of treatment that might be advantageous to the subject;
  7. A statement describing to what extent records will be kept confidential, including a description of who may have access to research records;
  8. For research involving more than minimal risk, an explanation and description of any compensation and any medical treatments that are available if research subjects are injured; where further information may be obtained and whom to contact in the event of a research-related injury;
  9. Information on the amount of remuneration/compensation, if any, that will be provided to subjects;
  10. An explanation of whom to contact for answers to pertinent questions about the research and the research subject’s rights (include the clinical center’s patient representative and telephone number);
  11. A statement that participation is voluntary and that refusal to participate or discontinuing participation at any time will involve no penalty or loss of benefits to which the subject is otherwise entitled.

INFORMED CONSENT PROCESS FLOW

Notes to Flowchart

Source documents must reflect that consent was obtained before the start of study treatment and procedures

A copy of the signed consent form must be kept at the site

All versions of approved consent forms must be kept in the site study file; only the current Institutional Review Board (IRB) approved version may be used to consent new patients.

WAIVERS TO INFORMED CONSENT

  1. A waiver of informed consent under 45 Code of Federal Regulations (CFR) 46.116 (d)
  2. An alteration of consent under 45 CFR 46.116 (d)

An IRB may waive the requirements to obtain informed consent provided the IRB finds and documents that:

    • The research involves no more than minimal risk to the subjects;
    • The waiver or alteration will not adversely affect the rights and welfare of the subjects;
    • The research could not practicably be carried out without the waiver or alteration and
    • Whenever appropriate, the subjects will be provided with additional pertinent information after participation.
  1. A waiver of parent/guardian permission under 45CFR 46.408 (c)
  2. A waiver of assent under 45 CFR 46.408 because the minors are not capable of assent
  3. A waiver of assent under 45 CFR 46.408 because the research holds out a prospect of direct benefit that is available only in the context of the research

CHALLENGES IN INFORMED CONSENT PROCESS

Language Barriers

It is assumed that the individual who signs the consent form does so with full understanding of what is stated on the consent form. However, it is very difficult to evaluate their viewpoint about trial since there is no established method to measure the level of understanding that a participant has about the information given. Thus, it can be assumed that there is a degree of misunderstanding that occurs. Misunderstandings can occur because of incorrect or inadequate language translations. Many individuals sign the consent form without being fully aware of what they are signing, which results in withdrawal of subject at later stages of ongoing clinical studies. Hence, the responsibility of researcher enlarges when a study is performed in multilingual subjects.

Religious Influence

The informed consent process is designed to give every participant the liberty to decide whether to accept or refuse the recommended medical treatment. Sometimes their decision for participating in researcher projects is influenced by the religious beliefs. It is commonly observed that how the methodology of the experiment come into conflict with the rules of behavior set by a participant’s religion.

False Expectations

Even when there are no language barriers or religious impediments to hinder the communication relationship between researcher and participant, misunderstanding can still occur due to participants false expectations of the experiment outcome. Some patient fear of being treated as mere “experimental model” for the studies while others refuse to take part because of historical evidences of clinical trial fraud and misconducts known to them.

Patient Perceptions

Most patients believe that, trials will put extra burden on them. They assume that the conventional treatment is best and they are afraid of the unknown side-effects of new treatment. Convincing and receiving an informed consent from such patient is most difficult. In some case disclosing too much information of the potential side-effects may unnecessarily scare the patient away from a potentially life-saving or life-enhancing surgery or procedure.

Children

Where research involves children (under the age of 18) consent/permission has to be obtained from parents. If the child is above 7 years of age then “child assent” is also mandatory. It is arguable that children are capable of being partners in research and that they have rights to receive information, to be listened to, have their wishes and feelings taken into account and to give or withhold consent if judged competent to do so. Difficulty arises when parents give their consent while child refuses to assent.

Vulnerable People and Groups

Vulnerable groups include the person who is absolutely or relatively incapable of protecting their interests. Obtaining informed consent is critical when working with them, specifically with some groups like people with learning disabilities. There may be potential problems of understanding what the research is about, what their role in the research will be and how the research will be used. Hence, obtaining informed consent can be difficult and special care needs to be taken to develop the appropriate strategies for communicating the implications of involvement in research.

Indian Scenario

In countries like India, the clinical investigations are based on regional values and practices, the concept of disease as perceived through social values and power hierarchies in family of villages based on cultural systems. To get a meaningful and ethical informed consent in these settings become challenging due to differences in cultural values in western countries and local customs in developing countries including India. In a study by DeCosta  that was carried out in a village of Haryana state of India, the majority of respondents interviewed by them could decide on clinical trial participation after discussing with community members. Another important factor emerged from this study, which showed an implicit trust by respondents in the medical system and ignorance about the information that should be known before consenting to be a part of the research study. These factors put a huge responsibility on the part of the investigator to get informed consent. The investigator must explain in most comprehensive and complete manner the risks involved in participating in the research study. Thus, investigator should have the patience to get informed consent from these subjects allowing them to discuss with other family and community members. The ethical principles of western countries require all adults to be the primary decision makers of their participation, which may not be applicable in Indian system, which is culturally and socially different from the western world. Another important aspect of informed consent arises in psychiatric clinical studies. As large numbers of psychiatry studies are conducted in India, these studies present complex and unique challenges in Indian context. These issues include risk of worsening of illness, use of placebo and validity of informed consent. The informed consent procedure requires patient to be of sound mind and in understanding the information presented and make a sound judgment regarding participation. Assessment of consent capacity may be difficult due to fluctuation in illness, which requires continued assessment of consent capacity. Thus, conducting clinical trials and obtaining informed consent for psychiatry studies is difficult and raises a doubt on the conduct of clinical trials due to lack of trained researchers. The guidelines are prepared keeping in mind the western culture and may not replicate the same results due to cultural variability in non-western countries like India. The dilemma in obtaining informed consent from subjects with cognitive impairment includes validity of informed consent by subject, implications and validity of third party consent, protection of human subjects. Regulations don’t provide information and guidance on ethical issues of psychiatry research.

CONCLUSION

Though enveloped by challenges, informed consent is an important tool in clinical trials, which facilitates the entry of new therapeutic interventions into the market. No research activity involving human subjects can be conducted and proceed unless informed consent is completely sought. The responsibility of conducting trial ethically and genuinely lies in the hands of those involved in it. Everyone must understand their obligations and should not misuse their power for own benefit. Rights, safety and well-being of trial subjects should always prevail over the interest of science and society, so that a layman never feels being deceived off in name of a social cause. The issue of informed consent in India is a challenge on the part of investigator as a lot of complexities arise. Further, regulations are based on the western guidelines, which do not necessarily reflect the requirements of India. The guidelines on informed consent in India should be based on complex factors such as culture, level of education, demographics and risks involved during the study.

Recently, Indian Society is experiencing a growing awareness regarding patient’s rights. This trend is clearly discernible from recent spurt in litigation concerning medical professional or establishment liability, claiming redressal for the suffering caused due to medical negligence, vitiated consent, and breach of confidentiality arising out of the doctor patient relationship.

What Is Medical Negligence?

Negligence is simply failure to exercise due care. The three ingredients of negligence are as follows:

  1. The defendant owes a duty of care to the plaintiff
  2. The defendant has breached this duty of care.
  3. The plaintiff has suffered an injury due to his breach.

And in case of medical negligence mostly the doctor is the defendant. Negligence is predominantly a theory of liability concerning allegations of medical malpractice, making this type of litigation part of the Tort Law.

 

Civil Liability and Medical Negligence

Negligence is the breach of a legal duty to care. It means carelessness in a matter in which the law mandates carefulness. A breach of this duty gives a patient the right to initiate action against negligence.

Persons who offer medical advice and treatment implicitly state and undertake to have the skill and knowledge to do as under:

  • To undertake particular job.
  • To decide whether to take a case or not ,
  • To decide the treatment suitable for particular case
  • To administer that treatment.

This is known as an “implied undertaking” on the part of a medical professional.

However, no human being is perfect and even the most renowned specialist could make a mistake in detecting or diagnosing the true nature of a disease.

A doctor can be held liable for negligence only if one can prove that she/ he is guilty of a failure that no doctor with ordinary skills would be guilty of if acting with reasonable care. An error of judgment constitutes negligence only if a reasonably competent professional with the standard skills that the defendant professes to have, and acting with ordinary care, would not have made the same error.

Doctors must exercise an ordinary degree of skill. However, they cannot give a warranty of the perfection of their skill or a guarantee of cure. If the doctor has adopted the right course of treatment, if she/ he is skilled and has worked with a method and manner best suited to the patient, she/ he cannot be blamed for negligence if the patient is not totally cured.

Certain conditions must be satisfied before liability can be considered. The person who is accused must have committed an act of omission or commission; this act must have been in breach of the person’s duty; and this must have caused harm to the injured person. The complainant must prove the allegation against the doctor by citing the best evidence available in medical science and by presenting expert opinion.

Criminal Liability and Negligence

Indian Penal Code 1860 sections 52, 80, 81, 83, 88, 90, 91, 92 304-A, 337 and 338 contain the law of medical malpractice in India.

A physician can be charged with criminal negligence when a patient dies from the effects of anesthesia during, an operation or other kind of treatment, if it can be proved that the death was the result of malicious intention, or gross negligence. Before the administration of anesthesia or performance of an operation, the medical man is expected to follow the accepted precautions.

In such cases, the physician should be able to prove that he used reasonable and ordinary care in the treatment of his patient to the best of his judgment. He is, however, not liable for an error judgment. The law expects a duly qualified physician to use that degree of skill and care which an average man of his qualifications ought to have, and does not expect him to bring the highest possible degree of skill in the treatment of his patients, or to be able to guarantee cures.

“Gross Lack of competency or gross inattention, or wanton indifference to the patient’s safety, which may arise from gross ignorance of the science of medicine and surgery or through gross negligence, either in the application and selection of remedies, lack of proper skill in the use of instruments and failure to give proper attention to the patient.” (Hampton v State; State v Lester)

When Does The Liability Arise In Case Of Medical Negligence?

The liability of a doctor arises not when the patient suffers injury but when the injury results due to the conduct of the doctor, which was below reasonable care. Hence once there exist a duty which has to be established by the patient, then the next step is to prove breach of such duty and the causation.

Normally the liability arises only when the plaintiff is able to discharge the burden on him of proving negligence. However, in some cases the principle of “res ipsa loquitor” which means the thing speaks for it might come into action. Mostly the doctor is liable only for his own acts. However in some cases a doctor can also be made vicariously liable for the acts of another. The example of such a situation is when a junior doctor assisting the senior doctor commits a mistake it becomes the duty of the senior to have supervised him hence vicariously liable.

Proof of Medical Negligence

It has been held in different judgments by the National Commission and the Hon’ble Supreme Court that a charge of professional negligence against a doctor stood on a different footing from a charge of negligence against a driver of a vehicle. The burden of proof correspondingly greater on the person who alleges negligence against a doctor. It is known fact that things can go wrong even wit the best doctor. And the guilt or the negligence should be established beyond all reasonable doubts that his skill fell below reasonable care that he ought to take during the treatment/ surgery.

Steps/ Procedure to File Complaint Pertaining To Medical Negligence

Medicine is a noble profession and practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise reasonable degree of care. Neither the very highest nor a very low degree of care and competence, judged in the light of the particular circumstances of each case, is that the law requires.

  1. Damage to organ due to negligence.
  2. Wrong treatment due to wrong diagnosis.
  3. Money receipt or prescription or discharge summary or test reports when not provided.
  4. When treatment not chosen as accepted and established in medical norms /as per medical research/available medical literature.
  5. Theory of res ipsa loquitur [a thing speaks of itself] – in case any instrument left in the body, a wrong part removed, allopathic treatment given by a homeopathic doctor etc.
  6. Govt Hospital liable if contribution from the employee’s salary deducted OR Payment made by insurance company.
  7. Negligent if three steps necessary are not observed by the medical practitioners.
    First – To decide whether he has to take up the case or not:Third- Whether the treatment given as per the diagnosis made.
  8. Hospital can also be negligent if ‘it is a case of non- availability of oxygen cylinder either because of the hospital having failed to keep available a gas cylinder or because of the gas cylinder being found empty.

The Indian health system includes public and private hospitals as well as specialised Ayurvedic hospitals offering this traditional Indian system of alternative medicine. English-speaking doctors are easy to find, as most Indian doctors speak fluent English. All major cities and medium-sized urban centres have private hospitals that provide an excellent standard of care.

Health insurance only covers hospitalisation and emergency costs. Other care must be paid for upfront, but even privately it is extremely reasonable compared to other countries, so medical costs should not be a significant expense.

Most western expats working in India take out private health cover, either independently or as an employee benefit. As such, foreigners should head to or call a private hospital in an emergency, as the quality of treatment and care is likely to be better than a state hospital.

Government-funded Healthcare

Publicly funded government hospitals provide basic care only and often lack adequate infrastructure. They can also be crowded and waiting times can be long. Government hospitals are often understaffed, which is why a family member usually attends to the patient during a hospital stay.

Though the cost of care is less at these government hospitals, the standard is inferior compared to private hospitals, and in general western expats opt for private healthcare.

The Private Sector

Most locals and expats prefer to use the services of private hospitals and clinics. These offer a high standard of care that is at the same level as North American and European countries. Private hospitals are modern and well equipped, and the doctors are highly qualified and often trained abroad. The following private hospital groups have good reputations and are located in all major cities:

The cost of medical care is very reasonable compared to other countries. Some hospitals practice double-pricing, with higher fees for foreigners. These fees can be negotiable.

Doctors and Clinics

General practitioners are available in hospitals, clinics and in private practices. The best way to find a doctor is to ask for recommendations from friends, co-workers or neighbours. Embassies and consulates can also provide a list of recommended doctors.

There are hundreds of medical facilities across the country. Your health insurance provider will normally provide details of the options in your locality. In addition, the following links provide contact information for a range of hospitals and clinics.

  • The Health section on the India government website provides details and directories of a number of health care options.
  • For lists of contact details for selected hospitals and clinics.

Pharmacies

All types of prescription medicines and health care products are available in India at a very low cost. Doctors provide prescriptions for certain medications but some pharmacies do not always ask for them.

Pharmacies are easily found in almost every street in all Indian cities. These can be simple roadside stalls or bigger shop-like businesses. Some may display green or red crosses.

Dental Procedures

There are many qualified dentists in India operating in private practices offering high-quality dental care and procedures at very reasonable rates. Health insurance does not cover dental care but if a dental procedure requires hospitalisation, this may be covered.

Again, ask for recommendations for a dentist from friends, co-workers or neighbours. Always check that the dentist has the correct qualifications.