1.
IMA supports registration
and regulation of clinical establishments by an autonomous Hospital Authority
of India which has democratic and representative character.
2.
Government licensing out healthcare institutions will lead onto
harassment, corruption and nepotism.
3.
Government imposing
uniform treatment protocol is unacceptable .This endangers patient safety.
4.
Government fixing rates is
unrealistic. Government should first define parameters to measure skill and
proficiency of doctors.
5.
Government have taken a
layman’s approach to the subject as evidenced by the ‘stabilization clause’.
First aid is the right of the patient and duty of the medical profession.
Stabilisation is unachievable.
6.
Single doctor
establishments should be exempted from the act.
7.
The proposed autonomous
Hospitals Authority of India should provide single window clearance for all
legislations regarding clinical establishments.
8.
The clinical
establishments act should include provisions for promotion of healthcare
institutions. It should be The clinical establishments (Registration and
Regulation and Promotion)Act 2010.
9.
The licensing character of
regulation should be replaced by a more friendly procedure.
10.
Complaints cells are
incompatible with administration and delivery of health care services.
Alternative forums already exist.
The
clinical establishment (Registration and Regulation) Act 2010 has become a fait
accompli. Nevertheless the law in its present format is unacceptable to the medical
profession of the country. It is admitted that registration of the clinical
establishments is necessary for various reasons. However the regulation aspect
of it has serious flaws. License raj imposed on healthcare institutions will
lead onto disappearance of single doctor practitioners, corporatization of
health care and promote corruption and nepotism.IMA is apprehensive of large
scale harassment of private sector.
(A)
General
Objections:-
1.
Who
is affected:
The
private sector consists mainly of single practitioners or small nursing homes
having 1-20 beds. 90% of the facilities
are manned by single practitioners. According to
the survey in 2001-02 there were approximately
13 lakh enterprises providing health care
services in the country. The majority of these enterprises are own account
enterprises (OAEs), which accounted for over 80% of the total health facilities
in the country. OAEs are typically run by an individual or are a house hold business providing health services
without hiring a worker on a fairly regular basis. The number of health
establishments in the country was roughly around 2.3 lakhs. Establishments are
those that hire at least one worker on a regular basis. OAEs are dominant in
rural areas. There are 92% OAEs and
around 7% of establishments in rural areas . In the urban areas, establishments
accounted for roughly 38% and the remaining 62% facilities were OAEs. If we
consider all the 13 lakh private health
providers, a little over half of them are modern medicine practising
physicians and specialists. So it is clear against whom the Government is
moving. If 90% of the healthcare institutions in this country are manned by
single practitioners, it does not take much to understand that the target of
these regulations are these single practitioners. By imposing standards
unachievable by them these regulations are going to lead to closure of majority
of these small institutions. India is well served by its army of family
physicians and small hospitals. They provide low cost service at the doorsteps
of the commonman 24x7.Any law resulting in diminution of the role of single
practitioners will seriously hamper the accessibility and affordability of
healthcare. Government will do well to recognise that these family doctor
single person institutions are holding the lifeline of Indian masses. Every
year 3.3% of India’s population is pushed below poverty line due to
unaffordable healthcare cost. Any decline in the share of family doctors in the
health care delivery of the nation is bound to adversely impact this percentage
of impoverishment.
2.
Who is benefitted:
There is an increasing trend towards corporatization of healthcare
supported by private healthcare
insurance. This apes the American model of healthcare which is expensive but
not necessarily the best or inclusive. Moreover young medical graduates shun
family
practice and prefer to be
employed in large hospitals. License raj and its regulations will demotive them
further from entering into family practice. Enactment of this law raises serious doubts regarding
the intentions of the Government. Is the Government playing for the corporate
hospitals and the private medical insurance which are the only entities to be benefitted from this law ?
IMA has no hesitation in condemning this law as anti people and antipoor. The
Hon Union Minister for Health stated in
Rajya Sabha:-
“Shri Avtar Singh Karimpuri,
Shri K.K. Mohanty and Shri Mysura Reddy had expressed concerns about single
doctor establishments being brought under the purview of this law. Even if it is
one doctor establishment, you just don't know what he is giving; from where
he is operating; what he is upto; what equipment he is treating, etc. It is all the more important for
one doctor establishment to register and he
has to comply with it . He should have some minimum standard. It is all the more important for one doctor
establishment because you don't have
any other facility. He is
a doctor for heart diseases; he is a doctor
for cancer; he is a doctor for diabetic patients; he is everything. So I think
we need to have some minimum standards for him. If we let him off then he is at
the mercy of god.
As my friend said, somebody was using knife or chaku or chura for
operation, so he will also be using chaku or chura. I think it is all the more important that one-man doctor should be included in this. By keeping these doctors out of the purview of
this law, we would be excluding a major category of health- care providers”.
So the agenda seems to be
elimination of single doctor clinics to the advantage of big players.
3.
Attack on the federal structure of the country :
Legislation in respect of
"Public health and sanitation, hospitals and dispensaries" are
relatable to Entry 6 of List II — State List in the Seventh Schedule to the
Constitution and Parliament has no power to make a law in the State list. Under article 252 of the Constitution where
the Legislatures of two or more States pass resolutions empowering Parliament
to pass the necessary legislation on the subject, a bill may be introduced in
Parliament. The Legislatures of the States of Arunachal Pradesh, Himachal
Pradesh, Mizoram and Sikkim have passed such resolutions in this case.By
enacting this law the Indian Parliament has transgressed the federal spirit of our
constitution. It has actually encroached on the rights of the states. It may
actually take away whatever the states have done.Various states have also
enacted their own legislations for regulating clinical establishments.
a)
Bombay Nursing Homes
Registration Act, 1949
b)
The AP Private Medical
Care Establishments Act, 2002
c)
Delhi Nursing Homes
Registration Act, 1953\
d)
Orissa Clinical
Establishment (Control and Regulation) Act, 1991
e)
Punjab State Nursing Home Registration Act,
1991
f)
Manipur Nursing Home and
Clinics Registration Act, 1992
g)
Sikkim Clinical
Establishments, Act 1995
h)
Nagaland Health Care
Establishments Act, 1997
i)
MP Clinical Establishments Regulation Act.
j)
Tamilnadu private clinical
establishment Act 1997
k)
The West Bengal Clinical
establishment Act 1950
It
is also gathered that some more states such as Rajasthan, Karnataka Kerala and
Haryana have drafted the regulatory legislations but have not been able to get
them tabled and considered by their respective legislative assemblies.
4.
Over
regulation:
Private
healthcare is a sector which is already governed by multiple legislations.
Inspite of all these hindrances private health care institutions have grown
because they meet the expectations of the people. The Honorable union minister
for Health is on record saying that the private sector is helping the
healthcare system and that lot of capacity building has happened. He himself
has admitted that bringing in a very hard legislation will be a great deterrent
for the private hospitals to come up. According to him the Government will be
creating new problems.
The
following enactments regulate various activities of healthcare institutions :
However the list is not exhaustive because different states have different
combination.
a)
Laws
regarding service delivery:-
1.
The Drugs and Cosmetics
Act,1940(Central Act of 23 of 1940) and Rules 1945 including blood bank rules.
2.
Intoxicating
Drugs(Control)Rules,1983
3.
The Drugs (Prices
Control)Order ,1995
4.
Narcotic Drugs and
Psychotropic Substances Rules,1985
5.
The Mental Health Act,1987
and The Central Mental Health Authority Rules,1990
6.
The Pre-Conception and
pre-Natal Diagnostic Techniques(Prohibition of sex selection)Act 1994 and The Pre-Conception and pre-Natal Diagnostic
Techniques(Prohibition of sex selection)Rules ,1996
7.
The Drugs and Magic
Remedies (Objectionable Advertisements)Act 1954 and The Drugs and Magic
Remedies (Objectionable Advertisements)Rules,1955
8.
Corneal Grafting Act ,1963
and Corneal Grafting Rules,1963
9.
The Creation of Eye –Bank
Rules ,1970
10. The
Medical Termination of Pregnancy Act,1971 and The Medical Termination of
Pregnancy Rules ,2003
11. The
Transplantation of Human Organs Act,1994
and The Transplantation of Human Organ Rules,1995
12. The
Bio –Medical Waste (Management and Handling)rules,1998
13. The
Clinical Thermometers(Quality Control)Order,2001
14. The
Poison Act,1919(central Act XII of 1919)
15.
The Standards of
Weights &Measures Act,1976(Central
Act 60 of 1976)& The Standards of Weights&
Measures(Enforcement)Act,1985(Central Act 54 of 1985)
16.
Atomic Energy Act 1962
17.
The Epidemic Disease Act
of 1897
b)
Laws
regarding the professionals :-
18.
The Indian Medical Council
Act ,1956
19.
The Medical Council of
India Regulations,2000
20.
The Indian Medical Degrees
Act,1916
21.
The Indian Medical
Council(Professional Conduct ,Etiquette and Ethics )Regulations 2002
22.
The Indian Nursing Council
Act,1947
23.
The Nurses and Midwives
Act,1953
24.
The Pharmacy Act,1948 and
The Pharmacy Council of India
Regulations,1952
25.
State enactments regarding
state Medical Councils (Medical Practitioners’ Acts )
c)
Laws
regarding human resources
26.
The Minimum Wages
Act,1948(Central Act 11 of 1940)& Rules,1950
27.
Payment of Wages Act 1936
28.
The Maternity Benefit Act
,1961
29.
The National and Festival
Holidays Act
30.
The Gratuity Act 1972
31.
Weekly Holidays Act
,1942(Central Act 18 of 1942)
32.
The Employees Provident
Fund and
Miscellaneous Provisions Act
,1952 (Central Act 19 of 1952)
33.
The Employees State
Insurance Act
34.
The Payment of Bonus
Act,1965 (Central Act 21 of 1965 )&Rules,1975
35.
The Welfare Fund Act
36.
The Industrial Employment (Standing Orders)Act 1946
37.
The Industrial Disputes
Act 1947
38.
Payment of subsistence Act
,1972(Act 27 of 1973)
d)
Laws
regarding the Institutions:-
39.
The Building Tax Act 1975
40. Dangerous
trades &Offensive practices Act
41. The
Shops& Commercial Establishments Act
42. The
General Sales Tax Act,1963/VAT
43. The
Municipality (Registration of Private Hospitals and Private Paramedical
Institutions)Rules and The Panchayat Raj (Registration of private Hospitals and Private paramedical institutions) Rules
44.
Service tax (certain instances)
45.
Luxury Tax
If all the above
legislations which are already in force have failed to bring the desired
outcome it shows the process of
legislations in poor light.
5. The Lok
Sabha has passed the bill to regulate the healthcare institutions without any
discussion. Whether a bill passed
and adopted without any mind application has the legal and moral
sanction to govern us is an important question to be answered. IMA also would
have expected the discussions in Rajyasabha
to have been unbiased and of a quality befitting the stature of elders.
6.
Infringement on
fundamental rights of doctors:
a)
Under
article 19(g) all citizens have a fundamental right to practice any profession
or to carry on any occupation trade or business. Article 21 specifically states
that no person shall be deprived of his life or personal liberty.The
Hon.Supreme court has held in various
judgments that right to life
includes right to earn a living.This act restricts the right to practice the
profession freely in order to earn the wherewithal.
b)
The citizens
have a fundamental right to health as held by the supreme court in its interpretation of the right to
life under article 21.This right to health is against the Government.It is the
duly of the Government to ensure the protection
of health of the citizens.This duty cannot be passed onto
citizens/doctors by colorable exercise of power.
(B)
Specific Objections to the clauses of clinical establishments
(Registration and Regulation)Act
1.
Preamble : The
preamble of the act has invoked the mandate of article 47 of the constitution
for improvement in public health. The entire act does not include a single public health initiative.
The conflict of interest could not be more glaring since the prime purpose of
the act is to regulate curative services.
2.
Type of Regulation :One of the concerns raised by Hon.members of the Rajya Sabha is
that this act will result in inspector raj and corruption. The Hon Minister
himself has admitted in the floor of the house that the intention of this
legislation is not to impose upon the health sector any structure of licence
raj. The Government have very carefully
avoided the word license. However the mandatory nature of registration
with severe penalty clauses with powers for cancellation cannot hide the
licensure nature of the regulation.
The Planning Commission
of India in its report of the working group on clinical establishments
professional services regulation and accreditation of Health care
infrastructure for the 11th
five year plan has given the following definitions.
Licensure :-
a government administered mandatory process that requires healthcare
institutions to meet established minimum standards in order to operate.
Certification :- a voluntary governmental or non-governmental
process that grants recognition to healthcare institutions that meet certain
standards and qualifies them to advertise services or to receive payment or
funding for services provided.
Accreditation:-
a process by which a government or non-government agency grants recognition to
healthcare institutions that meet certain standards that require continuous
improvement in structures, procedures or outcomes. It is usually voluntary,
time-limited and based on periodic assessments by the accrediting body, and
may, like certification, be used to achieve other desirable ends such as
payment or funding”.
IMA
demands to know from the Government the form of regulation it has chosen. Is
this a license or not? If the Government have chosen licensing let the
Government admit the fact. It is clear from the definition of the planning
commission that the procedure that has been adopted is licensing. On the other
hand the Government have used the term certificate. Certification is a voluntary process.
The
post independence period before liberalization of early nineties stand evidence
to the negative impact that licensing can create to the growth and the amount
of corruption it can
breed.
What has the health sector done to deserve a license raj where as every other
sector has come under the process of liberalization and growth?
3.
IMA disapproves of the constitution of National and State
councils.
The
government have opted for total control of the private healthcare institutions
by the central and state governments.The National Council is chaired by the DGHS
and the central Government appoints an officer of the rank of joint secretary
in MOH as the secretary. The state council
is chaired by the secretary health and DHS is the member secretary. The
district registering authority is chaired by the district collector and the
district health officer (DMOH) is the convenor. The powers of the district
registering authority is vested in DMOH. In effect the Government is taking the
private sector entirely into its ambit. This is just one step short of
nationalization of healthcare services. Nothing has happened in the healthcare
delivery system of the country to effect
such a total takeover of the reins of the private sector . Placing a
serving Government officer at the head of the DRA effectively brings the private
sector entirely under the Government control. Private sector cannot function as
an extension of a Government department. DMO(H), Superindent of Police and the
NGO have conflict of interest with the healthcare institutions.IMA feels that
they are unsuitable for the job.They cannot function in a fair and unbiased
manner. The structure of the act in the present format is unacceptable to the medical
profession of the country and IMA will resist this black law lock stock and
barrel.This tantamounts to martial law being proclaimed in health sector. There
is very little doubt this misadventure will destroy the vibrant private sector
in healthcare and the scars will be visible for generations to come. If this is
the proclaimed policy of this Government, IMA feels that the Government should
revalidate its mandate from people. Government are imposing a law on the people
which can seriously impact the health of a nation.
IMA brings to the attention of the people
what the planning commission had suggested:
·
As
far as possible, registration should be done on the basis of documents
certified by licensed professionals
such as Chartered Accountants, approved valuators, assessors etc. The setting
up of administrative paraphernalia for inspection is to be discouraged.
·
To
the maximum extent possible, the responsibility of actual registration should
be entrusted to Panchayati Raj Institutions (PRIs). There is already a
multiplicity of licensing/inspector authorities under various health related
legislations. These are, therefore, required to be consolidated.
·
Due
care would have to be taken to avoid over emphasis on standards for infrastructure.
Otherwise investments required to comply with standards might have a spiraling
effect on service costs in the health sector. Greater focus would, therefore,
be required on standards for service delivery.
In
terms of implementation, two aspects are of prime importance – firstly there is
a need to empower Panchayti Raj Institutions to undertake registration and
monitor the minimum standards for clinical establishments. This is already
mandated by the 73rd and 74th amendments to the Constitution of India. Secondly
there exists a need
for
provision of resources and developing capacities to undertake the task of
implementing standards that may get to be prescribed. To create an autonomous
institution with representative democratic character under the central and
state governments like the MCI and state medical councils will be a more
acceptable option.
4.
Representation for modern medicine
Objection: 90 percent of the private healthcare delivery system consists
of single practitioners. Roughly 50 percent of them are modern medicine
doctors. Almost 90percent of the hospitals also offer only modern medicine
services. IMA demands proportionate representation in these bodies for modern
medicine doctors on democratic basis.IMA also objects to the representation
provided for sections who do not represent healthcare institutions. We demand
that representatives of healthcare institutions run these councils with
representations for central and state Governments respectively in the national
and state councils. Modern medicine cannot be grouped with
other systems of medicine in the proposed councils.Each system has a separate
identity and character which has to be protected. It would be better to have
separate autonomous institutions for all recognized systems. Systems of
medicines with a regulatory council alone should be considered as recognized
systems.
5.
‘Stabilisation’ Clause
with layman’s perspective
·
“The
clinical establishment shall undertake to provide within the staff and
facilities available, such medical examination and treatment as may be required
to stabilise the emergency medical condition of any individual who comes or is
brought to such clinical establishment”.
·
“emergency
medical condition" means a medical condition manifesting itself by acute
symptoms of sufficient severity (including severe pain) of such a nature that
the absence of immediate medical attention could reasonably be expected to
result in—
(i) placing the health of the
individual or, with respect to a pregnant women,the health of the woman or her unborn child, in serious
jeopardy; or
(ii) serious
impairtment to bodily functions; or
(iii) serious
dysfunction of any organ or part of a body;”
·
"to
stabilise (with its grammatical variations and cognate expressions)"
means, with respect to an emergency medical condition specified in clause (d), to provide such medical treatment
of the condition as may be necessary to assure, within reasonable medical
probability, that no material deterioration of the condition is likely to
result from or occur during the transfer of the individual from a clinical
establishment”.
Objection: These clauses are open invitation for litigation against the
healthcare institutions. Doctors and
the institutions who are already suffering the ill effects of CPA are placed
under further harassment. All the words in the above clauses can be interpreted
and misinterpreted to suit one’s temperament. Such a cart blanche against
doctors and institutions cannot be accepted.IMA will resist this clause with
all its strength from patient’s point of view it would be better if the law
entailed him to life saving first aid rather than ‘stabilization’ which is an
arachic term. For eg a case of ectopic pregnancy without pulse or BP would
survive if referred to a higher institution rather than being subjected to
stabilization in a primary care set up.
More over there are Supreme Court judgments protecting the rights of citizens in this
regard. All health care institutions in this country are duty bound by law to
provide emergency care and no one could be refused such a care even now. In
countries like US such a care is paid for by the state.
The Government is bound to answer the
following questions:
1.
Who will pay
for the treatment?
2.
Where will
the patient be transferred?
3.
Who will pay
for the transfer?
The basic legal principle is that there
cannot be a duty without a corresponding
right. The act imposes a duty to provide
expensive treatment without any provision for paying the cost.
6.
Section 49 under chapter VII states,
“Without prejudice to the
foregoing provisions of this Act, the authority shall have the power to issue
such directions, including furnishing returns, statistics and other information
for the proper functioning of clinical establishments and such directions shall
be binding”.
Objection: In a democratic country
like ours the Government cannot empower itself so as to run the private
healthcare institutions according to their
whims and pleasures. This clause is ultravires of the freedom enshrined
in the constitution of India.IMA demands that this clause be repealed.
(C)
Specific objections in draft rules
Page no :7
·
“Each category of clinical establishments shall
comply with the Standard Treatment Guidelines and maintain electronic medical
records of every patient as may be notified by the Central Government from time
to time”
Objection:
Government have no right to
prescribe standard treatment guidelines and require the clinical establishments
to comply. It is emphasized that various treatment protocols approved by the
medical profession alone will be abided with. Each medical condition is an
abstract situation requiring multiple approaches and the plurality of the
opinions inside the medical profession have to be respected. Practice of medicine is an ocean.There are multiple
modalities of treatment for any one given condition. It is the right of a
doctor to choose a particular modality as per his judgments. Any mandatory rule
to comply with the treatment guidelines of the Government are not only
unacceptable but betrays lack of
sensitivity on the part of the Government in understanding what they are regulating. This clause infringes
on professional independence and seriously impacts patient safety. While
keeping medical recording electronic form might be ideal whether the idea is realistic in Indian conditions has to
be re examined.
·
“Each category of clinical establishments shall
charge the rates for each type of procedure and service within the range of
rates to be notified by the central government from time to time, for such
procedures and services”.
Objection:
Government fixing rates for various procedures
is unacceptable .This hits at the root of fundamental right to practice the
profession. What parameters the Government would use to measure the competency and skill of
different doctors though they all might have similar qualifications?. Moreover
the cost of a procedure will vary from
patient to patient depending on multiple
variables; And how will treatment of
complications be compensated ? Government will be well advised to withdraw this
clause. In case Government wishes to still persist with the same IMA demands
that the Government engage the Institute of cost and accountants of India to
estimate the costs and devise viable rates for each state separately with due
consideration of status of (ABCD) urban centers and rural areas.
·
Every Clinical Establishment shall display the
rates charged for each type of service provided and facilities available, for
the benefit of the patients at a prominent place in the local dialect and as
well as in English language. The minimum list of services for which rates are
to be displayed are given in CG 4 Annexe.
Objection :The
services cannot be structured into a fixed rate pattern; Neither it is
aesthetic to display the same as in a ration shop, It is however possible that the process be made
transparent through preadmission counselling.
·
Each category of clinical establishments, as may be
notified by the Central Government shall carry out every prescription audits
every 3 months.
Objection:
Audit of every prescription is not realistic. It is suggested random
prescription audit is feasible and acceptable.
·
Penalties
In
keeping with the provisions of Section 41 (1) (2) (3) and Section 42 (1) (2)
(3) the Act whoever carries on a clinical establishment without
registration or whoever willfully disobeys any direction, or obstructs any
person or authority or withholds any
such information or provides false information shall be liable for a monetary
penalty.Whoever carried on a clinical establishment without registration,
shall, on first contravention be liable to a monetary penalty upto fifty
thousand rupees, for second contribution to a monetary penalty which may extend
to two lakh rupees and for any
subsequent contravention to penalty which may extend to five lakh rupees.Whoever wilfully disobeys
any direction lawfully given by any person or authority empowered under this
Act to give such direction, or obstructs any person or authority in the
discharge of any functions which such person or authority is required or empowered under this Act to discharge,
shall be punishable with monetary penalty which may extend to five lakh rupees.
Objection:
The penalties
are harsh and excessive.The law should be gentle on law abiding citizens like
doctors.
The Government should also promote healthcare
institutions:
The
law should also include promotion in addition to registration and regulation.
a)
A national corpus fund
should be created from the funds of the Central Government to facilitate
establishment, maintenance and upgrading of clinical establishments. This
should have state outlets. Grants and subsidized loans should be available for
above purposes and for raising the standards of service.
b) Every
effort should be made for encouraging
young medical graduates to take up family practice .Subsidy and retainership
could be tools to reach out to the young doctors.
c)
Special consideration
and incentives should be provided for
doctors setting up practice in rural areas.
d) Protocols
for establishing three tier referral system across the sectors should be
created.
Dr D R Rai Dr
Vinay Aggarwal
IMA Hony. Secretary General IMA National
President
Dr R V Asokan Dr
Zameer A Pasha
Secretary IMA Hospitals Board of India Chairman IMA Hospitals Board of
India
Annexure
Number of
enterprises in the unorganized health services by States 2001-02
State
|
Rural
|
Total
|
Urban
|
Total
|
Aggregate
|
Total
|
||||
OAE
|
Establishments
|
OAE
|
Establishments
|
|||||||
OAE
|
Establishments
|
|||||||||
Andhra Pradesh
|
48306
|
2865
|
51171
|
17951
|
8705
|
26656
|
66257
|
11570
|
77827
|
|
Assam
|
38802
|
2239
|
41041
|
4431
|
1071
|
5502
|
43233
|
3310
|
46543
|
|
Bihar
|
105563
|
13850
|
119413
|
14504
|
6281
|
20785
|
120067
|
20131
|
140198
|
|
Chhattisgarh
|
7222
|
724
|
7946
|
1475
|
3766
|
5241
|
8697
|
4490
|
13187
|
|
Delhi
|
170
|
419
|
589
|
7226
|
8256
|
15482
|
7396
|
8675
|
16071
|
|
Goa
|
246
|
16
|
262
|
125
|
465
|
590
|
371
|
481
|
852
|
|
Gujarat
|
14235
|
957
|
15192
|
6680
|
12687
|
19367
|
20915
|
13644
|
34559
|
|
Himachal Pradesh
|
4449
|
228
|
4677
|
509
|
344
|
853
|
4958
|
572
|
5530
|
|
Haryana
|
10591
|
2354
|
12945
|
6791
|
5305
|
12096
|
17382
|
7659
|
25041
|
|
Jammu and Kashmir
|
7876
|
340
|
8216
|
1492
|
741
|
2233
|
9368
|
1081
|
10449
|
|
Jharkhand
|
56702
|
1055
|
57757
|
6553
|
1566
|
8119
|
63255
|
2621
|
65876
|
|
Karnataka
|
12181
|
2717
|
14898
|
10126
|
14037
|
24163
|
22307
|
16754
|
39061
|
|
Kerala
|
15132
|
5940
|
21072
|
6359
|
3541
|
9900
|
21491
|
9481
|
30972
|
|
Madhya Pradesh
|
26547
|
644
|
27191
|
15749
|
7687
|
23436
|
42296
|
8331
|
50627
|
|
Maharashtra
|
23409
|
3389
|
26798
|
32664
|
34064
|
66728
|
56073
|
37453
|
93526
|
|
Orissa
|
46064
|
884
|
46948
|
3197
|
1489
|
4686
|
49261
|
2373
|
51634
|
|
Punjab
|
20298
|
2794
|
23092
|
10349
|
6370
|
16719
|
30647
|
9164
|
39811
|
|
Rajasthan
|
16935
|
1035
|
17970
|
13041
|
4208
|
17249
|
29976
|
5243
|
35219
|
|
Tamilnadu
|
11350
|
3508
|
14858
|
9380
|
10566
|
19946
|
20730
|
14074
|
34804
|
|
Uttar Pradesh
|
253989
|
13565
|
267554
|
49678
|
21618
|
71296
|
303667
|
35183
|
338850
|
|
Uttaranchal
|
5404
|
1570
|
6974
|
1845
|
1137
|
2982
|
7249
|
2707
|
9956
|
|
West Bengal
|
78519
|
3781
|
82300
|
42332
|
9966
|
52298
|
120851
|
13747
|
134598
|
|
Others
|
8699
|
174
|
8873
|
2201
|
1386
|
3587
|
10900
|
1560
|
12460
|
|
Total
|
812689
|
65048
|
877737
|
264658
|
165256
|
429914
|
1077347
|
230304
|
1307651
|
|
“Source: Extracted from the unit-level record
data of the 57th Round, Survey of Unorganised Services, NSSO
Note:
(i) OAEs indicate own-account enterprises wherein an undertaking is run by a household,
usually without any hired labour working on a fairly regular basis. ii)
Establishments are the ones that employ atleast one hired worker on a fairly regular basis.iii)
Others include all minor States and Union Territories”
Percentage distribution of enterprises in
the unorganized health services by states 2001-02
State
|
Rural
|
Urban
|
Aggregate
|
|||
OEA
|
Establishments
|
OAE
|
Establishments
|
OAE
|
Establishments
|
|
Andhra
Pradesh
|
94.40
|
5.60
|
67.34
|
32.66
|
85.13
|
14.87
|
Assam
|
94.54
|
5.46
|
80.53
|
19.47
|
92.89
|
7.11
|
Bihar
|
88.40
|
11.60
|
69.78
|
30.22
|
85.64
|
14.36
|
Chhattisgarh
|
90.89
|
9.11
|
28.14
|
71.86
|
65.95
|
34.05
|
Delhi
|
28.86
|
71.14
|
46.67
|
53.33
|
46.02
|
53.98
|
Goa
|
93.89
|
6.11
|
21.19
|
78.81
|
43.54
|
56.46
|
Gujarat
|
93.70
|
6.30
|
34.49
|
65.51
|
60.52
|
39.48
|
Himachal Pradesh
|
95.13
|
4.87
|
59.67
|
40.33
|
89.66
|
10.34
|
Haryana
|
81.82
|
18.18
|
56.14
|
43.86
|
69.41
|
30.59
|
Jammu and Kashmir
|
95.86
|
4.14
|
66.82
|
33.18
|
89.65
|
10.35
|
Jharkhand
|
98.17
|
1.83
|
80.71
|
19.29
|
96.02
|
3.98
|
Karnataka
|
81.76
|
18.24
|
41.91
|
58.09
|
57.11
|
42.89
|
Kerala
|
71.81
|
28.19
|
64.23
|
35.77
|
69.39
|
30.61
|
Madhya Pradesh
|
97.63
|
2.37
|
67.20
|
32.80
|
83.54
|
16.46
|
Maharashtra
|
87.35
|
12.65
|
48.95
|
51.05
|
59.95
|
40.05
|
Orissa
|
98.12
|
1.88
|
68.22
|
31.78
|
95.40
|
4.60
|
Punjab
|
87.90
|
12.10
|
61.90
|
38.10
|
76.98
|
23.02
|
Rajasthan
|
94.24
|
5.76
|
75.60
|
24.40
|
85.11
|
14.89
|
Tamilnadu
|
76.39
|
23.61
|
47.03
|
52.97
|
59.56
|
40.44
|
Uttar Pradesh
|
94.93
|
5.07
|
69.68
|
30.32
|
89.62
|
10.38
|
Uttaranchal
|
77.49
|
22.51
|
61.87
|
38.13
|
72.81
|
27.19
|
West Bengal
|
95.41
|
4.59
|
80.94
|
19.06
|
89.79
|
10.21
|
Others
|
98.04
|
1.96
|
61.36
|
38.64
|
87.48
|
12.52
|
Total
|
92.59
|
7.41
|
61.56
|
38.44
|
82.39
|
17.61
|
“Source: Extracted from the unit-level record
data of the 57th Round, Survey of Unorganised Services, NSSO
Note:
(i) OAEs indicate own-account enterprises wherein an undertaking is run by a
household, usually without any hired
labour working on a fairly regular basis. ii) Establishments are the ones that
employ atleast one hired
worker on a fairly regular basis.iii) Others include all minor States and Union
Territories”
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