Competition commission of India (CCI) has recognised that super-speciality healthcare hospitals operate as an integrated care delivery system and rejected the proposition that hospitals function as isolated “aftermarkets” once patients are admitted.

The order brings closure to nearly a 10-year-long investigation by the CCI into issues relating to healthcare delivery practices and hospital operations.

The case was initiated after a complaint filed by an informant in 2015 alleged that Becton Dickinson India (P) Ltd., a manufacturer of disposable syringes, in collusion with Max Hospitals, Patparganj, a procurer of disposable syringes, deliberately printed a higher maximum retail price (‘MRP’) on the disposable syringes of Becton Dickinson India (P) Ltd. being sold at the in-house pharmacy of Max Patparganj, in comparison to the MRP printed on the same product of Becton Dickinson India (P) Ltd. being sold in the open market.

CCI, after finding a prima facie case of contravention of the provisions of Competition Act 2002 asked the Commission’s Director General to investigate the matter and submit a report.

After several hearings and follow up investigations that followed, CCI in its order on May 21, observed that patients are provided comprehensive pre-admission cost estimates across key heads, including procedures, medicines, diagnostics, and room charges, enabling informed decision-making, comparison across providers, and access to second opinions. It further noted that patients retain freedom of choice and are not subject to structural or operational lock-in.

The order also recognised the operational realities of super-speciality healthcare delivery and noted that hospital pricing reflects broader investments required across clinical infrastructure, specialised manpower, emergency preparedness, diagnostics capability, inventory management, and continuity of care.

Further, the commission noted adherence to applicable statutory pricing mechanisms, including compliance with printed maximum retail prices (MRPs) and relevant national pharmaceutical pricing authority (NPPA) price ceilings where applicable. It also observed that procurement efficiencies do not create a legal obligation to pass wholesale discounts directly to patients.

The association of healthcare providers of India (AHPI) welcomed the CCI Order. “The CCI appears to have taken a nuanced position. It rejected the idea that every hospital becomes a separate “aftermarket monopoly” over admitted patients, mainly because patients usually have a choice before admission and can compare hospitals, packages, reputation, doctors, and estimated costs. Healthcare delivery operates as a coordinated ecosystem to ensure continuity, safety, and quality patient care,” said Dr Girdhar Gyani, director general, AHPI.