How Centre's new rules will curb your hospital ventilator bills

Guidelines for Transparency in Ventilator Usage by Private Hospitals, posted on the Directorate General of Health Services website recently, and reviewed by Mint, aim to ensure that this life-saving treatment is used ethically and not as a tool for financial exploitation.

“The government aims to restore trust in the private healthcare system and ensure that critical care does not remain a challenge or a source of financial distress," said an official close to the development, on the condition of anonymity.

“Hospitals must justify ventilator use exceeding 14 days through internal reviews and expert committees, creating a strict paper trail for government inspection. Additionally, facilities have to establish time-bound grievance systems, allowing families to formally report billing discrepancies," the official added.

This move assumes significance given that the Indian ventilator market, valued at $207 million in 2024, is projected to reach $351.12 million by 2032, according to global market research firm Credence Research Inc.

“A key challenge in India’s health system is the asymmetry of information and bargaining power: hospitals and doctors possess far greater knowledge and leverage than patients," said Indu Bhushan, founding chief executive of Ayushman Bharat and senior associate, Johns Hopkins University, adding that greater transparency would help level the playing field and ultimately lead to better health outcomes.

Bhushan acknowledged that public grievances about inflated bills in private hospitals are often well-founded. “Globally, intensive care unit (ICU) care requires explicit informed consent and is subject to rigorous audits to deter unnecessary procedures. India has historically lacked such enforcement," he observed, adding that while India often has robust regulations on paper, the persistent weakness lies in implementation.

Mint's emailed queries to the health ministry spokesperson remained unanswered.

The new guidelines

The new guidelines are grounded in core bioethical principles, including autonomy (respecting patient choices and informed consent), beneficence (acting in the best interest of the patient), non-maleficence (avoiding harm through unnecessary or prolonged interventions), and justice (ensuring fair and equitable access to ventilator support).

A key pillar of the rules is mandatory informed consent. Doctors must obtain explicit consent from a patient’s caregivers or legal representatives before initiating mechanical ventilation.

“This process must include a detailed explanation of the clinical need, expected outcomes, potential risks, and limitations of the procedure [and] clarification of the nature of invasive or non-invasive ventilation," the document said.

The document added that the daily cost of ventilator support and associated ICU care must be disclosed to caregivers at the time of consent, ensuring families are financially prepared.

To curb inflated billing and hidden costs, the government has introduced standardized and transparent pricing structures. Private hospitals must implement uniform ventilator charges across departments to eliminate discrepancies. They must also maintain itemized pricing for consumables used during ventilatory care—such as circuits, humidifiers and filters.

Further, hospitals must publicly display the costs of ventilator-related services and consumables in patient-accessible areas, including billing desks, ICU waiting areas, and hospital websites.

The rules also enforce usage-based billing, specifying that ventilator charges may be levied only when the equipment is actively used for patient care. This provision prevents hospitals from billing for idle equipment or during periods when the patient is not on ventilator support.

“Facilities must ensure accurate documentation of ventilator usage duration and mode—whether invasive or non-invasive—to support fair billing," the document said.

For patients with uncertain prognosis, the guidelines recommend time-limited ventilation trials of 48-72 hours, with mandatory daily reassessments to determine whether support should be continued, escalated, or withdrawn.

Hospitals must conduct daily objective assessments using standardized scoring systems and maintain detailed documentation, including vital signs, response to therapy, and weaning attempts. To ensure families remain informed, daily counselling sessions with patient attendants are recommended to communicate the prognosis and care plans.

For cases involving ventilation beyond two weeks, the guidelines mandate review by a multidisciplinary committee. Hospitals will also be required to conduct monthly internal audits for all cases involving ventilator use exceeding 14 days. These audits must assess the clinical justification for prolonged ventilation and verify the completeness of documentation.

In addition, facilities must maintain comprehensive records of patient outcomes, mortality, and the duration and type of ventilatory support provided. These records must be securely archived and made available for review by oversight authorities.

Hospitals must also establish time-bound grievance redressal mechanisms accessible to patient families, providing a formal channel to address concerns related to clinical care or billing.

The guidelines assume significance given the scale of the country's private healthcare sector, which comprises 43,486 private hospitals nationwide, according to the Association of Healthcare Providers of India (AHPI), representing a network of nearly 20,000 hospitals.

Essential fix or red tape?

While respiratory support with a ventilator can be life-saving when needed, unwarranted use in ICUs can not only be economically oppressive but also biologically harmful due to increased risk of nosocomial respiratory infections, said (prof) Dr K. Srinath Reddy, former president of the Public Health Foundation of India (PHFI). “The new government guidelines are helpful in restricting use to clear indications and ensuring clear communication of clinical indications and financial implications to families."

Dr. Aashish Chaudhry, managing director, Aakash Healthcare Pvt. Ltd, termed the government’s move a “welcome and much-needed step". “ICU treatment often involves advanced, best-in-class medical care, which entails costs. However, due to limited family access—necessary to prevent infections—this can unintentionally create mistrust. Clear protocols, defined review periods for ventilator usage, and mandatory audits for prolonged ICU stays will significantly improve accountability."

He added that ethical healthcare institutions already maintain robust clinical justification and documentation for extended care. “This initiative will help distinguish transparent, patient-centric hospitals while strengthening trust, affordability, and accessibility across the healthcare system."

Dr. Dilip Bhanushali, national president of the Indian Medical Association (IMA), representing over 400,000 doctors, also stated that doctors were already following these ethical practices voluntarily, even without a legal mandate. “These new strict rules are just a reaction to public anger, not a fix for a real medical problem. By turning our judgment into government regulations, you are taking decision-making power away from the experts (doctors) who act in good faith and handing it over to rigid bureaucratic rules."

“We were already doing the right thing. These rules are unnecessary red tape caused by public frustration, and they stop doctors from making flexible decisions based on what's best for the patient," he added.

The Bharatiya Janata Party member of Parliament Dr. Anand Kumar first highlighted the urgent need for guidelines to ensure transparency in ventilator use in the private healthcare sector in August in the Lok Sabha.

Subsequently, a high-level committee was constituted under the chairmanship of Dr. Sujata Chaudhary, additional director general of health services, in the health ministry to finalize these guidelines. The panel included senior doctors from All India Institute of Medical Sciences, Safdarjung Hospital, and Ram Manohar Lohia Hospital.