This research was about the expansion and changing face of private sector hospital care and related diagnostic services through an organised, and increasingly transnational, healthcare industry. The research team was composed of social scientists from King's College London and public health researchers and health rights activists from India. To explore this issue, we constructed a detailed case study of the sector in Maharashtra State, India which has many expanding healthcare hubs. We interviewed a wide range of medical practitioners, managers, facility owners, regulators, policy makers, patient organisations and health rights advocates, in order to examine the implications of these emerging forms of healthcare delivery and their business and management practices for the healthcare sector, for medical practitioners and for healthcare users.This research is about the expansion and changing face of private sector hospital care and related diagnostic services through an organised, and increasingly transnational, healthcare industry. It responds to concerns, expressed in a recent paper in the Lancet, about how incentive structures within health services may become distorted to meet the economic interests of this industry, and about the risks of regulatory capture and disempowerment of communities and citizens. The research team is composed of social scientists from King's College London and public health researchers and health rights activists from India. To explore this issue, we will construct a detailed case study of the sector in Maharashtra State, India which has many expanding healthcare hubs. Our objectives are first to examine the implications of these emerging forms of healthcare delivery and their business and management practices for the healthcare sector, for medical practitioners and for healthcare users. As there is no central register, we will conduct a mapping of facilities by collating information from various registers and business media reports; we will interview a wide range of medical practitioners, managers, facility owners, regulators, policy makers, patient organisations and health rights advocates; and we will conduct a 'witness seminar' to explore the contemporary history of corporatisation of healthcare in the State. Second, we will consider the nature, successes and failures of past attempts at regulation of the private medical sector in the State. For this we will hold a stakeholder consultation and a witness seminar exploring recent regulations, and obstacles and distortions in implementation. The final stages of the project will be to develop and advocate for mechanisms of 'social regulation', such as patient and citizen involvement in monitoring of enforcement of rules and regulations from a rights-based perspective, and to draw lessons for other low and middle income countries.

Semi-structured audio-recorded qualitative interviews were conducted between December 2017 and June 2018 with 43 respondents. We sought interviews representing a range of backgrounds, institutions and viewpoints and respondents were selected using a combination of purposive and snowball sampling. They were informed of the aims of the research and the purpose of the interview and were invited to participate in the research at a time and place of their choosing. At the time of the interview, respondents were informed how the data they provided would be managed, asked to complete a consent form and informed that they could withdraw their responses from the study at any time up until the end of the data collection period. Interviews were conducted by two of the team (SM and IC), primarily in English and also in Hindi or Marathi as appropriate. Interview were questions related to changes in the practices of workers, patients and managers in the private healthcare sector.