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"To shut down/lock/de register the establishment" and "de-licence" the establishment is THE most powerful tool in the hand of government officers. And they use their "discretionary powers" to lethal effect.
Indian shopkeeper, small businessman and small industry owners worked under these "licence-permit raj" conditions since Independence.

This gave rise to nepotism, black economy, attempt at huge profit margins to compensate for corruption and elimination of genuine competition.
This ultimately hurts the consumer by reducing choice, quality, innovation and ultimately making services/products of substandard quality and unreasonable price.
Enough has been written about it from economics point of view.

Do you know/realise that this is exactly how healthcare providers are treated by govt?
Additional and terminal threat for a doctor is "cancellation of registration" that is now used more frequently by govt.
I am not qualified to comment on whether this changed in any way in 1991, but medicine is still ruled by 1947 mindset.

THIS is the reason you see doctors behaving like shopkeepers and patients reduced to consumers.
As it is true for all corrupt and mis-regulated systems, smaller players are unfairly harmed. The larger you are, more immune you are from govt regulations.
THIS is the current existential crisis for medical practitioners - to continue working as a stand alone professional or to be part of corporate (healthcare industry).
Public has no clue about fundamental wrongs in healthcare. Their concern about good quality care at reasonable cost can NOT be addressed unless fundamental wrongs are corrected by a determined government.
Goverment must decide nature of healthcare as ONLY one of the following -
1.Social service
2.Professional service - provided by govt
3. Professional service - left to market forces
4. Business
5. Industry

All have their pros and cons.
Unless current hodge-podge of model is changed into a unified vision with forward and backward integration in specified time frame, everyone (public, doctors, investors) will continue to be unhappy.
As a practitioner, I don't think that we have moved AT ALL since 1947.

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