Big Fish Eating Small Fish Alex George LEGISLATIONS to control private and voluntary health care institutions are at different stages of enactment or implementation in a number of states. These legislations in Tamil Nadu, Bihar, MP and Andhra Pradesh are supposed to regulate the functioning of private and voluntary hospitals, diagnostic centres, clinics, dispensaries, etc. No doubt, they are certainly the result of several years of consumer pressure, particularly from the by now transnationally sought-after Indian middle class articulated through various mass media. That due to its much trumpeted consumption capacity, the concerns of this class are being taken as representative of India and finding their way into international policy formulations for the country is clear from the observation of a leading international expert on health policy in his foreword to a paper on the country's private health sector. According to him "talk of India's 5,00,000 villages is giving way to attention to the country's emerging middle class of 250 million consumers, One of the things that members of this class consume is medical care" which rhcy are increasingly doing so from private providers Gwatkin D R in Bhat R 1995], The legislations discussed here are coming up against the background of increasing capitalist investment in the health sector which is being promoted by the World Bank and other international funding organisations as was clearly reflected in the WDR1993. The World Bank's prescription for public financing in the health sector in developing countries includes only public health and essential clinical services both defined in extremely narrow terms and just a sprinkling of low cost effective interventions, thus leaving the rest of the field wide open for the private sector [World Bank 1993: George 1997].