On account of continued pressure from an articulate middle class and the media, Quality Assurance (QA) is gaining importance in Indian health policy planning. This has to be seen in the context of the high utilisation of the hitherto unregulated private health sector by both Out Patients - 81%, and In Patients - 56.2% in rural India (National Sample Survey Organisation 1998). The small scale private hospitals/ clinics with less than 30 beds are the predominant providers of health care in rural India (George A 1998). Therefore, though measures to regulate private health sector should be welcomed, the recent legislation to control this sector, without discriminating between the small providers in rural areas and the large urban hospitals could lead to a massive closure of small units. It will constrict whatever access is now available to the rural poor. This legislation is currently in different stages of enactment or implementation in several states of India. Though some of these laws talk of standards, it is only a sketchy description of structure standards. What is necessary, is graded standards for the different sizes of hospitals, with more emphasis on process standards, rather than unviable structure standards in the classical Western framework based on large hospitals. In this context a 'multidimensional'and 'integrated' approach to QA, which is sensitive to the social and economic issues of access and equity (Maxwell R J 1993, Johanson K S 1989) needs to be developed. The current paper presents an argument on these lines.