In India, walking into a clinic used to feel like asking for help. Now it often feels like checking into a billing system. Just half a decade ago, outpatient fees at private clinics hovered around ₹300. Today, ₹500 is standard. In metro cities, specialist consultations easily cross ₹1,000, often hitting ₹2,000 without any prior tests or procedures. That’s before any medicines, scans, or surgeries are recommended. It isn’t just inflation. It’s profit, plain and simple.
Now consider the government doctor. He sees patients for free during the day in a state-run hospital, overcrowded, under-resourced, and held together by overworked nurses and sheer habit. But come morning or evening, the same doctor sees 40–60 patients in his private clinic or at home, charging ₹300–₹500 each. Some even work weekend shifts. Do the math. In a single day, an honest government servant earns more privately than what many Indians make in a month. And it doesn’t stop there.
Surgery slots in public hospitals are tight. So some doctors subtly guide patients toward their preferred private hospitals, offering the same surgery “on priority” at a “nominal” fee. These partner hospitals are often empanelled under state or central health insurance schemes, so the government foots part of the bill. But not all. The rest, sometimes as much as 50%, comes directly from the patient’s pocket. That percentage is growing.
Meanwhile, private hospitals have built an entirely different ecosystem, one where profit isn’t just a side effect of care, it’s the point. Patients often report being asked to repeat tests already done elsewhere, especially if they weren’t from the hospital’s “preferred” lab. The tone changes dramatically when a patient reveals they have insurance. Suddenly, the private room is available. Dietician consultations appear. Daily doctor visits become mandatory and charged. CT scans, MRIs, blood panels, lots of them, are recommended “just to be safe.”
Insurance knows this. That’s why most insurers negotiate special rates, 10% to 30% lower than the hospital’s walk-in pricing. But the insurance doesn’t cover “non-medical” costs: admission kits, gloves, hand sanitizer, phone charger, pot. These can add ₹10,000 or more to a stay, paid out of pocket, no questions asked.
In the post-pandemic years, a new pattern has emerged. Surgeries and implants are becoming front-and-center. Orthopedic, cardiac, gynecological, even cosmetic procedures are pushed with barely veiled urgency. Medical device multinationals aggressively promote their new implants to doctors and hospitals. The more advanced, the more expensive. A “better outcome” is promised, with barely a nod to what patients can afford.
The result is predictable: families take loans, sell gold, or mortgage ancestral land. just to keep someone alive. Sometimes, to buy a few more months. And yet, the doctor walks out smiling, with a hefty consultation fee, a cut from the hospital or device company, and a bonus for high patient volumes. His son or daughter, often in the final year of a medical degree, prepares to inherit the system.
This isn’t a story of a few bad apples. It’s the quiet normalization of health as a revenue stream. The doctor is no longer just a healer. He’s part of a closed economic loop, linked to labs, devices, hospitals, and insurance, where the patient is the only one who never negotiates. In the absence of price controls, in the presence of unchecked incentives, and with the protection of white coats and degrees, India’s health economy is beginning to resemble a cartel.
The tragedy is not that doctors earn well. They should. The tragedy is that the entire system, from appointment to discharge, is designed not around healing, but around billing. And that most patients are too desperate, too uninformed, or too afraid to push back.
Until we start asking hard questions, not just about medical ethics, but about pricing, oversight, and the toxic link between care and commissions, India’s hospitals will keep filling, not with patients, but with profits. Its no surprise that The General Insurance Council (GIC) and the Insurance Regulatory and Development Authority of India (IRDAI) are in discussions with the central government to establish an independent regulatory body for the healthcare sector.
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