A major disturbing trend in Indian healthcare is that the room conveniently left unoccupied by the state has been filled by the nasty private sector whose expenditure in the health sector was 2.71 per cent of GDP in 2012. The sheer supremacy and dominance of the private sector gets clearly reflected in the share of inpatient and outpatient cases handled by it. Its share in hospitalisation cases increased from 40 per cent in 1986 to 62 per cent in 2004 for the urban region and from 40 to 58 per cent for rural areas.

In 2012, hospitals accounted for 71 per cent of the total healthcare revenues in the country. Private sector hospitals accounted for 74 per cent of the hospitals, with a 40 per cent share of hospital beds. According to a recent statistical estimate, government hospitals have a share of only 19 per cent in healthcare spending as compared to private hospitals who have a whopping share of 81 per cent. By the end of 2014, the private hospital market in India was estimated to be worth $54 billion.

While it cannot be denied that India as a developing country has walked miles in healthcare since independence, the role of our state as a provider of healthcare hasn’t been satisfactory. In the past 15 years, elephantine private hospitals have come up in almost all metropolitan cities of India. With private sector hospitals showing mammoth increases in growth rates, it becomes imperative to see how they work, particularly when there have been worrying concerns about the methods they adopt to draw patients and the way treatment is administered to them.

It’s like opening the Pandora’s box. It’s an open secret that many private hospitals have tie-ups with small-time private practitioners, which zero morals or ethics, running small, unequipped clinics to refer their patients to them. How sick patients are handled is another sad story that must be told.

For luring patients to these hospitals, filthy marketing strategies are employed. Apart from vociferously advertising on various platforms like print, electronic and social media, they also market themselves to doctors running outpatient clinics and to those who practise in smaller hospitals, public or private, which do not have all the requisite facilities, begging them to refer their patients to these big hospitals. Now, for these ‘referrals’, the malicious and hungry-for-money physicians are offered ‘incentives’ and ‘kickbacks’, a system commonly known as ‘cut practice’.

The system of cut practice has come under the scanner in the past few years. It’s painful to watch super-specialized doctors referring patients to private hospitals; the trusted ‘god-like’ doctor instead of acting as a dedicated, honest, health professional, treating the patient on the basis of his/her rich experience, consistency and education, becomes an ‘agent’ for the hospital. The agent’s commission is fixed on the basis of patients referred. In a noble profession like healthcare, the profit motive is becoming increasingly dominant. This motive is turning private hospitals into dirty businesses, which need to take care of their ‘investments’ for the bottom line.

Sick patients visit hospitals to seek medical help. It’s not that they are there for a vacation. Public sector specialized hospitals are often over-burdened. In such a situation, it is expected that the private sector will help ease the pressure by providing life-saving medicines and procedures and other healthcare services to patients. Unfortunately, they see this as a period of ‘boom’ in the business cycle where they can ‘cash in’ on poor, sick patients, burdened by misery and pain, to harass them unnecessarily just to augment their earnings.

Basic health services like consultation and operative procedures are theoretically supposed to be based only on scientific evidence like lab reports, patient history, etc, added to the logic and professional experience of the doctor, which moulds the perception of scientific facts. In order to ‘exist’ or ‘break even’, these private hospitals have to ensure that they are commercially viable ‘profit making’ units. It is understandable that a rational human being is driven by profit, which is in fact the basis of economic theory. So the twin goals to remain cost-effective and yet at the same time deliver the right kind of healthcare to patients should ideally coexist in harmony. Regrettably, in the recent past, respectable medicos and academicians have legitimately raised fundamental questions about the paramount emphasis on ‘profit maximisation’ at the cost of the precious health of the patients.

It’s a notorious scandal where business concerns seem to rule and preside over all medical treatments and procedures administered to the patients. Forget medicine being a noble profession, the very fundamentals of medicine, that is logical proof and the doctor’s experience, have taken a back seat. So many unethical practices just leave one sick to the stomach.

Apparently, ‘targets’ are handed over to doctors for mandatorily conducting a given number of operative procedures or minor/major surgeries in the hospital or to keep patients longer than required only to raise hospital revenues. For example, worthy gynaecologists who bring to this world new life, perform C-section surgeries where a normal delivery will do, as a profligate, revenue earning procedure. Perverse, isn’t it?

I carry no hesitation in establishing an analogy which goes like this. Private hospitals, especially the ones mushrooming in small towns, are running like industrial units, where a bare minimum amount of healthcare services in the form of surgeries, x-rays and laboratory tests have to be produced, irrespective of whether it is required or not.

In this industrial plant, ‘doctors’, nurses and other operating staff form the labour; factors of production like the building, machines, etc, are the capital and infrastructure and medicines and procedures are the inputs and the costs associated with this apparatus put together become input costs. The patients on the assembly line are the guinea pigs, the ‘chosen ones’ who have to cover these costs and pay in addition to increase the profit margin of the hospital. It is like an optimisation or linear programming problem in managerial economics, whereby the objective function of the firm is to minimise the cost or augment the profit and the constraints are the aforementioned components.

The corrupt and shady practices adopted by some hospitals to increase revenue, turning doctors into demon like agents and treating the patients as mere customers overlooking their health needs and safety is a distressing trend. There are two fragments within the medical fraternity, one which is comfortable and content with the commercialisation of the healthcare system and forms an integral part of this blooming racket and the other which is honest, devoted and professional. This borderline fanatical group vehemently and bravely opposes the unwarranted commercialisation. This second section has broken free from the shackles of oblivion and fear and is increasingly becoming verbal. However, this section is pretty helpless and cannot do much if it does not get support from state agencies and law makers. Wake up and smell the coffee, before it’s too late!

The writer is a Chandigarh-based economist and freelance journalist.