The book Games Hospitals Play by Abantika Ghosh looks to “decode your private healthcare experience” by exposing a slew of profit-maximising strategies that some corporate hospitals exploit, at the cost of a helpless citizenry. People suspect deceit but lack the knowledge to decipher the subdivision of hospital costs to question or argue. They pay because there is no choice. The book fills this gap admirably by presenting a detailed and accessible analysis of the factors that contribute to high healthcare costs, and by listing questions and checkpoints.
The book covers a large canvass describing a range of situations—huge mark-ups in hospital pharmacies that stonewall external purchases while charging more than the MRP; pressures on doctors to deliver revenue; excessive costs attributed to consumables to pad up bills; inflated charges for unnecessary diagnostic tests, procedures and extended ICU stays; and how referrals and package rates actually work (or do not). If, as she says, corporate healthcare prefers that the patient undergoes an MRI instead of the less expensive and quicker CT scan, regulators should have issued need to issue enforceable guidelines on the rational use of technological advancements.
The book highlights how hospitals often push for ‘emergency’ angioplasty after routine angiograms, recommending stent implants with only 50–60 per cent blockages. The author highlights what is true- that patients are easily swayed by doctors’ recommendations and choose a more expensive option despite having to pay a steep (and even unaffordable) cost, out of pocket. On stents the author enters the sensitive terrain of biomedical research. She places reliance on sources including newspaper articles which support her narrative which can be problematic as there is nothing a reader can do about such information, except worry!
Despite laying bare the modus operandi of a slew of malpractices, the book is unlikely to change anything mainly because giant regulators have tried and failed or given up.
According to Ghosh, statutory bodies such as the Competition Commission of India, the National Consumer Disputes Redressal Commission, and the National Pharmaceutical Pricing Authority, despite finding instances of consumer deprivation, have had their recommendations stalled in court or could not—or did not—translate findings into policy change.
Despite the influence and indispensability of corporate hospitals, Ghosh shows that at a micro level, managements that are impervious to argument have meekly cancelled billed items after matters began to snowball towards adverse publicity.
The book also flags another visible trend- the bane of medical advertising which entices patients to agree e.g., to bariatric surgery, sometimes leading to lethal consequences.
She shows how strong oversight and exemplary punishment are not meted out because the Clinical Establishments Act, 2010 although it exists and applies to corporate hospitals is inoperable because the rules are in abeyance. Likewise, Ghosh questions how when physicians are legally embargoed from advertising their professional position, skills, or achievements, hospitals routinely issue advertisements!
While the book describes how commercial pressures shape clinical behaviour, it also casts a doubt on the overall legitimacy of the entire private healthcare which needed clarification. The corporate hospitals account for less than 5% of the total private hospital beds; the bulk of private care is delivered by small hospitals and nursing homes, which are outside the book’s scope.
Some basic facts about the corporate health sector were also needed to provide a context. Corporate hospitals focus on high-demand, high-tech super-specialty care and without question offer outcomes comparable to overseas centres at significantly lower cost.
They are major employers. They function as businesses governed by the Ministry of Corporate Affairs and SEBI, with no altruistic mandate. They attract 100% FDI and because private equity follows corporate growth, profit and loss are fundamental to their functioning and market standing. While they must remain ethical and transparent, that applies to all businesses not just hospitals.
Had the book highlighted how ethical regulation works elsewhere in the world, the book would have gained in robustness. As a long-time health journalist, Ghosh could have pressed for deployment of AI tools to flag aberrant billing patterns.
The UK’s NHS limits arbitrary billing through nationally determined tariffs. In the United States, sophisticated analytics flag billing anomalies, triggering audits and penalties. These systems do not replace clinical judgment but enforce accountability.
The chief strength of the book lies in the way it has demystified opaque processes and shown how information asymmetry enables obfuscation. Accounts of high-profile tragedies prove the point but stop there. The long-drawn litigation that follows — an integral part of the “games hospitals play” — also deserved attention, as billing disputes and negligence cases linger for years, wearing down litigants.
Two conclusions she draws are worrisome. One is that regulatory oversight has not been a policy priority because corporate care caters to a class of people who are notoriously reluctant voters. The second—that the political class does not view accessible and affordable healthcare as an election winner. Both propositions are debatable and involve state governments which needs a larger discussion.
Games Hospitals Play opens an essential conversation. It must be read by Health Ministers, civil servants, independent directors on corporate hospital boards, and hospital risk-management committees. The Government too must tighten regulation to protect the public. While the book presents a necessary critique, if reform was its aim, it risks shaking trust.
(The reviewer is a public policy commentator and was formerly Secretary in the Health Ministry and Chief Secretary, Delhi)
You can find the book here.
Published on January 11, 2026
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