Like most of us, I am part of several school, college, and neighbourhood WhatsApp groups. Apart from politics and civic issues, the one unfailing subject that attracts intense, and sometimes angry, discussion is the sudden illness of a family member or friend and the experience families face in hospitals. This, I suspect, is a common feature across the middle class worldwide. It has become increasingly difficult to meet someone who does not have a grievance about hospitalisation, medical care, trouble with insurance, and bills that drain lifetime savings at lightning speed—not always with a good clinical outcome.

This is not just a frivolous, middle-class complaint. It is a profound global problem. In India, out-of-pocket expenditure is among the highest in the world. One unforeseen illness can push a family into devastating poverty, leaving them trapped by usurious private loans, forcing children to drop out of school, and compelling the sale of essential assets. All of us have witnessed at least one such case in our family circles or neighbourhoods. While state-sponsored schemes like Ayushman Bharat are certainly useful to a degree, the latest National Sample Survey Office surveys reveal that they have not eliminated such out-of-pocket costs entirely.

In her elegant and meticulously documented book, the journalist Abantika Ghosh examines the serious flaws within a health sector increasingly dominated by private entities, corporatisation, and international finance capital. Across 12 chapters, she brings to light the realities of the private healthcare industry with shocking and sobering examples.

In chapter after chapter, Ghosh documents the maladies that plague modern, mostly gadget-dependent private medical care. The list is comprehensive: from inflated drug pricing and referral kickbacks to unindicated and costly therapies and surgeries. As she argues, quite rightly, private healthcare cannot be compared to any other commercial venture. The service being sold is fundamentally linked to human life, making it dangerous to treat healthcare as just another profit-oriented business. Yet that is precisely what it has largely become.

To understand what is unfolding today, it helps to step back in time. From Independence until India’s liberalisation, the healthcare framework was primarily guided by the Bhore Committee’s recommendations. The system relied largely on primary health centres for basic care, vaccinations, and maternal and child health. Secondary and tertiary care were supported by district and taluk hospitals, as well as State-run medical colleges.

Alongside State facilities, there were prominent Central institutions like the All India Institute of Medical Sciences, New Delhi and a few private medical colleges, such as the Christian Medical College, Vellore. Private healthcare was largely delivered by individual doctors, small nursing homes run by individual doctors and mission hospitals. Treatments were individualised, relatively affordable, and driven by patient care rather than profit. Malpractices existed even then—such as unnecessary surgeries, pharmaceutical kickbacks, and caste-based cross-references—but on a much smaller scale, and they did not devastate individual patients financially.

The paradigm shifted drastically when private hospitals turned corporate and got listed on the stock market. Profit, shares, dividends, board of directors, and EBITDA (Earnings Before Interest, Taxes, Depreciation and Amortisation) became the new buzzwords. As medical science evolved, clinical medicine gave way to diagnosis and treatment largely dependent on advanced technology, including massive diagnostic facilities, CT scans, MRIs, and PET scans. The vast capital required for these fast and forever-changing technologies was injected by foreign institutional investors.

Today, major hospitals are controlled by what is essentially international finance capital, transforming the primary objective of healing the sick into a quest for super profits. Coupled with the astronomical fee structures of the recently mushroomed private medical colleges, which are also run with profit as the sole motive, medicine has shifted from a calling rooted in passion and empathy to an industrial enterprise.

Ghosh’s book makes sense to anyone who understands this modern reality. The final chapter acts as a thoughtful and necessary guide for patients and their families. It outlines the specific areas where a vulnerable patient may face exploitation and offers actionable steps to identify and halt these practices. She writes: “Healthcare choices are fundamental to the right to life. The only option we have is to fly blind because authenticated, neutral and reliable reviews of healthcare professionals and institutions, based either on their competence or the ethics and the affordability of the medicine they practise, are not available.”

This is a damning admission, and an accurate one. Exercising rationality becomes incredibly difficult when a family is desperate and forced to make rapid treatment decisions in an emergency. Ghosh’s book reminds us that until systematic transparency is established at all levels of medical care, the burden of protection lies with the patients. It is unfair to push that heavy responsibility of an already sick person on the family, but as Ghosh argues, there is little choice left until an effective supervisory mechanism is made available. A random financial and clinical audit by an independent, State-created, autonomous organisation may bring some discipline. State governments can think about creating such an entity.

The picture that emerges is bleak. Private medical care in India is opaque, profit-driven, and controlled largely by global finance capital, with little state regulation. Private medical education is even worse and lacking in quality. Both are proliferating unchecked, thanks to a Central government that has resolved to produce more doctors without any stated commitment to standards. There is no mention of quality.

We will end up producing more medical graduates of diminishing quality, who are keener to recoup the fees they paid as students than to serve their patients. The National Eligibility cum Entrance Test (NEET) has only aggravated this crisis. Prone to leaks and systemic malpractices, this over-centralised exam produces one-trick ponies—adepts at cracking multiple-choice questions but devoid of critical thinking. The immense psychological strain it places on lakhs of students is directly linked to rising rates of mental illness and student suicides. NEET needs to go.

This book is a wake-up call and not just for those in the middle class, though they are its most immediate audience. Read it, and then ask yourself what you can do to stem the tide. The alternative is unthinkable. 

Dr Amalorpavanathan Joseph is former Member, Tamil Nadu State Planning Commission, former Member Secretary, Transplant Authority of Tamil Nadu and former Director of Vascular Surgery, Madras Medical College.

Also Read | Why India’s women find cancer too late

Also Read | Pay to heal