Corporatisation in Private Hospitals Sector in India

Transformation in the Indian private hospitals sector is examined in Maharashtra, employing qualitative interviews, witness seminars, and desk research. Findings point to significant changes: hospitals viewed as businesses to yield profits; adoption of business strategies to ensure financial viability and returns; changes in not-for-profit and small hospitals; and consequences for institutional and medical practice. Policy shifts towards greater private sector involvement in health, industry advocacy, availability of insurance, and patient expectations drive these changes towards corporatisation, which is not just about the growth of corporate hospitals; it entails structural and behavioural changes across the healthcare sector solely favouring economic goals.

Ethical clearance was obtained from Institutional Ethics Committees of Anusandhan Trust, Mumbai and King’s College, London. The authors acknowledge the contributions of Deepali S Y, Abhay Shukla, and Arun Gadre, all from SATHI Pune. They also acknowledge Sanjay Nagral and all respondents and participants of the witness seminar. The UK Joint Health Systems Research Initiative, funded by the UK Medical Research Council, Economic and Social Research Council, Department for International Development, and Wellcome Trust, supported this study under MR/R003009/1. The authors also acknowledge the comments of the anonymous reviewer.

The current policy focus on universal health coverage (UHC) in low- and middle-income countries (LMICs) is predicated on successful state engagement with the private sector (McPake and Hanson 2016). Over the past decade, it has received further support from international agencies (UHC2030 2019; Clarke et al 2019) Although contested, the broad rationale for such measures is that they would lead to more efficiency, better services, and more choice for users. In this context, there is a pressing need for a detailed examination of this private sector, its form, and the consequences of its ways of working for the entire healthcare system.

Features of the private healthcare sector in India have been elaborated on in terms of commercialisation,¹ the dominance of individual and small providers, and the establishment of corporate hospital chains (Bisht and Virani 2016; Narayana 2003; Nandraj et al 2001; Baru 1998). Since the 1980s, hospitals have been set up as business enterprises, as private and public limited companies. In several southern Indian cities, doctors set up the initial corporate hospitals, with support from businesspeople and non-resident Indians (NRIs).