On paper, it was a respectable hospital. Good pay, established name, a place most young doctors would be proud to join. In reality, it took only a few hours for that illusion to collapse.

The doctor quickly realised she was not there to treat patients. She was there to legitimise decisions already made. Admissions were not based on medical need but on revenue potential. Patients who could have been treated as outpatients were admitted without hesitation. Once admitted, the next step was predictable – shift them to the ICU, keep them there, and extend their stay for as long as possible.

What made it worse was not just the practice, but the control. A senior gynaecologist (who was not even a physician) was dictating treatment decisions across cases. Clinical judgement had been replaced by administrative authority. Medicine had been reduced to compliance.

The doctor understood the risk immediately. Her name would be on prescriptions, her degree would validate the process, but the decisions would not be hers. If something went wrong, the system would remain intact. She would not.

So she left. Not because she could not handle the job, but because the job demanded something she was unwilling to give up – her ethics. That decision, rare as it is, exposes something far larger. If a system cannot retain those who refuse to compromise, it inevitably selects for those who will.

The Pattern Everyone Knows, But Few Confront

What the doctor encountered may be dismissed as an isolated incident. However, the reality is that is not. It is a pattern – visible, repeated, and quietly accepted.

Unnecessary tests are prescribed, often routed through preferred labs where commissions are built into the system. Patients are admitted when outpatient care would suffice. Discharge is delayed, not because recovery demands it, but because billing allows it. Medicines are chosen not for affordability or necessity, but for margins.

Even pricing is elastic. The same procedure, performed by the same doctor in the same operating theatre, can cost vastly different amounts depending on the room a patient occupies. In extreme cases, procedures themselves become questionable – surgeries recommended where none are needed, interventions pushed under the weight of fear.

These are not hidden practices. Patients sense it. Families discuss it in hospital corridors. Stories circulate widely, often dismissed as exaggerations until they are experienced firsthand.

Popular culture has even mirrored it. Films like Gabbar Is Back resonated not because they were fictional, but because they felt familiar. The outrage exists. What is missing is accountability.

At the centre of it all lies a simple shift – patients are no longer just patients. They are billing units. And once that shift is normalised, everything else follows.

When Exploitation Turns Criminal – The Bihar Case

If overbilling and unnecessary procedures are the system at work, cases like Bihar show what happens when that system stops pretending altogether.

In Patna, at a private hospital empanelled under the Ayushman Bharat scheme, at least six women walked in for routine or unrelated treatments. They walked out without their uteruses. They were never told. They never consented. They only discovered it later, when their bodies began to change in ways they could not explain.

They had been admitted for procedures like hernia or piles. What they received instead were unnecessary hysterectomies – surgeries that permanently altered their lives. The incentive was simple: claim higher reimbursements under a government scheme designed to help the poor.

This was not negligence. It was design. One of the victims, a widowed mother, described how her health deteriorated after the surgery – chronic pain, weakness, and a life that became harder overnight. For her, this was not just a medical violation. It was economic destruction.

When the case surfaced, a probe confirmed what had happened. The hospital’s registration under the scheme was cancelled. Committees were formed. Reports were written. And yet, the most basic questions remain unanswered – why were arrests delayed, why was the investigation limited, and how many more cases were never reported?

Because this was not new.

Bihar had already seen a similar scandal over a decade ago, where thousands of unnecessary uterus removal surgeries were allegedly carried out to claim insurance money. Cases were filed. Names surfaced. And most of those accused continued to practice.

That is the pattern. The system reacts when exposed, but rarely corrects itself. Punishments are selective, delayed, or diluted. The underlying incentives remain untouched.

What happened in Bihar is often described as shocking. It should not be. It is simply what happens when profit-driven healthcare is given both opportunity and impunity.

At that point, exploitation is no longer incidental but becomes structural.

The Industry Behind The White Coat 

What appears as individual malpractice is, in reality, a well-aligned system.

Private hospitals do not operate in isolation. They sit at the centre of a network that includes pharmaceutical companies, diagnostic labs, insurance firms, and medical colleges. Each layer feeds into the other. Each has a financial incentive to keep the system exactly as it is.

Start with medical education. With limited seats in government colleges, many aspiring doctors are pushed into private institutions that demand steep capitation fees. By the time they graduate, they are already carrying the weight of a costly investment. The pressure to recover it is not abstract. It shapes decisions.

Then comes the hospital.

Doctors are paid well, but not freely. Expectations follow – how many tests are prescribed, how many admissions are converted, how many procedures are performed. Ethical restraint does not fit easily into that structure. Those who resist often find themselves isolated. Those who comply, progress.

Pharmaceutical companies and diagnostic chains complete the loop. Expensive drugs are prescribed over cheaper alternatives. Tests are routed through preferred labs. Commissions are built in. Sometimes, tests are not even conducted properly, yet reports are generated to justify further treatment.

Inside hospitals, the practices become routine. Patients are admitted when outpatient care would suffice. ICU stays are extended. Procedures are recommended not always because they are necessary, but because they are profitable. In some cases, even diagnoses are exaggerated to push interventions—patients being told they have severe conditions requiring urgent surgery, only to later discover otherwise.

There are cases where surgeries are performed unnecessarily. Cases where they are simulated. Small incisions, anaesthesia, hours in an operating theatre and a bill to match. Patients rarely question it. They cannot. The system relies on that.

Because the imbalance is built in.

The doctor knows. The patient trusts. And in moments of fear, that trust is absolute. Families will agree to anything that promises survival. That is where the system finds its leverage.

This is not just about overcharging. It is about conversion – of fear into revenue.

Over time, hospitals themselves have changed. They resemble corporate spaces more than centres of care – expansive, efficient, revenue-driven. The comparison is uncomfortable, but accurate. Healthcare has begun to resemble retail. The patient is no longer just someone in need of care. The patient is a unit within a system designed to generate returns.

None of this requires coordination. It only requires alignment.

When every participant benefits from higher billing, restraint becomes a disadvantage. Ethics become optional. And what begins as deviation becomes standard practice.

At that point, the white coat is no longer just a symbol of care. It becomes part of the business model.

The Economics of Illness; Who Really Pays

The cost of this system does not stay within hospital walls. It spreads quietly, predictably, and widely.

For salaried professionals, it shows up in rising insurance premiums. Employers renegotiate policies every year, and the math is simple – the higher the claims, the higher the cost next year. What begins as inflated billing in a hospital room ends up as a deduction in someone’s salary structure.

Insurance companies do not fundamentally resist this cycle. As long as premiums adjust upward, the system remains viable. In many cases, they recover losses by increasing rates for individual policyholders, capping payouts, or rejecting portions of claims. The burden is redistributed, not reduced.

For those without corporate cover, the situation is harsher. Individual health insurance is expensive, often prohibitively so. Many remain uninsured, which means every hospital visit is paid out of pocket. One prolonged admission, one unnecessary procedure, is enough to destabilise a household’s finances.

This is not incidental. India already has one of the highest levels of out-of-pocket healthcare spending. When costs are inflated within hospitals, the impact is immediate and direct. Families borrow, liquidate savings, or simply delay treatment until it becomes unavoidable.

And then there are those who fall through entirely – the informal workforce, daily wage earners, the rural poor. For them, schemes like Ayushman Bharat are meant to provide relief. But as seen, even these can be exploited, turning safety nets into revenue streams.

The result is a system where illness does not just threaten health. It threatens financial survival. Healthcare inflation, in this context, is not a side effect but built into the structure.

The Collapse of Oversight; Who Is Accountable?

A system this entrenched does not function without weak oversight.

On paper, India has regulators. The National Medical Commission replaced the Medical Council of India with the promise of reform. Guidelines exist. Ethical codes exist. Complaint mechanisms exist.

In practice, enforcement is sporadic, delayed, and often ineffective.

Cases surface, outrage builds, committees are formed, and then the process slows down. Investigations drag. FIRs are delayed. Hospitals continue operating. Doctors accused of serious violations frequently return to practice after securing legal relief. The cost of wrongdoing is uncertain. The rewards are not.

The Bihar case is a clear example. A medical board confirmed malpractice. The hospital’s registration under a government scheme was cancelled. Yet, basic questions – criminal liability, wider investigation, systemic accountability – remain unresolved.

This is not an exception. It reflects a deeper problem.

Regulation requires capacity, independence, and intent. All three are uneven. Oversight bodies are often under-resourced. Legal processes are slow. Patients, especially those from vulnerable backgrounds, face barriers in pursuing complaints – cost, awareness, and fear of retaliation.

There is also a structural imbalance. Hospitals and healthcare corporations operate with financial and institutional strength. Patients operate with urgency and limited information. In that imbalance, accountability weakens further.

At times, the problem goes beyond capacity. It becomes a question of willingness.

When the same system that must regulate is closely tied to the interests it oversees – through influence, lobbying, or dependency – enforcement becomes selective. Violations are addressed when they become visible, not when they occur.

The result is predictable – a system where rules exist, but consequences do not. And in such a system, malpractice is not deterred. It is absorbed.

The Question We Keep Avoiding

At its core, this is not just about malpractice. It is about what healthcare has become.

Is it a service built around care, or a system built around revenue?

Because the two do not coexist easily.

Healthcare operates on a built-in imbalance. The patient does not have the knowledge to question decisions in real time. The doctor does. That gap is supposed to be held together by trust. Instead, it is increasingly being monetised.

And when fear enters the equation, that imbalance deepens.

A family faced with a critical diagnosis does not negotiate. It complies. It agrees to tests, procedures, and costs without pause because the alternative is risk. That is where the system finds its leverage. Not in secrecy, but in urgency.

This is why overdiagnosis, overtreatment, and inflated billing are not random. They are structurally enabled.

The question then is not whether unethical practices exist. It is whether the system, as designed, makes them inevitable.

Over time, India has moved toward a model where private players dominate healthcare delivery. Public investment has remained limited, forcing dependence on a system driven by financial returns. The result is predictable – pricing power shifts to providers, and access becomes conditional on the ability to pay.

The scale of that shift is not small. A majority of healthcare in India is now delivered by private institutions. Out-of-pocket spending remains among the highest in the world. Millions are pushed into financial distress each year because of medical expenses. 

This is not a side effect. It is the outcome of policy choices.

The argument has long been that private healthcare brings efficiency, access, and quality. What it has also brought is a conflict that cannot be easily resolved – the pursuit of profit within a space built on vulnerability.

And that conflict does not stay theoretical.

It shows up in decisions like what tests are prescribed, how long a patient is kept, whether a procedure is recommended, how aggressively treatment is pursued. Each of these decisions exists at the intersection of care and revenue.

When those lines blur consistently, the system does not drift. It settles. Which brings the question back, stripped of all abstraction.

Can a system built on profit reliably protect those who enter it at their most vulnerable?

Or has the answer already been playing out 0 in hospital rooms, billing counters, and operating theatres – long before we chose to acknowledge it?

What Can Be Done And What Won’t Be

The solutions are not unknown. They have been discussed for years.

Standardised treatment protocols can reduce unnecessary variation in care. Greater transparency – on procedures, pricing, and outcomes – can help patients make informed decisions. Independent ratings of hospitals and doctors, based not just on infrastructure but on ethical conduct, can shift incentives. Stronger penalties, including disbarment and criminal action in severe cases, can create deterrence.

Even structural changes are obvious. Expanding affordable medical education can reduce the financial pressure on doctors. Strengthening public healthcare can reduce dependence on private systems. Improving regulatory capacity can close gaps in enforcement.

None of this is new but what is missing is consistent execution. Because each of these changes challenges an existing incentive. Transparency affects pricing. Regulation affects margins. Accountability affects power.

As long as the system continues to function – financially, politically, and institutionally – the urgency to disrupt it remains limited. Which is why reforms tend to be incremental, reactive, and incomplete. The problem is acknowledged. The response is measured. The system adjusts, but does not change.

And so, the same patterns continue only with different patients. Different hospitals. The same outcomes.

The Last Bit, The Real Diagnosis

On her first day, the young doctor chose to walk away but most patients cannot.

They enter the system with trust, urgency, and very little room to question what follows. Decisions are made quickly, often without full information, and almost always under pressure. By the time doubts arise, the process is already in motion.

That is where the system holds its advantage.

It does not rely on secrecy. It relies on imbalance – of knowledge, of power, of timing. And once that imbalance is built into the structure, individual ethics are not enough to correct it.

The doctor refused to be part of it. That is why her story stands out. Because the system is not designed to reward that choice.

It absorbs compliance. It sidelines resistance. And it continues, largely unchanged.

Which brings the issue back to where it began.

If a system pushes out those who refuse to compromise, and retains those who adapt, the problem is no longer about a few bad actors. It is about the design itself and until that changes, the diagnosis remains the same.