In Goa, the choice between public and private healthcare is increasingly perceived as a choice between two forms of insecurity. In the former, the patient may fear for his life; in the latter, his family may fear for its inheritance. While the State remains responsible for providing accessible healthcare, private hospitals are increasingly relied upon for specialised treatment, critical care and prolonged hospitalisation.
The uncomfortable question is whether private healthcare has evolved into a commercial enterprise in which medical treatment remains the principal service, but disproportionate accounting determines the patient's financial fate.
The anatomy of an inflated bill
In September 2026, Maharashtra Food and Drug Administration Commissioner Tukaram Mundhe disclosed findings concerning extraordinary differences between the procurement prices and printed maximum retail prices of hospital consumables. An intravenous infusion set procured for Rs 11.05 carried an MRP of Rs 325, representing a difference of approximately 2,841%. Similar discrepancies were identified in syringes, catheters and other essential supplies (2026).
The matter was referred to the National Pharmaceutical Pricing Authority, raising questions concerning the regulation of medical-device prices and the distribution of margins between manufacturers, distributors and hospitals.
The problem is not confined to procurement records. An independent examination of publicly displayed prices on the Romsons medical supplies website, undertaken on 19 September 2026, revealed that an infusion set carrying an MRP of Rs 402 per unit was being offered at Rs 27.60 when purchased in a 25-piece pack. A three-way stopcock carrying an MRP of Rs 322 was advertised at approximately Rs 16.14 per unit in a 50-piece pack.
Where such consumables are charged to patients at or near MRP, the resulting margin requires scrutiny. The patient undergoing intensive care cannot bargain over the price of a syringe, demand an alternative supplier or independently verify every item entered into the hospital's billing system.
The ordinary principles of consumer choice are rendered practically meaningless by medical necessity.
The physician and the accountant
An equally revealing disproportion may be observed between professional consultation fees and the eventual hospital bill.
A specialist may have spent more than a decade acquiring medical qualifications, undergoing clinical training and developing expertise. Yet, the professional fee charged for a consultation may constitute only a small fraction of the total expenditure incurred by the patient.
The remaining amount is distributed across room charges, nursing services, investigations, consumables, equipment, pharmaceuticals and institutional overheads. Many of these expenses are legitimate and indispensable. Their existence, however, does not dispense with the obligation to justify their pricing.
Nevertheless, where a hospital is managed principally through financial performance indicators, the possibility of commercial priorities influencing patient expenditure cannot be ignored.
The physician's clinical obligation and the hospital's commercial interests must therefore be distinguished.
A doctor may remain committed to the patient's welfare while the institution continues to generate substantial revenue from every additional day of hospitalisation.
The Hippocratic tradition concerns the ethical practice of medicine. It cannot reasonably be invoked to justify an accounting structure over which the treating physician may exercise little control.
Insurance against financial ruin?
The affordability crisis is compounded by the cost of private health insurance.
Premiums are determined by factors including age, coverage, underwriting risk and the insurer's claims experience. For older persons, particularly those requiring extensive coverage, maintaining adequate insurance can become a substantial recurring household expense.
The Insurance Regulatory and Development Authority of India has recognised the sensitivity of premium revisions for senior citizens, issuing a circular in January 2025 concerning the review of such increases.
Insurance nevertheless does not guarantee complete financial protection. Exclusions, co-payments, sub-limits, non-payable consumables and exhaustion of the sum insured may leave families responsible for substantial expenditure.
The DDSSY question
Goa's Deen Dayal Swasthya Seva Yojana was conceived to provide financial assistance for eligible medical treatment. Its existence, however, should not be mistaken for comprehensive protection against every form of healthcare expenditure.
The adequacy of its provisions for prolonged geriatric care, home-based nursing, rehabilitation and palliative treatment requires particular scrutiny.
A scheme that finances specified procedures but fails to provide adequate support for the continuing needs of dependent patients may leave a significant gap between hospital treatment and actual recovery.
Profiting from the final stages of life
Palliative care presents perhaps the most difficult ethical question.
A patient approaching the end of life may continue to require pain management, respiratory support, nutritional assistance, nursing care and treatment for distressing symptoms. These interventions are not necessarily curative, but they remain medically important.
The distinction between treatment intended to prolong life and care intended to preserve dignity must therefore be clearly communicated.
Hospital-acquired infections, complications and prolonged admissions can further increase expenditure. Their occurrence does not automatically establish medical negligence, but the resulting treatment costs warrant transparent accounting and appropriate clinical review.
Towards accountable healthcare
The solution cannot be confined to controlling consultation fees or imposing arbitrary restrictions on hospital revenue. Transparent procurement, itemised billing, rational medical-device pricing and accessible mechanisms for challenging disputed charges are equally necessary.
In Goa, an independent examination of private hospital billing practices, together with a review of public geriatric and palliative-care capacity, would provide a factual basis for regulatory intervention.
