A practical perspective on affordability, quality and sustainability

India faces a fundamental healthcare challenge: Patients want affordable healthcare, hospitals need financial sustainability and the country needs continuous investment in better healthcare infrastructure. 

These objectives are not contradictory. In fact, all three must be achieved together for a healthy healthcare ecosystem.

There is a widespread perception that private hospitals overcharge patients. However, the perception often overlooks the substantial costs involved in delivering quality healthcare, including infrastructure, technology, skilled professionals, managing risks financing care, ensuring access for different income groups and providing round the clock services. 

A hospital bill can place a family under considerable financial strain. Patients deserve to know what they are paying for, why a treatment is needed and whether a more affordable option is available. Their concerns about the cost of private healthcare must be taken seriously.

At the same time, hospitals need adequate income to retain skilled people, maintain safe facilities and invest in better care. The practical question is how to meet these needs while keeping treatment within the reach of more families.

As hospital leaders, we must begin with the costs we can control. Before raising charges, we should examine avoidable complications, delays and waste within our own institutions. Better management can reduce the cost of delivering care without compromising its quality.

Start with avoidable costs

The OECD’s 2017 report, Tackling Wasteful Spending on Health, identified substantial spending that contributed little or nothing to better health outcomes. Its findings concern OECD health systems and should not be treated as a measure of waste in Indian hospitals. They nevertheless raise a useful question for every hospital: which activities add cost without helping the patient?

A test repeated because an earlier report cannot be found, an operating theatre left unused because preparation is incomplete, or a discharge delayed by paperwork can all consume resources unnecessarily. Hospitals should identify these recurring problems, assign responsibility for fixing them and review whether the changes actually reduce costs.

Treat patient safety as an economic priority

A hospital-acquired infection can mean additional medicines, further procedures and a longer stay. The patient bears the physical consequences, while the family and the hospital face additional expense.

Hand hygiene, safe catheter and ventilator care, and careful antibiotic use therefore deserve sustained investment. Clinical teams should lead these programmes, with management ensuring that staffing, supplies and training are adequate. Leadership reviews should examine infection rates and preventable complications alongside financial performance.

Cutting essential nursing or infection-control resources to achieve short-term savings risks creating greater costs later. Safe care is a condition of responsible cost management.

Make everyday processes work better

Many improvements begin with better coordination. Operating lists should be planned with the required staff, equipment and investigations ready. Discharge planning should start early, with medicines, summaries and billing prepared in parallel once the clinical plan is clear.

For example, a patient who is medically ready to leave should not spend hours waiting because different departments process the discharge one after another. Resolving such delays improves the patient’s experience and makes beds available sooner. Discharge must always remain a clinical decision.

Hospitals can track a few useful measures, such as theatre start delays, time from discharge approval to departure, and repeat tests caused by missing information. Reviewing these measures with the teams doing the work is more useful than collecting data that nobody acts on.

Purchase carefully and use supplies responsibly

Medicines and consumables need disciplined purchasing and inventory management. Hospital groups can combine demand across locations, negotiate with suppliers and reduce losses from expired or excess stock.

Clinical teams should help select products based on quality, suitability and total cost. Quality-assured generic medicines can be considered where clinically appropriate. A lower purchase price is useful only when safety and reliability are maintained.

Procurement savings should also benefit patients. Hospitals should review how lower acquisition costs can support more affordable medicines, consumables and treatment packages.

Give families clarity about the bill

Affordability includes knowing what to expect. Patients should receive a clear estimate before planned treatment, with an explanation of what is included and what could change the final bill.

Packages for suitable, well-defined procedures can reduce uncertainty. Their exclusions must be easy to understand, including how complications or additional treatment will be charged. When the care plan changes, families should receive an updated estimate and a timely explanation.

An itemised bill and a staff member who can answer questions help families understand the charges. Patients should also be told about clinically appropriate alternatives and their likely costs so that they can make informed choices with their doctor.

Make affordability a leadership responsibility

Hospital boards and management teams should review the cost of common treatments alongside outcomes and patient feedback. They should ask whether fewer complications and better purchasing are reducing the cost of care, and whether patients are benefiting.

Efficiency alone cannot absorb every increase in salaries, technology or other essential inputs. When price revisions are necessary, hospitals should explain them clearly. India also needs stronger public healthcare, wider financial protection and payment arrangements that support timely, good-quality care.

For hospital leaders, the immediate responsibility is practical: prevent avoidable harm, remove delays and make costs transparent. A financially sound hospital can sustain its services and invest in better treatment. Earning patients’ trust requires us to show that we use those resources responsibly and keep affordability central to our decisions.