Why does a Rs 10,000 car service have better transparency than a Rs 5,00,000 hospital stay?

Over the past year, I have spent a significant amount of time inside some of the most premium hospitals in the country. Because of my father’s illness, we have faced hospitalisations almost every two months, lasting five to seven days at a time. I did not expect this experience to change how I think about my own work. It has, more than almost anything else in the last decade.

Every admission starts well. You enter the Inpatient Department, sit through a counselling session and receive a tentative daily cost breakdown — room rent, doctor visits, diagnostics and other charges. You deposit your advance, or your TPA insurance clears, and for a moment, it feels like someone is accounting for what is happening to your family.

Then the visibility black hole begins.

From that point, you have no real-time idea what is being charged while your father lies a few floors above you. Instead, you receive SMS alerts informing you that your limit has been consumed and that you need to deposit more money, often without an itemised explanation.

Want to see the bill? You walk to the accounts department, wait in a queue and are handed a physical printout. You then manually audit hundreds of lines, cross-referencing medical codes you were never taught to understand, while trying not to miss visiting hours.

During our stays, I have repeatedly found errors this way: items billed that were never delivered, duplicate charges across departments and consumables billed in quantities that did not appear plausible. Correcting even one error means phone calls, escalations and repeated explanations — all while carrying the actual weight of why you are in that hospital.

Nobody should have to become their own forensic auditor in the middle of the worst weeks of their life.

This is not about one unusually bad hospital. It reflects a larger systemic problem. A nationwide LocalCircles survey of over 35,000 respondents across 329 districts found that 53 percent of patients in India did not receive a fully itemised hospital bill, while 74 percent wanted the government to mandate a standard, transparent billing format.

The regulatory response shows that the problem is recognised. The Bureau of Indian Standards has introduced a standardised, itemised hospital billing format intended for national application. However, it remains voluntary today, with expectations that it may become mandatory only in 2027. The Clinical Establishments Act, passed in 2010, already requires clinical establishments to disclose treatment costs and service charges clearly, yet it has been adopted in barely half of India’s states. Rule 9, which provides for government intervention in private hospital charges, has also never been enforced and is currently the subject of a pending Public Interest Litigation in the Supreme Court.

This is not a technology gap. It is a system that has not yet made transparency non-negotiable.

The financial consequences of this opacity are significant. India’s out-of-pocket health expenditure has improved, falling from 62.6 percent of total health expenditure in 2014 to 43.4 percent today. Yet at the household level, the burden remains substantial. Rural households still pay out-of-pocket costs equal to 95 percent of their hospital bill and urban households 83 percent. The average cost of a hospitalisation has nearly doubled since 2017, while close to 90 million Indians are pushed into catastrophic health expenditure every year.

Here is the comparison I keep coming back to: if a modern car garage can send me a real-time link on my phone to approve a Rs 500 wiper replacement before it is fitted, why can a premium hospital charging lakhs for an admission not provide a family with a live dashboard showing medical expenses as they happen?

The technology is neither exotic nor untested. Real-time itemised billing, point-of-sale visibility and digital approval flows already exist and work across industries carrying a fraction of healthcare’s stakes.

Families going through hospitalisation are already fighting an emotional battle they did not choose. They should not have to fight an accounting battle at the same time.

This is not a call for hospitals to charge less. Pricing is a separate and important conversation. This is a call for hospitals to be transparent about what they are charging while care is happening — not after the fact, not at discharge and not at the billing counter.

I have spent years building systems that give people real-time visibility into where their medicine is, what it costs and whether it is genuine. I believe patients and their families deserve the same clarity in healthcare.

Hospital billing should meet the standard we already accept for a car service, a food order or a courier package: visibility while the transaction is happening, not merely a bill after it is over.

The technology exists today. What is missing is the will to make transparency a basic right for every family already carrying more than enough.