A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India, the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semistructured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra and from a witness seminar on the topic of transformation in Maharashtra’s healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities and the perceived benefits of work in larger providers. We describe a ‘reprofessionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying ‘restratification’ within this part of the profession affords prestige and influence to ‘star doctors’ while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals’ bodies can, and should, play in contemporary transformation of private healthcare and the implications of these trends for health systems more broadly.
- health systems
- health policy
- qualitative study
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Handling editor Kerry Scott
Contributors All the authors were involved in the design of the study and contributed to conceptualising this manuscript. SM analysed the data and wrote the first draft of the manuscript and the coauthors (BMH, IC, AS and SFM) contributed to the writing of subsequent versions. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding The study was conducted with support from a UK Joint Health Systems Research Initiative grant (MR/R003009/1), which was cofunded by the UK Medical Research Council, Economic and Social Research Council, Department for International Development and the Wellcome Trust.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Institutional Ethics Committees of Anusandhan Trust, Mumbai and King’s College London.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement According to UK research councils' Common Principles on Data Policy, and Wellcome Trust's Policy on data, software and materials management and sharing, all data supporting this study will be openly available via the UK Data Service at https://www.ukdataservice.ac.uk/
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