Is Healthcare Sector shifting from Service-Oriented Care to Profit-Driven Practice?
The future of Kashmir’s healthcare system depends on restoring balance between public service and private practice, between professional ambition and social responsibility
IMRAN LONE The healthcare sector in Kashmir stands at a critical juncture. While visible progress has been made in recent years—through the establishment of new medical colleges, expansion of hospital infrastructure, and introduction of modern diagnostic tools—the ground reality tells a more complicated and, at times, troubling story. Beneath the surface of development lies a system struggling with structural inefficiencies, uneven accessibility, and an increasing tilt toward commercialization. Traditionally, healthcare has been regarded as a public good—an essential service aimed at safeguarding the well-being of society. However, in Kashmir today, this foundational principle appears to be gradually eroding. The shift is subtle but significant: from service-oriented care to profit-driven practice. One of the most pressing challenges remains geographical and seasonal accessibility. Harsh winters in Kashmir often disrupt mobility, particularly in rural and remote areas. Snow-covered roads, limited transport options, and long distances to hospitals make even basic medical access difficult. In such conditions, the role of local health centres becomes crucial. Yet, many Primary Health Centres (PHCs) continue to suffer from inadequate infrastructure, shortage of medical staff, and a lack of essential medicines. As a result, patients are frequently forced to travel long distances, sometimes at great personal risk, to seek treatment. Urban healthcare facilities, although better equipped, face a different set of challenges. Government hospitals in major towns and cities witness an overwhelming influx of patients daily. Long queues outside outpatient departments (OPDs), overcrowded wards, and limited doctor-patient interaction have become routine scenes. While demand continues to rise, the capacity and responsiveness of the system struggle to keep pace. In contrast, private clinics present a sharply different picture. Here, patients often experience shorter waiting times, more attentive consultations, and relatively organised systems. However, this convenience comes at a cost—one that is increasingly becoming unaffordable for large sections of society. A typical scenario illustrates this divide clearly. In a government hospital, a patient may wait for hours in a crowded OPD, only to receive a brief consultation due to the sheer volume of cases. The same patient, if visiting a private clinic, is attended to promptly, often with greater attention and time. Yet, the consultation fee itself may pose a financial burden. Moreover, many private clinics operate with fixed validity periods—such as consultations valid for only 10 to 14 days— after which patients
must pay again, regardless of their financial capacity. When viewed against the backdrop of Kashmir’s per capita income, this model raises serious concerns. For middle-class and economically weaker sections, repeated consultation fees, diagnostic tests, and medication costs can quickly become overwhelming. In effect, access to quality healthcare begins to depend not on need, but on the ability to pay. This growing commercialisation also brings into question the evolving mindset within the medical profession. Medicine has long been considered a noble field, rooted in service and ethical responsibility. However, there is a noticeable perception among the public that, for many practitioners, the focus is shifting toward financial gain. The expansion of private clinics, high consultation charges, and even commissions linked to prescribed medicines contribute to this perception. It is important to clarify that this does not apply to all doctors. Many continue to serve with dedication and integrity, often under challenging conditions. However, the increasing number of cases where professional priorities appear misaligned cannot be ignored. The issue is not individual morality alone—it is also systemic, shaped by a lack of regulation and accountability. Another critical concern is the apparent imbalance in attention between government and private practice. It is often observed that doctors associated with government hospitals devote comparatively less time and energy to public duties, while maintaining active private practices. In some cases, OPDs in government institutions are irregular, with patients reporting that consultations happen only on specific days or with limited engagement. Meanwhile, private clinics operate with greater consistency and focus. This disparity raises fundamental questions about accountability. Government hospitals are meant to serve the general public, particularly those who cannot afford private care. Ensuring the availability and active participation of doctors during designated working hours—such as 9:30 AM to 4:30 PM—should not be optional but strictly enforced. The issue extends further into medical education and institutional capacity. While new medical colleges have been established, many of them face shortages of qualified faculty, insufficient infrastructure, and inconsistent patient care systems. Reports of professors or senior doctors being irregular in OPD duties only deepen the crisis. The result is a dual failure: compromised medical education and inadequate patient care. Equally concerning is the quality and effectiveness of treatment. There is a growing perception among the public that recovery times in Kashmir are
longer compared to other regions. Whether due to delayed diagnosis, inadequate follow-up, or systemic inefficiencies, this trend warrants serious investigation. The absence of widespread awareness initiatives by healthcare professionals further compounds the problem, as preventive care remains underemphasized. At its core, healthcare is not merely a sector—it is a social responsibility. Doctors, in many ways, act as the driving force of a healthy society. Their role extends beyond clinical practice; they are custodians of public well-being. In such a profession, the distinction between personal and professional responsibility naturally becomes narrower. However, the increasing influence of market dynamics—where healthcare begins to resemble a commercial enterprise—risks undermining this very foundation. The entry of unchecked capitalism into the healthcare system shifts the focus from collective welfare to individual profit. This is particularly concerning in a region like Kashmir, where economic disparities are already pronounced. Addressing these challenges requires more than incremental changes—it calls for a comprehensive policy rethink. The government must play a proactive and decisive role in regulating private practice, ensuring fair pricing, and maintaining ethical standards. Mechanisms should be introduced to monitor doctor attendance, enforce duty hours, and evaluate performance within public institutions. At the same time, efforts must be made to strengthen public healthcare infrastructure, especially in rural areas. Investment in medical staff, equipment, and training is essential. Expanding affordable healthcare schemes and increasing their reach can help bridge the gap between accessibility and affordability. Public awareness must also become a priority. Educating people about preventive healthcare, early diagnosis, and rational use of medical services can significantly reduce the burden on hospitals and improve overall outcomes. Ultimately, the future of Kashmir’s healthcare system depends on restoring balance between public service and private practice, between professional ambition and social responsibility, and between economic sustainability and ethical commitment. If the current trajectory continues unchecked, the consequences will not only be felt in overcrowded hospitals or rising medical costs, but in the overall health and stability of society. However, with timely intervention, strong governance, and a renewed commitment to the core values of medicine, it is still possible to build a system that serves all sections of society equitably. A healthy Kashmir is not just a policy goal—it is a necessity for its social and economic future. (The author is a UPSC aspirant and can be reached at: imranlone6006@gmail.com)
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