The silent takeover of India's health care

The Silent Syndicate examines how private equity and global finance are reshaping India's healthcare system, raising questions over ownership, regulation and patient welfare

The Silent Syndicate: How Big Finance is Destroying India’s Healthcare

by Ameer Shahul

Published by 

Hachette India

312 pages ₹799

 The shifting nature of ownership within India’s health care ecosystem — effectively a takeover by big finance, as it were — has had a profound impact that extends far beyond what meets the eye. Though this development has brought immense benefits, it is clear that they are not universally shared, straying from independent India’s broader vision to ensure that health remains a right, not a privilege. 

In The Silent Syndicate, author and public policy expert Ameer Shahul delivers a timely, urgent investigation into how global financial interests are extending their reach deep into private health care, reshaping it with massive cash injections. It follows his recent work, Vaccine Nation , another meticulously researched book tracing India’s vaccine and immunisation history since colonial times. 

 

Excavating financial data, personal stories and ground-level reporting, Mr Shahul builds a compelling narrative of how this “syndicate” operates across all corners and poses great risks, with eye-opening financial detailing, policy shifts and stories of the good doctors and trusted hospitals undone by the pursuit of financial gain (with notable exceptions). 

He begins with the telling transformation of Kimshealth in Thiruvananthapuram, once a “symbol of altruistic ambition”. It mirrors a wider trend across similar institutions originally established by visionary doctors to deliver affordable care, swallowed up by domestic and global corporate greed. Following a layered $1 billion deal with Blackstone, Kimshealth now functions like a “fortress under foreign command, its corridors humming with transnational energy,” the author observes. 

As cardiologist and public health expert K Srinath Reddy writes of the book: “It shows how global players cynically view the healthcare needs of Indians as a ready-made market from which to extract enormous profits with little regulatory restraint.”

The book traces the origins of the acquisitions, with subtle shifts from the 1980s accelerating through the economic liberalisation of the 1990s. Structural adjustment programmes encouraged by the World Bank and the International Monetary Fund opened doors to private capital. With abysmal public spending on health, the role of private enterprise rose dramatically, bringing with it the first wave of corporatised, efficiently-run hospitals flush with innovation.  

For the middle class that gained from this expansion, it is natural to view this shift as necessary progress. But Mr Shahul offers a stark counter-narrative: As health care began to be seen as a major economic growth driver, foreign capital swooped in, targeting an expanding consumer market, with little interest in public health priorities and human rights. The author notes how private equity swept major players into its fold, from hospital networks such as Apollo, Fortis, Max, Manipal, and Medanta to diagnostic giants like SRL and Dr Lal PathLabs. The book should also be read as a cautionary tale for the education sector, where private equity is steadily making its way into schools. 

“Healthcare was now an asset class. For PEs like Blackstone, India’s healthcare promised the one thing global investors craved: The predictability of illness and thus the certainty of cash flow,” writes Mr Shahul as he poses troubling questions like: Who truly owns India’s health care? 

He contrasts global health regulatory frameworks with India’s porous one. Where the UK relies on the NHS and centrally-determined tariffs, and countries like Germany and France use diagnosis-related group systems, many others employ benchmark charges overseen by statutory authorities. India remains “an open field for prioritising profit”. With key decisions about India’s hospital operations made increasingly in the boardrooms of New York or London, he quotes a doctor at a corporate chain as saying, “We are never asked how well the patients are. But how full the beds are.” 

Across four sections, the book maps this complex web, showing how global capital flows through hospitals, diagnostics and devices, patient data, pharmaceuticals, and health insurance. The entire gamut is intricate, far-reaching and often opaque, and 

Mr Shahul brings it to life with an absorbing narrative that often strikes a philosophical tone. 

Some of the systemic flaws plaguing Indian health care are well documented, from how powerful lobbies influence national policy, aggressive patents that keep life-saving drugs out of reach, to the paradox of the world’s largest producer of generic medicines nurturing a domestic medical system so profit-focused that a single hospital stay can drive millions into debt.

Yet, actionable solutions are less discussed. Here, Mr Shahul lays out a roadmap: Foreign investment must align with national health goals, independent commissions must evaluate who benefits from these investments, and robust regulatory authorities must be appointed to enforce fair pricing and ethical insurance practices. Health policy research must remain independent rather than donor-driven. Profit and ethics can coexist if the patient remains at the centre. To reclaim its health sovereignty, the book rightly emphasises, India must first recover its moral compass. 

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The reviewer is a Delhi-based author and journalist