The crisis facing the small clinic in India:

The small, friendly neighbourhood clinic has for long been the backbone of medical practice in India. But of late, the arrival of large hospitals or multispeciality hospitals is rapidly changing the scenario.
In Cochin, where I work, many of the smaller and even midsized hospitals are feeling the heat, as large hospitals mushroom all over the place. The situation in the field of radiology is also undergoing rapid change. Until 5 years back, independent diagnostic centers ruled the turf of radiology. There were diagnostic centers with CT scan and ultrasound facilities “under one roof”. Then MRI scan was also added to the range of services. When even that was not sufficient, pathology labs were added to these “centers”. Even large hospitals would refer cases to these diagnostic labs. But, soon, these same hospitals decided that, rather than buy the cake, they might as well make it. The result, almost all the major hospitals in town have their own complete diagnostic facilities. The situation is so bad, that some of the independent labs have shut shop or shifted their equipment to greener pastures.
So, what does the future hold for medical practice here. Obviously, many of the numerous labs (and also the smaller hospitals) in this part of the world have to adapt to the changing times; many might simply close shop. Others would merge with the large mega-hospitals, to survive. The friendly neighbourhood clinic, or lab might operate on a part- time basis, with the radiologist operating part time at a number of labs.
The trends one sees in the corporate world will be mirrored in the medical field also.
Kerala, with its high literacy rates (almost 100%) and consequent health consciousness, coupled with inflow of petro- cash (from overseas Indians in the Arab countries), has an abundance of private healthcare facilities. In fact, it is estimated, that, Kerala has one of the highest number of CT scan machines, per unit population in the world. The changes in this microcosm will reflect those in the West and elsewhere.