The Numbers Game

Negotiation is not a skill they teach in medical school. You learn to read an ECG, to interpret an ABG, to break bad news gently. No one trains you to sit across a polished table and argue over the price of a ventilator as if it were a sack of onions in a village market.

Yet as Medical Superintendent, I negotiated almost every week—sometimes every day. With vendors, contractors, bankers, and occasionally even with colleagues. In the beginning, I found it intimidating. I would listen too politely, accept explanations too easily, and come away feeling I had paid more than we should have. A hospital has many needs, and a limited purse. If you don’t negotiate, you don’t merely lose money—you lose beds, drugs, oxygen, monitors, and time.

Over the years, I learned to bargain hard. Not because I enjoyed the contest, but because the hospital depended on it. Every rupee saved on a machine could become a rupee spent on a patient who could not pay. In Sevagram, that was not philosophy. That was daily arithmetic.

The Committee Room Tableau

The scene was almost always the same. We would sit in a committee room in simple khadi—sometimes slightly crumpled, often un-ironed, always honest. Across the table sat representatives of multinational companies, immaculate in suits and silk ties, carrying glossy brochures and a confidence polished by boardrooms.

The contrast was not just in clothes. It was in vocabulary, in posture, in assumptions. They came from a world where margins mattered. We came from a world where a family sold a goat to buy medicines. And yet, when the meeting began, the table levelled itself. A hospital can be poor, but it cannot be weak.

A Deal in the Dean’s Office

Let me recreate a negotiation that could easily have taken place in the Dean’s office—one of those exchanges where the price looks fixed until you start asking questions.

Me: Let us begin. We have gone through your proposal for the ventilator. It looks good, but the price is high. Why is it ₹13 lakhs?

Agency: Sir, this is a high-end ventilator. It has advanced modes, multiple alarms, excellent reliability, and is designed for critically ill patients. It is user-friendly and built for safety.

Mr. Tapdiya: Can you break down the cost? Which features are driving it up?

Agency: The cost includes the machine, installation, training, and service support. The advanced ventilation modes also add to the price.

Dhirubhai: We understand quality. But we have a limited budget. Can you bring it down to around ₹8 lakhs?

The representative would smile at this point—part sympathy, part disbelief, as if we had asked him to sell a Mercedes at the price of a Maruti.

Agency: That is a large reduction, Sir. How many units do you need?

Me: Around ten. We need reliability, ease of use, and good service support. We need a warranty of at least two years, and we want AMC for eight years, capped at 3%—no annual escalations.

The representative would then try the standard escape routes.

Agency: Would you consider reducing the warranty or service terms to lower the cost?

Mr. Tapdiya: We cannot compromise on quality or support. But we can explore bulk purchase discounts.

Agency: If you order twenty units, we can offer a 5% discount. That brings it to ₹12.35 lakhs per unit. We can also offer a three-year payment plan.

Dhirubhai: We cannot buy twenty. We do not have that kind of money.

Then Dhirubhai would lean forward—less like a negotiator, more like a man explaining his life.

“Look,” he would say, “this hospital is not like others. We are a teaching hospital in a rural village. We follow a Gandhian philosophy. We subsidise heavily. Our patients cannot afford private ICU rates. You may not believe how low our charges are compared to Nagpur. We need equipment, yes—but we need it at a price that does not betray our mission.”

And then I would add what vendors understood even better than morality: the future.

Me: Our ICU is a training ground. Residents who learn on these ventilators will become intensivists. They may buy the same brand later. This can be long-term business for your company. But our final budget is ₹8 lakhs. Not a rupee more.

The agency would respond with the familiar dance of small concessions.

Agency: We can offer an additional 2% discount if you purchase within two months.

Dhirubhai: We will not do anything under the table. No bribes, no commissions, no “extra charges.” We pay promptly—within a week of installation. Clean, transparent. That is our strength. But the price must come down.

Agency: If you pay upfront, we can offer 5% more. That brings it to ₹10.16 lakhs.

Me: Still two lakhs above our ceiling.

At this point, Mr. Tapdiya would usually deliver the final nudge—quiet, precise, and impossible to ignore.

Mr. Tapdiya: We are also buying monitors, infusion pumps, analyzers. And we are expanding. If you match ₹8 lakhs now, we can build a long relationship. Otherwise, we will have to explore alternatives.

The representative would ask for time. He would “check with his superiors.” He would leave with a polite smile and a slightly less polished confidence.

And then—after a few days of back-and-forth—the final offer would arrive: ₹8 lakhs per unit.
Suddenly, the “impossible” became possible.

What the Chair Taught Me

Negotiation taught me lessons that textbooks never could.

First, never be seduced by flattery. A vendor’s compliments are often more expensive than his invoice. Second, do your homework. The best negotiation begins before you enter the room—by talking to alumni, comparing prices, learning from other hospitals, and understanding what you truly need, not what the brochure claims you must have. Third, fight for every rupee, because in a hospital, every rupee has a moral weight.

And finally, negotiate as a team. The strength of Sevagram was never one person’s sharpness. It was collective resolve—Dhirubhai’s instinct, Tapdiya’s arithmetic, and the hospital’s stubborn commitment to affordability.

One alumnus shaped my approach more than most: Dr. Skand Trivedi, a cardiologist from Bhopal. He taught me to be tough, almost unsentimental, in negotiations. “You are not bargaining for yourself,” he would remind me. “You are bargaining for patients you will never meet.”

That line stayed with me.

In the end, the numbers were never just numbers. They were oxygen cylinders, antibiotics, dialysis sessions, sutures, and ventilator days. In Sevagram, negotiation was not a corporate sport. It was a quiet form of care.

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