In April 2016, when the National Payments Corporation of India started its UPI service, few newspapers would have had the story on their front page, even though at that time, as many as 21 banks had signed up to offer the service to their clients. Today, with UPI payments exceeding those by credit and debit card by a big margin—UPI payments rose from nothing in April 2016 to Rs 290,537 crore last month—all news of UPI, such as its plan to introduce offline payments, are being eagerly reported, and read. Much the same will apply to the personal health record prime minister Modi is going to unveil on Independence Day; for now, though, most will pass it off as some utopian plan, bound to fail in much the same way the PM Fasal Bima Yojana has.
Certainly, the public health record and all that it stands for can be a grand failure, but if it takes off like UPI did, it can transform India’s pathetic health system in 5-10 years; UPI, to be fair, got a big fillip—even if inadvertent—from demonetisation, and it is not clear what will play that role for the health record, though the pandemic may have nudged things in that direction. Whether the public health record transforms the health sector, at the end of the day, will depend upon how much it is pushed and whether there is a vested interest in pushing this.
Two sets of persons have a vested interest in pushing it, whether they do so or not, though, is up to them. The first group comprises the insurance firms who stand to save thousands of crore if the health system transforms as the high referral-driven health insurance payouts will decline dramatically. If hospital admissions and laboratory tests have come to a near halt today due to the pandemic, it does suggest that a significant chunk of tests and hospital visits can just as easily be avoided; how much these will rebound after the pandemic gets under control will tell you just how much doctor referrals were artificially driving up health costs, but chances are it will be significant.
Related to this is the issue of making healthcare more affordable as well as accessible; logically speaking, this should get the entire political class behind the personal health record—and the revolution this promises—but as we’ve seen in the case of plugging ration shop and other leakages like those on LPG cylinders which would have benefitted the poor, till Modi became PM, this didn’t quite enthuse the political class either. In other words, a concerted government push will be critical; as in the case of the UPI, the ability to get more people to onboard the system—the more doctors, hospitals, and laboratories there are, the more the patients will be, and vice versa—is what will make it stronger.
The way this will work is that, once an individual who has a personal health record—this may or may not be linked to an Aadhaar or a Digilocker—gets any test done, the laboratory will send a digital copy to her health repository, in the Digilocker or elsewhere. Ditto for all doctors’ consultations/prescriptions. The complete records can then be shown to any doctor anywhere in the world.
That is the obvious part of the story, where do the savings and the access come in? Once there are enough people onboarded, it is the data collected that will drive the savings. Government programmes, for instance, can then better target those with specific diseases; regular diabetes check-ups, for instance, could be aimed at these groups, they could even be given discount coupons for their medicines. Laboratories or diagnostic centres could be graded according to the quality of machines they use, and costs can be posted online; the GEM portal could be used to get 24×7 quotations, with special rates for those covered by different insurance schemes including those like the Pradhan Mantri Jan Arogya Yojana.
Fraud management will also get a leg up as, once there is enough data, analytics and AI can help track fraud; how can one person get two appendix operations even if spread across a year, how were you billed for a knee surgery when the marker for this—revealed in your blood test—didn’t show there was a problem? The list is endless.
Once doctors have complete data on a patient, and with the advances in telemedicine, certain kind of patients may not even need to come to big hospitals in big cities. If a hospital, say an AIIMS, can monitor hospitals/clinics in smaller towns, and ensure they are taught the same protocols—say, for chemotherapy—that it follows, patients can be treated in smaller facilities closer to where they live. Once 5G or good enough optic fibre broadband is available, certain kind of surgeries can also be conducted remotely using robotic equipment. Better-equipped diagnostic centres can be monitored remotely—even solutions like the rapid antigen tests for Covid-19 will emerge for other diseases—and patients given medical treatment locally.
Indeed, once the health records are digital, a lot of health claims can be processed at a far lower cost electronically and, if doctors’ prescriptions are digital—that means they can be checked for authenticity later—even OPD costs can be covered by insurance. Building this multi-layered health system is not going to be easy, but as in the case of UPI, its success will depend upon how many people adopt it.
So, there are a lot of places where it can fail, but go to swasth.app and look at the number of diagnostic centres, hospitals, insurance players and platforms, health-tech players and technology players that are already onboard the digital health train; over time, there would be more than one swasth.app; indeed, the more there are, the better. When that happens, India’s shortage of doctors and hospitals may still be there, but it will be a lot less felt than it is right now because the existing resources—including Asha workers and paramedics—will be much better utilised. On Independence Day, starting to break free from the shackles of the broken health system can only be a good thing. – Financial Express