Context: The covid-19 crisis is being seen as a Demo in parts of the Indian healthcare policy circles.
- It takes a crisis to bring in deep reform, for e.g. the 1991 liberalization that came in the backdrop of the terrible economic crisis.
- Deep reforms seem difficult in the normal course because of the incumbents who prevent any change.
Scenario of Indian Health System
- Immediate issues
- Post lockdown, fully normal life may depend on what is being called health passports or green passes to certify both the presence of antibodies against the disease and the lack of an active infection.
- But if even just the working population is to be brought under this green pass, it’ll mean a rehaul of the medical system to deal with the millions who will need testing.
- As of now, there is no way of knowing how many doctors are there in a city, what their capacity is and what part of the capacity of a hospital is utilized.
- Similarly, for path labs. It would need a system to ensure that path labs eligible for the antibody tests are accountable and are indeed performing the tests.
- Lingering issues
- Indian health system is plagued by an inability to provide the golden trinity of accessibility, affordability and quality healthcare to all the citizens.
- Although various demand and supply side solutions have been tried, including a ₹5 lakh health cover for the poor through the PMJAY scheme, to turn the supply side weakness into a demand side push.
- But the friction in the system rests on a fragmented, agency-specific view of the healthcare landscape with high costs of verification of both doctors and patients that elevates the cost and disbursement of insurance.
- Prevalent fraud in the healthcare system is the problem that not only raises costs but also reduces trust in the system.
Opportunity in Crisis - Reforms needed
- To make an online data repository, online machine-readable registry is needed for both doctors and path labs.
- It would also need a health records registry, something like a digi-locker, where an individual can store and have control over her health records, that can be shared with doctors and insurers for services.
- This could even store the prescriptions that can be used to order medicines.
- A claims and coverage platform too is needed for faster disbursement of insurance claims.
- Named as the Health Stack, the blueprint for such a system has been in place for a couple of years, but it is still work in progress.
- The volunteers have been working since 2015 on this digital public utility, much as they did on the payments grid long before demonetization made a real-time, fully digital, low-cost, safe payment system the need of the hour.
COVID crisis as demo moment
- The covid crisis changes the status quo by giving a pressing reason to bring about change in the decades-old rules and regulations.
- Recently, the Ministry of Health & Family Welfare recently issued the telemedicine guidelines enabling a practice protocol for access to healthcare through technology platforms.
- Going forward, if India decides to go down the path of the health passports, the back end infrastructure in terms of the software architecture is already in place, but the behavioral challenge remains in getting states, departments, courts and civil society to see the merit of moving out of the past into the future.
What will the health stack mean for consumers of healthcare and health insurance?
Health stack can be understood as a public infrastructure that is built and handed over to both public and private sectors to fulfil various goals such as
- Far more control and privacy of medical records of consumers.
- More information, other than word of mouth, of doctors and path labs.
- Faster claims.
- Low-cost OPD policies and instant claims.