The Budget 2018 announcement of ” #Ayushman Bharat ” aimed at financial risk protection from catastrophic healthcare expenses is a clearly articulated strategy towards providing Universal Health Coverage and India’s march towards achieving the UN sustainable development goals #SDGs.
Government sponsored health insurance schemes in India have run into the risk of becoming scams
in the past, where the availability of insurance cover have been an incentive to perform investigations and procedures
that were perhaps clinically unnecessary and in some cases physiologically impossible
, such as males having their uterus removed ( procedure called hysterectomy
, when one thinks of a male undergoing the same would roll hysterically !) and worse still these procedures being reimbursed by the insurance providers under the government sponsored schemes.
There is an urgent need to empower the citizens to make informed choices and participate in shared decision making process. The National Health Portal
has a wealth of information around health conditions and tools that aim to empower the citizens towards informed choices around health, there has also been concerted effort to make these available in regional languages.
Also, since a significant provision of secondary and tertiary care is in availed in the private sector, seamless referral mechanisms between the primary healthcare systems (which are mostly in the public sector and closer to where majority of the rural communities live) and the specialized private healthcare establishments would be fundamental to the successful implementation of the National Health Protection Scheme #NHPS.
The frontline healthcare workers empowered with #electronic health records of the populations they serve and using #clinical decision support tools could serve as the gatekeepers to triage and refer those needing higher level services into the healthcare delivery institutions. #electronic tracking of the referral would not only ensure that the healthcare delivery systems are not overwhelmed with sudden influx of a large number of patients wanting specialized services that the current healthsystems are ill-equipped to deliver but also serve as a regulatory mechanism for these well intended schemes from being misused and protect the vulnerable citizens from being exploited and their organs being sacrificed at the alters of greed (akin to the killing of the golden goose). Any well intended scheme is a potential scam unless robust mechanisms prevent them from being misused.
Health Systems generated Electronic health records or better still patient held electronic health records such as MyHealthRecord
as envisaged by the ministry of health and family welfare along with functional regional and central health information exchanges would be the backbone for the national health protection scheme to be efficiently operationalized.
Currently, most insurance linked health care provision is administrated through third party agencies, while few of the government insurance schemes are cashless, Ayushman Bharat is an immediate opportunity to scale up #digitalhealth based real-time health insurance handshakes that enable citizens to avail the benefits of this scheme without being pulverized in bureaucratic pain in addition to their physical pain from undue delays for “preauthorization” before they can avail essential healthcare services.
While we have several islands of excellence in #mhealth, many of them still at national level pilot stag , a national Digital Health Platform would also help connect these islands and help navigate through the muddy waters towards a well-functioning digital health ecosystem with an aim to ensure a level playing field for all the stakeholders in the healthcare delivery space, thereby paving the path for more efficient and transparent healthcare delivery.
More over a national digital health platform / grid backed by a robust health information exchange would also create an enabling environment for “start up entrepreneurs” to plug in and contribute to the transformative vision articulated by the government towards achieving universal health coverage for all Indians.
The article was first published in Dr. Oommen John’s LinkedIn Pulse page, its been re-published here with the authors’ permission