BackOpinion | What the ‘demo moment’ in Indian healthcare means
The covid-19 pandemic throws an opportunity to push difficult reform in India
PremiumThe covid-19 crisis is being seen as a “demo moment" in parts of the Indian healthcare policy circles. We know that it takes a crisis to bring in deep reform—the 1991 liberalization is possibly the biggest example of this when the Narasimha Rao government used the terrible economic crisis to begin shedding the socialist chains that were chocking growth. Reform is difficult in the normal course because of the incumbents who prevent any change, but when there is a cliff in front of you, even the cynics and virtue signallers fall in line behind the reform.
The Indian health problem can be defined as the inability to provide the golden trinity of accessibility, affordability and quality healthcare to all the citizens. 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 has an impact on the costs and disbursement of insurance.
The covid crisis throws an opportunity to push difficult reform. If India wants to unlock the nation for work, it will take months before we can fully go back to normal. Pandemics are known to come in waves and we don’t yet know if there is a second or third wave waiting in the wings for its moment of fame. The partial lift of the lockdown that began on 20 April will tell us in a couple of weeks if the disease is raising its head again. But 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. These are being tried out in the developed world as well. But if even just the working population is to be brought under this passport, it’ll mean a rehaul of the medical system to deal with the millions who will need testing.
It would need an online machine-readable (as opposed to PDF files dumped in some state health authority’s hard drives) registry for both doctors and path labs. Today 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. Fraud in India in the healthcare system is the problem that not only raises costs but also reduces trust in the system.
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 she can share with doctors and insurers for services. This could even store the prescriptions that can be used to order medicines. And it would need a claims and coverage platform for faster disbursement of insurance claims. Called 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 at iSpirit (ispirt.in) 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.
The covid crisis changes the status quo by giving a pressing reason to bring about change in the decades-old rules and regulations. For example, on 25 March, the ministry of health and family welfare 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 in terms of the software architecture is already in place, the hard work of getting states, departments, courts and civil society to see the merit of moving out of the past into the future remains.
What will the health stack mean for us as consumers of healthcare and health insurance? One, far more control and privacy of our own medical records. Two, more information, other than word of mouth, of doctors and path labs. Three, faster claims. Four, low-cost OPD policies and instant claims. To understand the health stack, think of it as a public infrastructure that is built and handed over to both public and private sectors. Both can use it to fulfil various goals. Just as GPS allows for tracking of your lost mobile phone when you go to file a police complaint, it also allows private sector innovations on it, such as Uber, Zomato, Airbnb and Swiggy. If the Health Stack sounds like a pie in the sky, did you think in 2010 that you wold be zapping money safely and cheaply to the fruit on the road just a few years down the line?
Monika Halan is consulting editor at Mint and writes on household finance, policy and regulation
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