Many challenges for the digital health mission: The Tribune India
Health policy expert
Around the world, the ideal of a public monopoly in the provision and financing of health care has recently come under scrutiny. Even the strongest proponents of public sector health care have come to recognize that public sources of health care funding, such as general taxation, are unable to keep pace with the growing demand for health care across the board. the world.
This awareness is accompanied by a markedly increased inclination towards private sources of finance and various forms of public-private partnerships (PPP), without however undermining health equity as much as possible.
Recently, the Center announced the nationwide deployment of the Pradhan Mantri Digital Health Mission (PM-DHM), which is in its pilot phase in six UTs. The hallmark of this initiative is the provision of a health ID card and a unique 14-digit health ID number that will serve as an individual’s personal digital health account – in addition to other features. such as the register of health facilities and the register of health professionals to facilitate access to health centers and staff.
Aspects such as the easy exchange and interoperability of health data, access to a more complete range of useful medical information and the possible impetus for the development of long-term evidence-based health policies , which are the obvious benefits of this initiative, were widely debated.
And, the same goes for the possible drawbacks such as breach of privacy and confidentiality.
However, the bigger picture lies in the more subtle aspects, which go hand in hand with the Centre’s ambitious plan to extend health coverage in the medium and long term.
PM-DHM was launched on the occasion of the third anniversary of the Centre’s flagship health program, the Ayushman Bharat (ABM) mission. Starting from the bottom up, the ABM aims to gradually extend access to health care to all Indians through insurance, through a public-private partnership. For such a large-scale public-private partnership to be justifiable, engagement with the private sector must be strategic. The cornerstone of these strategic purchases is the availability of good quality data, not only for the government to assess the performance of private actors, but also for private actors to operate optimally and profitably.
This requires building a robust healthcare IT infrastructure, block by block, as ambitious insurance-based healthcare expansion plans unfold in parallel. The PM-DHM is therefore a central pillar of the plans of the current central dispensation aimed at extending and strengthening the role of private actors and insurance companies in the country’s health landscape, which must not be done. entirely at the expense of Indian health care. All the benefits accruing to individual patients are in fact incidental.
The second most important aspect to discuss is the administrative roadblock that this is likely to accompany this initiative, which deserves to be minimized as much as possible in the interest of the fragility of the country’s health infrastructure and human resources. The experience of the United States shows how such a digital health framework could entail considerable administrative costs.
In the Indian context, where public funds for health care are sustainable, each additional rupee spent on administrative expenses raises ethical concerns, as these costs do not directly contribute to improving the health of the population. This does not minimize the importance of deploying the digital health framework. It also does not imply that the same should be postponed until health funds are plentiful.
However, there is a need to strike a balance between competing concerns. We must not ignore the increase in the administrative workload of doctors and other health personnel that this initiative could entail, and which would be felt all the more strongly as the health workforce is scarce. Data literacy is often poor, even among trained medical personnel. In addition, Internet connectivity is still precarious in large parts of the country. While these problems should not discourage initiative, it will be imperative to work around them.
Another important aspect of the initiative is its inherent link with the healthcare insurance model, specifically ABM. Pradhan Mantri’s precursor Jan Arogya Yojana (PMJAY, the insurance component of ABM), namely Rashtriya Swasthya Bima Yojana (RSBY), was filled with alleged reports of insurance fraud, such as bogus beneficiaries. PMJAY was not spared either.
With the healthcare IT system increasing the availability of healthcare data unprecedentedly, it becomes a kind of double-edged sword, as the data could be used to both incite and deter insurance fraud. This deserves caution as the weak regulatory environment in the country may tip the scales in favor of the former.
Second, it is worth noting the profile of the beneficiaries of PMJAY, which is currently 40 percent of the poorest population, which in the future could be extended to 85 percent of the population (including the large informal sector). ) on a contributory basis. This population is quite possibly the most lacking in data literacy, exacerbating ethical concerns around consent and confidentiality.
It should also be noted that the extension of contributory health insurance to the large informal sector is itself an administratively difficult exercise, involving significant administrative costs and potentially wasteful. Concerns have also been raised about the large-scale availability of health data that could facilitate the expansion of the private sector market as well as lucrative segmentation of the patient population.
However, this data could also be of great use in building successful public-private partnerships, and it is up to the government to ensure that things are on the right track.
Finally, it is necessary to undertake a cost-benefit analysis of the initiative. The overall costs, including the indirect costs of setting up the digital health framework, could be substantial and crowd out investments in other critical areas of public health.
The immediate benefits would mainly come in the form of a better experience and better patient management, which is unlikely to be significantly reflected at the population level. In the medium to long term, a boost to strategic private sector engagement and more effective public health policy making may be the possible benefits, but none are guaranteed and would require strong government management.