What is National Healthcare System, Digital Health ID, Improvement

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National Healthcare System-Healthealthcare has become one of India’s largest sectors. It comprises of hospitals, medical devices, medical tourism, medical insurance etc. The healthcare providers are divided into public as well as private services. The public healthcare services that involves government services are present as tertiary and secondary healthcare facilities and primary health centres in rural areas. Lack of adequate and quality healthcare services in Public sector forces people to move to the private sector services that are very costly and involves huge out of pocket expenditure.

Several schemes have been run by different State Governments to improve healthcare services for various sections of services that were until now not available to them, but still various deficiencies exist.

To fulfil these deficiencies in the public health sector, the Prime Minister on the occasion of Independence day announced the launching of a National Digital Health ID. It will be a digital identification method that will contain the records of the health related information which could be easily shared with health authorities with a patient’s consent. All the stakeholders such as hospitals, laboratories, insurance companies, telemedicine firms etc. will be expected to participate in the health ID system.

National Digital Health Id

A national digital health Id is a unique Id that will be assigned to every person which will identify the person, authenticate them and keep their health records for his/her medical history with the consent of the patient. It will allow for a seamless flow of health information across various systems for better service delivery to the patient. A health Id will be created by using the basic details and mobile or Aadhar number which will be unique to that person.

At present, digital health Id has been announced in Andaman and Nicobar Islands, Chandigarh, Dadar and Nagar Haveli, Daman and Diu, Ladakh, Lakshadweep and Puducherry. Apart from the patient’s health information repository, the program will also include

• Digi Doctor

It will be a comprehensive data gathering platform of all doctors that are currently practising or teaching modern/traditional system of medicine. It will allow the doctors to get connected to India’s digital health ecosystem.

• Health Facility Registry

It is a comprehensive record of health facilities across the country. It will include both public and private health facilities including hospitals, clinics, diagonistics, laboratories, pharmacies etc.

•Electronic Medical Records

It will be a digital version of patient’s treatment history from a single facility. The health information recorded in a facility will be stored locally at the establishment where the patient was registered. This information will be linked to patient’s health Id.

Deficiencies of Healthcare System In India

Deficiencies in the healthcare system of India include inadequate reach of basic healthcare services, shortage of trained medical professionals, lack of quality services etc. It is necessary to find ways to use technology in health services to improve delivery of services and provide truly universal access to every citizen. But these objectives are not fulfilled due to various reasons. These are :

Low Priority to Public

Health Keeping communities healthy through prevention of diseases and promotion of health and wellness has been a low priority historically in India. Of all the current expenditure on health, preventive care only accounts for 6.7% whereas curing people involves more expenditure as it involves other expenses such as pharmaceuticals, other medical goods and transportation. India, accounting for 18% of global population accounted for 3.6% of global tuberculosis and 26% of premature mortality due to diarrhoea, and a range of non-communicable diseases.

Limited Training

In most states, public health management positions are taken over by doctors, that are trained mainly in the provision of curative services or by generalist civil servants. They have limited public health training to understand the cause and effect between risk factors and diseases as well as disciplines such as epidemiology, biostatistics, behavioural sciences and management of health services. Hospitals in rural areas are run by clinicians that have little expertise in managing health facilities.

Poor Primary Health Services

The existing primary healthcare model is limited in scope. Services that are provided in these primary centres are only the services related to childcare, womencare, motherhood and certain services related to national health and schemes. These account for very low proportion of the essential services that people demand for their welfare and wellbeing and to prevent morbidity. Thus, there is no provision for services such as hypertension, heart disease, adolescent health, mental health, disability, ageing health, and early cancer detection

Low Workforce in Healthcare

India’s healthforce is characterised by a diversity of healthcare workers in fields of allopathy, alternative systems of medicine such as ayurveda, homeopathy, unani and siddha. The doctor-population ratio in India is 1:1613. The nurse-population ratio is 1:1588. This is very low as compared to developed countries.

The distribution of existing workforce is concentrated in urban areas. Urban areas have four times as many doctors and three times as many nurses as in rural areas. As medical and nursing colleges are concentrated in Southern states, these conditions also increase the inequality in availability of trained medical healthcare providers. Apart from this, there is also shortage of allied health professionals such as lab technicians, radiologists etc.

Increasing Cost of Medical Services

for various medical tourists India is an appropriately favourable destination for world class cheap healthcare but for Indians, healthcare has become increasingly expensive, remaining out of reach of many people. The price of treatment has risen at double the speed of rise in income as per the NSSO surveys. Many private establishments overcharge patients and also recommend unnecessary tests. This further raises the costs of hospitalisation and out of pocket expenditure.

Lack of Standardisation

Different healthcare organisations have varying software supplies, depending of their size of working, management system and infrastructure. There is no standardisation in the delivery of healthcare. This creates confusions among the doctors when a patient moves from one health institution to another. Moreover, several patients are asked to start fresh treatment if they have switched from one doctor to another.

Digital Initiatives to Improve Healthcare

Many initiatives have been launched by the government in India such as the National Digital Health Blueprint, National Health Stack etc. These aim to overhaul India’s existing healthcare ecosystem. They seek to digitise health records so that patients do not have to carry their lab reports, prescriptions etc. in physical form and digital records are available to them at their convenience. These digital records can also be shared with any doctor or family member with the patient’s consent

In this direction, the NITI Aayog proposed a nation-wide framework to digitise the healthcare in India, in the form of a National Health Stack. The National Digital Health ID is one of a horizontal component of the National Health Stack, which was announced by the Prime Minister from the ramparts of the Red Fort in his Independence day speech.

The components of the framework proposed by NITI Aayog include:

  1. An electronic national health registry that would serve as a single source of health data for whole country.
  2. An insurance claim platform that will allow the expansion of existing health coverage schemes such as Ayushman Bharat.
  3. A personal health record system that would enable the patients to access their own health data as well as access by doctors.
  4. A national health analytics platform that would provide a holistic view by combining various health initiatives to improve policymaking.
  5. Other components such as a Unique digital health Id.

How will these digital initiatives improve healthcare in India?

Technology based initiatives will revolutionalise the set of public as well as private healthcare system in India. It will provide following benefits for the healthcare

• The digitisation of medically critical information will help the doctors in diagnosing the patient easily. The doctor will have access to the current and previous diagnostics, current and previous diseases, medical reports, prescriptions, discharge summaries, etc. It will reduce the time involved in the initial diagnosis and provide the patient with better quality healthcare services.

• Patients will be able to access health services remotely with the help of teleconsultations, e-pharmacies, online appointments etc. Patients will be able to access this information on a mobile app. This will reduce the inequality between rural and urban in the availability of health services.

• It is going to improve the efficiency, effectiveness and transparency in the health service delivery. Patients will be able to share their health records and history with the medical services providers quickly with the click of a mouse. This is going to reduce diagnostic and treatment time for critically ill patients who are in urgent need of care.

• Better quality of health data is going to be most beneficial for policy makers that will enable the government in forming better policies even for a particular region. It can be used to monitor the healthcare of India both geographically as well as demographically. This will strengthen government program implementation

• Preventive healthcare will be strengthened because if an elaborate database about the prevalent diseases will be available to the government it will be in a better position to form policies and programs to establish, run and monitor the primary health centres to the preventive health needs of citizen.

• Research and development will greatly benefit from the availability of such aggregated information as there will be critical evaluation of effectiveness of various programs and policies by the government. There will a good network of feedback between researchers, policy makers and providers.

• Data will also be used by the private players securely to further improve their own services so that the vast number of patients associated with the private health facilities will able to access better services at cheaper costs. This will also improve access to healthcare because private healthcare accounts for majority of healthcare providers in India.

Way Forward

All these high and tall promises can not be fulfilled without addressing the concerns associated with the privacy and data of the patient. There has been a little movement in the data protection framework of India. Medical health data is very critical. If it is not handled carefully, it will lead to invasion of privacy and other related issues with the patients. Further, the government will need to incentivise the hospitals, clinics, patients etc. so that they adopt the new technologies as it will require significant investments in technology setup and operation of the digital system.

There must be standardisation across all the systems so that it does not become confusing to the patient as well as the services provider. The system will also be required to be error free as updation of data on the server involves significant errors that inturn may affect patient health. Apart from this, government will also be required to regulate the use of private data by the private players so that it is not misused. Thus, all these concerns if addressed can provide significant gains to healthcare in India and health of Indians.

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