The right prescription PDF Print E-mail
Thursday, 18 July 2019 00:00
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Setting up a health-data repository of Ayushman Bharat beneficiaries, especially with Aadhaar linkage—a health ministry panel recently recommended this, as per The Indian Express—is a significant step forward towards not just better public health management and fraud prevention in the government’s flagship health insurance scheme but also nurturing an ecosystem of health-related enterprises, creating jobs. The National Digital Health Mission (NDHM) that the panel proposes mirrors the goals of the National Health Stack that the NITI Aayog had talked about last year; data collected from Ayushman Bharat will be managed and analysed digitally, and a system of personal health records would be created. Aadhaar linkage would mean that every health-related detail is entered into a beneficiary’s record even if she avails of the healthcare coverage at different places; but, given, the committee notes, Aadhaar can’t be used in every context as per existing regulations, linking an element of the PHI to Aadhaar—name of patient and that of her immediate family along with personal details like gender, date of birth, or mobile number or e-mail ID, etc—will be a must if the mission goals are to be realised.

The government must learn the right lessons from Rajasthan’s Bhamashah experience—a PSU insurer burnt its fingers, thanks to fraudulent claims in the absence of a robust verification such as a Aadhaar-based one, and walked out. The insurer’s pain, though, helped flag the fraud. With as many as 14 states and three UTs out of the 33 that are implementing Ayushman Bharat having chosen the trust-only model (nine have opted for insurance-only and seven have opted for trust-&-insurance), frauds will bilk the government since checks at the level of the insurer will be absent—having a third-party administrator, too, doesn’t help if fraud is effected with the connivance of the administrator or happens due to its failure to monitor rigorously.

Apart from fraud reduction, an Aadhaar-linked health-data repository offers many positives. This will allow a beneficiary to migrate—the scheme targets BPL families, many of which see members frequently move from city to city for jobs—without having to worry about safe-keeping and physically carrying around her health records. Such portability is also an advantage for the government, given it means a disease trail to study contagion, if the case is such, is there for it to follow. Consolidated health data means healthcare professionals will be able to serve the beneficiary better, more so, if they are aided by artificial intelligence and big-data analytics. Data analytics can also be used by the government to map disease/location specific healthcare expenses to check over-billing, to settle claims faster and even in epidemiology to study endemic diseases that can be used to hone community medicine intervention. With the appropriate privacy safeguards, data mined from such a wide pool of patients as the one Ayushman Bharat serves presents an enormous advantage to medical research in the country.



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