1. Healthcare in India: As Indian economy turns cashless, Narendra Modi government must aim at digitised medicare

Healthcare in India: As Indian economy turns cashless, Narendra Modi government must aim at digitised medicare

Neither the original nor the modern Hippocratic Oath touches upon the commerce of healthcare, which is a travesty.

Published: January 16, 2017 6:25 AM
aam aadmi party mohalla clinics This can be very easily termed as black health, akin to the black economy. Black health is more of an administrative failure, which can only be solved by administrative innovations.(Thinkstock)

Neither the original nor the modern Hippocratic Oath touches upon the commerce of healthcare, which is a travesty. About 70% Indians pay for their own healthcare, while a dismal 25% have insurance. Private hospitals and practitioners along with private health insurers are often maligned for their malpractice. This can be very easily termed as black health, akin to the black economy. Black health is more of an administrative failure, which can only be solved by administrative innovations.

In the wake of the demonetisation, digitising the economy has taken the centre stage, but a very critical part of economy has been hitherto ignored—healthcare. Making healthcare digital and cashless would increase access and decrease the cost of service.

Healthcare like any other public service suffers from the rigid iron triangle of cost, quality and access with an added dimension of timeliness to it. It has been a conniving conundrum for the policy-makers and civil society to break this iron triangle. Ushering in radical innovation which involves a new service and an expanded user base is a possible solution.

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But this cannot be envisaged without citizens accepting and internalising new practices. For-profit businesses push such disruptions to reap enormous dividends and attain competitive advantage. There is little reward for policymakers to innovate, but huge disincentive if the innovation fails. In such a scenario, it is imperative for the government to incubate social enterprises and partner with tech start-ups to scale bottom-up innovations in services and social sectors. More than 100 health-tech start-ups were founded in 2016, and it’s time philanthropy shared its burden with business solutions, so that managerial and commercial success can better serve the market.

The present government has revamped the archaic Planning Commission; introduced and re-packaged projects like Swachh Bharat and Rashtriya Swathya Bima Yojana. But, these are all top-down innovations leaving the citizens to get their heads around them. Demonetisation, however, changed that and made everyone a part of radical change in weeding out black economy. But, is anyone thinking about weeding out black health?

Demonetising healthcare

Seventy percent of expenditure incurred on health is out of pocket and 70% of this is used to buy medicines. Besides, India spends R400,000 crore on health but commercial health insurance covers only about R16,000 crore. FICCI has pointed out that the commercial health insurers, i.e, the ‘organized’ corporate sector is only able to cover an abysmal 0.7 % of the population. Also, only about 25 % Indians are covered by the government funded social health insurance schemes.

The radical step of demonetising is not only a welcome step for digital wallets, it should also become a catalyst in digitising the healthcare. The whole ecosystem of healthcare services, medication and health insurance can be made cash free. This would not only encourage transparency, but also encourage data management like the maintenance of Electronic Health Records (EHR), which would go a long way in eradicating the problem of irrational medication and drug overdoses.

All India Institute of Medical Sciences had started booking OPD slots through Aadhaar cards. It’s time all public hospitals and health centres followed suit.

India is the second largest exporter of generic drugs and supplies the world to the tune of R45,000 crore. And yet, buying medicines is the biggest health expense for an ordinary man, where pharma companies do not hesitate in earning 1,000% as profit margins. A radical innovation in the garb of free distribution of generic drugs to BPL patients was successfully implemented in Rajasthan. Among other things, it also broke the nefarious nexus of doctors and pharma lobby. Few states which have instituted this model are marred by hoarding and depend heavily on pharmacists’ integrity. This can be taken care of by digitising the whole supply chain of procuring and distributing generic medicines.

Most of the developed world has initiated Electronic Health Records (EHR) and telemedicine projects. With abysmal coverage and poor quality of health services, India would do a world of good by investing in technology driven innovations. Digitising the whole ecosystem will benefit from ushering in uniformity and transparency. Primary Healthcare Centres can be linked to Aadhaar, which can be used for both health records and insurance coverage. Duplicity in terms of BPL and RSBY cards along with MGNREGA job cards can also be taken care of.

Mother and Child Tracking System (MCTS) has not only utilised technology at every step of pre-natal and post-natal care, but also used social innovation as a medium to implement as well as to communicate the benefits of the program for pregnant women by roping in the local village ladies as Accredited Social Health Activist (ASHA). The success story of MCTS should be studied and replicated across programmes and geographies.

Healthcare is an immediate need of our young and progress-hungry nation, but it cannot develop unless our healthcare systems are robust, universally accessible and immune to corruption. The Holy Grail for breaking the iron triangle would be digitisation and providing cashless services by using JAM trinity with social innovation as an outcome. Rewarding bureaucrats and social entrepreneurs and generously incentivising community participation can be another successful recipe.

The author is a fellow program in management scholar, public policy & governance, Management Development Institute, Gurgaon.

By- Devasheesh Mathur

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