Modicare

While the 'incrementalist' approach of the the ruling dispensation in Delhi has been a trifle disappointing, its agenda for healthcare could well turn out to be refreshingly ambitious. The newly minted Ayushman Bharat National Protection Mission - which in all probability would sport the moniker 'Modicare'- has all the trappings of large scale reform, possibly even the promise of life transforming social impact.

Sample the numbers. Modicare will sweep under its cover massive swathes of the country's population, an estimated 100 million families or 500 million people who are poor and vulnerable. The scheme will take care of the secondary and tertiary healthcare of those under its cover and all of this will be done digitally with minimal or no paperwork.

While it is easy to conceive but painfully hard to deliver, a well thought out strategy and design can make the difference between sparkling success and a stillborn misadventure. Here are a few thoughts on what could make such a grand scheme work.

To start with, at the policy making and governance level there ought to be a 'federal' approach with active participation from the states many of whom have a similar scheme already in place. The success of the GST council in managing a fiendishly complex regime is a clear pointer.

Undoubtedly the right IT strategy will play a crucial role in ensuring 'Modicare' takes off in the manner envisioned. Imagine a scheme which will have to deal with data across insurance companies, hospitals of myriad sizes and sophistication and involves millions of citizens. How will information flow among the hospitals, government and insurance companies? How will privacy be protected? Can one prevent frauds and leakages?

One easy decision should be to home in on a couple of principles. For instance, 'track the money' is a dictum that should be an absolute necessity given the size of the scheme (the government itself is expected to spend at least Rs 120 billion annually, a modest premium from the beneficiaries would add to the size of the pie as well). Data should be captured and reported at the transaction level of healthcare treatment, akin to filing invoice data for GST compliance purpose. Transaction level information can fold into periodic financial reports from health care institutions. Finally, the wealth of data emanating from medical and treatment expenses and financial reports can be crunched and analysed in multiple ways so that a set of indicators including benchmarks can emerge. Though money leakage and frauds are endemic to large social schemes, a wealth of data, insights and oversight can doubtlessly be an effective deterrent.

Secondly, the whole information chain should be governed by a robust data standard. Access to financial and accounting information is at the core of the philosophy of 'follow the money'. Healthcare institutions, insurance companies as well as the state and central ministries use a range of accounting systems. Ensuring data interoperability is obviously the key in this complex situation.

Of course, there is the larger question of data privacy and security since information is linked to an individual's health and medical treatment, nature and costs. However, even now insurance companies ask for treatment and healthcare information from those who undergo treatment. 'Modicare', on the other hand, is expected to be fully digital which brings in huge benefits of scale and granularity but puts that extra onus on data security. Extending this train of thought, information across medical and health indicators of an individual can go digital too, right from the diagnostic equipment. Such data sets have obviously significant privacy implications necessitating tightly controlled access and consent architecture. It should be safe to assume that this is an initiative that might not happen too soon.