Healthcare delivery in India faces multiple challenges. There have been many health-related initiatives by the Centre and the states. However, despite adequate funds and the right intent, healthcare schemes have yielded little results in improving the health infrastructure of the country. According to the National Sample Survey (NSS), only 11.3% of the bottom 40% population has any insurance coverage. Further, only 4.5% of total hospitalization expenses are reimbursed to the bottom 40%, resulting in high Out-of-Pocket expenses. There is absence of reliable and timely data aggregation at the patient level which reduces the quality of care and hinders effective policymaking. To address these widespread issues in the health sector, the government of India is developing the National Health Stack (NHS).
It is a digital infrastructure that would pave the way for the effective rollout of various Health initiatives. Although the government is developing NHS for effective implementation of the National Health Protection Scheme (NHPS), it also aims to further supplement the existing and future health initiatives. NHS will rigorously facilitate the collection of comprehensive healthcare data. This will help the policymakers to experiment with policies, detect fraud in health insurance, measure outcomes and move towards smart policymaking through data analysis.
The National Health Stack is organized into two layers. There is a National Health Registries layer, which forms the base of the Stack and has the services required to manage the master data for all health programs. Above it, there is a layer of software services required for operationalizing programs. This includes Coverage and Claims Platform, a Federated Personal Health Records (PHR) Framework, and a National Health Analytics Framework (NHAF) amongst others.
Layer-I National Health Registries
Each department of the government, implementing different schemes tend to maintain their own copy of the data and it becomes a tedious process to update or restrict data sharing across programs. This eventually affects the efficacy of various health initiatives. National Health Registries will encompass data for various health-sector stakeholders’, for instance, healthcare providers such as hospitals, clinics, labs, etc., doctors, insurers, and ASHA workers as well as beneficiaries. It may also contain data about other aspects of health programs like information on drugs and interventions. This layer will be utilized by all programs which are built on top of the National Health Stack.
The source for each attribute in the Registry should be visible and viewers should be able to tell who added what information and when. This would usher in greater trust in the data and stronger accountability. Further, The Creation, updating, and retrieval of data would be possible using open APIs. Moreover, it will not enable data deletion from registries. Although it may be possible for the registry owner to mark certain entries as obsolete.
The master data for all healthcare providers in the country which includes hospitals (both government and private), clinics, diagnostic labs, and other clinical establishments would be essential for running any insurance scheme effectively and in running other programs which rely on the veracity of the data provided.
Layer- II Coverage and Claims platform
The coverage and claims platform constituents to implement any large-scale health insurance program, enabling both public and private actors to implement insurance schemes in an automated, data-driven manner through open APIs. There will be three primary sub-components of this platform: a policy engine, a claims engine, and a fraud management service.
The Policy Engine will empower beneficiaries to get a unified view of all their health insurance policies in a convenient and user-friendly manner. These policies are to be developed based on Smart Contracts, a derivative of Blockchain Technology. Smart contracts will enable policies to have intelligence embedded in them, which will allow each policy to directly interact with the Claims Engine. The Claims Engine will manage the way claims flow in health insurance schemes and ensure ease of filing and settling claims. Finally, the fraud management component is responsible for ensuring that the fraudulent claims settled by coverage and claims platform is minimized. The component aims to reduce losses due to dishonest claims and ensure that the healthcare system covers the people who need it the most.
The NHS will provide a digital health ID every user participating in the system can be uniquely identified with. This would reduce medical errors, unnecessary costs, reduce inefficiency and increase the quality of care.
Federated Personal Health Records
Personal Health Records (PHR) refers to the integrated data comprising of medical history, medication, and allergies, immunization status, laboratory test results, etc. PHR is maintained in a secure and private environment considering the sensitivity of data. The flow of such data would be consent-based across different stakeholders.
A federated personal health record refers to an individual’s ability to fetch all her records from health care providers who she has consulted with. This framework would be based on the guiding principle of making an individual controller of its data which will ensure the privacy of users.
The National Health Analytics framework
The National Health Analytics Framework will enable the creation of aggregated datasets that will point to the overall position of the health infrastructure of the country/state/district. This will lead to data-driven decisions and targeted policymaking in the health sector. This would comprise of, for instance, the average number of patients treated in a day, most commonly occurring diseases in India, average billed amount / billed amount for a particular medical procedure, etc. It shall be published as part of this framework to increase transparency, accountability, civil society engagement, and innovations in service delivery. It will also aggregate information specific to disease surveillance, predicting epidemics, classifying and clustering population segments for proactive care, nutrition and health schemes. This would pave the way for a real-time approach leading to smart policy decisions.
Benefit of NHS
NHS aims to improve health care affordability through justified pricing, instant adjudication, and timely payment of claims which would subsequently reduce out-of-pocket payments. It further seeks to increase accessibility and availability to the common woman. The NHS will include features of portability of Health care, providing the mass with the convenience of availing health care benefit anywhere in the country and at any point of the time. It would also aid in adopting data-driven research and policymaking through analytics and enable effective management of various health schemes.
NHS can be viewed as a foundational building block that would pave way for the rapid rollout of various healthcare initiatives. It would lead to faster settlement of claims of the beneficiary through better fraud detection and faster adjudication of claims. Health records can enable real-time decision-making and lead to data-driven policymaking. The National health analytics framework can be helpful in identifying disease incidence, treatment outcomes as well as performance evaluation of various initiatives.