National Health Stack - A Feasible Reality or Distant Dream?

The Government of India has designed healthcare initiatives under Ayushman Bharat Yojna to help the low-income households get medical treatments at nominal cost. National Health Stack (NHS) has been designed to support these initiatives and aid implementation of digital health infrastructure. While NHS had many benefits, its enactment involves certain challenges. It is essential to overcome hurdles and ensure that this plan is correctly implemented nationwide.

The Government of India laid the foundation for the Ayushman Bharat Yojana in its annual budget for FY018–19. The program aims to provide healthcare services to the needy and weaker sections of society by setting up Health and Wellness Centers for comprehensive primary healthcare. The plan will cover over 10 crore vulnerable and low-income families, providing coverage up to INR 500 thousand per family every year for secondary and tertiary care hospitalization under the Pradhan Mantri-Rashtriya Swasthya Suraksha (PM-RSS) Mission.

If successfully delivered, these health sector initiatives under the Ayushman Bharat Program will ensure enhanced productivity and well-being and arrest impoverishment.

The Government of India is stepping up financial commitment toward public healthcare through Ayushman Bharat Yojana. Although, financing of the scheme holds great importance on the demand side, constructing a robust national digital health infrastructure pivotal to ensure readiness on the supply side is equally important. The PM-RSS Mission provides a great launch pad to construct an infrastructure of such magnitude.

Through the PM-RSS Mission, the government aims to congregate innumerable health schemes implemented by different states into a single umbrella scheme over time. To achieve Universal Health Coverage and Portability, convergence of various schemes is crucial. This means creating an environment where all people can obtain health services anywhere in the country, whether in private or government hospitals, without suffering financial hardship or high indirect costs.

What is National Health Stack (NHS)?

NHS is conceived as a set of building blocks essential to implement the digital health infrastructure and avoid duplication of efforts to successfully achieve convergence. NHS is the foundation on which the National Health Digital Mission (NHDM) will function.

The Prime Minister launched the NHDM in September 2021 to provide a unique 14-digit Health ID issued by the Ministry of Health and Family Welfare to every citizen. This ID contains an individual's complete medical history—including test reports and prescriptions—and will be accessible to the patient and players across the healthcare chain, including hospitals, labs, insurance companies, etc.

NHS - Components

NHS comprises five components:

• An electronic database/registry acting as the single source of all data related to health, also known as an electronic national health registry.
• An electronic facility/exchange for settling claims and coverage.
• Federated/amalgamated health records of individuals that can be accessed by the individual and all agencies involved in the medical chain.
• An advanced analytics platform to be used for an advanced policy meeting.
• Other components, such as unique digital health ID, supply chain management for drugs, health directories, and payment gateways, that can be shared across health-related programs.

Challenges

The government has launched several ambitious schemes in the past to deliver quality healthcare services to the masses that could not be implemented effectively due to following challenges:

1. Low enrolment of entitled beneficiaries: As per National Sample Survey (NSS) 71st round (2014), only 11.3% of the bottom 40% of the population had any insurance coverage.
2. Low participation by service providers: Many hospitals and nursing homes declined participation or refused to offer services post-empanelment, citing reasons such as low package rates compared with that of the market, long payment times, and lack of transparency in the claims process.
3. Difficulty in detecting frauds: Identifying frauds related to insurance claims becomes difficult due to less effective systems. This leads to long claims cycle time, funds leakage, and increased rejected claims as insurance providers adopt a conservative approach.
4. Lack of reliable and timely data & analytics: The absence of reliable and timely data impacts patients who do not receive quality care and policymakers who cannot identify the pain areas.

Benefits envisaged through NHS

With the implementation of this digital health platform, the government aims to achieve the following:

1. Providing a gamut of healthcare services to a significant portion of the population as NHS enables the availability of information and facilitates interoperability and coherence of health schemes.
2. Endeavoring to reduce future health protection costs by focusing on wellness from illness.
3. Ensuring protection for the poor through cashless care.
4. Addressing the issue of delayed payments to service providers. 
5. Plugging the leakage of funds by implementing a robust framework of fraud detection.
6. Improved and effective policy making.
7. Implementing proper audit trails to improve trust and fix accountability. 

Final Thoughts

Through the NHS, the Government of India aims to make a significant achievement in providing “Health for All.” However, to do so, it must overcome existing challenges and address the new ones that can crop up during implementation.

These obstacles can be attributed to procedural challenges, wherein all users must be incentivized to adopt a standard operating procedure. Moreover, it must be a well-thought-out process about what to document, when, and by whom.

The other major and significant challenge would be regarding data security and privacy because sensitive data leakage can impact individuals and pose a national security risk. Foreign agencies could use this data to target high-value targets.

Thus, NHS seems to be a tough ask due to the peculiarities of India's health sector, but given the success of AADHAR, India can achieve this dream.