Current Affairs – 26th November, 2016

GOVERNANCE AND SCIENCE AND TECHNOLOGY

 

TOPIC:

General Studies 2

  • Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
  • Government policies and interventions for development in various sectors and issues arising out of their design and implementation.

General Studies 3

  • Indigenization of technology and developing new technology.

 

National e-Health Authority (NeHA)

 

Introduction – What is NeHA

Health-services in India are lagging behind in terms of use of Information and Communication Technology (ICT). The common man still archive doctor’s prescriptions, labs and X-ray results as was done decades ago. Till date, the vast majority of Indians have no organised medical records, whether paper or electronic. Therefore to overcome the problems due to limited use of ICT the government has proposed the NeHA.

 

  • National e-Health Authority (NeHA) is proposed to be set up by the Government of India as a promotional, regulatory and standards setting organization to guide and support India’s journey in e-Health.
  • It will also subsequently lead to realization of benefits of ICT intervention in Health sector in an orderly manner.
  • It will be set up under the government’s Digital India programme and will work towards the integration of multiple health IT systems in a way that ensures security, confidentiality and privacy of patient data.

 

Method of Operation 

  • NeHA will be set up as a health information network where various different stakeholders and contributors to health information will set up a repository of information.
  • They will also be allowed to communicate with each other with the help of so-called Application Programming Interfaces (API). This will function in the same was as many mobile applications in our devices do so.
  • Healthcare APIs would allow the doctor’s to communicate with the chemists and the testing labs and centres to communicate with the hospital’s database.
  • This further provides scope for development of more applications for patients, doctors, researchers, and policy makers. For instance there could be an app to remind mothers to vaccinate their children, push notifications to remind you to take your medication, or an alert that you are travelling to an epidemic belt.

Challenges for NeHA

This seemingly perfect health information system has its own set of challenges:

  • There is poor uptake of electronic records by doctors in India.
  • The lack of inter-operability between systems and devices leads to duplication of tests etc thus increasing inefficiency.
  • Inter-operability will need more than law and mandates since it will bring with itself the legitimate concern for privacy, security and safety of medical data.
  • End users are not involved in health information systems’ design and implementation strategies.
  • Risk-averse institutions and outdated laws have slowed down digital innovation in healthcare.
  • Once the system is in place it will be a challenge to ensure adequate outreach to the masses.

Addressing the Challenges

 

The challenges mentioned above can be addressed with the following measures:

  • To encourage the doctors to adopt Electronic Medical Records (EMRs) the proposed systems must be easy to use and affordable.
  • The system should ensure that it collects only that data which is required thus helping in data minimisation and avoiding any kind of overload. There have been instance in the US insurance companies where digitisation led to workplace dissatisfaction and physician burnout.
  • Ensure a participative approach where all stakeholders are involved in the planning of design and implementation. This will help in getting the best feedback from the users themselves.
  • Proper funding, research and analysis needs to be done. It will ensure that inter-operability is achieved thus contributing to the efficiency of operations and avoiding any sort of duplicity.
  • Encourage investments and promote an API-based ecosystem incorporating inter-operability and standardisation at inception.
  • Substantial intellectual rigour must be devoted to building safeguards to protect the patients from any abuse.
  • Even though the new law accompanying NeHA is expected to provide the patients with data ownership rights still a more nuanced strategy is recommended that thinks of ownership in terms of control and access. This will protect the interest of the patients as well as provide a congenial environment for smooth research or policy making.
  • The problem of the outreach will have to be addressed with the assistance of large-scale initiatives. Large private hospitals should open up their digital platforms to API-based solutions.
  • Government schemes like the proposed National Health Protection Scheme (NHPS) have the power to reach tens of millions and hence an API-based architecture can be integrated with the NHPS.
  • A common patient identifier or Unique Identification Authority of India (UIDAI) / Aadhar number deserves serious emphasis considering its mass outreach.

 

Conclusion

Any health information architecture proposed by NeHA must therefore provide technical or legal solutions to the above challenges. NeHA and regulatory laws will define India’s health information ecosystem and will have deep, long-lasting impact on healthcare delivery. The government has to ensure the following:

  • It gives primacy to the needs of patients and clinicians
  • Adopts a user friendly design.
  • Abandons traditional institution-based EMRs in favour of an API-based eco-system.
  • Ensure passing of privacy laws in sync with these new technologies.

With all the necessary ingredients available in the form of a robust telecom infrastructure, unique ID authentication, and a large talented pool of IT professionals, such a reform can usher in an era of unprecedented growth in the scope, quality and safety of Indian healthcare.

Connecting the dots

  • Discuss the importance of National e-Health Authority (NeHA) and critically analyse how well prepared India is to set up the National e-Health Authority.

 

HEALTH

 

TOPIC: General Studies 2

  • Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
  • Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
  • Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes;

 

Improving the Indian healthcare system- Lessons from Thailand

  • India and Thailand share similar demographic and economic similarity which makes comparison between the two countries relevant.
  • Health expenditures as a share of GDP (gross domestic product) are similar — Thailand: 4.4% and India: 4.1%. However, the outcomes vary a lot.
  • In Thailand, the under 5 years’ age mortality is 12.3 per 1,000 live births; maternal mortality, 20 per 100,000 live births. Whereas in India, the under 5 years’ age mortality is 47.7 and maternal mortality at 174 per 100,000 live births.

India at a glance- Health

  • National Rural Health Mission, launched in 2005 was flagship programme in increasing access to health services.
  • This was later expanded to urban population through the National Urban Health Mission (NUHM) in 2013.
  • Rashtriya Swasthya Bima Yojana (RSBY) was launched to provide financial protection to targeted populations, including those below the poverty line.
  • In addition, there are a number of state-specific schemes like involving free diagnostics facilities and offering free medicines; others are government-funded health insurance schemes in several states.
  • At 60%, India’s out-of-pocket expenditure for health is one of the highest in the world.
  • To sustain its economic growth, India will need to have a healthy population and address health inequities. In this context, Universal Health Coverage can be the driver and benefit the entire population.

 

The Thai healthcare system

  • In the early part of the century, there was strong macroeconomic growth in Thailand.
  • Thus, the Thai government launched a universal health coverage (UHC) scheme for the informal sector covering 70% of Thailand’s 70 million people.
  • And this scheme was adequately matched with structural reforms which helped the successful implementation of scheme.
  • In India, the programmes have been brilliantly envisaged but not accompanied by necessary structural reforms which explains a big part of the huge gaps in expenditures and outcomes between the two nations.
  • Thailand initiated a purchaser-provider split. Here, a new quasi-independent purchasing is paid on the basis of services and performance and not inputs like beds and staff, as is the case in India.
  • If the doctors and nurses did not perform, they were not paid. Incentives were built into these contracts for efficiency. Equity through models such as age-adjusted capitation and per admission payments adjusted for diagnosis was implemented.
  • Public as well as private providers were brought into the system, though private providers remain at a relatively low level of around 25%.
  • Thus, these mechanisms add up to ‘strategic purchasing’ for healthcare services and placed Thailand at Western Europe’s level.
  • Along with this decision, the Thai government brought new revenue means in the system- cigarette tax. This reduced the demand, improved health and expanded the revenue means to fund healthcare system.
  • This revenue was used in health promotion and disease prevention programmes—from HIV to diabetes to hypertension.
  • Also, incentives were developed and fresh medical graduates were redistributed to remote areas for a minimum tenure.
  • In this, the citizens benefited as a whole. Quality of care became a national priority through an independent accreditation body that developed a three-step system of quality improvement.
  • Thailand’s Quality and Outcomes Framework (QOF), used to measure the quality of health services, offers immense learning opportunities for India.
  • Government established world-class technology assessment process to bring in the new and cost-effective, while eliminating obsolete and unsafe drugs, devices and procedures.
  • It decided to invest early in information technology to provide mobility and convenience to citizens, easy monitoring of fiscal performance of the health sector and to also facilitate the gleaning of information from health claims to calculate quality and utilization measures.
  • Thailand’s national civil registration database forms the backbone of all health schemes in the country.
  • It ensures that a beneficiary cannot enrol in two schemes at the same time. India through its Aadhar project can verify the same when National Health Protection Scheme (NHPS) is soon going to be launched.
  • Today, the system has close to eight million in-patient transactions and more than 160 million out-patient transactions every year.

 

Challenges to health sector in Thailand

  • The distribution of providers across urban and rural areas remains inequitable. In contrast to rural health services, urban health systems are characterized by hospital-oriented care, private clinics and hospitals and a lack of effective primary health care systems, particularly to treat chronic non-communicable diseases.
  • Most records are still maintained in paper form and some in electronic form but they are not shareable across facilities.
  • Electronic medical records (EMRs) are not stored on the national ID smart cards, which could have made the ID a coverage verification tool.

Conclusion

India should take a cue from Thailand’s Universal Healthcare system and improve prepayment and strategic purchasing, expand the health care provider network in rural areas, and also stimulate digitization.

An Aadhar enabled NHPS could mark the beginning of effective universal health coverage for India having a robust information and communications technology platform to support it. For this, India has to have standards of data exchange, a unified data model and strong IT infrastructure.

Thus, much of Thailand’s success goes to development of good policy based on solid evidence and then systematically building capacities to implement them.

Now India has to embark upon achieving its ambitious target of Universal Health Coverage for all with a definite vision, federal cooperation, strong political commitment, robust infrastructure with adequate insurance coverage and monitoring and accountability mechanism.

Connecting the dots:

  • What is Universal Health Coverage? How can India maintain a healthy population?
  • Healthy economy is based on healthy population. Critically analyse.