A digital health mission needs to get all the fundamentals of the ecosystem right
Prime minister Narendra Modi has announced National Digital Health Mission, the most prominent aspect of which is that all citizens will have the option to voluntarily choose a health ID, a 14-digit health identification number Which will uniquely identify each and every citizen and will be a repository of their medical history. For example, it will have details of every test, every disease, doctor’s visit, medicines taken and diagnosis. The portability it provides means that a person will, in principle, never have to carry their reports around. The doctor examining the patient can give more well-informed advice because it is possible that the patient may not consider, or sometimes forget, aspects of their medical history relevant to sharing with the doctor, But which may be valuable for a better diagnosis. This ID can be generated using a person’s basic details and mobile number or Aadhaar number, and will likely have an app acting as a convenient interface.
As tempting as it all sounds, right now a digital health ID is really a solution to a problem in search of a solution. There is no clear justification that the immobility of medical records is an insurmountable barrier to the provision of affordable, high-quality health care in India. Health care challenge in India as decades of research and experience novel coronavirus pandemic shown, can be expressed quite simply. There are very few hospitals with trained staff to cater to all Indians. But expanding the health care system will not be easy. India’s federal structure, the size of its population – and a large rural one at that – the cost of researching, finding and purchasing appropriate drugs and treatments, competitive systems of medicines and the very challenging nature of health, mean that the issues are manifold. . The serious problem is that the technological glut of digital health IDs hides vast reserves of personal data, which in the absence of privacy legislation and in the absence of public awareness and control over their data, can be open to abuse. There is a danger that any large private insurance company could use sophisticated algorithms in health and other databases to create risk-profiles for people and make it difficult for people to access affordable insurance. Also, data mining can prioritize certain affluent demographics for its services and make public and private resources reach people who can afford high premiums for their services, rather than those who need them. But they can’t pay that much. For a digital health ecosystem to work, it is important that the fundamentals are laid down from the ground up.
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