India’s evolving data protection regime will have to work to make Prime Minister Narendra Modi’s flagship programme Ayushman Bharat a success. The Personal Data Protection Bill 2019 must be in conjunction with the National Digital Health Blueprint, which governs India’s overall health data. For it to work, the digital architecture has to incentivise private sector buy-in.
The core question here is whether private sector participants such as Apollo and Manipal hospitals will look at the combination of NDHB and PDP Bill as another set of cumbersome hurdles to work around or as progressive, enabling mechanisms. We think there are a set of incentives built into these laws that may improve private participation.
Incentive for private players
First, the structure of schemes like Ayushman Bharat — and its several state-level counterparts — incentivises healthcare providers to adopt digital capabilities in order to easily submit claims and receive payments. For private providers to play a part in such schemes, they will have to be engaged in the NDHB’s data ecosystem; the handling of personal data will be governed under the guidelines stipulated by the PDP Bill.
Previous experience on the national scale supports this: after a large-scale analysis of Rashtriya Swasthya Bima Yojana, researchers from the India Health Insurance Experiment suggested that a strong digital backbone is needed for Ayushman Bharat’s success. Ayushman Bharat has already met with success in terms of digitisation of payments, but the leverage it has can be used to push digitisation further, in-line with the NDHB. If private providers wish to benefit from the expanded healthcare demand enabled by Ayushman Bharat, they should support the implementation of the NDHB as quickly as possible.
Cost reduction for all
Second, a digital infrastructure that enables easy, secure and verifiable transfer of data will reduce friction in the healthcare system, in turn reducing costs for all in both transaction and administration. Indian healthcare providers have plenty of room to improve on this front; an Indian School of Business survey of providers found that less than half of them were able to access patient information generated outside of their organisation.
To enable improved information flow, the architectural principles of the NDHB’s proposal are based on proven precedents like interoperability, open source, and data information exchanges. For example, at UnitedHealthcare, a US insurance provider, combining multiple data sources into a single internal data information exchange reduced fraud and inaccurate claims, leading to 2200 per cent return on its investment.
More data, more benefits
Third, healthcare providers will benefit from medical advances driven by scientists delving into datasets enabled by the NDHB’s ecosystem. The PDP Bill recognises the importance of leveraging data in the advancement of knowledge, because it grants exceptions for data use in research. We see this in the US where, by combining data from multiple sources, researchers discovered novel uses of Desipramine, an antidepressant, for lung cancer treatment.
Similarly, Asthmapolis — a startup — uses GPS-enabled inhalers to better understand what environmental factors trigger symptoms of asthma. Insights that drive improvements are only possible when there is sufficient data. The NDHB allows for the easy aggregation of data while protecting privacy and ensuring consent, providing a valuable public good.
Protection with NDHB
Under the proposed PDP Bill, if a data fiduciary or processor (an entity that holds personal data on an individual’s behalf, such as a hospital or healthcare mobile application) violates the law’s provisions, it can face prosecution and may have to pay heavy fines. By participating in the government’s NDHB architecture, private players can avoid inadvertently violating PDP provisions and the costly consequences of doing so. This is yet another reason for private players to adopt the evolving digital architecture.
Previous attempts to unify the healthcare system have met with limited success, such as the Clinical Establishments Act, 2010. This was, in part, due to a lack of incentive for private players. The current push stands in contrast; there are ample incentives. And according to McKinsey Global Institute estimates, the digitisation of India’s healthcare system will create a potential value of at least $10 billion annually by 2025. If the Modi government truly wishes to provide ‘health for all’, it will keep this factor — the need to take private players along — in mind.
Alexander Fager is Analyst and Princeton-in-Asia Fellow, and Prakhar Misra is Senior Associate at IDFC Institute. Views are personal.
This is the second in an IDFC Institute-ThePrint partnership series, part of the Data Governance Network’s work on data governance policies and infrastructure in India.