Aadhaar has the potential to improve health outcomes, reduce medical errors, and save people both time and money
Bill Gates once said this about the computer: “Never before in history has innovation offered the promise of so much to so many in so short a time.” There is no better place to find this promise than right here in India, and no better example than Aadhaar, the country’s unique identity system, an identity database over which an authentication platform has been built.
India’s unique identity scheme has enrolled almost a billion members already, having covered almost 50% of the population just a year ago. By the end of this year, the tally will stand close to 100% of all residents in India. With the scope of the project enlarged from what was originally envisaged as a proof of identity and proof of residence project, Aadhaar now also serves as the financial address for its residents. Armed with this system, India has been able to revolutionize its financial systems, rethink the nature of its welfare state, cutting back on benefits in-kind and market-distorting subsidies, and turning to direct cash transfers paid into the Jan Dhan accounts of the neediest. But what about health?
In his book Rebooting India, Nandan Nilekani has provided a first cut on how Aadhaar can be used to overhaul the healthcare sector when he discussed data for public health surveillance in quickly identifying patterns of emergent epidemics, and understanding our rapidly changing burden of chronic diseases compared to patterns in Western Europe.
This seems to be the tip of a very big iceberg. In our everyday world, a unique identifier means better medical records for the individual and family, and links connecting the patient experience regardless of doctor or facility, something desperately needed in our mobile and migratory social context.
Perhaps the biggest win that Aadhaar can bring about is that it can accelerate the process of “interoperability” in healthcare. Interoperability is the seamless exchange of data across the patient care continuum, not just between the internal systems of the provider network, but also an outside laboratory and pharmacy, and their connection with the insurance company’s claims department. When systems are interoperable, patients and their families and doctors can access patient information. This translates into no longer having to lug stacks of charts, lab and x-ray results, and other documentation from doctor to doctor.
When systems are interoperable, if you need care on a business trip to Hyderabad or Bengaluru, again, the provider will connect with your provider network in New Delhi, or wherever you reside. That saves you and your family time and money, not to mention you receive appropriate care more quickly. Yes, Aadhaar has the potential to improve health outcomes, reduce medical errors, and save you both time and money. That improves health, productivity and satisfaction. At a system level, it can save precious funds. In the US, interoperability has the potential to lower health costs by $30 billion annually. Currently, there is $36 billion in addressable waste within the US healthcare system of which 97% is attributed to lack of interoperability.
New ideas and initiatives are taking hold as leaders discover its possible applications. One simple example is an initiative in Krishna district in Andhra Pradesh, where doctors and nurses are tracked for absenteeism using biometric markers. This has improved attendance and access by patients.
Fast forward: Links with longer-term health sector reforms?
India is struggling with the way forward in terms of health reforms. Recently, the government has looked to state nodal agencies as loci for moving to a social insurance model as in Canada, to improve financial protection while improving quality. Could Aadhaar be linked to bank accounts for automatic premium payment by above poverty line (APL) groups?
In the villages of Rajasthan, for example, under a recent public-private partnership, over 40,000 service centres provide electronic payment of utilities and other services. Many of these villages lack water and sanitation, yet monetary transactions are electronic and just a click away. Primary care centres are now starting to use Aadhaar for linking individuals and their medical records.
But is Aadhaar enough for cementing all these innovations? International experience suggests caution. Doctors and nurses may manipulate tracking systems. Consumers may evade premiums, not seeing coverage as a good investment, just as has occurred in nearby Vietnam, Indonesia and the Philippines. More may be needed such as high-quality services, and subsidies of premiums for the near poor and informal sectors, and education for accessing entitled services. While Rajasthan villages have electronic service centres, the primary care centre down the road often still has no drugs or the doctor is absent. Building a “demand side” with no access to quality services will not work.
It may be argued that Aadhaar is necessary for big sectoral reforms, but it is certainly not sufficient. It can be a building block for the medium term. The supply side asks, however, remain. The central government must play a key role in setting data standards and regulations, and perhaps incentivizing the development of the network for health. At the same time, it will need to protect data regarding patient privacy and confidentiality of records.
Aadhaar’s benefits can clearly extend to our individual health, on to a healthier system for all. The prime minister has remarked that India is becoming the fascination of the world—the potential of the Aadhaar-health connection is just one fascinating aspect that leaders are watching from around the world.
Jack Langenbrunner is senior program officer, Comparative Health Systems in Integrated Delivery Team, Bill & Melinda Gates Foundation.