On Independence Day, Prime Minister Narendra Modi announced what he claimed would be the great panacea to India’s health woes – the National Digital Health Mission, which would provide individuals with a health ID that could be used to access data about their medical history and other details. The coronavirus crisis, Modi continued, had shown India the need for self-reliance and this was a step towards universal health coverage. This is a poor diagnosis of the problem. If the pandemic underlined anything, it was the acute lack of health services for citizens, especially in the public sector.
The idea of a digital health ID is not new. It can be traced back to Niti Aayog’s 2018 proposal for a National Health Stack, a centralised database to store the details of each health ID holder. The ID will reportedly be created using a person’s basic details, their mobile number or their Aadhaar, a 12-digit unique identification number.
The National Digital Health Mission is to seek the patient’s consent before data from their personal records is used by various healthcare providers, such as hospitals, laboratories, telemedicine firms and insurance companies.
Several concerns had been raised when the proposal was introduced in 2018 – that it impinged on rights to privacy, that data stored could be inaccurate, that it could be used to discriminate against patients when it came to jobs or getting insurance, that patients should not be required to provide identity proof in order to get treatment.
Although the Aadhaar Act mentions that demographic information collected under the ID would not include medical history, such scruples have long been set aside. As far back as 2016, the health ministry had started collecting the Aadhaar numbers of patients seeking treatment at government hospitals and medical colleges.
It gave rise to debates over who would own the data, the government or the patient. Some argued that while patients had the right to access their personal records and give consent to use it, once it was anonymised, the government had the right to use it as it chose.
Ethical concerns aside, the database does nothing to address the lack of public health services. By the end of May, 80-90% critical Covid-19 cases had been treated in public hospitals. States like Kerala, with robust public healthcare sectors, were better able to deal with the pandemic. Primary healthcare was particularly key to containing the spread of the virus.
By all accounts, the private sector failed miserably in this crisis, turning away Covid-19 patients or shutting down. Government insurance schemes that gave patients access to private hospitals did not work either. In Maharashtra, the worst affected state, frequent reports of overcharging prompted the state government to cap the price of 170 medical procedures.
At this moment of crisis, the government needs to recognise its fundamental duty to provide affordable healthcare for every last citizen. For that, it must increase public health capacities instead of relying on the private sector. It needs to raise health budgets, ensure more beds, doctors and equipment for the thinly stretched public sector. Too often, the government has used the rationale of service delivery to extract data from citizens. But while it creates vast databases, the services provided by government do not improve noticeably.
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