India

Despite efforts to increase financial coverage for people living in poverty, out of pocket expenses still make up two thirds of total health expenditure in India. Employees in the formal sector have health coverage through their work, ninety percent of the Indian labor force exists in the informal sector where no such coverage exists. Rising costs of healthcare are becoming unaffordable even to the middle class, the majority of whom do not have any form of health finance protection. Interstate migrants, most of whom come from poorer sections of society, are denied public health insurance benefits. Given the highly fragmented payer system, there is a compelling case for the need for feasible plans to aggregate these pools to make the payer system most efficient and effective. ACCESS Health India, in partnership with national and international institutions, is working on modalities of risk pooling for policy uptake.

India continues with a decades old system of supply side line item budgeting for the public healthcare delivery system, despite the fact that this approach is inherently ineffective and inefficient. While the bundled payment system adopted by state and national public health insurance programs has introduced some efficiencies, the principles of strategic purchasing have yet to be adopted by the system at large. ACCESS Health and other international expert organizations are actively engaged with agencies implementing these insurance programs at the national level and in certain states on strategic purchasing with a goal to improve efficiencies across the health system.

In the face of limited public health expenditure, many states never realize the full potential of their allocated budget, with some states leaving nearly a third of their allocated budget on the table and unused due to inefficient finance management. ACCESS Health is working with the state government of Assam, USAID, and other strategic partners in India to optimize public health finance management. Other states may adopt similar improvements as well.

ACCESS Health India was awarded the Secretariat role in a new health systems research consortium currently being developed in India. As the Secretariat, ACCESS Health India will coordinate research with a goal to providing guidance for health policy and implementation.

While financial protection for health is expected to improve with the rollout of the Ayushman Bharat program, many lives continue to be lost and many left disabled d due to poor quality of care in both public and private healthcare facilities. ACCESS Health India, in partnership with Health Care Services (HCS) Group, has created a performance improvement framework and tools to improve quality while reducing costs of delivering care. Some of the quality improvement learnings from our earlier flagship program on quality of care, Safe Care, Save Lives, were incorporated in the design of the framework. ACCESS Health is also focusing on evolving modalities to drive quality using strategic purchasing through state health authorities as a financial lever of in public and private health insurance programs.

Along with HCS Group, ACCESS Health has developed a 5 ‘P’ model for disease prevention and management programs: People, Pathways, Practice guidelines, Platform, and Performance measurement. We offer these models to digital health platforms for adoption. We are also working with partners to create a project to test the extension of benefit packages by social insurance programs for outpatient management of hypertension. The project will test the usual care approach against a team based disease management approach. We are also working with tech platforms to aggregate fragmented primary care networks to enable purchasing of primary care services from these networks. In addition, these platforms are being tested to integrate primary care with hospital-based care as an extended care model.

ACCESS Health is partnering with educational institutions to design and offer the courses to build human resources needed for digital health transformation.

Along with metadata standards, ACCESS Health has introduced unique concept of e-Objects (e-discharge summary, e-claims, e-prescription etc.,) to further standardize core elements involved in health insurance information systems (HIIS), healthcare delivery information systems (HDIS), electronic health records (EHR), and personal health record (PHR) modules. ‘E-Claims’, designed by ACCESS Health is being adopted in the latest version of HIIS being commissioned by National Health Authority (NHA), the implementing body of PM-JAY.

As part of NDHB plans, national registers are being created for healthcare professionals, providers, and payers etc., to have accurate data for formulating policies. ACCESS Health Digital is actively engaged in designing the digital tools for these registers.