Healthcare for all? Need data, AI and funding

MUMBAI: Can all Indians have seamless access to healthcare regardless of location or socio-economic status by 2047? A report by consulting firm BCG and TPA Medi Assist says it is possible with the a tiered approach that taps health data and AI.

According to the report, the population needs to be categorised into emerging, middle, and affluent groups with support from govt, employers, and private insurers, respectively. This will require unified online health data, AI-driven automated claim settlements and fraud detection systems.

The 'borderless health' plan segments the population into groups with tailored healthcare approaches. While affluent India focuses on personalised plans, the middle requires expanded employer-sponsored insurance and emerging needs strengthened govt-funded schemes.

The report highlights India's low healthcare spending and insufficient insurance coverage, and emphasises on the need for increased investment and comprehensive reforms. To enable and deliver this vision, it proposes leveraging the troika of the medical JAM - joined health data, automated claim settlements for 100% cashless transactions, and mobile-enabled on-demand healthcare access.

India's healthcare spending, at 3.3% of GDP, severely lags global counterparts' - including both developed and emerging nations - according to the report. This underinvestment, coupled with insufficient insurance coverage, places substantial financial burden on citizens, particularly those in rural areas with limited access to quality healthcare.

The report also pointed out that the healthcare system is skewed towards curative care, with a disproportionate 38% of spending allocated to in-patient services and treatments. In contrast, preventive care receives only 14% of the funds, highlighting a reactive rather than proactive approach to healthcare. This imbalance contributes to long-term inefficiencies and escalating healthcare costs.

Adding to the strain, healthcare costs continue to surge, with claim sizes increasing by 11.4% and medical inflation reaching 14% in 2023. This further highlights the urgent need for comprehensive insurance reform to alleviate the financial burden on families.

With out-of-pocket payments accounting for approximately 45% of total healthcare expenditures, India faces a critical challenge in ensuring access to affordable and quality healthcare for its citizens, the report added.

Ready to Master Stock Valuation? ET’s Workshop is just around the corner!