Healthcare access for all Indians by 2047: AI and health data have roles to play

India could achieve universal healthcare access by 2047, according to a new report by consulting firm BCG and TPA Medi Assist. The report proposes a tiered system using data and artificial intelligence to categorize the population into three groups: emerging, middle, and affluent. Each group would have a different support structure: government for the emerging group, employers for the middle group, and private insurers for the affluent group.

This “borderless health” plan aims to provide tailored healthcare approaches for each group. Personalized plans would be the focus for affluent individuals, expanded employer-sponsored insurance for the middle group, and strengthened government-funded schemes for the emerging group. The plan relies on unified online health data, AI-driven automated claim settlements, and fraud detection systems.

The report highlights India’s current low healthcare spending at 3.3% of GDP and insufficient insurance coverage. It emphasizes increasing investment and comprehensive reforms. The report’s proposed solution involves what it calls the “medical JAM”: joined health data, automated claim settlements for 100% cashless transactions, and mobile-enabled on-demand healthcare access.

Currently, India’s healthcare system favors curative care, with 38% of spending going towards in-patient services and treatments, compared to just 14% for preventative care. Healthcare costs are also rising, with claim sizes up 11.4% and medical inflation at 14% in 2023. Out-of-pocket payments make up roughly 45% of total healthcare expenditures.

(wih ToI inputs)