The Government’s move to grant permission to a private development agency with foreign affiliation to access the confidential medical treatment data of patients covered under Ayushman Bharat-Karunya Arogya Suraksha Padhati (AB-KASP), is promising to rake up serious concerns of insurance data sanctity violation and breach of agreement between the Government and the health insurance provider.
According to sources at KASP office, a consultant, hired by a private development agency offering technical support to the National Health Agency (NHA) for AB scheme, has been granted official permission to directly access the medical claims data of all Government Medical College hospitals and major Government hospitals in Kerala to study claims management pattern in public sector hospitals.
The medical treatment details of 41.5 lakh families in the State and the data on insurance claims pattern is very valuable population-based health information and a potential goldmine for the pharmaceutical industry and private health insurance companies.
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Sensitive information
Allowing a third party to access this highly sensitive personal medical data including insurance claims, violates all principles of data sanctity and integrity associated with a health insurance contract, even if the consultancy firm is a technical collaborator of NHA, it is pointed out.
AB-KASP is being implemented in Kerala on the basis of an agreement signed by the Comprehensive Health Insurance Agency of Kerala (CHIAK), as the designated State Health Agency (SHA) and the Reliance General Insurance Ltd.
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The confidentiality of information and data protection clause in the tender document states that all data generated by the insurer in relation to the implementation and management of the scheme shall be the property of the SHA and the Union Health Ministry.
It further states that the insurer should treat all health, treatment and payment related information as confidential.
All the beneficiary and transaction data generated through the scheme shall be kept securely by the insurer and will not be shared with any other agency than the ones defined in the agreement.
Sticky wicket
“The NHA uses the services of several private consultancies for technical and development support for AB scheme. These agencies cannot claim to be NHA representatives and seek sensitive data. Moreover, CHIAK is using NHA’s software and server to upload all KASP data. So why would NHA ask its representative to collect the data it already has on its server? The Government is certainly on a sticky wicket here,” a senior official told The Hindu .
The ₹691 crore AB-KASP scheme, covering 41.5 lakh families in Kerala is almost entirely owned by the State, with the Centre share being only ₹137 crore.
Data integrity and security was sacrosanct in an insurance scheme of such mammoth proportions.
As the signatory to the confidentiality agreement with the insurance agency, the State Government was responsible for protecting patient rights and ensuring that the data generated was not misused by anyone, he said.
Though the Government has appointed a Special Officer (KASP), CHIAK is the SHA in charge of the implementation of KASP.
Interestingly, KASP authorities seem to have given permission to the consultant of the private entity to seek claims data directly from the district programme managers of CHIAK, totally bypassing the authority of the head of SHA.
“As a representative of the German agency, which is a development partner of NHA, I am also part of the NHA. It is on authority from the Special Officer (KASP) that I have been tasked to facilitate claims management and medical audits,” the representative of the private agency, who did not wish to be quoted, told The Hindu .
Agreement
As the custodian of the insurance claims data, even if the Government decided that the data can be shared, it can do so only after issuing a GO and ensuring that a non-disclosure agreement has been enacted by the third party, it is pointed out.