The economic impacts of digitalising services in the health sector  

Over the past decade, the introduction of eHealth solutions has not resulted in a decrease in healthcare expenditure for the governments, providers or patients. By 2015, all EU Member States had implemented some form of eHealth system.

Financial relief for consumers, however, can only be observed in some countries such as Belgium, Germany, France, Finland, or Sweden, whereas in other Member States patients have been increasingly charged for access to healthcare systems.

In a similar vein healthcare provider expenditure has largely increased in the concerned timeframe. Only providers residing and operating in Greece, Cyprus, and Portugal could notice a reduced financial impact, which, however, can be traced back to the generally worsened economic landscape in these countries.

Even though the initial look at economic impacts do not suggest that digitisation has led to cost-savings, a more nuanced look reveals additional insights. First, it should be noted that investments into digitalisation increase healthcare costs in the short term as they are additional costs.

Furthermore, the demand for healthcare services is increasing along with growing and ageing populations, as well as improved medical treatments and better medical equipment, diagnostics and pharmaceuticals – all of these factors lead to an increase in healthcare costs.

The benefits of digitalisation

The benefits of digitalisation are both direct and indirect. The direct ones relate to productivity (more efficient care processes, care can be provided at lower costs). Indirect benefits originate from improved care processes facilitated by digitalisation. They result in better health, which reduces healthcare costs in the longer term.

This is why it is not always possible to see economic benefits from digitalization in the short term by looking at the healthcare budgets or healthcare spending. This is especially true for countries that are only introducing, piloting eHealth solutions. Such actions act as additional costs on top of maintaining old healthcare systems.

This, however, presents the need for a more systematic evaluation of the economic impacts of digital care. Especially evaluations need to be performed 3-5 years after the adoption of particular solutions to demonstrate the long-term impacts.

Experiences from both similar and divergent

The ESPON project eHealth examined eHealth solutions in Finland, Bulgaria, Estonia and Slovenia and identified best practices but also challenges and opportunities related to the digitalization in the health sector

eHealth project found that there is no harmonized approach among the countries in approaching digitalised healthcare. For instance, digitalised approaches to healthcare are largely incorporated and already implemented in the Estonian healthcare system with the primary funding stemming from mandatory health insurance.

A similar situation applies in Finland, where funding is provided through mandatory health insurance. However, Finland demonstrates a more decentralised approach with regions and municipalities playing a larger role.

Slovenia’s funding for digitalised approaches to healthcare is largely integrated into the mainstream healthcare system. 

Bulgaria, on the other hand, pursues an approach where funding is mostly institutional, regulated and based largely on EU grants, and assigned to solutions development rather than fundamental and integral structural changes.

Finland and Estonia are leading in all data-related matters (with high trust, adoption and usage indicators), with Slovenia more or less closely following suit. Bulgaria, on the other hand, distinctively lacks necessary infrastructure and instead relies on several initiatives that have been launched in parallel to eHealth, but not directly targeted this domain.

According to the project several eHealth solutions, are present in most stakeholder countries with ePrescriptions, eConsultations, eRegistrations, as well as national patient portals.

These tools work in a more or less integrated manner with the respective national patient portal and enable generally seamless information flow between the organisations connected in the eHealth network.

Again differences were identified between countries. Finland, has several separate entities managing different solutions which are then aggregated within its national patient system.

On the other hand, Estonia appears to have all eHealth functions fully integrated under a single institutional banner. For both Estonia and Finland the development of eHealth solutions was the culmination of a long process of digitisation.

In Slovenia, where most of its eHealth services introduced fairly recently, the government adopted a centralised approach and compulsory use of newly developed solutions by health institutions.

Finally, Bulgaria still lags behind as the country has not introduced any comprehensive approach for digitalised health services and eHealth in general.

Cross border healthcare

Estonia and Finland are the most concerned for the implementation of cross-border healthcare. Beyond the fact that they are pursuing bilateral collaborations in establishing common eHealth networks, both countries have further ambitions. Estonia engages in EU-wide programmes such as epSOS or eHDSI, and Finland participates in EPSOS projects and pursues intensified operations with its Nordic neighbors.