Table 5.
Overview of the identified financial barriers and facilitators.
| Topic | ||
|---|---|---|
| Barriers | Facilitators | |
| Business modeling (n = 15 studies) | Insufficient integration of eHealth development into global business models (42) | Invest in early and effective collaboration with stakeholders (including third parties) (40, 53–55, 65, 67, 70) |
| Absence of a viable business model for preventive interventions (58) | Create a financially sustainable business model (54, 58, 67) | |
| High financial investments are required for business models for eHealth (53) | Invest more in developing public-private partnerships (53, 60) | |
| Complexity arising from diverse reimbursement and funding systems across countries impeding commercialization of eHealth technologies (47) | Provide appropriate incentives to stakeholders, including users (40) | |
| Double payment issue: Public hospitals supplying data to private manufacturers for free, resulting in additional costs for innovation access (39) | Ensure third parties integrating health data understand the data limitations (45) | |
| Inadequate resources for establishing and sustaining IT infrastructure to support AI processes (70) | Consider commercialization through licensing agreements post-CE certification and clinical effectiveness evidence via RCT studies (53) | |
| Uncertainty in the management and maintenance of eHealth technology (67) | Develop eHealth infrastructures and human capacities for long-term reusability and improvement in centers of excellence, rather than project-specific use (70) | |
| Lack of clarity regarding the value proposition of eHealth for patients (58) | Ensure the technology is both technically and socially sustainable (49) | |
| Consider agile business models like pay-for-use or app prescriptions as alternatives to traditional licensing-based revenue (53) | ||
| Foster innovation (60) | ||
| Reimbursement of eHealth (in practice) (n = 10 studies) | Challenges in assessing the cost-effectiveness, clinical benefits, and intangible impacts of health technology (41, 54, 66, 70) | Promote value-based approaches and economic modeling for health technology reimbursement to ensure long-term viability (41, 42, 53) |
| Uncertainty about long-term, sustainable guarantee of reimbursement (58, 67) | Secure funding and support for early-stage technology implementation and testing to build evidence for reimbursement (42, 53) | |
| Lack of structured financial reimbursement mechanisms for the health technology (64) | Enhance transparency in information sharing and communication among stakeholders to support reimbursement (53, 66) | |
| Challenges in implementing reimbursement models spanning multiple healthcare sectors (54) | Facilitate information sharing on health technology costs between the healthcare systems and technology providers (53) | |
| Funding misalignment between healthcare department budgets hindering cooperation between health insurers and healthcare providers (54) | Streamline the CE marking and certification process for health technologies to expedite reimbursement (53) | |
| Challenges in navigating insurance complexities, cost-benefit balancing, and risk selection (66) | Create assessment frameworks that offer temporary reimbursement for CE marked technologies (53) | |
| Excessive costs related to improving and maintaining data validity, security, and storing (70) | Develop economic models and quality certification systems to support reimbursement (42) | |
| Explore the possibility of new hospital payment regulations, such as the “Optional reimbursement scheme” (54) | ||
| Collaboratively allocate financial risk between healthcare providers and insurers (54) | ||
| Demonstrate cost-effectiveness to attract health insurers’ interest (67) | ||
| Increase the patient population to make eHealth projects financially viable (54) | ||
| Specify that reimbursement for health technologies requires a prescription from a health professional (53) | ||
| Implement shared savings and bundled payment models to incentivize cost-efficient and high-quality care (54) | ||
| Utilize scalable cloud storage and server capacities to manage analysis needs efficiently and reduce computing costs (70) | ||
| Lack of funding for eHealth development and implementation (n = 5 studies) | Insufficient funding available for the integration of novel technologies into healthcare (41, 58) | Facilitators Not Identified |
| High development costs for novel technologies (42, 69) | ||
| Many development ideas are often not financially viable (42) | ||
| Limited willingness to invest for digital health solutions (66) | ||
| Uncertainty regarding responsibility for covering service costs (66) | ||