Factors Influencing Procurement of Digital Health Care: A Case Study in Dutch District Nursing

Abstract

Background: Digital health is considered a promising solution in keeping health care accessible and affordable. However, implementation is often complex and sustainable funding schemes are lacking. Despite supporting policy, scaling up innovative forms of health care progresses much slower than intended in Dutch national framework agreements. The aim of this study is to identify factors that influence the procurement of digital health particular in district nursing. Methods: A case study approach was used, in which multiple stakeholder perspectives are compared using thematic framework analysis. The case studied was the procurement of digital health in Dutch district nursing. Literature on implementation of digital health, public procurement and payment models was used to build the analytic framework. We analysed fourteen interviews (secondary data), two focus groups organised by the national task force procurement and eight governmental and third-party reports. Results: Five themes emerged from the analysis: 1) rationale 2) provider-payer relationship, 3) resources, 4) evidence, and 5) the payment model. Per theme a number of factors were identified, mostly related to the design and functioning of the Dutch health system and to the implementation process at providers' side. Conclusions: This study identified factors influencing the procurement of digital health in Dutch district nursing. The findings, however, are not unique for digital health, district nursing or the Dutch health system. The results presented will support policy makers, and decision makers to improve procurement of digital health. Investing in better relationships between payer and care provider organisations and professionals is an important next step towards scaling digital health.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

“…Another vital element is the development of funding options for digital therapeutics during and after the research phase (eg, innovation and research grants, pay-for-performance constructs, or payment/completed digital therapeutic use cycle). For the latter, it is important that the financial responsibility is not placed on patients to protect them from disproportionate out-of-pocket payments and ensure that digital therapeutics do not become an exclusive domain of higher socioeconomic groups [ 12 , 15 , 46 , 58 , 61 , 72 , 86 , 99 , 100 , 105 , 106 , 114 , 116 , 146 , 149 , 154 , 164 , 172 , 190 , 192 , 197 , 200 , 202 , 226 - 228 , 249 ]. It was emphasized that there were benefits to allowing the procurement of digital therapeutics as locally as possible, as health purchasers (eg, Integrated Care Boards in the United Kingdom, insurance companies in the Netherlands, and employer groups in the United States) are best placed to assess the needs and preferences of their covered population, although this could translate into longer adoption times and higher uptake costs, as each individual insurer needs to invest in the digital infrastructure.…”

“…Female and younger health professionals were reported to favor the prescription of digital therapeutics in Germany and the Netherlands [ 147 , 196 ], as did health professionals located in rural environments in Australia, the United States, and Taiwan [ 62 , 151 , 155 , 236 ]. The digital connectivity and literacy of health professionals were widely recognized as key components in determining their willingness toward and likelihood of prescribing digital therapeutics across countries [ 1 , 5 , 17 , 42 - 46 , 62 , 70 , 76 , 80 , 81 , 90 , 100 , 101 , 104 , 106 , 116 , 117 , 135 , 145 , 146 , 162 , 174 , 183 , 184 , 187 , 189 , 191 , 192 , 194 , 196 , 197 , 199 - 201 , 203 , 210 , 224 , 225 , 228 , 231 ], as were their personal attitudes toward, familiarity with, and trust in digital therapeutics [ 1 , 42 , 43 , 62 , 70 , 104 , 105 , 116 , 139 , 145 - 147 , 183 , 184 , ...…”

“…The design of digital therapeutics needs to be driven by the needs and expectations of patients [ 56 , 61 , 66 , 68 , 84 , 100 , 102 , 117 , 118 , 122 , 132 , 136 , 140 , 141 , 168 , 177 , 189 , 191 - 194 , 200 , 202 , 208 , 214 - 216 , 221 , 230 , 233 , 250 , 266 , 273 , 274 ] while acknowledging that patient needs may shift with time and disease progression [ 140 ]. They need to have clear aims and a position in the health care pathway that is understood by patients and professionals, with comprehensive and trusted information provided about the qualities and services of the devices and targeted health condition [ 56 , 57 , 93 , 118 , 142 , 174 , 177 , 178 , 186 , 190 , 214 , 221 , 228 , 250 , 252 , 259 , 265 , 266 , 273 ]. They should also be easy and straightforward to understand and use [ 1 , 4 , 13 , 19 , 40 , 42 , 117 , 135 ,…”

“…Finally, a key property of digital therapeutics was the existence of a strong evidence base that matches the corresponding evidence tier of the national regulatory framework. This should contain data on the positive health effects of using the digital therapeutic compared with the status quo or preexisting treatment options (eg, pragmatic randomized controlled trials using a real-world data arm), the context in which the digital therapeutic is to be implemented, how it affects the clinical workflow in the target setting, economic evaluations (cost-effectiveness, cost utility, and cost benefit), economic risk to the payer, budget impact, qualitative evidence on patients’ and health professionals’ experiences with using the tool, health system needs assessment, the safety of the patient and their data (eg, reports of regular penetration testing), and transferability and generalizability across population groups [ 1 , 4 , 13 , 15 , 44 , 46 , 49 , 54 , 61 , 65 , 85 , 86 , 91 , 98 , 105 , 106 , 108 - 112 , 117 , 118 , 133 , 144 , 188 , 196 , 197 , 200 , 210 , 228 , 229 , 232 , 266 ]. In this context, positive health effects include not only medical benefits, such as improved health status, shortening of the duration of disease, prolongation of survival, and improvement of the quality of life, but also broader elements, such as treatment adherence, patient safety and sovereignty, coping capabilities, and the reduction of therapy-related efforts [ 108 , 109 , 229 ].…”

“…The mapped literature highlighted the multidimensionality and versatility of digital therapeutics by showcasing their relative advantages compared with their competitors. At the patient level, the most reported relative advantages were improvements in health outcomes and shortened disease duration through novel health care options, faster diagnoses, decrease in adverse medical events, and improved monitoring of clinical and patient-reported outcome measures [ 11 , 17 , 41 , 43 , 45 , 47 - 49 , 53 , 60 , 61 , 69 , 71 , 74 , 80 , 81 , 88 , 92 , 94 , 95 , 100 , 102 , 105 , 124 , 128 , 130 , 132 , 133 , 135 , 137 , 138 , 146 , 153 , 163 , 172 , 173 , 179 , 189 , 202 , 207 , 218 , 224 , 226 , 228 , 229 , 231 , 232 , 234 , 239 - 242 , 244 , 246 , 248 , 257 , 260 , 262 , 263 , 265 , 266 , 270 , 275 ], a...…”