Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: May 12, 2019
Open Peer Review Period: May 13, 2019 - Jul 8, 2019
Date Accepted: Aug 12, 2019
(closed for review but you can still tweet)
Transformation of the German Health Care System – Perception of the Progressing Digitization among Experts and the Public: A Mixed Method Study
ABSTRACT
Background:
Health care systems worldwide are struggling to keep rising costs at bay with only modest outcome improvement among many diseases. Digitization with technologies like Artificial Intelligence or Machine Learning algorithms might address this. Although digital technologies have been successfully applied in clinical studies the effect on the overall health care system so far was limited. The regulatory ecosystem or data privacy might be responsible, but other reasons may also predominate.
Objective:
We analyzed how the digitization of the German health care market is currently perceived among different stakeholders and investigated reasons for its slow adaption.
Methods:
A Mixed Method study split into a qualitative Part A using the conceptual approach of the Grounded Theory and a quantitative Part B using the Delphi method was conducted. For Part A we interviewed experts in the health care system and converted the results into 17 hypotheses. The Delphi method consisted of an online survey, which was sent to the participants via e-mail and was available for three months. For the assessment of the 17 hypotheses, the participants were given a six-point Likert scale. The participants were grouped into patients, physicians, and providers of services within the German health care market.
Results:
There was a strong alignment of the hypotheses between experts (N=21) and survey participants together (N=733) with overall 70.5% agreement on 12 out of the 17 hypotheses. Physicians demonstrated the lowest level of agreement with the expert panel in 88% (15/17). Especially the hypotheses “H8: Digitization in the health care system will free up jobs” and “H6: Digitization in the health care system will empower the patients” were perceived to be in profound disagreement between physicians and the experts (P < .05 and P < .001, respectively).
Conclusions:
Despite the firm agreement among participants and experts regarding the impact of the digitization on the health care system, especially physicians demonstrated a more negative attitude. We assume that this might be a factor contributing to the slow adoption of digitization in practice. Physicians might struggle with changing power structures and therefore future measures to transform the market should involve them to a larger degree.
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