Problems and Barriers Regarding the Admission, Financing, and Service Provision of Digital Health Apps: Qualitative Stakeholder Survey.

Background: Since their introduction with the Digital Care Act in 2019, selected digital health apps (DiGA) have been a part of the German statutory health care system. In order to become a DiGA, digital health apps have to complete a certification process covering both technical and evidence-related aspects. After completion, DiGA are added to the DiGA directory, containing a list of all reimbursable DiGA within German statutory health insurance. The first apps were added at the end of 2020, with the number steadily increasing. The novelty of this digital health care service and the fast implementation led to problems and barriers to optimal use along the way, which are studied from different stakeholder perspectives in this paper. Objective: The aim of this survey was to identify problems and barriers in the context of the admission, financing, and service provision of DiGA in the statutory health care system in Germany. Methods: We used semistructured expert interviews to evaluate the perspective of stakeholders of the German health care system on DiGA. The interview guide was developed according to Helfferich. The interviews were transcribed and analyzed using the qualitative content approach by Mayring, with the adjustments by Kuckartz. We conducted web-based interviews with stakeholders between February and June 2022. The stakeholder collective consisted of DiGA, statutory health insurance, physician, patient, technological, and quality assurance representatives. Results: To identify problems from stakeholder perspectives regarding the admission, financing, and service distribution of DiGA, 21 interviews were conducted. The interviewed stakeholders reported problems with the authorization of DiGA and the corresponding process, for example, the duration of the DiGA Fast Track process. DiGA prices and the different negotiation positions were criticized, and financial challenges for smaller DiGA manufacturers were noted. Another problem was seen in the reimbursement of DiGA, independent of actual use by the patients. Within service provision, the participants reported superordinate aspects, for example, the negative public perception of DiGA and negative statements from stakeholders. In relation to the direct care process, technical problems (eg, with activation codes or software surrounding DiGA prescription) and insufficient knowledge and skills on the side of the patients, as well as the medical providers, were mentioned. Conclusions: Digital health apps have the potential to improve health care by addressing health problems in new, innovative ways. Since the evidence-based and regulated use of this technology is relatively new, problems and barriers limiting the optimized, patient-centered use arose throughout the first years. This study provides an overview of problems and barriers in the context of DiGA in Germany from different stakeholder perspectives. Nevertheless, with these problems being continuously addressed, digital health apps are trending toward becoming a contributing factor to health care in Germany. Since other countries showed interest in implementing a federally regulated approach similar to Germany, valuable implications can be drawn from this survey.