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The digitization of the German healthcare system has progressed steadily, with Germany being the first country worldwide to grant statutory reimbursement for digital health applications (DiGA). Since the adoption of the Digital Care Act (DVG) in 2019, patients have been legally entitled to access listed applications via either physician prescription or direct application to insurers. By 2024, 59 DiGA had been listed, and nearly one million activation codes were issued, most frequently in the areas of mental health, musculoskeletal conditions, and metabolic disorders. Policy reforms, including the Digital Act (DigiG, 2024), have expanded the framework toward value-based healthcare through outcome-oriented reimbursement and integration into the electronic prescription (eRezept) and electronic patient record (ePA). While this institutionalization has enabled innovation and international recognition, structural challenges persist. Utilization remains uneven across demographic groups, dropout rates are high, and health literacy disparities contribute to a “second-level digital divide”. Physicians remain crucial for adoption, not only as prescribers but also as mediators of patient trust and evidence-based use. International comparisons highlight complementary approaches, such as usability in France (PECAN procedure for digital medical devices, co-creation in Belgium (mHealth Belgium validation pyramid for mobile health apps), transparency in the UK (NICE Evidence Standards Framework for digital health technologies), and selective pilots in the United States (FDA regulation; Medicare RPM reimbursement). Germany’s model illustrates both the potential and the limitations of scaling digital therapeutics, with sustainability hinging on equity, provider engagement, and patient-centered outcome measurement.

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Patient-Centric Approaches to Digital Health: Payer Evaluation on the Utilization and Development of Digital Health

  • 章节

  • 出版模式：

    开放获取

  • 发表日期：

    2026年

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  • Ute Irene Wiedemann

摘要

The digitization of the German healthcare system has progressed steadily, with Germany being the first country worldwide to grant statutory reimbursement for digital health applications (DiGA). Since the adoption of the Digital Care Act (DVG) in 2019, patients have been legally entitled to access listed applications via either physician prescription or direct application to insurers. By 2024, 59 DiGA had been listed, and nearly one million activation codes were issued, most frequently in the areas of mental health, musculoskeletal conditions, and metabolic disorders. Policy reforms, including the Digital Act (DigiG, 2024), have expanded the framework toward value-based healthcare through outcome-oriented reimbursement and integration into the electronic prescription (eRezept) and electronic patient record (ePA). While this institutionalization has enabled innovation and international recognition, structural challenges persist. Utilization remains uneven across demographic groups, dropout rates are high, and health literacy disparities contribute to a “second-level digital divide”. Physicians remain crucial for adoption, not only as prescribers but also as mediators of patient trust and evidence-based use. International comparisons highlight complementary approaches, such as usability in France (PECAN procedure for digital medical devices, co-creation in Belgium (mHealth Belgium validation pyramid for mobile health apps), transparency in the UK (NICE Evidence Standards Framework for digital health technologies), and selective pilots in the United States (FDA regulation; Medicare RPM reimbursement). Germany’s model illustrates both the potential and the limitations of scaling digital therapeutics, with sustainability hinging on equity, provider engagement, and patient-centered outcome measurement.