In 2020, Germany became the first country in the world to introduce a structured reimbursement channel for digital health applications (DiGAs) in statutory health insurance, thereby creating a new business model for health apps. A recent study by ZEW Mannheim is the first to examine the impact of this model on the overall market for health apps, not just on approved DiGAs. The results show a significant increase in the number of German-language health apps, but no growth in high-quality applications that could be approved as DiGAs. Instead, apps that use patient data for advertising purposes dominate, which experts attribute to the entry barriers for DiGA approval being too high.

According to the paper, the introduction of DiGA reimbursement has noticeably stimulated the market for health apps in Germany. “Since it became known that apps on prescription will be reimbursed in Germany, the data shows a significant increase in applications available for the German-speaking market compared to other markets,” explains Sabrina Schubert, researcher in the Research Group “Health Markets and Health Policy” at ZEW and co-author of the study. However, the initial enthusiasm has not had the hoped-for effects. Neither has the variety of apps increased, nor has the number of data-saving applications increased. “The increase has been driven almost exclusively by apps that use patient data for advertising purposes,” emphasizes Schubert. Such business models are in contrast to the requirements for DiGAs, which must meet strict data protection and quality standards.

A key problem is the lack of quality improvement. “It is striking that the number of apps for which there are scientific publications has barely increased,” says Prof. Dr. Simon Reif, head of the “Health Markets and Health Policy” research group at ZEW and co-author of the study. “But that would be precisely the quality signal that ensures that health apps actually offer added value.” The high requirements for DiGA approval, such as proof of medical benefit through scientific studies, appear to be a deterrent for many developers. “For many app developers, the hurdles for reimbursement by health insurance companies still seem too high, which is why they focus on other business models, such as the use of data for advertising purposes,” explains Reif. As a result, insured persons have fewer high-quality and data-saving digital health services at their disposal.

The ZEW study is based on data on all health apps in the Apple App Store and examines whether the possibility of prescribing apps on prescription has promoted the development of apps for the German-speaking market. DiGA remuneration is financially attractive for developers: in the first year after approval, they receive an average of 135 euros per prescription per month. However, the strict approval requirements are slowing down the market for high-quality apps. Reif proposes a reform: “The system could benefit from lower entry barriers – with lower remuneration.” This could motivate more developers to develop apps that meet the requirements for DiGAs and at the same time expand the range of data-saving, medically validated applications.

The results of the study shed a critical light on the current design of the DiGA reform. While the introduction of the reimbursement pathway has triggered a surge in innovation, the hoped-for leap in quality has not materialized. Without adjustments, the market for health apps threatens to be dominated by data-driven business models that do not meet the requirements for data protection and medical benefits. The ZEW experts are therefore calling for a reorientation in order to fully exploit the potential of digital health applications in Germany.

Further information:

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_{Editorial office: X-Press Journalistenbüro GbR}

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