Government capacities and stakeholders: what facilitates ehealth legislation?

Achim Lang

doi:10.1186/1744-8603-10-4

Abstract

BackgroundNewly established high-technology areas such as eHealth require regulations regarding the interoperability of health information infrastructures and data protection. It is argued that government capacities as well as the extent to which public and private organizations participate in policy-making determine the level of eHealth legislation. Both explanatory factors are influenced by international organizations that provide knowledge transfer and encourage private actor participation.MethodsData analysis is based on the Global Observatory for eHealth - ATLAS eHealth country profiles which summarizes eHealth policies in 114 countries. Data analysis was carried out using two-component hurdle models with a truncated Poisson model for positive counts and a hurdle component model with a binomial distribution for zero or greater counts.ResultsThe analysis reveals that the participation of private organizations such as donors has negative effects on the level of eHealth legislation. The impact of public-private partnerships (PPPs) depends on the degree of government capacities already available and on democratic regimes. Democracies are more responsive to these new regulatory demands than autocracies. Democracies find it easier to transfer knowledge out of PPPs than autocracies. Government capacities increase the knowledge transfer effect of PPPs, thus leading to more eHealth legislation.ConclusionsAll international regimes – the WHO, the EU, and the OECD – promote PPPs in order to ensure the construction of a national eHealth infrastructure. This paper shows that the development of government capacities in the eHealth domain has to be given a higher priority than the establishment of PPPs, since the existence of some (initial) capacities is the sine qua non of further capacity building.

Highlights

This paper analyzes the factors that enable or impede the legislation of national eHealth infrastructure
The number of eHealth legislations is unevenly distributed between Organization for Economic Cooperation and Development (OECD)/European Union (EU) and developing countries
Does the participation of private organizations in developing national health infrastructures enhance the capacity of national governments to regulate these infrastructures? Does the participation of private organizations make a difference for autocratic or democratic regimes? What effect does the participation of private organizations have on governments with low or high governing capacities?

Summary

Introduction

This paper analyzes the factors that enable or impede the legislation of national eHealth infrastructure. The participation of stakeholders in policy-making is seen as an enabling instrument to successful policy implementation It is important when governments do not have the capacity to act or regulate the matter due to absent knowledge or resources. Increasing numbers of participating stakeholders in domestic policy-making and policy implementation may lead to mounting complexity concerning the policy process [1,2,3,4,5]. It is argued that government capacities as well as the extent to which public and private organizations participate in policy-making determine the level of eHealth legislation. Both explanatory factors are influenced by international organizations that provide knowledge transfer and encourage private actor participation

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