Lack of incentives and regulation prevent the scaling of platforms in healthcare

Challenge: Lack of incentives and regulation prevent the scaling of platforms in healthcare

• Fragmented and slow regulatory work slows down platform growth. Fragmented regulation makes it difficult to get a big picture of healthcare requirements and recommendations. National regulation is fragmented between many organisations (the Ministry of Social Affairs and Health, the Finnish Institute for Health and Welfare, the Social Insurance Institution of Finland, the Finnish Medicines Agency Fimea, the National Supervisory Authority for Welfare and Health Valvira, the Regional State Administrative Agencies, Findata and the Digital and Population Data Services Agency), which results in highly diverse regulation (regulations, recommendations, mandatory requirements, MDR, use of social welfare and health care data across the boundaries of individual registers, secondary use of data, and permits). For example, finding answers to questions that are not clearly within the competence of a specific agency is time-consuming. Legislators and decision-makers possess no big picture of the challenges associated with implementing and scaling data-based and platform-based solutions in the health sector. Slow legislative work prevents faster development in companies.
• It is difficult for small actors to gain a foothold in the market. Small health sector actors that offer platform-type and data-based solutions have few opportunities for dealing with large public or private health service providers. In public procurements, large actors are often in a dominant position and can dictate to smaller suppliers how integration into their platform must be done. The emergence of new platforms alongside the existing ones is also difficult because the public sector and large private actors dominate the market. This restricts the entry of new actors into the market and the creation of innovative platform-type solutions. Financing investments in platforms is often also considered too risky.
• There are no incentives for cooperation between service providers. The contrast between public and private healthcare arising from legislation slows down cooperation and erodes trust. The challenges lie in agreeing on common standards, integration of data systems and public procurement practices. These challenges result in costs for society that could be avoided through platform-based operation. While exclusive rights to a solution are often the objective in procurements, this does not promote the scaling of the solution. In addition, the current procurement legislation and public-private partnership agreements prevent the creation of scalable platform-based solutions. Cooperation and dialogue between different parties have proven difficult. This has prevented the emergence of national or international peer communities in which the actors could help each other and engage in co-development. Unlike private actors, public service providers are unable to participate in co-development within the framework of innovation and development funding. The focus areas and funding for the development also vary by government term, and the funding is often limited to specific use.

Recommendation: Prerequisites for platform-based healthcare should be created

• Prioritising the citizen’s point of view. The criterion for deploying new healthcare solutions should be whether they concretely contribute to better public health through services that are less expensive, more effective and of higher quality. Platform-based and data-based solutions are effective in customer-oriented development. Their advantages include data accumulating over time that can be used effectively to create complementary and alternative health services.
• Harmonising and clarifying healthcare requirements. The fragmented regulation can be clarified by stepping up cooperation between the actors (the Ministry of Social Affairs and Health, the Finnish Institute for Health and Welfare, the Social Insurance Institution of Finland, the Finnish Medicines Agency Fimea, the National Supervisory Authority for Welfare and Health Valvira, the Regional State Administrative Agencies, Findata and the Digital and Population Data Services Agency). This can also include reassigning responsibilities between the authorities. Clear and up-to-date guidelines should be provided for applying provisions. Regulation and legal acts should be harmonised between countries. For example, the EU Data Governance Act, EU’s Strategy for Data, data space and GAIA-X project will contribute to streamlining the safe use of data across state boundaries and to creating a common market area through harmonised practises, legislation, structures and standards. In public procurements, common interface standards should be used to promote public-private partnership activities, allowing for the existence of parallel platforms without exclusive rights to the solution. At the system level, the change means dismantling silos across administrative boundaries, also in steering and funding activities.
• Creating orchestrators for healthcare platform ecosystems. Operational prerequisites should be created for credible healthcare platform and data ecosystem orchestrators who would be responsible for promoting the use of platform-type solutions in the welfare and healthcare sector. Peer communities may support the development and act as channels for international benchmarking. Customer benefits should be at the centre of developing platform ecosystems. A precondition for platform-type service provision is that the customers can make choices on the platform. Incentives for development and innovation should aim for benefiting the patient, ensuring that they support the development of platforms across administrative branches and boundaries. Similarly, innovation funding should be developed through cooperation, for instance on developing, piloting and scaling new platform economy solutions by the Ministry of Social Affairs and Health, the Ministry of Employment and the Economy, Business Finland and Sitra. Their interaction should aim for specifying common standards and drafting legislation more rapidly. A centre of expertise with representatives from different fields could play a key role in this.