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Invest in benefits: Financing models for health ecosystems

Dr. Sebastian Krolop
Dr. Marko Queitsch

Realizing the vision of a national health platform as outlined in the Trusted Health Ecosystems project could generate financial benefits at many different points and help improve the overall economics of the healthcare system. However, this will require a sustainable and independent financing model that can provide the necessary flexibility for the initial development process, ongoing operations, and future updates and expansions. The solution most likely lies in a combination of different financing approaches.

Digital ecosystems can provide benefits in the healthcare sector in a variety of ways. For example, networking all relevant actors and using digital data creates transparency and facilitates personalized care offerings. Fully integrated healthcare offerings improve the user experience. Moreover, simplified procedures and digital support make the work of healthcare staff easier.

A recent McKinsey analysis shows just how great the financial benefits of a digitized healthcare system are likely to be, estimating the economic potential in Germany at around €42 billion per year (McKinsey & Company 2022). Digital ecosystems are not the only means by which to tap this enormous potential, but they could make an important contribution. For example, they could accelerate the digitalization process, while also linking disparate offerings and digital services together in a time- and cost-efficient way.

The OECD has also stated that facilitating access to high-quality health information, as an ecosystem modeled on the product vision outlined here would do, can have cost-saving effects. It estimates that between 3% and 5% of healthcare spending could be saved or used elsewhere through improved health literacy. For Germany alone, this would correspond to a sum of €9 billion to €15 billion per year.

However, depending on the project size, the investment needed to support the initial development, deployment and operation of such health ecosystems can in some cases be quite substantial. Ongoing operations also generate costs. This raises the question of what financing models are suitable for creating such an ecosystem and supporting ongoing platform operations, including future updates and expansions.

Requirements for national health platform financing models

A variety of financing models are conceivable for health ecosystems, each in turn entailing a number of advantages and disadvantages. In considering these options, it is important to keep in mind the core principles intended to guide the national health platform’s operations (see Objectives and conceptual premises):

  • Nonprofit model. The platform’s operation should not produce profits; any revenue generated will instead fund the platform’s further development. This has an effect on the potential legal form taken by the ecosystem (see Ownership: Public or private?). Of course, this stipulation applies only to the platform operator. Health information or service providers participating in the ecosystem can certainly function on a for-profit basis.
  • The ecosystem should act neutrally and independently of the particular interests of individual actors. This applies not only to healthcare providers and insurers, but also to private-sector companies with commercial interests. In practice, this rules out a number of funding options, such as advertising-supported operations.
  • The process of building and scaling an ecosystem requires time, and necessarily takes place in an environment of fast-moving technological change. Financing models should accordingly be designed for the long term.
  • Since the digital ecosystem will involve participation by private-sector and public-sector actors, and the ecosystem operator will presumably be acting on the basis of a statutory mandate, financing sources should be transparent and comprehensible to all. This will also increase users’ trust in the platform.
  • Open system. The national health platform should be developed as an open ecosystem that allows for links between disparate health providers. A number of features must be created to enable such functions, which in turn will generate ongoing costs – for example, for the development, deployment and maintenance of APIs and other core components.

Different financing models conceivable

In selecting suitable financing models, it is advisable to take a differentiated view of the platform’s initial development, ongoing operations, and future updates and expansions. Over this time, these separate phases will be associated with different financial requirements, for which different forms of financing are in turn available:

Initial development costs. Initial costs are incurred in setting up the basic infrastructure, for example for the IT platform’s technical development, for drafting legal and regulatory concepts, and for integrating the first healthcare providers into the ecosystem. Therefore, one-time basic funding is well-suited for this start-up phase – for instance in the form of grants or other funding from foundations, the government or the ecosystem’s stakeholders. One example of government support for digitalization can be seen in Israel’s National Digital Health Plan. There, the government has allocated a budget of around $300 million for this initiative, in part to build a big data platform containing anonymized health information relating to nearly all Israeli citizens.

Ongoing operating costs. Once the ecosystem has been established, its ongoing costs must also be covered. This relates to functions such as basic operations as well as maintenance, software licenses, marketing and personnel. These expenses can also be financed through public subsidies derived from taxes or social contributions. However, alternative funding models could also be considered as a means of complementing the independent basic financing. For example, in addition to traditional subscription models, co-op approaches or innovative models such as corporate profit sharing could prove useful.

  • Subscription models: Subscription models have been offered in the media and online retailing sectors for some time. For a regular fee, subscribers get access to news, streamed TV series or music, or other benefits. Membership fees could make a significant contribution to ongoing service improvements, but at the same time could constitute a financial barrier for users, thus increasing social inequality in access to health information. The consequent downward pressure on user numbers would also undermine the platform’s appeal to providers of health-related information and services.
  • Co-op model: Traditional cooperative financing, which is familiar from the banking, housing and agricultural sectors, is increasingly making its way into the healthcare sector in a modern form. The example of the French Welcoop Cooperative shows how a traditional pharmacists’ cooperative has developed into a digital ecosystem for patients, care facilities, hospitals and the pharmaceutical industry. A model of this kind could also create a sustainable and independent funding source for the national health platform outlined here.
  • Innovative financing models: In models such as brand licensing or corporate profit sharing, a portion of company profits are used to support healthcare initiatives. Options range from investing in research and development to funding programs that increase access to healthcare. In the context of the national health platform, participating companies could reinvest a portion of their profits into the ecosystem. No matter what legal form the platform ultimately takes, the operator and the company would determine together how these funds would be used, in order to avoid undue influence.

Update and expansion costs. Upgrading and expanding an ecosystem includes tasks such as the provision of additional services and interfaces in order to keep the platform appealing to existing users and attract new ones. Financing can be structured in a way similar to that of the initial development and ongoing operation phases (foundations, co-op models), but can also be supplemented by alternative models. The following variants have already been tested in the field:

  • Nonprofit business activities: The platform could pursue supplemental business models that are not primarily connected to its core business. For example, the platform could use its access to data to provide services to healthcare providers, and then use this revenue to fund its own further development.
  • Development on demand: Private healthcare providers that have been able to scale up their services through the ecosystem could also participate in funding platform updates. For example, on the Swiss healthcare platform, called Well, several physician networks are working with the operator to develop an appointment booking and check-in system through the Well app. In order to avoid competing with private-sector providers, the ecosystem operator’s development services could be limited to the platform infrastructure (e.g., interfaces).
  • Transaction fees: Alternatively, private healthcare providers could contribute to the funding stream via the use of their services. For example, they could pay a percentage-based fee to the ecosystem operator – as is done on travel and hotel booking portals – as soon as a service is used.

Another financing approach familiar from the e-commerce sector is the use of premium models, in which users pay for services that go beyond the basic offerings. However, these are less appropriate in the health setting, because (as noted above) they can limit general access to health information, and thus reinforce social inequality.

Creative solutions for sustainable financing

The vision of a national health platform, as is being developed in the Trusted Health Ecosystems project, promises many benefits. It has the potential to promote health literacy, create personalized care options and ultimately reduce healthcare costs. This great economic potential is offset by considerable financial challenges, because financing an ecosystem of this nature will require substantial investment not only to pay for its initial development, but also to cover the costs of ongoing operations and future updates.

The overall scope of these costs will depend on a variety of different factors. A more precise estimation will be possible only after a detailed planning process (see Initial thoughts on the technical structure of the national health platform). However, the financing of a national health platform with a strong civil society component will in any case require creative solutions that are shaped by the financial needs arising from the individual development phases, and which will provide the platform with sufficient financial flexibility.

Ultimately, the choice of funding model will depend on the national health platform’s specific requirements and goals. These include a focus on the common good, independence from special interests, sustainability, transparency and system openness. An integrative approach that combines different funding sources is likely to achieve the best results, while also supporting the ecosystem’s long-term development and ensuring its sustainability.

Bibliography

Eichler K, et al. (2009). The costs of limited health literacy: a systematic review. International Journal of Public Health 54. 313–324.

McKinsey & Company (2022). Digitalisierung im Gesundheitswesen. Die 42-Milliarden-Euro-Chance für Deutschland. URL: https://www.mckinsey.de/news/presse/2022-05-24-42-mrd-euro-chance

Ministry of Health, State of Israel (2018). The Government has approved a National Program for Promoting the Digital Health Field. URL: https://www.health.gov.il/English/News_and_Events/Spokespersons_Messages/Pages/25032018_2.aspx

World Health Organization (‎2019)‎. Interview with Jens Spahn, Federal Minister of Health, Germany. Public health panorama 5 (‎2)‎. 163–165. WHO. Regional Office for Europe. URL: https://apps.who.int/iris/handle/10665/327036

Authors

Sebastian Krolop, MD, PhD, MSc, is an expert with 25 years of professional experience as an emergency physician, and is additionally an economist, strategist and innovator. His areas of expertise include the transformation and financing of digital technologies in international health systems. He served as a board member of the Healthcare Information and Management Systems Society (HIMSS) in Chicago, IL, United States, where he oversaw areas including strategy, operations, startups and the company’s own digital ecosystem platform, called Accelerate. Previously, he was partner and industry lead for life sciences and healthcare at Deloitte. Krolop is the author of the annual Krankenhaus Rating Report, and has contributed as author and co-author to more than 40 books with a focus on the financing and digitalization of health ecosystems.

Dr. Marko Queitsch studied industrial engineering, and earned his doctorate in business management. He has conducted research as an economist on digital communication issues in healthcare, and has developed digital health solutions in the private sector. As head of business development for Weisse Liste gGmbH, a wholly owned subsidiary of the Bertelsmann Stiftung, he designs nonprofit business and financing models. In addition, he supports the Bertelsmann Stiftung’s Trusted Health Ecosystems project in the key areas of operating and financing models, as well in data and software architecture issues.

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    What can we learn from international platform solutions?

    Transcript

    Intro

    How do we create ecosystems that improve the public’s health literacy and promote prevention?

    How do we establish trust in a digital platform?

    In my opinion, it’s important to state how you go about establishing and building trust. This involves two things: For one, there’s clarity. What purpose does the ecosystem serve for citizens? And on the other, it’s important to establish transparency.

    Estonia stands as a notable example, in my opinion. They’ve legislated the specific purposes for which healthcare professionals can access health data, specifying when it’s permissible and when it’s not. They’ve also embraced transparency by allowing citizens to log in to their profile through the Estonian Central Health Information System and Patient Portal to track who has accessed their data.

    What additional elements are necessary to make a healthcare platform appealing?

    Utility is the key element. In the context of health platforms and health ecosystems, the focus is often on creating services that provide added value to both patients and citizens, as well as healthcare providers, such as nurses, caregivers, doctors and more.

    These services are often linked with each other, with a single service benefiting both citizens and healthcare providers.  It’s therefore crucial to develop these services with a user-centric approach and involve users and stakeholders from the outset. Ideally, this approach leads to the creation of a service that benefits multiple stakeholders and operates effectively and efficiently for those providing the service.

    Denmark serves as a compelling example in this context. They actively engage user panels, conduct user interviews and surveys, and collaborate with citizens and healthcare providers to co-create services. This leads to the development of services that not only deliver value but also, due to effective and efficient management, enhance user engagement.

    What objectives should a national healthcare platform strive for?

    The ambition could revolve around establishing ecosystems that boost the health literacy of the population, simplify preventive measures, empower individuals to manage chronic illnesses effectively, and ideally, free up healthcare providers to spend more time with patients and less on administrative tasks. An important concept to consider is the creation of open ecosystems, where third-party providers can offer their services within the ecosystem, insofar as they meet specific quality, transparency and security criteria.

    Israel has successfully implemented such an open ecosystem, with two noteworthy facets. First, health data exchange allows one doctor to access previous treatment information, which facilitates more informed decisions and improved patient care. Second, the involvement of third-party providers within the ecosystem, including startups and healthcare companies, fosters innovation on a national scale. This can prove to be a real boost to the country’s innovation advantage by bundling the innovative power of healthcare companies in creating a platform that makes innovative healthcare solutions more readily accessible to citizens.

    Content

    Expert

    Dr. Tobias Silberzahn holds a doctorate in biochemistry and is a Partner at the Berlin office of McKinsey & Company, Inc. His work focuses on healthcare innovation and the digital transformation of healthcare. Tobias also leads the global Health Tech Network, which brings together more than 1,800 health tech CEOs and founders, along with 250 investors and 300 corporations. He is co-publisher of the annual “eHealth Monitor,” a publication distributed by MWV publishing house that focuses on the digitalization of the German healthcare system. Within McKinsey, Tobias also co-manages a comprehensive health and well-being program that encompasses aspects such as sleep, nutrition, fitness, and stress management.

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      National health platform: Editorial content creation

      Transcript

      Intro

      The national health platform’s purpose should be to enhance, not replace, existing information services.

      Who bears responsibility for the content on a national healthcare platform?

      When it comes to the question of who bears responsibility for the content provided on a national health platform, it comes down to the nature of the content in question. The platform operator is initially accountable for their own content. However, if the platform operator assumes responsibility for third-party content –  by evaluating it before making it public or by expressing a willingness to take on such responsibility – then the platform operator may be held accountable.

      If an entity other than the platform operator assumes responsibility for assessing content before it is published, this might require a different legal assessment. In such cases, it’s possible that the platform operator could be held liable or share the responsibility for external content. This means that the platform operator must establish a mechanism for users to report false or unlawful information.

      How should the creation of original content be assessed from a competition law perspective?

      Evaluating the creation of original content for a national health platform in terms of competition law is complex, especially when government actors are involved. In principle, government initiatives should only be introduced when a form of market failure is evident. This means either insufficient information is being communicated or information in the healthcare sector is not being adequately transparent.

      Past experience has shown that digital healthcare service providers are quite capable of meeting this demand. The national health platform’s purpose should be to enhance, not replace, existing information services. This should benefit not only users but also providers of digital information services in the health sector.

      What insights can we gain from this for the platform’s content strategy?

      When it comes to shaping the national health platform’s content strategy, it’s important to bear in mind that creating or asserting ownership of content and disseminating it can be, in terms of competition law, challenging to justify, especially when government bodies are involved in the project. In this context, it seems preferable to prioritize the distribution of third-party content, meaning content generated by civil society or private-sector organizations. The providers of such information should be given fair and transparent access to the platform.

      Disclaimer

      The statements made in this interview are relevant exclusively to the German legal context. They offer a framework for guidance and should not be interpreted as providing legal counsel beyond the scope of the Trusted Health Ecosystems project.

      Content

      Expert

      While completing her doctoral studies, Prof. Dr. Laura Schulte gained experience in the field of constitutional law as a research assistant. Her doctoral thesis focused on data protection law, and she conducted further research on this subject at various institutions, including the Queen Mary School of Law in London. From 2020 to 2023, she was employed as an attorney at BRANDI Rechtsanwälte in Bielefeld, specializing in IT and data protection law. Since August 2023, she has held the position of professor of business law at the Hochschule Bielefeld.

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        Successfully establishing health ecosystems – models from abroad

        Dr. Tobias Silberzahn

        A health ecosystem, such as the one envisaged by the “Trusted Health Ecosystems” project, must fulfill several requirements if it is to bring value to stakeholders within a health system. International models have demonstrated that a successful operational model combines the active participation and coordination among involved actors with common technical standards.

        Digital ecosystems have transformed traditional business models across various industries, generating added value for customers and market participants. For instance, e-commerce-platform providers and prospective buyers can now directly interact, which leads to more efficient transactions. Open ecosystems of this type could also play a role in digital healthcare. Key characteristics of such ecosystems are:

        A multi-stakeholder network. An open ecosystem brings together different actors with varying interests. In healthcare, these actors may encompass patients, health service providers, payers and providers of products and services.

        Co-creation. The development of information, products and services does not rest solely with the platform operator. Third parties or stakeholders “on the platform” also contribute to this process. This principle serves as the basis for “app stores” provided by mobile phone companies, where external developers offer downloadable applications.

        Self-reinforcing effects. Value drives adoption, and platform activity attracts new users. This mechanism is well-known from social networks, which can rapidly expand once a critical mass of users is reached. Similar self-reinforcing effects could occur within a digital healthcare ecosystem. As more citizens use a digital health service, its relevance for healthcare service providers increases, and vice versa.

        Key considerations in designing health ecosystems: Four success factors from an operating model perspective

        Active participation of stakeholders constitutes a pivotal aspect of a successful ecosystem. An additional element is proper organizational design to unlock the ecosystem’s full potential. Here, four factors assume a central role, as illustrated by examples from other countries:

         1. End-to-end patient “pathways”

        From a user perspective, the seamless integration of stakeholders and services is critical: Patient pathways need to be designed end-to-end and thus ensure the harmonious orchestration of multiple services in a user-friendly way, e.g., a journey encompassing appointment booking, (tele-)consultations, e-prescriptions and medication delivery. Foundational “enabler applications,” such as electronic patient records, facilitate seamless care by maintaining consistent data across systems without necessitating changes.

        Case example: The Health Village in Finland

        Developed by Finnish university clinics, the Health Village comprises virtual hubs for a variety of care categories, including emergency care, rehabilitation and mental health. These hubs are brought together as required based on a patient’s diagnosis. Empowered by physician referrals, participants can access digital health services such as video-based consultations and self-help programs via smartphones. This innovative approach has introduced more than 400 distinct care pathways to complement on-site healthcare.

         2. User centricity

        To achieve widespread adoption, the offerings within the ecosystem must cater to user needs. User centricity means involving ecosystem participants in the development and enhancement of services, thus fostering stronger user loyalty.

        Case example: “Sundhed.dk” in Denmark

        Sundhed.dk, the Danish health portal, actively involves patients in developing and improving e-health applications through a dedicated “user panel.” Through methods like focus groups, interviews and questionnaires, targeted user feedback is collected. These insights, including feedback on existing solutions and requests for new functionalities, contribute to refining the user experience and ultimately benefiting patients.

         3. Governance to involve stakeholders

        Effective governance mechanisms are essential for the functionality of an ecosystem. Typically, the ecosystem operator assumes the role of orchestrator, overseeing a framework for demand- and solution-oriented interactions.

        Case example: The Well healthcare platform in Switzerland

        Initially founded by health insurers and healthcare providers, the Well platform now incorporates physician networks and other collaborators. The integration of various actors is orchestrated by the Well AG.

         4. Technical interoperability

        Successful ecosystems facilitate seamless information exchange between stakeholders through standardized interfaces. These interfaces are typically established by the ecosystem orchestrator and are based on international standards. For example, the Fast Healthcare Interoperability Resource (FHIR) standard creates a basis for national and cross-border data exchanges in the healthcare sector.

        Case example: FHIR in Israel

        Israel relies on the FHIR standard within the healthcare domain, enhancing the usability of health data through a mix of incentives and requirements. This includes the Israeli Health Maintenance Organizations (which operate like integrated insurers, service providers and hospital operators), research institutes, startups, and additional healthcare providers. These organizations all benefit from improved health data exchange.

        The future of open healthcare ecosystems

        Open healthcare ecosystems possess the potential to better connect healthcare stakeholders with citizens. Such ecosystems can build up on existing structures: For example, a Germany’s national health infrastructure known as “Telematikinfrastruktur.” Electronic patient records and e-prescriptions can serve as foundational elements for health data exchange within an open healthcare ecosystem.

        Building successful open ecosystems demands a multi-faceted approach: User-centric concepts, effective governance mechanisms and standards are needed. To achieve this, an organization can be established to develop the ecosystem’s strategic direction, oversee orchestration and provide stakeholders and third-party providers with participation opportunities.

        Author

        Tobias Silberzahn holds a doctorate in biochemistry and is a Partner at the Berlin office of McKinsey & Company, Inc. His work focuses on healthcare innovation and the digital transformation of healthcare. Tobias also leads the global Health Tech Network, which brings together more than 1,800 health tech CEOs and founders, along with 250 investors and 300 corporations. He is co-publisher of the annual “eHealth Monitor,” a publication distributed by MWV publishing house that focuses on the digitalization of the German healthcare system. Within McKinsey, Tobias also co-manages a comprehensive health and well-being program that encompasses aspects such as sleep, nutrition, fitness, and stress management.

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          Creating vs. brokering editorial content: Where does the content come from?

          Prof. Dr. Laura Schulte

          The vision of a national health platform outlined in the “Trusted Health Ecosystems” project raises questions about the origin of the content and services offered there. A demand-driven offering requires a diverse range of information and services, which a single provider may struggle to fulfill alone. However, the platform operator does not have to create the content on their own. The following considerations explore whether the platform operator should generate their own information or focus on facilitating third-party information.

          The challenge

          The dissemination of information involves certain legal requirements that differ in principle depending on who authors the content. The question of attribution depends on the perception formed by users of an information offering regarding the authorship or responsibility for the content. Relevant legal requirements in this context may involve preventive obligations to verify the accuracy of content, obtaining permission for third-party content, provider identification obligations, and the removal of unlawful content.

          For most information offerings, it is assumed that there is no obligation to check the accuracy and legality of third-party information in advance. However, the provider may be required to do so if there are indications of a potential violation of the law. The situation is different when the provider adopts third-party content as its own, especially if it appears that the provider has independently verified the information or deemed it correct on another basis.

          In addition to these liability considerations, the trade-off involved with generating one’s own content versus relying on third-party content and service offerings is also relevant with respect to the legal justification of the proposed national health platform. It’s important to take into account that opting to create original content, especially by a primarily publicly funded operator, could affect the range of opportunities available to private sector actors and potentially put market-active companies at a disadvantage. State information initiatives are always subject to the condition that they must serve a governmental purpose, among other requirements (see The state as a provider of information).

          The distribution of quality-monitored health-related information is clearly in the interest of health education and, by extension, in the interest of state healthcare policy. However, as of today, there is no state-issued mandate or explicit legal assignment of tasks regarding the operation of a national information hub in Germany.

          Background

          The first question that arises – irrespective of copyright attribution issues – involves identifying who is responsible for the information provided through an external entity. This can include a legal entity that has obtained the information through a licensing agreement or other arrangements with third parties, for example.

          From a German legal perspective, online information offerings are classified as telemedia services and are subject to the regulations specified in the German Telemedia Act (TMG). According to § 5 TMG, all telemedia services are required to disclose the provider’s information in an imprint or legal notice. To the extent that a telemedia service offers journalistic or editorial content, it is required to appoint an individual who will be held legally responsible for the content, separate from the information platform itself.

          These transparency obligations serve to identify an institution or individual against whom claims can be pursued in the event of legal disputes. However, being a provider doesn’t necessarily imply that all information or content must originate from that same provider. Being identified as a provider is initially a formality designed to to ensure that the responsibility for each telemedia offering is clearly delineated. It is crucial to distinguish between responsibility for the technical platform and responsibility for the content disseminated on that platform. Although a single entity may be held legally responsible for both aspects, this is not mandatory.

          Providers, as defined under the German Telemedia Act, can include institutions or individuals who have had no substantive influence on the information and merely offer it as third-party content. The provider thus serves as the primary point of contact for their own as well as third-party content. However, variations emerge in terms of responsibility, including the ability to claim removal or seek damages in cases involving the publication of unlawful or false content.

          In principle, the entity responsible for creating the content, such as the author of a text or the organization behind a study or figure, should assume primary responsibility for it. From a legal standpoint, the operator of an information offering is not directly liable for third-party content. Initially, liability applies only to their own content, not to third-party content.

          From a legal point of view, the distinction between one’s own and third-party content depends on how the content is visibly attributed. Authorship is not relevant in this context; what matters is how users encounter the information. If there is no clear distinction in an information offering, users typically assume that all information either originates from the platform provider or that the provider adopts third-party content as their own.

          Third-party content is considered as such only when users can clearly recognize that the online content does not originate from the provider and that the provider does not wish to assume responsibility for it. A reference to its third-party nature can be made by exercising transparency in indicating a different contact or an external source for specific content.

          Past experience shows that private or civil society actors are indeed capable of generating and disseminating relevant information themselves. Given this, it seems advisable for the national healthcare platform to make health-related information from third-party providers easily accessible to the public while leveraging both state and private sector or civil society resources. In sum, the platform operator should not create and disseminate their own content.

          “The national health platform should limit itself to bundling and organizing third-party content.”

          Prof. Dr. Laura Schulte

          From a practical perspective, it will be important to consider how third parties can be motivated to make their content available for further distribution on the platform. Presumably, third parties could be enticed to contribute their content if they are provided a high-quality environment in which they are credited as the source of the information.

          Moreover, a clear definition of guidelines for the inclusion of content and general procedures is crucial. This includes determining how the information should be presented and how frequently updates should occur. In such an environment, offering multiple equivalent options or information can provide users with a comprehensive and unbiased selection to choose from.

          Conclusion

          Aside from legal issues, the decision to adopt and offer information as proprietary content is primarily a strategic one. Providing one’s own information usually involves more significant effort, whether this means creating or acquiring relevant content. Handling third-party content requires less production-oriented effort but involves considerable effort in terms of coordination and alignment activity. The desired quality level is thus essential.

          From the perspective of competition law, adopting an open market approach and offering third-party content is preferable to claiming it as proprietary or creating it from scratch. This approach helps prevent potential infringements on the fundamental rights of information providers (see The State as a Provider of Information). The national health platform should therefore focus on bundling and organizing third-party content and refrain from engaging in the thorough examination of specific content, modifying content, or granting extensive usage and exploitation rights to the platform operator.

          Fact or value judgment?

          The responsibility for editorial content depends, among other things, on whether the content is classified as factual information or a value judgment – both of which are fundamental to the national health platform. Factual information is objectively true or false, which means the provider bears the risk of disseminating information that is factually incorrect. There is no legitimate interest worthy of protection in spreading false information. Such content must therefore be promptly removed or corrected once so identified. Value judgments, on the other hand, are not subject to objective evaluation. They are subjective opinions that cannot be labeled as “true” or “false.” This gives information providers more leeway in terms of managing content on the platform.

          Challenges arise when dealing with mixed forms, especially when opinions are based on verifiable facts. Information providers must therefore carefully monitor the content on their platform and address complaints appropriately (Hofmann, 2022).

          Providing information to the public always involves the risk that some information may, at a later date, be found false or misleading. This risk applies to both self-generated content and information obtained from third parties. In order to manage this risk effectively, precautions can be taken for both self-produced and third-party content.

          (Published on 27.09.2023. The statements in this article refer exclusively to the legal situation in Germany. They represent a guideline and not individual legal advice that goes beyond the Trusted Health Ecosystems project.)

          Bibliography

          Hofmann F (2022). Lauterkeitsrechtliche Haftung von Online-Plattformen. Die neuen Transparenzvorgaben im UWG 2022 im Kontext lauterkeitsrechtlicher Plattformregulierung. in: GRUR Gewerblicher Rechtsschutz und Urheberrecht, Volume 124, June 2, 2022 (11/2022), pp. 780 et seq.

          Author

          While completing her doctoral studies, Prof. Dr- Schulte gained experience in the field of constitutional law as a research assistant. Her doctoral thesis focused on data protection law, and she conducted further research on this subject at various institutions, including the Queen Mary School of Law in London. From 2020 to 2023, she was employed as an attorney at BRANDI Rechtsanwälte in Bielefeld, specializing in IT and data protection law. Since August 2023, she has held the position of professor of business law at the Hochschule Bielefeld.

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