The introduction of health apps and wearables into the German statutory health care system

This dissertation examines the integration of health apps and wearable technologies into the German statutory health care system (SHI), assessing their potential to improve patient outcomes, reshape data governance, and transform care delivery models. As digital health technologies gain traction under Germany’s Digital Care Act (Digitale-Versorgung-Gesetz, DVG), this research provides a systematic and empirical evaluation of their benefits, risks, and economic implications. Combining a scoping review, a discrete choice experiment (DCE), and a multi-method policy analysis, the study explores how health apps and wearables can contribute to patient-centered care while addressing ethical, regulatory, and financial challenges. The first study, Potential Benefits and Risks Resulting from the Introduction of Health Apps and Wearables into the German Statutory Health Care System: A Scoping Review, synthesizes evidence from international and German-language sources to assess the current state of digital health interventions. The review identifies four central dimensions: user engagement, effectiveness in improving health outcomes, opportunities for integrating self-tracked (“bring-your-own”) data, and associated data privacy concerns. Results indicate that while apps and wearables show promise in chronic disease management, prevention, and behavioral modification, their long-term clinical effectiveness and interoperability with SHI infrastructure remain limited. Data privacy and user trust emerge as key determinants of adoption, emphasizing the need for standardized certification and secure data governance frameworks. The second study, Pricing Through Health App–Generated Data: Digital Dividend as a Game Changer, employs a discrete choice experiment (DCE) to explore user preferences and willingness to accept (WTA) monetary compensation for sharing personal health data generated through digital tools. The analysis reveals heterogeneous preferences depending on data sensitivity, recipient type, and purpose of data use. Users show higher WTA for sharing data with private insurers or technology companies than with research institutions, underscoring the ethical tension between data monetization and public good. The study introduces the concept of a “digital dividend”—a potential pricing mechanism that compensates users for data sharing, thereby incentivizing participation while maintaining fairness and transparency. The third study, The Digital Care Act – A Chance to Relieve the Dust from the German Health Care System: A Multi-Method Approach, evaluates the early-stage implementation of Germany’s DVG, which formally enables the prescription of certified health apps (“Digitale Gesundheitsanwendungen,” DiGAs) by physicians and their reimbursement under statutory insurance. Combining qualitative interviews with health care providers and quantitative surveys of patients and insurers, the analysis highlights both the opportunities and barriers to institutional adoption. The findings reveal a generally positive attitude toward digital therapeutics but also identify substantial challenges, including limited physician familiarity, bureaucratic hurdles in certification, and uncertainty about clinical validation standards. While DiGAs demonstrate potential to increase patient autonomy and reduce administrative burden, their success depends on digital literacy, physician engagement, and streamlined reimbursement processes. Taken together, the three studies provide a comprehensive view of how digital health innovations can be responsibly and effectively integrated into a publicly funded health care system. The research concludes that the German SHI system stands at a pivotal point: by leveraging digital tools like apps and wearables, it can transition toward a more personalized, preventive, and data-driven model of care. However, achieving this transformation requires robust data protection policies, economic incentives for participation, and system-wide interoperability. The dissertation offers actionable recommendations for policymakers, insurers, and developers to balance innovation with patient trust, ensuring that digital health integration enhances both efficiency and equity in Germany’s statutory health care landscape.