Allowing citizens to easily access eHealth services online is a key goal for the majority of countries in Europe. Despite this, the implementation of such large-scale projects remains a distant dream for most nations on the continent. Indeed, new data from the European Commission’s eGovernment Benchmark reveals that while access to most public services online has generally improved, a yawning digital divide between the nations surveyed persists when it comes to the provision of digital healthcare services.
Covering the EU27 Member States, the European Free Trade Association countries including Iceland, Norway, and Switzerland, and EU candidate nations like Albania, North Macedonia, and Turkey, the report analysed more than14,000 government websites to gauge levels of accessibility for citizens across Europe. Perhaps unsurprisingly given their established reputations for digital innovation and strong civil societies, countries in Scandinavia and Central Europe ranked highly in most categories, alongside Eastern European tech powerhouses such as Estonia.
One notable entrant, however, was Malta. Known more for its flourishing tourist trade than its start-up culture, the Mediterranean nation has yet to establish a strong reputation for innovation in digital government services. However, data from the Benchmark reveals that at least nine out of ten government services in Malta can be found via a government portal, with users able to access these services without the need to print application forms or visit a government service desk in person. Indeed, as other European countries struggle to get their digital identity systems off the ground, more than 90% of government services in Malta can be accessed through the national digital identity system.
The reason for Malta’s success in eGovernment is largely down to its long-term investments in IT. Back in 2014, it launched the Digital Malta Strategy, a vision for the islands to prosper as a ‘digitally enabled nation in all sectors of society,’ with a particular focus on using ICT to improve access to healthcare and social services, improving education across demographics, and creating high-quality jobs. Building on this momentum three years later, the country launched the €40m CONvErGE Project to strengthen its nascent eGovernment programme by developing new systems and platforms for the tourism sector and disaster response, as well as building its national health infrastructure dubbed ‘eHealth’.
The physical size of the islands – which, together, form an area five times smaller than London - has also been a key factor behind Malta’s success in pushing forward digital government initiatives, explains Prof Ernest Cachia dean of the University of Malta’s ICT faculty. “There is the full range of government services but on a smaller scale, so we can get the results back quicker,” says Cachia. “There are advantages to being small.”
The data from the eGovernment benchmark also shows that two other relatively small states, Estonia and Luxembourg came in after Malta as the highest scoring countries for digital government services. Tech Monitor has previously reported on how countries like Estonia have pioneered eGovernment services such as digital identity systems, often through innovative projects such as its country-wide hackathon, where developers across the globe were invited to take part.
While size might not be the primary determinant behind a country’s success in providing digital government services, it can play a significant role in allowing states to react quickly and efficiently in the face of emerging trends. A study by Nesta on how innovation happens in five countries with populations of less than ten million arrived at a similar conclusion. “Lacking large domestic markets, or the scale to be at the leading edge of research in every field, they have made the most of their existing advantages, and developed others,” wrote the report’s authors.
The success of these countries is, of course, not shared equally across the European bloc. According to the data in the eGovernment benchmark, while citizens’ access to online public services has been made easier in 77% of European countries, key e-health services are still in their infancy. Just three countries – again, Malta, Luxembourg, and Estonia - have eHealth maturity scores of above 90%, which means that citizens in these three countries are well supported by digital health-related services.
An analysis of the Benchmark’s data also shows that at least eight countries have an eHealth maturity score below 50%, which conversely means that people in these countries need to resort to non-digital methods to access certain healthcare services. In Albania for example, citizens would not be able to obtain a European Health Insurance Card online or apply for electronic health records. Similarly in Austria, teleconsultations with doctors are unavailable and citizens have no access to digital means to register and reschedule hospital appointments. In France and Germany, meanwhile, efforts to establish online services to obtain an ‘e-prescription’ from a hospital doctor are currently lagging behind those of Spain and Italy.
The unequal access to these key health services is further pronounced when it comes to migrants. Survey data from the Benchmark shows that non-national citizens can only access three out of ten services (34%) online, with a lack of English information on hospital websites as the biggest barrier. While the maturity of digital government services has progressed since the pandemic, there is still room for improvement, explains Marc Reinhardt, head of public sector and health at IT consultancy Capgemini.
“We saw that good digital capabilities in the health space enabled countries to better cope with the pandemic, by helping to organise vaccination drives and decentralising treatments during lockdowns,” says Reinhardt. Even so, “this year’s eGovernment Benchmark Report identifies eHealth as a clear area for improvement with regards to user accessibility and experience across the board”.
Levelling the divide when it comes to the provision of eHealth services will be a key challenge for countries in the EU in the next few years, and there are clear signs that the regional bloc is taking the development of eGovernment services seriously. In July, EU member states agreed on a landmark policy programme to deliver digital transformation across the region, aimed at helping countries hit the transformation targets set out in the 2030 Digital Compass - a set of policies covering skills and digital infrastructure. But an analysis of targets set out by the EU to improve the bloc’s digital infrastructure across the board shows that member states have a long way to go.
While improving digital literacy is not too far away from the targets set for 2030, other aspects of the EU’s plans such as improving access to 5G, for example, remain in the distance. Countries like Denmark and Finland are already close to hitting their targets for the share of SMEs having a ‘basic level of digital intensity,’ but other countries like Romania and Bulgaria continue to lag. Whether EU member states that have demonstrated success in rolling out digital government initiatives can distribute the resources and their expertise across the region remains to be seen.