OBJECTIVES: Limited healthcare resources and rising demand impose a significant burden for healthcare systems sustainability. The digital revolution represents an opportunity to enhance healthcare delivery and reduce costs. The aim of this study was to identify current funding pathways of eHealth solutions in France, Germany, Italy, Spain and the United Kingdom, United States (US) and Canada.

METHODS: A targeted literature review was performed in Medline and Embase, complemented by ad-hoc and primary search with eHealth country experts and payers.

RESULTS: Few sustainable paths dedicated to eHealth solutions are available. Funding options include existing paths for health technologies and services, individual arrangements with payers, temporary pilot programs or experiments with innovative care delivery and payment models. Despite various funding sources, current level of pathways implementation is rated 2 to 3 in 6-point scale. In countries with decentralised healthcare systems (Canada, Spain, Italy), funding decisions are made at regional or local levels with differences in eHealth implementation among regions. In the UK, funding decisions are usually made by regional authorities, but central funding is also possible, however it requires evidence from prior local or regional pilots. In France, a legal framework supporting regional telemedicine pilots was defined in 2009 and sustainable national funding was recently introduced for teleconsultation and tele-expertise. National paths for various health technologies and services exist in Germany, but eHealth is usually funded through selective contracts. Coverage by private health insurance companies and out-of-pocket payments represents eHealth funding opportunity in the US and Canada but private payers require an individualized approach.

CONCLUSIONS: Funding paths for eHealth solutions are still immature. More experience is needed to assess its potential impact on healthcare organisations. Local or regional funding is most frequently observed, usually provided under temporary programs. Positive pilot outcomes may provide grounds for expanding to other regions or applying for national funding.