Business Models in Digital Health: Bibliometric and Systematic Review Focusing on Financial, Regulatory, and Adoption Aspects
Main Article Content
Keywords
digital health solutions (DHS), business model, bibliometric analysis, systematic review, healthcare innovation
Abstract
Digital health solutions (DHSs) have significant potential to improve the efficiency, accessibility, and patient-centeredness of healthcare delivery. However, many initiatives fail to progress beyond the pilot stage due to the absence of sustainable business models (BMs) that ensure financial, regulatory, and operational viability. This study combines bibliometric analysis with a systematic review of 34 peer-reviewed articles published between 2020 and 2025 to examine how DHS BMs are structured and to identify key gaps in the literature. The bibliometric analysis reveals a shift in research focus from foundational technologies such as telemedicine and personalized medicine toward strategic dimensions, including business models, value creation, data privacy, and healthcare policy, indicating a maturing research field. Nevertheless, reimbursement remains comparatively underexplored despite its practical importance. The systematic review shows that value proposition, resources, and partnerships are the most frequently addressed business model components, whereas cost structure, licensing, customer feedback, and customer relationships receive significantly less attention. This imbalance limits the scalability and long-term sustainability of DHS initiatives. Overall, the findings highlight a structural gap in current DHS BM research, where value creation is well developed but the financial and regulatory mechanisms required for sustainable implementation remain insufficiently addressed. These insights guide researchers, policymakers, and practitioners in advancing more balanced and sustainable digital health business models.
References
[1] Rønn C, Wieland A, Lehrer C, Márton A, LaRoche J, Specker A, Leroy P, Fürstenau D. Circular business model for digital health solutions: protocol for a scoping review. JMIR Research Protocols. 2023;12:e47874. https://doi.org/10.2196/47874.
[2] Bouabida K, Lebouché B, Pomey MP. Telehealth and COVID-19 pandemic: an overview of the telehealth use, advantages, challenges, and opportunities during COVID-19 pandemic. Healthcare (Basel). 2022;10(11):2293. https://doi.org/10.3390/healthcare10112293.
[3] Fagherazzi G, Goetzinger C, Rashid MA, Aguayo GA, Huiart L. Digital health strategies to fight COVID-19 worldwide: challenges, recommendations, and a call for papers. Journal of Medical Internet Research. 2020;22(6):e19284. https://doi.org/10.2196/19284.
[4] Mumtaz H, Riaz MH, Wajid H, Saqib M, Zeeshan MH, Khan SE, Chauhan YR, Sohail H, Vohra LI. Current challenges and potential solutions to the use of digital health technologies in evidence generation: a narrative review. Frontiers in Digital Health. 2023;5:1203945. https://doi.org/10.3389/fdgth.2023.1203945.
[5] Weimar SN, Martjan RS, Terzidis O. Business venturing in regulated markets: taxonomy and archetypes of digital health business models in the European Union: mixed methods descriptive and exploratory study. Journal of Medical Internet Research. 2025;27:e65725. https://doi.org/10.2196/65725.
[6] Fielt E. Conceptualising BM: Definitions, frameworks, and classifications. Journal of Business Models. 2014;1(1):85–105.
[7] Wirtz BW, Müller WM, Langer PF. The concept of business models: Development and research perspectives. International Journal of Innovation Management. 2022;26(7):2250056. https://doi.org/10.1142/S1363919622500566.
[8] Snihur Y, Markman G. Business model research: Past, present, and future. Journal of Management Studies. 2023;60(8):2177–2207. https://doi.org/10.1111/joms.12928.
[9] Business process change. In: Elsevier eBooks. Amsterdam: Elsevier; 2019. https://doi.org/10.1016/C2017-0-2868-9. Cambridge Service Alliance. Service business model innovation: the digital twin technology [Internet]. Cambridge: University of Cambridge; 2018. https://cambridgeservicealliance.eng.cam.ac.uk/system/files/documents/digitaltwins.pdf.
[10] Niemimaa M, Järveläinen J, Heikkilä M, Heikkilä J. Business continuity of business models: Evaluating the resilience of business models for contingencies. International Journal of Information Management. 2019;49:208–216. https://doi.org/10.1016/j.ijinfomgt.2019.04.010.
[11] Schoormann T, Schweihoff J, Jussen I, Möller F. Classification tools for business models: Status quo, comparison, and agenda. Electronic Markets. 2023;33(1):31. https://doi.org/10.1007/s12525-023-00639-2.
[12] Mathew PC, Joseph D, Zacharia A, Thomas AC, Oommen SE, Joseph J. Visualizing scholarly trends in electronic health (eHealth) business models: A bibliometric analysis. Cureus. 2024;16(11):e71337. https://doi.org/10.7759/cureus.71337.
[13] Pascarelli C, Colucci C, Mitrano G, Corallo A. Business models in digital health: Bibliometric analysis and systematic literature review. In: 2022 IEEE Symposium on Computers and Communications (ISCC); 2023. p. 1–4. https://doi.org/10.1109/ISCC58397.2023.10218237.
[14] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71.
[15] Tawfik GM, Dila KAS, Mohamed MYF, Tam DNH, Kien ND, Ahmed AM, et al. A step by step guide for conducting a systematic review and meta-analysis with simulation data. Tropical Medicine and Health. 2019;47(1):46. https://doi.org/10.1186/s41182-019-0165-6.
[16] Velayati F, Ayatollahi H, Hemmat M, Dehghan R. Telehealth business models and their components: Systematic review. Journal of Medical Internet Research. 2022;24(3):e33128. https://doi.org/10.2196/33128.
[17] Van Eck NJ, Waltman L. Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics. 2010;84(2):523–538. https://doi.org/10.1007/s11192-009-0146-3.
[18] Abdollahi A, Sadeghvaziri F, Rejeb A. Exploring the role of blockchain technology in value creation: A multiple case study approach. Quality & Quantity. 2023;57(1):427–451. https://doi.org/10.1007/s11135-022-01348-2.
[19] Christie HL, Boots LMM, Peetoom K, Tange HJ, Verhey FRJ, De Vugt ME. Developing a plan for the sustainable implementation of an electronic health intervention (Partner in Balance) to support caregivers of people with dementia: Case study. JMIR Aging. 2020;3(1):e18624. https://doi.org/10.2196/18624.
[20] Christie HL, Boots LMM, Hermans I, Govers M, Tange HJ, Verhey FRJ, et al. Business models of eHealth interventions to support informal caregivers of people with dementia in the Netherlands: Analysis of case studies. JMIR Aging. 2021;4(2):e24724. https://doi.org/10.2196/24724.
[21] Essen A, Frishammar J, Cenamor J. Entering non-platformized sectors: The co-evolution of legitimacy debates and platform business models in digital health care. Technovation. 2023;121:102597. https://doi.org/10.1016/j.technovation.2022.102597.
[22] Fürstenau D, Klein S, Vogel A, Auschra C. Multi-sided platform and data-driven care research. Electronic Markets. 2021;31(4):811–828. https://doi.org/10.1007/s12525-021-00461-8.
[23] Kelley LT, Fujioka J, Liang K, Cooper M, Jamieson T, Desveaux L. Barriers to creating scalable business models for digital health innovation in public systems: Qualitative case study. JMIR Public Health and Surveillance. 2020;6(4):e20579. https://doi.org/10.2196/20579.
[24] Hongdao Q, Bibi S, Mu D, Khan A, Raza A. Legal business model digitalization: The post COVID-19 legal industry. SAGE Open. 2022;12(2):21582440221093983. https://doi.org/10.1177/21582440221093983.
[25] Lokman L, Chahine T. Business models for primary health care delivery in low- and middle-income countries: A scoping study of nine social entrepreneurs. BMC Health Services Research. 2021;21(1):211. https://doi.org/10.1186/s12913-021-06225-6.
[26] Lupiáñez-Villanueva F, Folkvord F, Vanden Abeele M. Influence of the business revenue, recommendation, and provider models on mobile health app adoption: Three-country experimental vignette study. JMIR mhealth and uhealth. 2020;8(6):e17272. https://doi.org/10.2196/17272.
[27] Oderanti FO, Li F, Cubric M, Shi X. Business models for sustainable commercialisation of digital healthcare (eHealth) innovations for an increasingly ageing population. Technological Forecasting and Social Change. 2021;171:120969. https://doi.org/10.1016/j.techfore.2021.120969.
[28] Sibalija J, Barrett D, Subasri M, Bitacola L, Kim RB. Understanding value in a healthcare setting: An application of the business model canvas. Methodological Innovations. 2021;14(3). https://doi.org/10.1177/20597991211050477.
[29] Velayati F, Ayatollahi H, Hemmat M, Dehghan R. Key components and critical factors for developing a telehealth business framework: A qualitative study. BMC Medical Informatics and Decision Making. 2021;21(1):362. https://doi.org/10.1186/s12911-021-01707-3.
[30] Vimarlund V, Nikula N, Nøhr C. Business models and eHealth social innovations for social care services: Serving the two sides of the market. Health Policy and Technology. 2021;10(4):100555. https://doi.org/10.1016/j.hlpt.2021.100555.
[31] Saheb T. An empirical investigation of the adoption of mobile health applications: Integrating big data and social media services. Health and Technology. 2020;10(5):1063–1077. https://doi.org/10.1007/s12553-020-00422-9.
[32] Visconti RM, Morea D. Healthcare digitalization and pay-for-performance incentives in smart hospital project financing. International Journal of Environmental Research and Public Health. 2020;17(7):2318. https://doi.org/10.3390/ijerph17072318.
[33] Viswanadham N. Ecosystem model for healthcare platform. Sadhana. 2021;46(4):226. https://doi.org/10.1007/s12046-021-01708-y.
[34] Condry MW, Quan XI. Remote patient monitoring technologies and markets. IEEE Engineering Management Review. 2023;51(3):59–64. https://doi.org/10.1109/EMR.2023.3285688.
[35] Ivaninskiy I, Ivashkovskaya I. Are blockchain-based digital transformation and ecosystem-based business models mutually reinforcing? The principal-agent conflict perspective. Eurasian Business Review. 2022;12(4):643-670. https://doi.org/10.1007/s40821-022-00209-0.
[36] Tekkis NP, Richmond-Smith R, Pellino G, Kontovounisios C. Facilitating the adoption and evolution of digital technologies through re-conceptualization. Frontiers in Surgery. 2022;9:840595. https://doi.org/10.3389/fsurg.2022.840595.
[37] Lee A. A comprehensive review and investigation of business models. Enigma in Economics. 2024;1(2):49-54. https://doi.org/10.61996/economy.v1i2.31.
[38] Osterwalder A, Pigneur Y. Business Model Generation: A Handbook for Visionaries, Game Changers, and Challengers. Hoboken (NJ): Wiley; 2010.
[39] Taipale-Erävala K, Salmela E, Lampela H. Towards a new business model canvas for platform businesses in two-sided markets. Journal of Business Models. 2020;8(3):107-125. https://doi.org/10.5278/jbm.v8i3.4621.
[40] Weimar SN, Martjan RS, Terzidis O. Conceptualizing the landscape of digital health entrepreneurship: a systematic review and research agenda. Management Review Quarterly. 2024. https://doi.org/10.1007/s11301-024-00417-0.
[41] Ilan Y. Improving global healthcare and reducing costs using second-generation artificial intelligence-based digital pills: a market disruptor. International Journal of Environmental Research and Public Health. 2021;18(2):811. https://doi.org/10.3390/ijerph18020811.
[42] Arkwright BT, Leslie M, Light M. Telehealth finance variables and successful business models. Telehealth and Medicine Today. 2019;3. https://doi.org/10.30953/tmt.v3:140.
[43] Cozzolino A, Geiger S. Ecosystem disruption and regulatory positioning: Entry strategies of digital health startup orchestrators and complementors. Research Policy. 2024;53(2):104913. https://doi.org/10.1016/j.respol.2023.104913.
[44] Iqbal JD, Biller-Andorno N. The regulatory gap in digital health and alternative pathways to bridge it. Health Policy and Technology. 2022;11(3):100663. https://doi.org/10.1016/j.hlpt.2022.100663.
[45] Tarricone R, Petracca F, Cucciniello M, Ciani O. Recommendations for developing a lifecycle, multidimensional assessment framework for mobile medical apps. Health Economics. 2022;31(Suppl 1):73–97. https://doi.org/10.1002/hec.4505.
[46] Mosconi P, Radrezza S, Lettieri E, Santoro E. Use of health apps and wearable devices: survey among Italian associations for patient advocacy. JMIR Mhealth Uhealth. 2019;7(1):e10242. https://doi.org/10.2196/10242.
[47] Shiferaw KB, Mengiste SA, Gullslett MK, Zeleke AA, Tilahun B, Tebeje T, Wondimu R, Desalegn S, Mehari EA. Healthcare providers' acceptance of telemedicine and preference of modalities during COVID-19 pandemics in a low-resource setting: An extended UTAUT model. PLoS One. 2021;16(4):e0250220. https://doi.org/10.1371/journal.pone.0250220.
[48] Steinhauser S, Doblinger C, Hüsig S. The relative role of digital complementary assets and regulation in discontinuous telemedicine innovation in European hospitals. Journal of Management Information Systems. 2020;37(4):1155-1183. https://doi.org/10.1080/07421222.2020.1831778.
[49] van Eck NJ, Waltman L. VOSviewer Manual: Manual for VOSviewer version 1.6.20. Leiden: Leiden University; 2023. https://www.vosviewer.com/documentation/Manual_VOSviewer_1.6.20.pdf.
