125 / 169
DIGITAL INNOVATION NEEDS WELFARE
125
possession (that is, the data, including analogue
data, lie with i.e. doctors) or possession without
ownership (lots of data lie with lots of doctors,
care organisations and hospitals). With the
growing risk of cybercrimes, however, topics
like data safety and security will probably enter
the political agenda in more and more states
soon, especially when the new European
General Data Protection Regulation (GDPR) is
applied starting from 25 May 2018.
This is one side of digitalisation. The other is
better quality of life due to better and more con-
venient medical and care services, including in
rural and sparsely populated areas, if they are
equipped with the appropriate digital infrastruc-
ture, like for instance in Denmark, Finland,
Sweden, Estonia or Scotland. This is because the
digitalisation of health care offers huge opportu-
nities. For instance, it could avoid multiple ex-
aminations, cumbersome documentation and
bureaucracy, and therefore saving costs; it could
improve diagnosis, prevention, treatment and
medication; it could connect and dovetail formal
with informal care-givers in order to improve and
reduce the burden of social care; and it could
lead to more efficient processes, shorter waiting
times and approaches, and thereby more time
for people and person-centered services.
Using digital technologies requires digital lit-
eracy, in other words, basic skills that enable
people to draw the greatest benefit from these
new technologies. For citizens to be interested
in these technologies, however, they need to
recognise what the benefit is for them or how
these innovations could specifically improve
day-to-day life. If citizens are less prepared for
digitalisation and do not have the basic skills re-
quired, digitalisation will not be able to achieve
its full potential, whether from use of internet
connections in general through to health services
in particular. Here, Italy and Estonia represent
two contrasting case studies. It is striking that
the countries that have strong administration
units and that have tried to manage digitalisa-
tion top down in large-scale projects are those in
which the debate about small-scale innovations
is more prominent. Here, the problems experi-
enced in Germany and the United Kingdom with
health cards, the disappearance of patient data
and records and general data protection prob-
lems in the NHS with care.data provide particu-
larly noteworthy examples. On the other hand,
decentralised states struggle with translation
problems and fragmentation when implementing
digitalisation, as the examples of Spain and Italy
show. It seems that a mix of centrally determined
requirements and operational autonomy at re-
gional and local level is indeed conducive to
achieving objectives (
Chart 3
).
Digitalisation and welfare states – equal or
unequal?
Digitalisation is giving rise to challenges of vary-
ing intensities in the different welfare state
models. First, as chart 2 and 3 show, the coun-
tries examined occasionally differ widely in the
degree of digitalisation in the economy and so-
ciety that they have already achieved, from set-
ting up and expanding digital infrastructure to
building digital human capital, integrating digi-
tal technologies into the economy and driving
digital public services. Irrespective of the type of
welfare state, then, the key aim must initially be
to establish high-speed networks across all
states and to promote human capital. Second,
depending on the type of welfare state, there
are also different challenges in terms of content.
Measures that are comparatively easy to inte-
grate for one welfare state may have a centrip-
etal effect in other welfare states. For instance,