Digital health in social security systems in the Americas and Europe: good practices and challenges for more inclusive and sustainable care

Abstract

Social security systems face concurrent pressures: rising demand driven by demographic and epidemiological transitions, growing expectations for timely care, resource constraints, and the need to reduce inequities and the health sector’s environmental footprint. Digital health offers opportunities to expand access, strengthen continuity of care, streamline processes, and improve the insured person’s experience; however, it may widen gaps if implemented without an explicit focus on inclusion, governance, and human support. This special article synthesizes lessons for social security institutions based on a thematic documentary analysis of International Social Security Association (ISSA) reports, including its Information and Communication Technology (ICT) guidelines, and the World Health Organization’s Global Strategy on Digital Health 2020–2027 as the guiding framework. Illustrative cases from the Americas (EsSalud’s VIVA digital one-stop shop in Peru; EDUS in Costa Rica; Uruguay’s National Electronic Health Record) and Europe (digital empowerment/mandates in Belgium; digital mediation and accessible materials in France; a hybrid assisted model in Latvia; biometric authentication in Spain) are presented. Findings are organized into five domains: (i) service integration and simplification (transformational one-stop shop), (ii) deliberate digital inclusion and multichannel delivery, (iii) interoperability and clinical continuity, (iv) trust, security and a “human-in-the-loop” approach, and (v) measurable environmental sustainability. Operational recommendations oriented to public value are proposed: interoperable architecture, end-to-end integrated services, user segmentation, mediation and accessibility, digital service management (including SLAs), and integrated metrics for equity, quality/safety, efficiency and sustainability.