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Blockchain: A new technology for global health development?


Blockchain, the technological innovation behind cryptocurrencies like Bitcoin and Ethereum, has wide applications beyond finance, such as in global health. Scholars at the Robert Larner College of Medicine at the University of Vermont and Harvard Medical School elaborate upon this potential application of blockchain in a 2017 analysis published in BMJ Global Health.

The academics write that improving access to and quality of health care across the globe relies on increased capital. Health spending in low-income countries stands at a fraction of that in high-income countries — $120 per person compared to $5,221, according to World Bank data from 2014. Increased investments in the health systems of low-income nations could build the workforce and infrastructure necessary for improvements.

But, the scholars write, a lack of transparency in tracking these transactions (i.e., where investments are going and what returns they achieve), discourages potential investors. They suggest blockchain, a technology “built atop a network that makes trusted, secure, immutable and interoperable records of every transaction,” as one potential solution.

The team suggests a few mechanisms by which blockchain technology might improve global health coverage:

  • Universal access to financing: Blockchain-backed financial transfers do not require third-party intermediaries. This eliminates fees and broadens access. The authors cite the World Food Program’s pilot aid initiative for Syrian refugees, which effectively eliminated transfer fees through the use of blockchain. They also highlight blockchain’s resistance to fraud as another means to broaden global access to investments.
  • Smart contracts: The authors look to Ethereum’s system of smart contracts, in which the release of funding is pegged to the achievement of specific goals, for applications in health care. Such applications might track the use of supplies and the delivery of services, for example, and disburse funds according to outcomes. Development impact bonds, which are used already as an investment strategy for global health initiatives, face challenges with respect to tracking return on investment. Smart contracts “can automate social outcome-based funding and add new accountability to development financing.”
  • Transactions: Blockchain’s immutable ledger system has potential applications for healthcare transactions, including electronic prescriptions and insurance verifications. “As health information moves towards an interoperable health blockchain, or ‘Electronic Health Chain,’ an increasing number of currently siloed data sets will be linked, making fraudulent activity more challenging and the ability to detect it and other unusual activity less challenging.”
  • Health data: The ledger system is not limited to transactions. Blockchain can undergird a health data network, encompassing electronic medical records, information collected via wearable devices, prescription records and more. The authors suggest this data system might allow researchers to advance their work further.

There are a number of obstacles facing this potential innovation. The authors point out the need for regulatory guidelines for managing medical information and financial transactions on blockchain. The quantity and size of health data files present another obstacle to the migration of health records to a blockchain.

Citation: Till, Brian M.; et al. “From Blockchain Technology to Global Health Equity: Can Cryptocurrencies Finance Universal Health Coverage?” BMJ Global Health, November 2017. DOI: 10.1136/bmjgh-2017-000570.