The aging of society, the shortage of skilled workers, but also digitalization have shaped the healthcare system for many years and pose major challenges for its designers. With increasing age, the general risk of disease also increases (RKI 2020). Older patient groups are more likely to have multimorbidities and have an increased need for treatment measures that must be financed by the health system. At the same time, the system's income is falling because the financing model, at least in the GKV, is based on contributions that are based on income and the average income is falling with an increasing proportion of pensioners.1 In addition, the healthcare system is struggling with a shortage of qualified specialists is exacerbated by the increasing need for treatment (Wunsch/Buchmann 2019) and is already visible in basic medical care in structurally weak rural regions. Digitalization counteracts this by opening up location-independent ways of providing services in the healthcare system and even creating new service areas. The Digital Care Act (DVG) introduced the regular ability to prescribe and reimburse selected health apps, so-called digital health applications (DiGA), in the GKV. Nevertheless, the digital conversion and the creation of new service areas are associated with additional costs. Overall, the healthcare system is faced with a significant financing problem and it is foreseeable that the current supply and reimbursement logic is not sustainable.

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