Developing Public Policies for New Welfare Technologies: A Case Study of Telemedicine and Telehomecare

Abstract
Technology has for long been predicted to be a key development factor in answering the difficult questions on how to secure welfare in industrialised countries as life expectancy increases and the working population and taxpayers diminish. This is particularly assumed for information and communication-based technologies (ICT) for homecare and monitoring (telemedicine, telehomecare). Despite major investments and national commitment, public policies have not yet found a general approach to move from technological and clinical opportunity and into large-scale regular use of the technology (normalisation). This article provides two case studies from Denmark; one case with hypertension monitoring at a local level and another case on national policy implementation through funding of selected demonstration projects. Among the findings are that policy-making processes certainly face major challenges in capturing research and development for the transition of technologies into working practice. Furthermore, policy approaches of supporting experimentation and demonstration are found inadequate in promoting technology into a level of normalisation in highly cross-organisational operational environments. A research lens and a policymaking process are suggested upon balancing the rationales of infrastructure, business case, strategy and organisational constructivism over time with continuous review of the qualitative dimension of public policies in securing the fulfilment of societal needs. Improvements of policies have critical social implications in development of future technology-based welfare systems.

Introduction
The world’s industrialised nations are facing major challenges in the years to come. Demographic changes are leading to an ageing population (Koch 2006) requiring more care, suffering from more health issues, lifestyles creating chronic diseases, ever increasing limits for the medical science’ ability to treat patients, and shrinking budgets (Saha 2011). Technology could be the solution. Particularly technologies in the home or in the ambience of the citizen (patient) seem attractive as they reduce the need for physical presence of health care professionals, but introduce pervasive monitoring and hence comfort to the patient (Dinesen et al. 2008, Andreassen 2011, Rouck et al. 2008, Cegarra-Navarroa and Sanchez-Polo 2010, Essén and Conrick 2008, Prinz et al. 2008, Al-Qirim 2007, May and Ellis 2001, Takahashi 2001). Telemedicine has thus for long been predicted to be transforming the welfare services in Europe providing safety and quality-of-life to ageing patients (Bashshur and Shannon 2009, Hebert et al. 2006, Varghese and Scott 2004, Brender et al. 2000). Public policies, however, seem to lack systematic in conversion of expectations and experimentation into implementation, operations and normalisation (Murray et al. 2011); Miller (2007) calls this the lack of disjuncture between research and practice; Ekeland et al. (2010) talk about the need for “more focus on patients’ perspectives, economic analyses and on telemedicine innovations as complex processes and ongoing collaborative achievements”. The purpose of this article is to review and discuss mechanisms affecting the conversion process of shifting policies from loosely expressed ideas and intents into workable policies at relevant political and operational levels.


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