Adela Mesa and Pedro Martínez‐Monje
( for example the electronic prescription, etc.) which could have detrimental effects in the long term on said process.
The decentralisation process in the area Healthcare culminated in Spain in 2002( at different rhythms in each Autonomous Region), with the Autonomous Regions becoming competent over health planning, public health and management of healthcare services( Chao, 2012).
In this block we asked about the traditional manner of managing the public employees, in case it could be considered a barrier. The need to have public support, to achieve results in the short term, the convergence of different types of actors in the e‐government policies each with different interests, needs, etc.
Curiously, in this block the perception of big barrier is found in the question regarding the convergence of different groups of actors( politicians, managers, ICT specialists, etc.) with different interests and needs in the e‐Government policies. Other issues like the traditional form of management and doing things and the needs to achieve short‐term results are perceived as barriers, but the need to obtain the constant support from the maximum political level for the e‐Government policies is seen as a bigger hurdle.
In general, it is considered that the problem is not in the proceedings and in their adaptation introducing the new technologies, but rather that the biggest challenge lies in the relationship between the different actors and the interest and needs which each of them may have. In other words, it is the political aspects which is most likely to generate barriers to the development of e‐Government.
3. E‐Governance in health
The general study on the barriers to electronic government is applied in this part of the research to the specific area of healthcare. Healthcare and education are essential pillars of the welfare state and therefore one of the most sensitive for the population as a whole which is very much against reducing the expenditure on this public service( 94.6 % of the Spanish population according to a study from the Sociological Research Centre ‐ Centro de Investigaciones Sociológicas‐ in 2011).
We could briefly state that the territorial decentralisation of the power over healthcare was completed in Spain on the culmination of the transfers process in 2001 and one of the key problems which arises as a result is how to ensure the cohesion of the system. As a result, Spanish healthcare policy is entering into a decisive phase in the relations between the central Government and the autonomous administration, and as such the ICT also become part of that inter‐governmental dynamics.
On the organisation level, the entity which formulates the relations between the Ministry of Health and the autonomous departments in charge of health care is the Inter‐Territorial Council of the National Health System( CISNS). This intergovernmental body, which facilitates the relations between the administrative levels, was set up in 1987 and as representatives from the General State Administration( person responsible for the Ministry) and from the autonomous regions( person responsible for the autonomous departments and autonomous cities). The agreements of the CICNS are formulated through recommendations which are approved if appropriate by consensus, so that the cooperation agreements to carry out joint healthcare actions are formalised through agreements.
In the questionnaire mentioned in this study, the difficulties for e‐governance in the healthcare sector refer to the need for specific ICT applications, the population’ s attitude to health and their level of demand of electronic healthcare services, the need to train the healthcare personnel in e‐services, the need to safeguard the privacy of the population when using the electronic healthcare services, the different types of identification cards and the adaption of the healthcare system to the situations which affect public health.
Based on the results obtained, the main problem for the development of e‐Governance in healthcare lies, from the point of view of the technical personnel who were interviewed, in the diversity of the electronic identification cards as well as in the need to safeguard privacy and confidentiality in the use of the electronic healthcare services. Half of those interviewed think that both barriers are big or very big. These results lead to another series of questions: What degree of knowledge and what skills in the use are necessary so that the population can effectively use the electronic healthcare services?; How are the electronic healthcare services
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