Blockchain-Based Data Governance in Healthcare Enterprises from the Perspective of Digital Trust and Strategic Competitive Advantage

Abstract

Purpose – This study examines the effect of blockchain-based data governance on financial performance in healthcare organizations through an indirect mechanism mediated by data security, digital trust, and competitive advantage. It evaluates whether blockchain functions not merely as a technical infrastructure but as a strategic governance capability that generates organizational value in healthcare systems.
Design/methodology/approach – The study adopts a secondary-data-based, explanatory, and comparative research design. Data were derived from OECD, WHO, IBM, and international digital health reports to operationalize four core dimensions of healthcare system performance: digital health infrastructure, digital trust, blockchain integration, and competitive advantage. A multidimensional performance score (Pi) was calculated for each country to enable cross-national comparison, and inter-variable relationships were evaluated through a hypothesis-driven analytical framework.
Results – Findings indicate that blockchain-based data governance affects financial performance indirectly through multi-stage mediating mechanisms rather than direct effects. Blockchain integration improves data security and transparency, which strengthens digital trust, and digital trust subsequently enhances competitive advantage. In addition, reductions in transaction and verification costs indirectly reinforce data security and transparency. Estonia demonstrates the most balanced performance with an integrated digital governance structure, whereas the USA and Germany exhibit relatively lower digital trust despite strong digital infrastructures. Türkiye shows developing digital infrastructure but limited blockchain integration.
Discussion – Blockchain-based data governance represents a shift from a centralized data control model to a distributed trust architecture, offering not only a technological but also an organizational and strategic transformation. This approach strengthens the analytical foundation of digital transformation decisions in healthcare businesses. Furthermore, it demonstrates that blockchain in the healthcare sector is not a technology that directly generates financial output, but rather a governance mechanism that indirectly creates strategic value through data security, digital trust, and competitive advantage. The findings reveal that sustainable performance in healthcare businesses is more related to a trust-building data governance architecture than to technological investment.