Why Blockchain Benefits Don't Guarantee Adoption: An Integrated TAM-TOE Analysis of Technology Acceptance and...

Despite blockchain technology's demonstrated potential to enhance security, transparency, and efficiency in healthcare systems, adoption rates remain significantly lower than predicted, creating a persistent gap between perceived benefits and adoption feasibility. This study addresses the critical question of what explains this adoption paradox by developing and testing a comprehensive theoretical framework that integrates the Technology Acceptance Model (TAM) with the Technology-Organization-Environment (TOE) framework.

A systematic literature review is conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to synthesize existing research on blockchain adoption in health care. This study develops four key propositions examining how technology characteristics, organizational factors, external environmental pressures, perceived risks, and system quality collectively influence healthcare organizations' blockchain adoption intentions.

The analysis reveals that blockchain adoption in health care is influenced by a complex interplay of facilitating and inhibiting factors. Technology characteristics such as perceived usefulness (PU) and ease of use, combined with organizational innovation readiness and technology compatibility, positively influence adoption intention. External factors enhance perceived technology benefits and consequently affect adoption decisions. However, perceived risks moderate the relationship between PU and adoption intention.

Blockchain technology represents a transformative solution for persistent healthcare challenges, but successful adoption requires a holistic approach that simultaneously addresses technology, organizational, and environmental factors. The adoption gap can be bridged through strategic planning that aligns institutional readiness with user incentives, comprehensive risk management, and supportive regulatory frameworks. Future research should focus on establishing ethical governance models to support broad blockchain adoption in health care.