Smart Contracts, Blockchain, and Health Policies: Past, Present, and Future

The integration of blockchain technology into healthcare systems has emerged as a technical solution for enhancing data security, protecting privacy, and improving interoperability. Blockchain-based smart contracts offer reliability, transparency, and efficiency in healthcare services, making them a focal point of many studies. However, challenges such as scalability, regulatory compliance, and interoperability continue to limit their widespread adoption. This study conducts a comprehensive literature review to assess blockchain-driven health data management, focusing on the classification of blockchain-based smart contracts in health policy and the health protocols and standards applicable to blockchain-based smart contracts. This review includes 80 core studies published between 2019 and 2025, identified through searches in PubMed, Scopus, and Web of Science using the PRISMA method. Risk of bias and methodological quality were assessed using the Joanna Briggs Institute tool. The findings highlight the potential of blockchain-enabled smart contracts in health policy management, emphasizing their advantages, limitations, and implementation challenges. Additionally, the research underscores their transformative impact on digital health policies in ensuring data integrity, enhancing patient autonomy, and fostering a more resilient healthcare ecosystem. Recent advancements in quantum technologies are also considered as they present both novel opportunities and emerging threats to the future security and design of healthcare blockchain systems.