Developing Digital Health Ecosystems for Cost-Effective Public Spending: Challenges and Opportunities in the Republic of Moldova and Eastern Partnership Countries

The digitalization of healthcare systems has become a critical condition for optimizing budget allocations and increasing value for money, especially in the context of current demographic and economic pressures. In the Republic of Moldova and the Eastern Partnership countries, the transition to integrated digital ecosystems represents not only a technological modernization, but also a structural reform necessary to ensure the financial sustainability of the public healthcare sector. Current literature confirms that digital maturity reduces spending fragmentation, although the impact in transition economies remains underexplored. Studies highlight that institutional barriers in Eastern Europe limit the transformation of technological infrastructure into real economic efficiency. The study adopts a mixed methodological approach, using bibliometric analysis via the VOSviewer tool to map the scientific landscape and cooccurrence networks of key terms, together with the JRC SDG Mapper platform to assess the alignment of digitalization policies with the Sustainable Development Goals. The research seeks to answer the fundamental question of whether the integration of digital ecosystems in the Republic of Moldova can serve as a lever for reducing fiscal inefficiencies, while investigating the degree of convergence of national policies with the technological and sustainability standards of the European Union. The research reveals significant fragmentation of digital initiatives in the region, but indicates high potential for cost efficiency by centralizing health data and aligning it with UN sustainability indicators. The paper contributes to the literature by proposing a multidimensional evaluation model that integrates bibliometric analysis with sustainable development goals, providing a practical roadmap for optimizing financial resources in the process of digital maturation of health systems in the Eastern Partnership countries.