Democracies have a small radius of trust

No government data store for more than 5 million - they devolve to regional data stores.

England’s 57 million population is not devolved so not stored, instead pull on-demand from the local primary care settings.

No business model is working

Netherlands: none of the companies is making money from the market and the government stopped funding.

England: little funding for PHRs, only PEPs.

India: no funding for PHRs, PHR companies making money from commissions on transactions.

Many governments created companies that they own and buy exclusively from on a cost-plus model.