Blockchain scalability in healthcare: a systematic review of privacy and security considerations

Blockchain is increasingly being recognised as an advanced technology that can enhance health data privacy and security. However, scalability issues hinder its widespread adoption and acceptance, potentially leading to new privacy and security vulnerabilities. This study aims to identify primary reasons for scalability concerns and evaluate the efficiency of proposed solutions in addressing these issues. This paper will also examine how scalability leads to privacy and security challenges faced by users and healthcare providers. A literature review addresses the objective of this paper by identifying scalability vulnerabilities that lead to privacy and security concerns in Blockchain-based Healthcare. This paper selected the published papers between 2020 and 2025 using Google Scholar, IEEE Xplore, Scopus, and Web of Science. The findings have shown that the solutions offered in previous research papers to overcome scalability issues are not balanced between scalability, privacy, and security in Blockchain-based Healthcare. Analysing the causes of scalability issues enhances the effectiveness and awareness approach to privacy and security in managing extensive health data, improving data processing speed, and increasing adoption rates in Blockchain healthcare.