EU mHealth App Market Leaders Identified: Denmark, Finland, Netherlands, Sweden, and UK Top the Rankings

1. Summary

The ranking of the internet healthcare app market in EU countries is part of mHealth App Developer Economics, the world’s largest research project on internet healthcare. This year, more than 4,400 app developers, healthcare professionals, and digital health practitioners shared their insights on the global and EU internet healthcare markets.

These practitioners’ perspectives incorporate the results of market maturity assessments across various countries, which are based on five dimensions and 26 market indicators, including e-health adoption levels, digitalization levels, market size and healthcare expenditure, ease of doing business for startups, and regulatory frameworks for internet-based healthcare.

Based on the ranking results, Denmark, Finland, the Netherlands, Sweden, and the United Kingdom offer the most favorable market environments for digital health startups in the European Union. These countries scored highly in market maturity assessments and have gained recognition from digital health practitioners. Entrepreneurs in the digital health sector should consider these nations as their starting points for EU operations.

Germany and France, however, boast the most complex digital health markets within the European Union. On one hand, their market potential is viewed favorably by most digital health practitioners, given the large numbers of patients, physicians, and hospitals, as well as substantial healthcare expenditure. On the other hand, their market potential is dampened by lagging performance in regulatory oversight, adoption of electronic health services among patients and providers, and the overall level of digitalization within their healthcare systems. Consequently, companies in these countries exhibit a comparable degree of both engagement with and resistance to digital health initiatives.

Greece, Romania, and Latvia all rank relatively low. The market environments in these countries are not only below average but also suffer from a poor reputation within the digital health community.

Overall, market maturity varies across countries; nations that rank highest on market maturity indicators often provide a business environment more than twice as favorable as that of lower-ranking countries. Entrepreneurs in the internet healthcare sector must recognize these cross-country differences and adopt a selective approach in their market entry strategies.

At present, most EU countries have not yet begun to view internet healthcare companies as a means to attract top talent, improve patient outcomes, and reduce healthcare costs. Consequently, these countries lack both a roadmap for internet healthcare and any guidelines necessary to assure investors of the security of their investments in this sector.

2. Scope and Methodology

This report is part of the fifth “mHealth App Developer Economics” research program conducted this year.

The ranking of the digital health app market in EU countries is based on research findings from an assessment of the digital health business environment across EU member states, conducted by app developers. Participants were asked to select the top three and bottom three countries in the digital health sector from among the 28 EU nations, and to provide reasons for their rankings, which were typically grounded in their entrepreneurial experiences in these countries and word-of-mouth perceptions.

The second core element of the study on the maturity of the internet healthcare market in EU countries is the assessment of national status across five dimensions.

These five dimensions of market maturity for internet healthcare apps characterize the key national market conditions that impact the operations of internet healthcare companies, existing medical institutions, or startups. Each country is ranked according to these five dimensions and 26 market condition indicators.

3. EU Internet Healthcare App Business Accelerator

The EU Digital Health Enterprise Accelerator comprises several service organizations dedicated to helping digital health app developers and national agencies develop their own marketing approaches and market access strategies, thereby enhancing the country’s appeal to digital health entrepreneurs.

These services are built upon a comprehensive database that includes European digital health app developers, policymakers in government organizations, existing digital health marketing channels, and a team of experienced digital health consultants.

4. Ranking of Internet Healthcare App Markets in EU Countries

EU countries offer different market environments for internet healthcare companies, so it is essential to understand these differences before launching internet healthcare services in any given country.

The most favorable market environment is found in countries that receive high scores across all five dimensions of internet healthcare market maturity and are recognized by internet healthcare practitioners.

These countries can serve as an ideal starting point for internet healthcare businesses in Europe.

EU countries are categorized into four groups based on their market maturity and reputation among practitioners in the internet healthcare app sector:

First Choice: Denmark, Finland, the Netherlands, Sweden, and the United Kingdom.These countries demonstrate the strongest market environments, and their potential has been recognized by digital health professionals. They are the most favorable countries for launching digital health businesses within the European Union.

Optional—Belgium, Estonia, France, Germany, Ireland, Portugal, Spain.These countries may attract developers’ interest depending on their business models. Therefore, this group should be selectively included in the pilot programs for internet-based healthcare within the EU, as their prerequisites are not as favorable as those of the first group.

Watchlist – Austria, Croatia, Czech Republic, Hungary, Italy, Lithuania, and Poland.These countries either receive low ratings from developers of internet healthcare apps or have poor market environment ratings. These market conditions warrant further observation over the next two to three years to assess potential improvements.

Delay—Greece, Latvia, and Romania.These countries have a poor reputation among digital health developers, and their markets are in a relatively weak state; therefore, they should be placed on a “watch list” for further observation.

Bulgaria, Cyprus, Luxembourg, Malta, Slovakia, and Slovenia are not included in the market access status for telemedicine apps, as app developers have provided virtually no ratings for these countries.

In nearly half of the countries, market maturity conditions align with the perspectives of internet healthcare practitioners, indicating that internet healthcare companies maintain a pragmatic view of the market conditions in these countries.

For Germany, Ireland, Austria, Poland, and the Czech Republic, internet healthcare practitioners appear to hold an overly optimistic view of the market maturity of internet healthcare.

On the other hand, countries like Spain actually offer relatively favorable market conditions for the telemedicine industry, but this has not been effectively communicated to developers of telemedicine apps.

For most countries, it is necessary to develop a roadmap for internet-based healthcare. A national roadmap for internet-based healthcare should outline the steps to be taken over the next two to three years to improve market conditions, particularly by establishing clear guidelines that specify what is permitted and what is prohibited.

Secondly, it is becoming increasingly important to formulate a strategic approach for the internet healthcare developer market to attract top-tier internet healthcare companies to the country, create employment opportunities, and reduce healthcare costs through innovative methods.

4.1 Assessment of Participants in Internet Healthcare Apps

Predictably, internet healthcare practitioners from the EU have a deeper understanding of the market environment compared to their counterparts in North America, Asia, or other regions of the world.

Most internet healthcare practitioners (70%) have their top three countries in mind, but only 50% can identify those with poor market conditions for internet healthcare.

The analysis also points out that 20% to 50% of internet healthcare practitioners lack sufficient understanding of the medical system and the overall market environment for internet healthcare, making it difficult for them to assess the country’s market and formulate market entry strategies for their internet healthcare services.

If practitioners in the internet healthcare app industry were to assess a country's market, they would recognize that the United Kingdom is the best country for them to launch their internet healthcare services.

55% of digital health practitioners stated that the UK offers the most favorable market environment for digital health services, with Germany (41%), Sweden (23%), the Netherlands (23%), and Denmark (18%) also receiving positive feedback.

The bottom five countries—Portugal, Romania, Lithuania, Greece, and Hungary—were each mentioned by only 1% of participants.

Practitioners in the internet healthcare sector regard physicians’ willingness to adopt new technologies as a key component of the favorable market conditions provided by a country. Fifty percent of these practitioners stated that a country’s high ranking depends on whether physicians are willing to apply and integrate internet healthcare technologies into their patient treatment and communication practices.

Since EU countries generally do not provide reimbursement for internet-based medical services, the high rankings of these countries are driven more by physicians’ openness to new technologies than by the existing business models of internet healthcare.

Another key factor contributing to a country’s high ranking is the level of digitalization in its hospitals. The ability to integrate internet-based medical services, such as electronic medical records (EMR) and hospital process management systems, is regarded as another advantage driving the development of a nation’s internet healthcare industry.

Market size (e.g., resident population, number of patients and physicians, and healthcare expenditure) is another factor that internet healthcare practitioners consider when assigning a higher rating to a country.

"Integration with developers is regarded by 31% of digital health practitioners as a factor contributing to favorable market conditions."

Only 17% of internet healthcare practitioners believe that patients’ willingness to pay for internet medical services is a factor that can enhance their preference for the country.

Many other factors determine what constitutes a favorable market for an internet healthcare company. In countries where physicians have low acceptance of the internet healthcare model, patients are regarded as the primary driving force behind market growth. As one internet healthcare practitioner stated:

“The key to the success of internet healthcare lies in consumer willingness and demand, as well as the disruption of existing business models. This requires widespread broadband internet access, high penetration of mobile devices, a well-educated society, and a favorable social environment.”

From the perspective of digital health practitioners, the characteristics that constitute favorable market conditions vary by country. In the United Kingdom, Sweden, Denmark, and the Netherlands, physicians’ acceptance of mobile apps and a high level of digitalization are considered the primary drivers. Meanwhile, Germany’s appeal is attributed to its substantial market size and large base of potential users.

“Nordic countries and the Netherlands appear to be at the forefront of medical technology, with the Netherlands boasting a very strong entrepreneurial ecosystem.”

Some practitioners also view the number of app developers, demand for remote medication management, high levels of patient engagement, and user sophistication in countries such as Finland, Sweden, and Denmark as positive factors.

Developers (32%) regard Greece as the country with the least developed digital health sector. This may be influenced by the country’s economic environment, but there are also factors inherent to digital health itself, as they prevent digital health developers from bringing their businesses to Greece. Romania (25%) ranks second due to its poor market conditions.

Croatia, a country that has pledged to invest in digital health systems and is regarded as a pioneer in leveraging app-based ICT to enhance healthcare efficiency, has been ranked by internet healthcare practitioners among nations with poor market conditions. The country’s representatives need to reevaluate their communication strategy, as it appears they have failed to engage effectively with their primary target audience—developers of internet healthcare apps.

There are four other major factors that are equally important to developers. Prohibitive laws represent the largest national barrier, with 28% of respondents citing them as the primary reason for not conducting business in a given country. Following closely are patients’ unwillingness to pay for internet-based healthcare services (27%) and a lack of market awareness (27%). In contrast, high competition and the need for local partners are not considered major barriers to market entry.

Overall, internet healthcare companies believe that the European healthcare industry is relatively closed and lacks transparency, with limited communication among physicians and between doctors and patients. One practitioner summarized the disadvantages of Europe compared to the United States as follows:

“European countries do not share healthcare industry information (such as innovation, roadmaps, and standardization) with the broader public. In the United States, the public has access to more digital health industry information.”

4.2 Maturity of the Internet Healthcare Market in EU Countries

The market maturity of the internet healthcare sector is assessed based on five dimensions of market maturity and 26 market condition indicators derived from research. These dimensions describe the market environment relevant to the majority of internet healthcare industry models, including overall acceptance, stakeholders’ operational capabilities in the internet healthcare sector, market size, ease of doing business, and regulatory landscape.

The data represents the performance of 28 countries across five dimensions and 26 indicators on a scale from 0 to 1, with the highest-performing countries scored as 1 and the lowest-performing countries as 0.

Based on all dimensions and metrics, Denmark achieved the highest composite score. Although it does not have the largest market size, it ranked within the top five across all dimensions.

Following Denmark are Sweden, Finland, Spain, and the Netherlands; all five top-ranked countries boast digitalized societies. Their populations are accustomed to using medical technologies, and these nations have established supportive regulatory frameworks.

The lowest-ranked countries are the Czech Republic, Poland, and Romania. This is primarily due to their low acceptance of e-health, limited digitalization, and inadequate network coverage.

Germany’s ranking is relatively low. However, it cannot be denied that it holds the greatest market potential in terms of prospective users and potential purchasing power.

5. Guidance

Several conclusions can be drawn from the rankings of mobile app markets in EU countries: digital health remains a market with significant growth potential. Currently, digital health is not an integrated component of healthcare systems in EU countries, and the foundations of the digital health industry vary across the 28 EU member states. Companies seeking to invest in the EU market must recognize these differences. In general, whether for companies looking to invest in the digital health sector or those aiming to develop digital health operations in one or more EU countries, attention should be paid to the five market dimensions outlined in this report. When formulating market entry strategies, digital health companies should:

1) Engage with institutions in each country that can provide support for internet healthcare services;
2) Understand each market metric that can impact the business model;
3) Fully understand how the healthcare system operates;
4) Carefully select the EU countries in which to launch services (achieving success in one country is preferable to mediocre performance across several);
5) In the absence of clear grounds for objection, priority shall be given to the top five ranked countries;
6) Prior to market entry, consult with and fully leverage the experience of practitioners in the target countries;
7) Assess the preferences of physicians and patients;

On the other hand, national institutions should recognize that their competition aims to identify the best talent and technologies capable of integrating internet-based healthcare into the existing medical system, as well as to unlock its potential in improving patient outcomes and reducing national healthcare expenditures.

Analysis indicates that, with the exception of countries such as Denmark and Spain, government agencies have not assumed responsibility for attracting internet healthcare providers. This implies that formulating a national roadmap and guidelines for internet healthcare can yield competitive advantages and offset deficiencies in other market conditions pertinent to the development of internet healthcare services. National agencies should undertake the following measures for internet healthcare:

1) Recognize that internet healthcare companies are valuable partners, capable of digitizing medical systems to reduce costs and improve quality;
2) Listen to the perspectives and needs of internet healthcare practitioners regarding domestic market conditions;
3) Develop a national roadmap and guidelines for internet-based healthcare;
4) Actively participate in the market for developing internet healthcare apps;
5) Notify and mobilize physicians to adopt internet-based healthcare services, as they can serve either as barriers to domestic practitioners in this field or as drivers of industry growth;
6) Driving the digital transformation of healthcare systems, such as accelerating the adoption of electronic health records or enhancing communication between doctors and patients;

Source: research2guidance Compiled by Zhao Yinong Edited by Mo Renying