\n
But repeating that success in other markets has proved challenging. <\/p>\n
Doctolib expanded into Germany in 2016, but after eight years in the German market, the company has only recently begun to gain traction.<\/p>\n
Of the 900,000 healthcare providers and 80 million patients that have signed up to use Doctolib, Germans account for 200,000 providers and 19 million patients.<\/p>\n
Adapting from the centralised French system to Germany\u2019s federal setup was just the first among many obstacles that tested the flexibility of the platform.<\/p>\n
\u201cThere is no [one] German market entry,\u201d says Nikolay Kolev, managing director of Doctolib Germany. <\/p>\n
Each of Germany’s 16 federal states was a different market the firm had to adapt to.<\/p>\n
However, the complications that initially make it hard to get off the ground in Germany also protect established companies and make it difficult for new competitors to pose much of a threat.<\/p>\n
Dr Carol von Wildhagen, a medical doctor and health venture partner at Munich-based Caesar VC who previously led the German arm of Platform24, a Scandinavian telemedicine provider, says existing closed systems in practices are also a major barrier to entry.<\/p>\n
\u201cThe companies who make and sell the many, many, many [practice management systems] construct them as fortresses, so it’s very hard to connect any third-party software to a doctor’s practice software. That makes it very hard to deliver value to the doctor,\u201d she says.<\/p>\n
\u201cI can see how the big incumbents who traditionally produce practice information systems would be worried… they could become leapfrogged quickly because their systems are old, look old, feel old, are not very user-friendly, and might be replaced by something cloud-based that focuses on user experience.\u201d<\/p>\n<\/div>\n\n\n
RAISE Summit<\/span><\/div>\n<\/div>\n“Home field advantage” makes a big difference for European start-ups says Liam Boogar-Azoulay<\/figcaption><\/p>\n<\/figure>\n\n
\u201cI think home field advantage always plays a big role in the European start-up scene\u201d, says Liam Boogar-Azoulay, who founded France\u2019s bilingual startup blog, Rude Baguette, in 2011, and is now a co-founder at Waypoint AI.<\/p>\n
\u201cGermans like buying from German companies and I think that can’t be overstated. It’s the same for almost every country,\u201d says Mr Boogar-Azoulay.<\/p>\n
Perhaps part of the reason for this reticence about non-German companies, and a hesitation to embrace digitisation more generally, is a belief that only a homegrown company will understand the German desire for high levels of data security.<\/p>\n
Doctolib\u2019s 2022 acquisition of French data encryption startup, Tanker, may be a gesture toward setting data security-conscious minds at ease.<\/p>\n
But Mr Kolev doesn\u2019t believe that data security is really why the German system has been slow to change.<\/p>\n
\u201cThe best available security and privacy should be our baseline if we really want to move this industry forward. So I don’t think that data privacy is the problem in the German healthcare market. I think it’s more the fax machines.\u201d<\/p>\n
He\u2019s not joking. A 2023 study by German digital advocacy group, Bitkom, found that 82% of German companies still use fax machines on a regular basis. In many cases, fax is the go-to method for sharing medical information.<\/p>\n
Increasing digitisation has been on the German state\u2019s agenda for a long time. Germany\u2019s National Association of Statutory Health Insurance Physicians estimates that healthcare practices spend around 61 days per year on paperwork alone.<\/p>\n
Doctolib relies on the move away from paperwork to digital services.<\/p>\n
\u201c[Outdated tech is] not a problem that can’t be overcome. It\u2019s just a barrier to adoption,\u201d says Mr Boogar-Azoulay.<\/p>\n
\u201cI think just having the French tailwinds and having that market behind them, they’re gonna be able to throw money at the problem for a long time. It doesn’t have to be efficient. They can lose money in the German market for 10 years just to get over that barrier of fax machines.\u201d<\/p>\n<\/div>\n
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More Technology of Business<\/span><\/div>\n<\/div>\n\n
And it\u2019s easy to see why Doctolib is willing to invest a lot in making their operation in Germany work. As Mr Boogar-Azoulay points out, the market opportunity is “insane”.<\/p>\n
As Germany\u2019s 84-million-strong population continues to age and doctor shortages grow, the healthcare system sorely needs widespread optimisation to alleviate pressure and reinstate Germany\u2019s reputation for efficiency.<\/p>\n
The most recent available statistics show that Germany spent \u20ac495bn on health in 2023, around 13% of its total GDP. Germans visit the doctor around 9.6 times per year, which is significantly more often than most other Europeans.<\/p>\n
In 2022, German primary care physicians saw a weekly average of 254 patients, where their French counterparts saw around 114, with UK doctors seeing 110.<\/p>\n
Lessons learned from expanding into Germany are visible in how Doctolib approached the Italian market in 2021. Though Italian user numbers are still low, Doctolib acquired Italian competitor Dottori.it to gain an initial foothold in the market.<\/p>\n
And what about crossing the channel?<\/p>\n
\u201cThe UK is certainly an interesting one. But having said that, Germany, France, and Italy alone are 55% of the European healthcare market. So if you\u2019re well positioned there, that\u2019s already half the rent,\u201d says Mr Kolev.<\/p>\n<\/div>\n<\/div>\n
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