Babylon Health has by far the most money of all Europe's doctor apps but it's Sweden's Kry that now has the most downloads.
That's just one takeaway from a Sifted analysis of more than a dozen European digital healthcare startups who are using technology to revolutionise our relationship with our doctors.
We focussed specifically on startups that let people speak directly with a doctor via video or phone, known as ‘telehealth’ apps.
Their emergence is steeped in controversy, with many complaining that they are sapping the young and healthy from the existing health system and providing a sub-par standard of care.
But this has not stopped users flocking to the apps and investors, in turn, throwing money at the companies behind them. Babylon Health, Kry and Min Doktor have raised €577m, €87m and €69m respectively.
Outside the richest and most established companies there are many more European players emerging in the digital healthcare market, often targeting specific geographies.
Counting only those with funding over €1m Sifted found 14 startups across Europe that offer doctor consultations over the phone (see below how France's Qare, in particular, is punching above its weight).
We tracked them all down to compare their progress.
Which is the best-funded?
Up until recently Kry was the most highly funded healthcare app in Europe, with €87m in funding. But in early August Babylon received a game-changing cash injection of $550m from a collection of investors led by Saudi Arabia’s Public Investment Fund.
Babylon’s funding now dwarfs that of all the other digital doctor apps. In fact, it now has more funding than all of the others on the list put together.
Sitting in a mid-level bracket is French startup Qare (which has raised $20m) and Doktor.se (which has raised around €30m).
The other startups who shared fundraising figures with us have raised between €1m and €4m each.
Which apps are up-and-coming?
The dominance of first-movers Kry and Babylon can be seen in the number of downloads their apps have received — both way over a million.
While app downloads do not equate to the number of actual users that each startup has, they give a good idea of which startups are emerging fastest.
Interestingly, while Babylon is the best-funded company of them all, its app is not being downloaded at the fastest rate. In fact, it is Kry's app that comes out on top. Notably, though, this does not include other apps that include Babylon features, such as the South East Asian Pulse by Prudential app, like its Symptom checker.
Doktor.se's app is clearly one to watch, as it attracted the second highest number of downloads over the past year, after Kry.
Despite being a newcomer Qare has also reached an impressive download count.
Many more apps are also joining the fray. One to watch is Paris-based Doctolib, which traditionally focused on facilitating face-to-face doctor appointments but started offering consultations over the phone earlier this year .
How many actual consultations?
The number of consultations shows where the real activity is happening (though not every company was able to provide a figure).
On a global level, Babylon has facilitated over two million consultations to date - that's more than 1000 every day since it was founded. This also includes its operations in Rwanda, where the company says it has over two million users who access Babylon-enabled consultations via mobile phone (but not via app). Kry comes in at second place, having hosted around 1,200,000 consultations, while Min Doktor has hosted half this amount at 600,000.
Where are the startups?
France, Spain, Portugal and Russia all have homegrown doctor app startups, but notably there are none from Germany (more on this later).
The UK has by far the most, with five having already bagged over €1m in funding, while Sweden is home to three.
Who's leaving home?
Complex regulation and a reliance on public sector deal explains why most apps have not moved beyond borders.
Kry is the most notable exception. In September last year it launched under the new brand name 'Livi' for its expansion into new markets outside the Nordics and has since landed contracts in both France and the UK. It now has a substantial presence in Spain, Norway, France and the UK as well as Sweden, and around a third of its total app downloads now originate from outside of Sweden.
Babylon also has a global presence, providing digital services through partners in Rwanda, Canada, South East Asia and Saudi Arabia. For its Canadian expansion Babylon built a new version of its app, which now has over 60,000 downloads, alongside local partners Telus Health.
But this is just the beginning for Babylon when it comes to overseas expansion. Flush with its new $550m cash cushion the company is now gearing up for the next stage of its international strategy.
Unlike Kry, Babylon is not focusing its efforts on landing contracts in other European countries. Instead it has set its sights on the US and Asia, where it has ambitions to expand at speed across several countries and languages.
The four other doctor apps based in the UK — Q Doctor, Push Doctor, Now GP and The GP Service have all focused on serving UK customers.
Similarly, Qare is focusing on serving the French market, while DOC+ and Elma are concentrating on their home countries, respectively Russia and Spain.
Regulation is the name of the game
The ability of startups to expand has come hand in hand with regulation.
In France it took until the end of 2018 to pass a law that allows medical diagnoses and treatment to be delivered online. The new rules have since paved the way for the fast-paced growth currently seen by Qare and Kry’s French operations.
In Germany it was illegal to dispense medication to patients who had not been seen directly by a doctor up until August this year. Meanwhile, regulations around e-prescriptions are yet to be finalised, which explains why German doctor apps have been slow to materialise.
On the flip side, countries with governments that are more open to change have seen the most startup action.
A spokesperson for London-based startup Medicspot told Sifted that regulators in the UK are, in general, "willing to work with companies to support innovation”, with the main regulator often hosting sessions to support digital health providers.
The Swedish regulative landscape also has a history of being open to telehealth tech, though this isn’t to say it has been an easy road for Swedish startups, who have been frustrated by the government's impromptu changes to funding rates.
What's the cost
The cost of a doctor consultation varies depending on the partnerships that have been struck by each company. Many apps charge a subscription cost or one-off fee but they have to contend with the fact that healthcare is generally available for free in Europe.
For example Babylon charges £49 for a one-off appointment in the UK or £9.99 a month for an unlimited number, while MedicSpot charges £39 per GP consultation.
Hellocare in France costs €25 per consultation and offers a monthly subscription for doctors €45.
Many are free for patients and funded by the government via partnerships. This category includes Babylon’s 'GP at hand' service, which is available in some areas of the UK.
More money, more stars?
As you might expect the companies with satisfied customers also tend to be the ones with the most funding.
But at the same time the apps with the deepest pockets have not automatically created the happiest customers.
According to app ratings (compiled by analytics company App Annie) Babylon has lower app ratings than three of its lesser-funded competitors, despite enormous backing from investors.
Meanwhile, Qare appears to be punching above its weight, especially given that it has a far smaller pot of funding to play with.