So I do a lot of work in digital health, and regulatory alignment is not uniform across Europe, neither is the Health Technology Assessment (basically how effective from both a medical and a cost perspective) a technology is. That by and large is not in place at the moment so a startup would have to start from scratch in each country they go into rather than using evidence from one country as leverage when entering a second. That wouldn't be the case in the United States, for example.Of course a big single market can be a benefit, but how big does the single market need to be ? Is 450 million people enough ?, does it need to be over 1Bn ? Or do you just do a deal with India ? What is it you are going to sell to all of these people ? For instance Scottish Whisky is sold in 166 countries worldwide and not just the 27 in the Eu or America or China. How do they manage that ? The startups you refer to don’t need to conquer the world in the first year and can indeed take their growth one market at a time and learn a lot by doing so. What are the real markets for what products and who are the real customers ? Being in a little country like the U.K. or Japan isn’t a barrier to success, both have some very large companies as you are aware. Though I’m still struggling to understand why a Czech startup, which is in the EU, needs additional markets or what barriers are being put in its place. I can accept that each Eu country may well have differing requirements and that if all of the EU was exactly the same then life would be easier for them. But even in England alone there will be a myriad of systems requirements for different councils/hospitals/businesses or whatever their customers requirements are, so they might as well pick on one ‘international’ market and give it a go, then do the next, and the next......
As for how large, well that kinda depends doesn't it? At the moment one of the best health startups in the UK (@Jebus_lives may think otherwise) is Babylon. They've got 4 million or so users, which is a decent amount, and the majority of those are in the UK. For a bit they had a partnership with Tencent in China. Keep in mind that Tencent have well over 1 billion active users. It's perhaps no surprise that Tencent now does their own telehealth platform and ditched Babylon. Amazon are strongly expected to launch a telehealth platform of their own soon too and could quickly and easily market that to their 310 million customers, or even their 90 million Prime members. It's a different ballgame, and Babylon is valued at a few billion so is no small fry, but they haven't made a single dent in the European market.
