France’s start-up champion Doctolib struggles to make it abroad

“I think home field advantage always plays a big role in the European start-up scene”, says Liam Boogar-Azoulay, who founded France’s bilingual startup blog, Rude Baguette, in 2011, and is now a co-founder at Waypoint AI.

“Germans like buying from German companies and I think that can’t be overstated. It’s the same for almost every country,” says Mr Boogar-Azoulay.

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.

Doctolib’s 2022 acquisition of French data encryption startup, Tanker, may be a gesture toward setting data security-conscious minds at ease.

But Mr Kolev doesn’t believe that data security is really why the German system has been slow to change.

“The 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.”

He’s 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.

Increasing digitisation has been on the German state’s agenda for a long time. Germany’s National Association of Statutory Health Insurance Physicians estimates that healthcare practices spend around 61 days per year on paperwork alone.

Doctolib relies on the move away from paperwork to digital services.

“[Outdated tech is] not a problem that can’t be overcome. It’s just a barrier to adoption,” says Mr Boogar-Azoulay.

“I 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.”