The telemedicine market - France (2023)

1.2 The global market: regional differences but an overall growth trend

Worldwide market size

Telemedicine sales France, ****-****, in billions of US dollars Source: ****

The size of the telemedicine market reached approximately $** billion in **** and is expected to grow at a CAGR of **.*% over the period ****-****, reaching $***.* billion .

The increasing prevalence of chronic diseases and the growing need for patient management will positively influence market revenues. In addition, the Covid-** pandemic has had a very positive impact on the development of telemedicine (***).

The teleconsultation segment was the most important, accounting for **% of the telemedicine market.decine market share in ****(***), reflecting the growth in the geriatric population and the growing demand for home telemonitoring services.

Telemedicine market revenues in North America account for more than half the size of the global market and the US telemedicine industry will continue to grow at a CAGR of **.*% between **** and **** . the European market, meanwhile, is expected to exceed $** billion in ****, or **% of the global market size at that time.

The main market players are : Allscripts Healthcare Solutions Inc, AMD Global Telemedicine, American Well, Oracle Corporation (***), Cisco Systems, Eagle Telemedicine, Honeywell International Inc, Koninklijke Philips NV, McKesson Corporation, OBS Medical, SOC Telemed, Specialist Telemed and Teladoc.

Source: ****

Telemedicine use worldwide: very varied

Telemedicine usageWorld, ****, in %

Source: ...

1.3 The national telemedicine market: potential and barriers to entry in the wake of the pandemic

Value created by telemedicine

In June ****, the Institut Montaigne published a report entitled: E-santé: augmentons la dose! In the first chapter of this report, the institute takes stock of e-health in France, and seeks to identify the value-creation potential of the various segments. For the telemedicine segment, the report praises the exceptional prominence given to the solution by the Covid-** crisis.

Estimated value creation potential of telemedicine by segment France, ****, in billions of euros Source: ****

E-health is part of "healthtech" and encompasses innovations in the use of information and communication technologies (***) for health-related activities.

The French healthtech ecosystem comprises over *,*** companies, including *** biotech, *,*** medtech and *** e-health start-ups. According to the same Institut Montaigne study, the deployment of e-health could generate between ** and ** billion euros a year .

Of this sum,between *.* and *.* billion euros a year by **** would be released by telemedicine, which facilitates access to a healthcare professional and thus combats the phenomenon of medical deserts. Nevertheless, the report also outlines the barriers to entry in this market, notably the incentives for telemedicine, which are still too low, and the lack of equipment for professionals to practice remotely. The report goes on to say that certain solutions are essential if the ...

2.1 Covid-19 sees a recomposition of demand: knowledge of telemedicine and age of patients

The boom in telemedicine since the health crisis

The number of teleconsultations was around ***,*** a year before the crisis, and rose to over a million a week at the critical moment of the health crisis.

Between January and October ****, telemedicine experienced enormous growth: the number of teleconsultations increased *-fold for patients and *-fold for healthcare professionals, helping to better manage the health crisis and also modernize the healthcare system.[***]

In May ****, the Agence du numérique en santé (***) published a set of guidelines describing the expected functionalities of teleconsultation and teleexpertise software.consultation and telerexpertise software, and, on behalf of the French Ministry of Health, listed telemedicine solutions.

Beyond the pandemic, telemedicine is a fundamental lever for setting up new organizations capable of meeting today's challenges. These challenges include the aging of the population, but also the increase in chronic diseases (***). These illnesses are associated with a need for extensive medical follow-up , which can be made easier to endure with telemedicine.

How informed are the French about telemedicine?

Odoxa has already carried out * Telemedicine Barometers, in November ****, June **** and November ****, enabling us to track changes in the way the French and Europeans view this subject. Here are some interesting aspects.

In ...

2.2 Improving French people's opinion of telemedicine and avenues for improvement

As we've just seen, teleconsultation was the most widely used telemedicine tool for GHTs in **** , so we took a look at the current state of the practice.

Do patients and doctors like the principle of teleconsultation?

Patient and physician satisfaction with teleconsultation France, ****-****, in percent Source: ****

The proportion of French people satisfied with the principle of teleconsultation is gradually increasing among those who have tried it: in one year, between November **** and ****, the proportion of satisfied patients has risen from **% to **%, an increase of ** points to get closer and closer to all French people.

On the physician side, satisfaction is less marked, but still significant, with just over **% of doctors satisfied in November ****. A strange phenomenon can be observed: the proportion of doctors concerned fell sharply between November **** and June ****. There is no real explanation for this drop, but we can imagine that given the health crisis between February **** and June ****, which forced the use of teleconsultation by doctors who had not previously used it, this is the reason for the decline.decins who were not necessarily prepared for it and therefore found it harder to grasp and use this tool, generating a stronger feeling of dissatisfaction than in November ...

2.3 Tele-expertise

Telerexpertise enables a healthcare professional to remotely seek the opinion of one or more colleagues for their particular skills, using digital technology. It brings together a doctor with a request and a doctor in need. Telerexpertise acts have been billable to Assurance Maladie since February **, ****.

Telerexpertise consultations

Omnidoc is a telerexpertise platform that has released figures on the habits of doctors using the platform in ****[***] :

Response time

Omnidoc users took an average of * minutes to write a tele-expertise request and * minutes to respond.

Depends on specialty

In cardiology, the question (***). In dermatology, on the other hand, the question took * minutes and the answer ** minutes. Ophthalmology was the specialty with the fastest tele-expertise time: * minutes. Psychiatry, on the other hand, took the longest, at * and ** minutes respectively.

Response time

The average time between sending the request and the end of the tele-expertise was ** hours. This figure could vary, as some respond quickly between two consultations, while others wait for a suitable moment during the day or week. A quarter of tele-expertise cases were answered in less than * hours, while a quarter took more than * days, reflecting differences in response time habits.

Doctors and tele-expertise

Data on doctors and tele-expertise France, ****, in percent Source: ...

2.4 Consultation habits

It may be interesting to know the habits of the French towards health and doctors. We're going to base ourselves on a **** study by Doctolib, as unfortunately few studies have been carried out on these issues. Here are some interesting results:

Share of main reasons for GP consultations France, ****, in percent Source: ****

This graph helps us understand what the reasons for consulting a GP were, which, as we'll see in part *.*, represent the majority of consultations with the doctor. These are the main reasons, so the list of practices is not exhaustive. General medical reasons accounted for **% of all consultations. Prescriptions and certificates accounted for *% of the reasons, and we saw earlier that this was one of the reasons for teleconsultation. The fact that the proportion of consultation reasons concerning "specialized" problems (***) engages an easier projection of telemedicine and teleconsultation.the fact that general medical concerns relate to comprehensive, ongoing care that seems easier to manage at a distance makes it easier to project telemedicine and teleconsultation .

In ****, again according to the same study, the average waiting time for an appointment was * days for GPs and ** days for the other main medical specialties. A GP carried out an average of ** consultations ...

3.1 Telemedicine within the complex structure of e-health

Telemedicine is a segment within a complex ecosystem involving health and digital technology: e-health. A French government agency, theAgence du numérique en santé, is responsible for regulating, operating, promoting and enhancing the digital transformation of the healthcare system, and this is structured around * orientations:

Source: ****

Telemedicine is part of the *ᵉ orientation of the Agence du numérique en santé within article **. Since health insurance covers teleconsultations and ARS (***), the production of a functional reference framework for the urbanization of telemedicine platforms, the enhancement of the interoperability framework, and so on.

What is e-Health?

According to the WHO (***), e-health is defined as follows: "the use of tools for the production, transmission, management and sharing of digitized information for the benefit of health care practices.information for the benefit of both medical and medico-social practices"[***].

Source: ****

Telemedicine is therefore a sub-segment of telehealth, itself integrated into the concept of e-health. In fact, telehealth is divided into telecare and telemedicine, each of which is defined as follows:

Telecare, according to article L. ****-* of the French Public Health Code, is defined as "a form of remote healthcare practice using information and communication technologies. It puts a patient in contact with one or more ...

3.2 Player structure

The two types of offer

Under the impetus of the French government, a public offering has developed through regional platforms. The introduction of common law reimbursement by the French health insurance system has led to the emergence of a private sector (***) offering services directly to healthcare professionals and patients, making the available offer more complex: the regional platforms set up in response to the experimental framework are being called into question by the proliferation of new offerings, whose quality needs to be assessed.

In short, there are two types of telemedicine offerings in France today:

A regional public telemedicine offering, financed by the ARS and made available to local healthcare professionals; An industrial "BtoC" offering that has developed in parallel, especially since the reimbursement of teleconsultation and telerexpertise acts by the health insurance scheme. Some thirty new players have been identified, offering telemedicine services of widely differing quality (***).

There are also insurers and mutual insurers on this market, who see predictive medicine and connected objects as a way of improving their knowledge of health risks. As early as ****, Axa offered a teleconsultation service which, in three years, has reached **,*** annual appointments. Santéclair, VYV and April Santé Prévoyance soon followed ...

3.3 Regional players

Regional platforms refer to all the platforms implemented under the guidance of the Agences Régionales de Santé and their Groupements Régionaux d'Appui au Développement de la e-Santé. In ****, ASIP Santé (***) listed ** regional telemedicine platforms in one of its publications[***]. The Agency has not updated its list since.

Here are the details of these platforms:

Source: ****

Of the ** regions (***) surveyed, only Corsica stated that it did not have a dedicated regional platform. This can be explained by the close collaboration between Corsica and the PACA region on e-health development issues, with the PACA region making its tools available to Corsica. In some cases, there are several regional platforms. This multiplicity has arisen for a number of reasons:

Following the recent territorial reform, several regional platforms that had previously been developed by the GCS e-santé may have found themselves brought together in the project portfolio of a single GRADeS. In some regions, the process of bringing together the "former" regional platforms has begun (***). The platforms may have been developed on different perimeters: there may be a platform dedicated to tele-expertise and one dedicated to tele-consultation (***). Some platforms only allow telemedicine procedures to be carried out on mobile devices (***).

How regional ...

3.4 Diversity of private players: a market that is becoming more structured

Diversity of private players

The typology of players is highly varied, due to the diversity of products required to carry out telemedicine procedures:

Large groups (***) also have a role to play in this field, thanks to their ability to retrieve, store and process large quantities of data. SMEs and startups (***): French startups are well positioned overall in terms of innovation, accounting for **% of new measuring devices referenced on the market, placing France at the forefront of this segment. [***]

Thus, the telemedicine sector is conducive to strategic alliances that bring together digital and technical skills with knowledge of the medical ecosystem[***] :

Servier has entered into a partnership with Cardiorenal to develop a telemedicine tool for better monitoring of heart failure patients. Cegedim has developed a commercial partnership with VISIOMED to integrate Visiocheck, a portable telemedicine station, into its offering.the Visiocheck is a portable telemedicine station that meets most of the needs of a general practitioner during a consultation. Acetiam (***) has teamed up with Bepatient to deploy telemedicine solutions in France and Europe. The AXA Group has teamed up with H*D, which is developing the "consult station", a booth dedicated to teleconsultation.

Private platforms

Regional telemedicine platforms differ from private platforms, ...

4.1 Specialties covered: still incomplete but growing

The offer of diversified services is still most often carried by regional platforms, whose logic and economic model will have to be rethought following the arrival on the market of private providers of MLT platforms.[***]. Services can be offered by:

Regional telemedicine platforms: Agences Régionales de Santé (***) ; Public service providers: services provided by healthcare establishments and professional groups; Private operators: to the best of the knowledge of the people we spoke to at ARS and GRADeS.

Non-exhaustive list of specialties covered by telemedicine servicesFrance, ****

Source: ****

The table above lists the specialties covered by the various telemedicine services in the regions that responded in **** to theASIP questionnaire. Thus, it can be seen that specialties not covered by telemedicine services are rare in French territories. The full list is available on page ** of the Agence Française de la santé numérique report.Generally speaking, tele-consultation and tele-expertise services were similar, with two or three exceptions.in general, tele-consultation and tele-expertise were similar to tele-monitoring and tele-assistance, with just two exceptions: they were also the most developed practices compared to tele-monitoring and tele-assistance. In ****, the telemedicine offering was fairly well developed, but did not yet cover all medical specialties (***), such as allergology. ...

4.2 The regional platform offering: types of platform, functionalities...

Different types of regional platforms[***]:

Telemedicine platforms are mainly available:

Via the Internet, in SaaS mode (***) ; Via a web portal requiring installation of a lightweight application (***); Via a heavy-duty application (***).

Mobile access (***), on the main mobile environments in the case of an application.

Different platform functionalities

ASIP Santé's latest survey of regional platforms dates back to ****. At that time, the following functionalities were not available on all platforms: management of a list of participants(***). However, between **** and ****, the regional platforms will certainly see their functionalities increase, especially as the Agence du Numérique en Santé has been working to develop collective e-health actions in the region for several years.

Functionalities of regional telemedicine platforms France, ****, % of total Source: ****

Which tools?

Here are the trends for ****, according to ASIP:

Greater use of consumer terminals (***) ; Use of connected medical equipment is still low(***); Availability of teleconsultation carts (***).

4.3 Innovative offers

Examples of start-ups offering teleconsultation services[***]

Doctolib

The launch of its teleconsultation solution came late, in January ****. However, by September ****, more than **,*** teleconsultations had already been carried out on Doctolib, representing two-thirds of the procedures reimbursed by the French social security system. Between January **** and March ****, ** million teleconsultations were recorded, including ** million by GPs. This means that **% of general medical consultations on the platform are teleconsultations. [***]

Doctolib has also become the most valuable start-up in France, at *.* billion euros by ****. [***]

H*D, the teleconsultation booth

The start-up offers a cabin where the customer is placed in front of a connected screen. This cabin enables the patient to be weighed, measured and auscultated for teleconsultations. Seated in an armchair, the patient is weighed, measured and auscultated in front of a connected screen. LBO France and BPIFrance have invested in this start-up. It is a service company: by paying *,*** to *,*** euros a month to companies or senior residences, they can access the cabin. A secure appointment-setting module is installed on the facility's intranet. The basic consultation fee (***) is fully covered by complementary health insurance. Between **** and ****, some ** cabins had been deployed, with ** doctors consulting occasionally. [***]

In ****, the Yvelines département launched an unprecedented ...

4.4 Different issues

Various issues arising from the existence of a multiplicity of players

Clarification of the offer, clarifying the positioning of regional platforms and private platforms. As a result of this abundance of offerings, there is a lack of standardization, which can be limited thanks to support and guidance tools for players. These tools can provide a framework for :

Industry publishers (***); Healthcare professionals (***); Patients (***).

The construction and implementation of a standardization process (***) for telemedicine solutions would appear to be the best way of meeting these challenges.

The need for cooperation between players: particularly between regional platforms. Available data are not sufficiently consolidated, which hinders a global analysis that would be more relevant. The establishment of a " telemedicine observation center ",[***] based on cooperation between all the institutions piloting and supporting telemedicine.all the institutions steering and supporting the development of telemedicine (***), would enable us not only to better understand and analyze the deployment of telemedicine, but also to anticipate developments in this still new practice and support professionals in the field.

Security issues

The protection of personal data is a key issue: it represents a major risk for the patient, and therefore requires efforts in terms of quality and security of care (***).

5.1 General regulations

The entry of telemedicine into common medical practice law

Since its introduction into French law in ****(***), telemedicine has developed around a number of priority areas.priority axes embodied in the various guides and specifications published by the DGOS, as well as legislative and regulatory texts:

In ****, article ** of the French social security financing law (***) provided for experiments in the deployment of telemedicine in the city and in healthcare facilities.decine in town and in medico-social structures for a period of four years in pilot regions, then to the whole territory from ****. [***]

The publication of several specifications define the conditions for implementing these experiments:

order of April **, ****: specifications for chronic and/or complex wounds ; order of April **, ****: teleconsultation and tele-expertise specifications (***); order of December *, ****: remote monitoring specifications (***); order of April **, ****: specifications for remote monitoring of diabetes ; order of November **, ****: specifications for telemonitoring of patients with implantable cardiac prostheses for therapeutic purposes.

In ****, telemedicine became part of common medical practice law.in concrete terms, one of its components, teleconsultation, has been reimbursed by the Assurance Maladie since September ****, in the same way as "classic" consultations and the reimbursement from from February **** of telerexpertise, which enables a doctor to remotely seek the opinion of ...

5.2 Government measures to help integrate the practice

Government intervention

There are several reasons why public authorities want to make telemedicine more widespread:

Combating medical deserts; Reducing appointment waiting times (***); Control health-related expenditure. The economic stakes are also high, since telemedicine, by enabling better risk prevention and optimizing the organization of care, could save money.organization of care, telemedicine could generate substantial savings for the healthcare system (***).

Actions taken by the French government: developing a regional public telemedicine offering

In ****, the French government set up the ETAPES program (***), which "encourages and financially supports the deployment of telemonitoring projects throughout the country."This program defines a legal framework and sets a fee structure that enables healthcare professionals to develop coherent, relevant projects, in response to healthcare needs and the regional healthcare offer.

The provision of telemedicine-based care has developed progressively and uniformly across the country, around regional telemedicinegional telemedicine platforms funded by the Regional Health Agencies (***). [***]

Reimbursement for teleconsultation and tele-expertise

Since September **, ****, teleconsultation has been reimbursed by the Assurance Maladie[***]. However, there are several conditions for eligibility for reimbursement of the act by Assurance Maladie:

The teleconsulting doctor must know the patient (***); Teleconsultation must be part of the patient's care pathway (***).

Exceptions apply in emergencies, depending on the patient's ...

6.1 Positioning the players

• Ortif- Outil Régional de Télémédecine d’Île-de-France
• Maincare
• Omnidoc
• Qare (HealthHero)
• Doctolib
• NEHS Digital
• Feeli
• Hellocare
• Livi (KRY International AB)
• Medadom
• Teladoc
• Tessan
• Tunstall Vitaris (Tunstall Healthcare)