HealthTech is a growing business right across Europe, taking second place after FinTech in numbers of innovative scale-ups. That’s hardly surprising: the ageing population, the increase in chronic conditions, and new technologies and treatment methods such as mHealth, CRISPR and immunotherapy are putting existing working methods and business models in health under serious fire. More than anything, we expect care systems everywhere in Europe - and worldwide - to adapt in the direction of more prevention, more home care, more mobile and digital health, with greater entrepreneurship and an emphasis on quality.

Care facilities and businesses in the sector are already making these changes here and there. The healthcare field is changing, and we see that in the nature and scope of heath entrepreneurship as well.

The data provided by Sirris on the Belgian startup landscape and the European scale-ups makes it possible to put Belgian HealthTech, a collective name for CareTech, RegMed and MedTech companies, in perspective: what is the identity and core culture of the Belgian and European HealthTech scene? What is the situation in terms of growth from start-up to scaleup? And what can the analysis of HeathTech investments teach us about Belgian health entrepreneurship from a European perspective?

Five things you need to know about the Belgian HealthTech ecosystem in 2017

1) Belgian HealthTech is alive and kicking

HealthTech is the undisputed leader in the Belgian start-up landscape, even outranking FinTech and manufacturing. Almost 10% of all technology companies are in HealthTech. 2014 (with the launch of at least 35 start-ups) and 2015 (29) were top years for the sector, which has seen persistent growth since 2009. Likewise, when it comes to scale-ups, healthcare is number one in Belgium: in fact, with 46% scale-ups, the sector scores well above the average of 39% for all sectors. This shows that the ‘new kids on the block’ really can grow up. These are attractive, striking figures for a country as complex, diverse and frankly tiny as Belgium. It is true to say that health start-ups in Belgium don’t find themselvesin the easiest of markets.

This may also explain the large number of spin-offs and spin-outs among Belgian HealthTech starters: 18% of them have grown out of research organizations, twice the percentage that other sectors experience. This means that HealthTech entrepreneurship has more links to existing organizations and structures than entrepreneurship in other sectors.

However, the majority of HealthTech companies do not have this spin-off link. In recent years, we have also seen many initiatives and networks that are supporting healthcare entrepreneurship (e.g. Voka Health Community, MIC Flanders, innovation by impulse.brussels; Leuven Mindgate; BlueHealth Antwerp, Agoria Health, Caring Entrepreneurship Fund, MedTech Flanders, Flanders Care, Le WeLL etc.), thus creating a real crucible of opportunities for entrepreneurs, new ones in particular. It was not without reason that the European Commission’s European Innovation Scoreboard still ranked Belgium as a champion of innovation networks at the beginning of September.

Belgian HealthTech is also doing extremely well in terms of the number of investments. Nine Belgian players have already taken the plunge and scaled up this year, each attracting at least a million euros in external financing: Ontoforce, Molecubes, Icometrix, Nyxoah, Sihto, Bloom Technologies, OncoDNA, Qaelum and UgenTec. The latter won the hotly contested Deloitte Rising Star trophy for 2016.

Thanks to these growing businesses, we rank an impressive fourth in Europe:

If we take population size into account, Belgium is actually in second place for HealthTech. Here, too, courage and self-confidence are required, however: there is sufficient capital available in our country to support businesses. Unfortunately, it is not available as risk or growth capital. Belgian entrepreneurs are often too modest. That is to their credit, but it must not hold them back. It takes an average of five years for them to attract substantial external financing, which is longer than in other European countries. The size of investments also needs to increase: we do extremely well in terms of the number of deals, but in terms of capital raised in healthcare, we drop back to sixth place and Switzerland, another small country, ranks first in Europe. That is thanks to GIMV, incidentally, which has invested invarious Swiss companies.

2) Brussels, Ghent and Leuven are the places to be for HealthTech, or Paris, Stockholm and London at international level

If we zoom in on the healthcare ecosystem in Belgium, Brussels, Ghent and Leuven stand out as particular breeding grounds for new entrepreneurship in health. 26% of health start-ups are to be found in the capital city, with another 10% in Ghent and 8% in Leuven. Hasselt is also up and coming, thanks to projects including the Mobile Health Unit, a joint venture between several hospitals and Hasselt University, the effect of the Corda tech campus and CareTech initiatives such as Happy Aging.

The number of HealthTech start-ups / scale-ups by region:

  • Brussels 26% (and 16% of all scale-ups)
  • Flanders 55% (and 56% of all scale-ups)
  • Wallonia 20% (and 28% of all scale-ups)

Wallonia’s position is also striking: the HealthTech landscape contains far fewer newcomers, most of which are located in Louvain-la-Neuve, Liège, Charleroi and Mons. A far larger proportion of existing companies is mature and has already made the transition to scaling up.

This means that Brussels is the crucible but lacks breakthroughs for growth, Flanders needs to extract value from its growth at international level and Wallonia needs to attend to the creation of a HealthTech pipeline by stimulating new businesses.

Ghent has been doing particularly well as a scale-up city in 2016: internationally, Ghent is in sixth place for health scale-ups.

But the absolute toppers among European scale-up cities for HealthTech are Paris, Stockholm and London. Sweden in particular finds itself in an attractive position: the country has fewer than ten million inhabitants, but has signed no less than 15 HealthTech deals this year. Specifically, the capital city Stockholm turns out to be even more popular than the several times larger, over-hyped Berlin. It is also striking that two Swedish HealthTech companies (Frisq and Cellink) were launched on the stock exchange this year, outpacing the whole of Europe. More astonishingly still, Cellink, a 3D bioprinting company, was founded less than a year ago and has already gone public with success, with 15 million euros in its coffers. That is a record that even blowing people in Silicon Valley away.

The country with the most HealthTech deals is France, however, which signed 24 this year. MonDocteur, Rythm and Physidia raised more than 10 million euros each. Nonetheless, the biggest European deal was for Switzerland, where MindMaze raised an impressive 89 million euros. Equally remarkable is that the investor comes from India: Hinduja Group. Another item of note is that the third largest HealthTech venture round comes from Serbia: Seven Bridges, which raised 40 million euros.

3) The government plays a major role

Throughout Europe, the government is the most important investor for start-ups, mainly through public and semi-public investment funds. The same applies to Belgium. The most active funds for HealthTech are LRM, Capricorn, Qbic, Gemma Frisius Fund and PMV as first among equals.

The link with research organizations in Belgian HealthTech is not only strong when the company starts out, but also when it scales up: a quarter of the Belgian scale-ups have grown out of research institutions. That is mainly the case in the harder sub-segments of health where patenting is possible, such as biotech, semiconductors, MedTech and nanotechnology. Both imec and Leuven University are in the European top three, right behind the University of Cambridge. What is more, Ghent University and Antwerp University are also listed.

Almost 25% of health scale-ups in Belgium have followed an accelerator program, which is a surprisingly high figure. It is true that an accelerator is not an absolute necessity for a successful scale-up, but we have noted that businesses that do use one are able to scale up an average of two years faster. iStart (by the former iMinds, now imec) is the Belgian health accelerator with the highest scale-up figures, and not only that, they are in the first place in Europe, ahead of even the prestigious Y Combinator and Seedcamp. LeanSquare from Liège is also doing very well.

A government that is committed to the digital economy is an important trigger for digital health start-ups. Incidentally, that corresponds perfectly to the World Economic Forum’s indication that health, after FinTech, is the area where digital evolution will make itself most strongly felt. If we want to be prepared for what lies before us in health and care, digital health needs to be included in all the policy activities and contexts being developed by various government bodies.

4) The dominant business model is B2B

It is also striking that 66% of European HealthTech scale-ups are located on the B2B side (business-to-business). In Belgium, no less than 78% are oriented towards B2B. Only Switzerland is in a situation comparable to Belgium.

In Sweden, for example, only 33% of HealthTech scale-ups are B2B. This demonstrates that every ecosystem has its own character. This is why a few of the Swedish scale-ups are spin-offs, in contrast to Belgium and Switzerland.

Belgian start-ups and scale-ups tend to be business-to-business companies anyway. HealthTech is a little different to the other sectors in that respect: Belgium is a thoroughly B2B country. The number of HealthTech scale-ups that work B2C is close to the Belgian average. A large proportion of those focus on hardware-based innovation.

We do expect the number of B2C companies in health to increase in the years to come. This is partly due to people-oriented financing in care, mobile health becoming more embedded and remuneration being increasingly focused on prevention and quality. The holy grail of well-performing platform models in health (the domain of companies such as Esperity and Cubigo) is also more B2C oriented.

This provides food for thought: should we continue to invest in our strengths (research-driven, B2B, hardware and MedTech) or try to boost our weaknesses (B2C, app-driven, CareTech)?

5) Enhancing value and attracting foreign funding present challenges

Entrepreneurship in Belgian HealthTech is alive and kicking, and capable of taking the leap towards international business. We genuinely do have a whole crowd of interesting health start-ups with the potential for further growth.

Realizing this potential requires faster market penetration, lock-in must be achieved within existing health care models and processes, and more resources need to be attracted faster for further growth. Our HealthTech companies hardly attract any foreign funding at all. The HealthTech capital raised in Belgium is indeed growing, but it is no great shakes either:

We need to go international more quickly, in a way that is attractive enough for the growing businesses to continue with further developments on the home market as well. This will enable Belgium to harvest the fruits of that process here as well, in terms of added economic value and employment.

Reasons why this value enhancement is such a difficult process can be found in the complexity of the care system, whether here or in other countries: the 27 countries in the EU have 27 separate care systems, each with their own culture and policy framework. This makes it fairly strenuous and difficult for start-ups to gain scale quickly in Europe.

A second reason is the difficulty of embedding new products and services with demonstrable added value in existing processes. Belgium scores extremely poorly here. We refer too frequently to the stringent policy contexts, to a lack of business model and integration into the value chain. Nonetheless, there is nothing to prevent entrepreneurs from bypassing the current models and/or applying them creatively. Neither is there anything to prevent players throughout the entire value chain from working together on integrated solutions that ultimately offer a higher quality (and hence a higher value). We still lack the necessary knowledge and courage for this. Some may also lack the financial leeway that would give them the freedom to experiment with business models.

We can learn here from the leaders in the field, Sweden and Switzerland: stimuli for broad innovation technologies across all sectors influence the more rapid adoption of innovations in health. That makes policy relating to the digital economy extremely important. Moreover, we need a culture (and regulatory framework) of open, ‘flowing’ entrepreneurship: the leeway and willingness among entrepreneurs, specifically those in care, to open up their businesses, to attract extra financing with courage and to sell their companies or merge them with foreign players.

Conclusion

The HealthTech sector in Belgium is on the cusp of maturity: countless new players are standing at the gates, health is the fastest-growing start-up scene and health care itself is the site of immense challenges in Belgium, for which new products and services will be vital. Traditionally, the HealthTech sector has a large number of spin-offs, but we are witnessing a gradual change in this: new businesses no longer have to come from a research background to be successful. Nonetheless, our universities, knowledge centers and university hospitals remain fertile ground for new entrepreneurship in health. The heart of the HealthTech scene is in Brussels, Ghent, Leuven and Hasselt. As a small country, we score highly in terms of the number of health scale-ups, achieving strong results. However, there are still too many health starters that fail to make the leap. We often find it difficult to integrate the careprocess, develop the business model at international level and source risk and growth capital.

Just like a start-up, however, Belgium doesn’t need to be big to do great things.

By Omar Mohout and Sofie Staelraeve

Omar Mohout is a start-up expert at Sirris, the innovation centre for the Belgian technological industry. He is a director of Startups.be and a professor of entrepreneurship at the Antwerp Management School.

Sofie Staelraeve is the founder of dash_+, where she helps businesses make the transition to becoming integrated health companies. She is a co-founder of Voka Health Community and her other activities include membership of the e-health platform management committee.