Telehealth needs local integrations to scale

European telehealth usually stops at the border because the hard part is not video calls, it is rebuilding local healthcare plumbing country by country. Each market has different reimbursement rules, prescription systems, care pathways, and public buyers, so a company has to win local contracts, integrate local records and pharmacy flows, and often connect digital visits to physical care. That is why companies like Kry describe expansion as commercially local even when the product and technology are reusable.

• The winning pattern is deep localization, not simple software rollout. Kry expanded beyond Sweden by adapting to different payer models in the UK, France, and Sweden, then reorganized around shared cross market functions only after it had already built local contracts, trust, and integrations.
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• Most national players stayed narrow. Qare presents itself as a France focused teleconsultation service for patients across France. Push Doctor describes its role through NHS workflows across the UK. Min Doktor operates Swedish digital care, clinics, and pharmacy based vaccination sites. Each is embedded in one domestic system.
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• Doctolib is the important exception because it behaves less like a pure telehealth app and more like healthcare infrastructure. Kry points to Doctolib as a software led model sold into provider workflow, and Doctolib materials show a broader international footprint, including Italy and the 2023 Siilo acquisition in the Netherlands.
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The next wave favors companies that own the messy local integrations and can layer more services on top, from scheduling and messaging to referrals, diagnostics, and AI assisted triage. In Europe, scale will come less from one app spreading everywhere, and more from building a reusable operating system that can be reconfigured for each country’s healthcare bureaucracy.