🔍 Key Findings from the Survey of 54 Startups

1. Bridging to Survive

A staggering 62 % of startups are currently hanging on by raising bridge or extension rounds—clear evidence of the current funding pinch .

2. Existential Risk Ahead

Almost half (41 %) warn they face existential threats unless they secure additional funding or quickly demonstrate traction within the next 6–12 months .

3. Burnout After Pandemic Surge

Those that boomed during COVID in digital therapeutics and telehealth are now seeing unsustainable burn rates (55 %) and struggle to prove ROI to health systems (48 %) .

4. Distress‑Driven Decisions

Almost 39 % are evaluating distressed M&A, mergers, or downsizing to survive in the current climate .

🌍 Europe‑Specific Challenges

• Fragmented Healthcare Systems

With different regulatory frameworks, reimbursement models, and EHR systems, scaling pan‑European is proving tough—and expensive .

• Dip in Investment Appetite

Healthtech funding in Europe has trailed off since its 2021 peak, with many VCs pivoting toward biotech, AI infrastructure, or U.S. ventures delivering faster returns .

• Demand for Evidence‑Based ROI

Health systems are increasingly scrutinizing cost savings and patient outcomes. Startups that scaled too fast without hard evidence are now paying the price .

💡 Implications and Outlook

While digital health remains central to the longer‑term transformation of healthcare, this survey from Black Book underscores a pressing need for:

• Enhanced reimbursement frameworks

• EU‑wide regulatory alignment

• Funding models attuned to the slow maturation cycle typical of health innovation

“The European market doesn’t suffer from a lack of ideas,” says Doug Brown, Founder of Black Book. “It suffers from systemic frictions that stall even the most promising innovations from reaching scale.”

What This Means for You (If You Are…)

A Digital Health Founder?

Focus on real-world evidence, don’t over-invest in hiring or infrastructure without revenue validation, and consider strategic partnerships or alternative funding options early.

An Investor?

Be prepared for a longer ROI runway, but there are compelling opportunities among startups that deeply integrate with health systems and can surface strong clinical and financial outcomes.

A Health System Leader?

Utilize this moment to negotiate from a stronger position—demand robust pilot data and scalable results before committing to procurement, and use phased adoption to drive real-world validation.

About Black Book Research

A leading independent authority in healthcare technology research and surveys, Black Book delivers unbiased, crowd-sourced data on satisfaction, user experience, and market readiness—without vendor or investor influence