A patient likes the app. Her doctor recognizes its value. The hospital even agrees to a pilot. Six months later, nobody signs the contract. This fictional scenario illustrates a classic digital health pitfall: confusing enthusiasm for a tool with the existence of a market. For an entrepreneur, the first question is not just “does this improve care?” but “who can pay, from which budget, and for what outcome?” Looking ahead to September 2026, this discipline could matter even more than technological sophistication.
Three roles, three definitions of value
The user interacts with the product: a patient, nurse, doctor or medical secretary. The advocate, in commercial terms, lends legitimacy to its adoption: a department head, professional network or medical leadership team. The payer commits the money: a healthcare institution, France’s statutory health insurance system, a supplementary health insurer, an employer or an individual. These roles can overlap, but treating them as a single “customer” leads to mistakes in design and sales.
Consider a tool for monitoring patients at home after surgery. The patient wants reassurance without having to complete fifteen questionnaires. The nurse wants to spot concerning situations quickly. The surgeon expects a reliable care pathway. The finance department asks what the institution will actually gain or avoid. The same feature can therefore create value for some while generating extra work for others.
The clinical advocate is not always the purchasing decision-maker, either. A convinced doctor can open a door without having a budget. Conversely, management may buy a solution that teams barely use. Viability requires alignment, not simply a collection of favorable opinions.
The paradox: useful does not mean fundable
Prevention is a particularly clear illustration of this mismatch. A support program can deliver lasting health improvements, yet its costs are immediate and its benefits emerge later, sometimes for another stakeholder. A supplementary health insurer whose members switch policies does not necessarily capture all the future savings. Under its funding model, a hospital does not automatically have an incentive to reduce certain paid activities.
Another difficulty is that time saved does not always translate into budget savings. Giving each healthcare professional ten minutes back every day can improve working conditions without reducing payroll costs. That is genuine value, but it needs to be expressed differently: additional capacity, reduced overtime, staff retention or better service. Promising an automatic financial return undermines the discussion.
Finally, the available budget may sit somewhere unexpected. A tool presented as a medical innovation may sometimes be purchased to streamline operations. This repositioning must remain honest: companies should not claim an unproven clinical benefit to attract attention, only to sell a dashboard.
In France, reimbursement is no magic business model
Real developments have opened up opportunities. Remote medical monitoring became eligible for standard reimbursement in France in July 2023. The PECAN scheme, launched in 2023, provides early coverage for certain digital medical devices intended for therapeutic use or remote monitoring. These mechanisms show that public funding can evolve to accommodate digital applications.
Yet they are neither a universal funding gateway nor a guarantee of profitability. Eligibility, evidence requirements, technical conditions and the assessment pathway depend on the device. A wellness app does not become eligible for reimbursement simply because it supports patients. CE marking, where required, does not amount to a reimbursement decision.
For a young company, pursuing this route means financing the gap: development, assessment, compliance, deployment and administrative procedures often precede recurring revenue. It is also necessary to understand how payment for the technology fits alongside payment for professionals. Funding provided for on paper is not enough if nobody can organize the service around it.
Choosing a payer means choosing a business
Selling to healthcare institutions
An institution can buy a subscription, a license or a service. The challenge is then as much organizational as medical: integration with information systems, security, training, support and change management. The competitor is not just another start-up. It is also the software already installed, the existing spreadsheet or a project deemed more urgent.
Selling to individuals or organizations
Direct payment by patients can sometimes shorten the purchasing decision, but it brings exposure to price sensitivity, acquisition costs and dropouts. It also raises an access issue: the people who would benefit most from the service are not necessarily those who can afford it.
Employers and supplementary health insurers can fund services for their employees or members. Their rationale differs, however, from that of public reimbursement: the appeal of the offering, engagement, prevention or service quality. Confidentiality becomes critical, particularly when an employer funds the solution. The contract must maintain a clear separation between the service offered and access to individual health data.
Before the product, investigate the budget
Good customer discovery is not about asking: “Do you find this idea interesting?” It is about reconstructing a recent purchasing decision. Who requested it? Who authorized it? Which budget was used? Which checks delayed signing? These questions yield more reliable information than a statement of intent.
- Identify a budget line: an existing allocation, or a credible process for creating one.
- Name the decision-maker: distinguish between the clinical ally, the signatory, procurement and the stakeholders capable of blocking the project.
- Define the evidence: clinical outcomes, time freed up, additional activity or service quality, depending on the buyer.
- Set the pilot’s exit terms: duration, success criteria, proposed price and conditions for moving to a contract.
A free pilot can be a learning opportunity. It becomes dangerous when it substitutes for a sale indefinitely. Before launching it, asking what will happen if the results are good often reveals the real problem: nobody has been authorized to buy. It is better to discover this before spending six months on integration.
Calculate what each contract really leaves you
The listed price does not tell the whole story. You must subtract hosting that meets applicable requirements, support, interfaces, training and any human-delivered operations. An apparently software-based solution can conceal a highly labor-intensive services business. If every new customer requires bespoke development, revenue growth does not guarantee margin growth.
Sales cycles and payment terms matter too. A company can have a relevant product and run out of cash before it reaches wider adoption. The financing plan must account for this timing, without treating grants as evidence of commercial demand.
What next? Looking ahead to September 2026, one hypothesis is that the growing ubiquity of AI tools will make certain features easier to replicate. The advantage could then shift toward evidence, integration and access to sustainable funding. Before starting development, an entrepreneur should be able to complete this sentence: “This stakeholder will pay for this service from this budget if we demonstrate this outcome.” Without a credible answer, the next step may not be code, but a conversation with the person who controls the finances.
