Innovation Estonia : DTX Estonia 2023

Dr.Kamal Jethwani, Managing Partner and CEO, Decimal.health shares some powerful insights from his week-long experiences at DTx Estonia 2023 where he delved into the dynamic world of digital health and entrepreneurship!

I had the privilege last week of attending a week-long event in Estonia, focused on promoting innovation, especially in digital health and digital therapeutics. 

I had the privilege a few weeks ago of attending a week-long event in Estonia, focused on promoting innovation, especially in digital health and digital therapeutics. 

As my first time in the country, I’m walking away with a lot of reflections. The amazingly powerful digital infrastructure, very engaged innovation community, excellent support for tech innovation, and a country learning how to leverage initial success from 6-7 unicorns to build out an ecosystem that’s startup-friendly!

1. My highest respect goes to the digital infrastructure that the country has built, which started very soon after they gained independence in the early 90s. They were the first to have a mandatory electronic ID for all their citizens, and one today that has 99.6% of government services provided digitally (including marriage!)
2. This infrastructure was further strengthened when they launched X-Code, a platform to enable interoperability between any technologies that leverage the national database (and also enable SSO with their national ID)
3. Some well-known unicorns were formed in Estonia – Skype, Bolt, Pipedrive, etc. given the country its first millionaires who are now back and acting as angel investors and mentors for others (as well as launching new companies of their own) 
4. The drawback of being a small country is that it’s not really a strong market on its own. With 1.3M residents, it’s smaller than an average US city. Yet it has some unique challenges in providing care – with over 2200 islands, many of which may only have 30 odd residents during winter time, reach and access are big issues in the country. 
5. Estonia is also dealing with the same demographic issues as others (aging population, declining birth rate). In fact, they aren’t able to even find enough students to train in medical school. In addition, the physician shortage is going to be exacerbated because ~30% of their PCPs will be of retirement age within the next 3-5 years. 
6. Estonia also has fairly strict immigration laws, which means that healthy immigration will not solve these demand/supply issues anytime soon. Their largest influx of immigrants was right after the Ukraine war started, but other than that their total population is stable or declining. 

With these factors, Estonia is positioned to have real reasons to innovate, as well as a good basis of infrastructure that they can scale from. These issues are also very time-sensitive, given that decades of generational medical knowledge will be lost within the next 5 years.  

The humility and self-awareness that the decision-makers have around these issues was a very pleasant surprise to me (compared to narratives here in the US). The Estonia Health Insurance Fund (their single payer in the country) has an innovation fund that will invest in building economic evidence for digital health solutions. Karl Henrik Peterson, CDTO at Estonia Health Insurance Fund is extremely motivated to make digital successful in the country and is thinking about it in all the right ways. I hope to have him in the US soon to learn how they’re justifying these investments in early-stage ideas. 

The Minister of Health of the Republic of Estonia, Riina Sikkut, another promising public figure and politician, understands the problem the country faces down to levels of detail that I have rarely seen politicians engage in. She spoke about how she doesn’t need technology to simply replace clinicians but rather enable them to operate at the top of their license and in more scalable ways. She has great ideas of how to use allied APPs like pharmacists etc. to bridge access gaps that they face, and has the humility to invite her startups to name the problems they face so she can help solve them. 

Finally the entrepreneurs – I’m amazed at the immense amount of talent and passion I was able to see in a short duration – amazing ideas, beautiful digital products, and such motivated and passionate individuals! They’re achieving milestones in their companies at a fraction of the funds raised as compared to their European and American competitors. Their markets are small but if given a level playing field in the right markets I wouldn’t be surprised if they beat out the competition by miles!

I’m starting to think about how we can do exactly this – how can we support such entrepreneurs and technologies to get wider adoption and provide them a fair shot at building incredible businesses in bigger markets, and also – what technologies do we have in other parts of the world that can solve these time-sensitive problems quickly for Estonia? They offer a red carpet for companies that are motivated to solve real problems – wouldn’t this be a great pilot for those companies struggling to make a mark in highly competitive and complex markets like the UK and US?

Join me in a conversation with some of these amazing Estonian companies this week: Wednesday 9/20, 9am Eastern – link to register

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About Decimal.health

Decimal.health provides solutions that help companies navigate the complicated healthcare ecosystem and become a market leader rather than a market follower. The team brings several decades of deep experience in digital health, provider, and payer systems to help digital health businesses develop strategies that accelerate the launch and growth of their business and maximize their impact. Decimal.health combines relevant clinical and care delivery experience with the technology needs of our care providers and patients to create useful, usable, and enjoyable product experiences.