Hinge Health Exposes the US EU Health Tech Divide

When Hinge Health filed to go public in the US recently, it marked the latest milestone in a story that actually began in Europe. The company, which started life in London and took early money from Seedcamp and Atomico, has since gone on to become one of the most valuable digital health startups in the world. With over $1 billion raised, more than 1,000 employees, and annualised revenue of almost $500 million (reached in 9 years), Hinge’s trajectory has been remarkable. But it didn’t happen in Europe. And that’s the point.

Like so many ambitious healthtech companies before it, Hinge packed its bags and moved west. The US offered deeper capital markets, faster regulatory pathways, bigger payor budgets, and a culture more willing to take risks on new care delivery models. Europe, for all its scientific depth and healthcare systems, still can’t seem to produce companies of this scale. And that should worry anyone trying to build, invest in, or regulate the next generation of healthtech innovation on the continent.

The European Origins of Hinge Health

Founded in 2015 by Gabriel Mecklenburg (a German national) and Daniel Perez in London, Hinge was part of a new cohort of tech-enabled care delivery platforms focused on musculoskeletal (MSK) conditions. Early on, they received backing from European seed investors including Seedcamp and Episode1 Ventures. But it became clear early on in their journey that to build a truly global digital health business, Europe wasn’t going to cut it.

By 2016, the company had relocated to San Francisco, and from there things accelerated. The US healthcare market—bloated, fragmented, and incentive-driven—turned out to be the perfect environment for Hinge’s offering. Large employers and payors, desperate to rein in MSK costs, were willing to try digital-first solutions. The company won contracts with Fortune 500 employers, built out a clinical network, and began scaling revenues.

Hinge raised a Series A in the US in 2018 led by Insight Partners, then raised from Coatue, BOND, and Tiger Global in later rounds. The company’s Series D in 2021 valued it at $6.2 billion (valuation has since cooled with market cap at $3 billion, impressive nonetheless). It was officially one of the biggest digital health bets ever made—and none of that would have happened if they had stayed in London.

Sword Health: Similar Story

Ditto Sword Health. Born in Portugal, Sword is another MSK platform offering digital physiotherapy and pain management. Also venture-backed, with more than $300 million raised from General Catalyst, Khosla Ventures, and Founders Fund and valued at $2 billion at its last round in 2022, Sword has also focused on US employers and payors from the get-go.

Sword followed the same playbook. Despite its European roots, most of its revenue comes from the US and its executive team is heavily US-based. Like Hinge, its regulatory strategy, sales model, and growth plan were designed for the American system. Sword is arguably Europe’s best digital health export. Again, growth only became possible because it looked outward.

Ditto Oura Health on the consumer side where leadership, market, and operations are all largely based in the US.

More US Successes — And the European Void

Hinge is far from the only success story in US digital health. Livongo IPO’d  at c. $3 billion and was subsequently acquired for $18.5 billion by Teladoc. One Medical IPO’d and was later acquired by Amazon for $3.9 billion.  Omada Health is now IPO’ing at c. $1 billion and, on the consumer health side, Hims & Hers is on a complete tear (Q1 2025 revenue of $586 million, up 69% YoY)).  

By contrast, Europe has very few digital health companies at scale. Babylon Health, one of the UK’s most high-profile players, went public via a SPAC and subsequently collapsed. Kry in Sweden (Livi in the UK) has built a solid telehealth business but remains sub-scale compared to its US equivalents. Doctolib in France is a standout with a multi-billion valuation, but it is largely confined to its home markets. Few have managed to expand across borders, let alone crack the US. Investors in those companies are also trapped with a secondary (at a steep discount) likely their only liquidity route in the short to mid term.

There is perhaps more local traction on the tech-bio side (Cradle, Latent Labs, BioOptimus, Isomorphic Labs) although realistically the big dollars, partnerships and experienced commercial operators (as these projects go commercial) are also in the US in this area.

The Talent Deficit

One often-overlooked barrier is talent. Scaling a healthtech company from startup to IPO requires a deep bench of experienced operators—regulatory experts, go-to-market leaders, payer partnership heads, compliance veterans, and product managers fluent in clinical workflows. The US has spent the last decade building this bench across companies like Livongo, Teladoc and Flatiron.

Europe lacks that ecosystem density. There simply haven’t been enough large outcomes to generate a flywheel of experienced digital health operators. As a result, European startups often struggle to hire the kind of leadership needed for scale. Founders are forced to relocate or hire abroad to find that talent.

Why Europe Struggles to Build Big Healthtech Companies

Digital health is a textbook case of Europe’s scale problem. While the region is packed with top-tier hospitals, universities, and public health systems, those strengths don’t easily translate into fast-scaling startups. Some reasons why:

• Fragmented Markets: There is no single European healthcare system. Instead, there are 27 different national systems with unique reimbursement models, procurement structures, and clinical protocols. Scaling across Europe is like doing 27 different market entries.
• Local Bias: buyers in one country are often biased against providers from other regions, making scaling across the continent slower.
• Slow Procurement and Bureaucracy: Public health systems dominate European healthcare, and their procurement cycles can be glacial. It can take years to sell into the NHS or similar bodies, and the budgets are rarely large.
• Risk-Averse Culture: European systems tend to be more conservative in adopting novel care models, particularly those that challenge traditional provider hierarchies. In contrast, US employers and insurers have both the incentive and authority to try new things quickly.
• Capital Constraints: The US has far deeper pools of late-stage venture capital willing to back digital health companies through hypergrowth - in 2024, $17 billion in the US versus $5 billion in Europe.
• Exit Environment: IPOs for healthtech companies still overwhelmingly happen in the US. Hinge Health (and now Omada) follow a long line of others: Teladoc, Livongo, One Medical and dozens more. There is no real public market path in Europe for these types of businesses.
• Operator Talent Scarcity: Without a bench of seasoned executives who have scaled similar businesses before, European founders are left reinventing the wheel. The US has a ready-made talent pool; Europe is still building it.

What This Means for Founders and Investors in Europe

The good news is that I have never seen better founders in Europe choosing to build in this important area. However the harsh truth is that if you’re building a digital health startup in Europe and have any ambition of reaching scale, you will probably need to look west. That’s not just about access to capital—it’s about access to markets, speed of adoption, talent and exit optionality. European founders are increasingly aware of this and planning accordingly.