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The Finnish
Health Startup
Industry Report
2017
by
About this report
The following report was created by Upgraded – Health Startup
Association of Finland, to map the Finnish health and wellbeing
startup industry.
The goal of this paper is to provide a better understanding on the
current startup companies in this field and the challenges they
face.
1
In 2015, a similar cluster research was
conducted by HealthSPA ry. The results of the
study showed that the most significant
challenges health and wellbeing startups in
Finland were facing two years ago were
related to funding, expansion of distribution
channels, and to marketing. 1 When giving
their insights, the informants of 2015
concluded that Finland is an excellent
platform for companies of the sector, however,
they did indicate that the better collaboration
of the different industry players is a necessity
for the further development of the industry.
The following report aims to reflect on the
challenges mentioned by the informants of
2015 and to present the situation of 2017 by
creating an overall picture of the health and
wellbeing startup industry in Finland, to
promote the ecosystem and to strengthen
Finland's position in the sector. By gaining
insights into the experiences of these
companies, we hope to understand their needs
and acquire more information about the aid and
contribution needed from the other players in
the industry. Hence, this report functions as a
tool for development of activities in the
ecosystem.2
1 For further reading: HealthSPA ry (2015). Health Technology Industry.
2 Ibid. pp 19-21.
2
About
Upgraded (formerly known as HealthSPA ry) is the non-profit association for Finnish
health startups. The organization is best known for its annual event called Upgraded
Life Festival. Upgraded has 5 years of expertise in working with startup companies
and other key players in the health ecosystem. This expertise consists of a great
variety of factors, such as knowledge and insights about the currently available players
present in the health and wellbeing industry in Finland.
3
Contents
Introduction: The Finnish Health Sector 5
Startup Definition 7
Methodology 9
Overview of the Companies 10
Finland as a Platform 23
Challenges Startups Face 35
Conclusion and Discussion 42
References 43
4
Introduction
The Finnish Health Sector
Finland ranks among the three strongest health
technology economies in the world.
Multidisciplinary expertise and problem-solving
has raised the country among the main players of
digital health. 3 The country is home of a rapidly
growing ecosystem of health and wellbeing
startups.
According to Healthtech Finland, the value of
Finland’s exports of health technology products
rose to €2.11 billion in 2016, an increase of 9.7%
over the prior year. Imports of health technology
products rose 8.0% to €1.10 billion. The net trade
balance exceeded €1 billion for the first time in
2016. Health technology is a significant export
segment of high-tech of Finnish industry. The sector
made a positive contribution of €222 million to
Finland’s balance of trade4 in 2016.5
3 “Finland – The Land of Future Health”. Source: http://www.finlandhealth.fi/-/finland-the-land-of-future-health. Accessed: 13.10.2017.
4 Please note, that is it stated in the quoted reference, that not all company activities are captured in trade statistics for goods: foreign-financed R&D, intellectual
property transfers and services, healthcare related IT license and maintenance service exports are not included in the product trade statistics. Most products, that
are related to the field of “wellness” are not generally considered to be health technology for trade purposes either. For further reading:
http://healthtech.teknologiateollisuus.fi/sites/healthtech/files/attachments/finnish_healthtech_trade_in_2016.pdf
5 “Exports of Finnish health technology grew to over €2.1 billion in 2016”. Source:
http://healthtech.teknologiateollisuus.fi/sites/healthtech/files/attachments/finnish_healthtech_trade_in_2016.pdf Accessed: 01.11.2017.
5
These factors include: strengthening of co-operation
between university hospitals, universities, and
enterprises; establishing the National Genome
Centre and National Cancer Centre Finland;
strengthening the joint activities of biobanks;
regulation supporting innovation; establishing
national and regional centres of expertise;
developing research infrastructures; commercializing
research; lobbying at EU; promoting export and
attracting investments; enabling the usage of social
welfare services and health data for research use;
innovative public procurement. It is among the plans
to review the implementation by 2020 on whether
the work can be finished in strategy format.8 The
answers of startups who have taken part in the
current research often echo on these points, when
talking about factors to be developed in the
industry.
Growth has been one of the key traits in wellbeing
and health innovation in Finland during the recent
years. Finnish economic growth is supported by
private consumption, exports and productive
investments of companies, as well as by the long-term
investments in education, innovation, and research
infrastructures. 6 International investors have also
identified the potential of Finnish startups, and
according to recent information, the amount of
venture capital obtained by Finnish startups and
growth companies is the highest in Europe in relation
to the GDP. 7 As one of the Finnish Government’s key
aims is to accelerate growth in the health sector, in
June 2016 they published a roadmap, entitled
“Health Sector Growth Strategy for Research and
Innovation Activities”. The roadmap identified the key
factors that are necessary for the further innovation of
the industry for the period 2016–2018.
6 Economic Outlook. Technology Industries of Finland”. Source:
http://teknologiateollisuus.fi/sites/default/files/file_attachments/t_talousnakymat_3-2017_eng.pdf. Accessed: 14.12.2017.
7 “Finland’s startups receive most venture capital in Europe” Source: http://www.goodnewsfinland.com/finland-s-startups-receive-venture-
capital-europe/ Accessed: 15.10.2017.
8 “Health Sector Research Strategy for Research and Innovation Activities. Roadmap for 2016-2018.” p.5. Source:
http://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/75145/MEE_guidelines_8_2016_Health_sector_growth_strategy_17062016_web.pdf?s
equence=1. Accessed: 07.10.2017.
6
Startup Definition
When defining what a health and wellbeing
startup is, we considered a variety of factors.
On the practical level, we based our definition
on the information acquired from Statistics
Finland.9 According to this10
categorization, we considered companies
with:
• no more than 50 employees
• with the annual revenue are not
exceeding €10 million
• not more than 10 years of operations
Moreover, we took the factor of when were
the studied companies established into our
consideration. Startups that operate in the
field of health and wellbeing often face
longer regulatory and validation processes
(e.g., trials, testing, official permissions).
Hence, we decided to include startups that
were established maximum ten years before
our research was conducted. We aimed to
include enterprises, which focus on issues
concerning health and wellbeing and identify
themselves as startups in these fields.
9 Statistics Finland is the only Finnish public authority established specifically for statistics. Statistics Finland combines collected data with its own expertise to
produce statistics and information services. For further information: http://www.stat.fi
10 Source: http://www.stat.fi/meta/kas/pienet_ja_keski.html. Accessed: 15.11.2017.
7
Besides health- and medtech solutions, we also included startups who offer
products and services that encourage their users to do physical activities, live a
healthier life, or that help preventing injuries. We did explicitly exclude companies
that have their core focus on enhancing sports performance or that provide
solutions that can be used in a wide range of other industries. We did not include
companies, which do not have their focus and operations primarily in the health
and wellbeing industry. According to our estimate, there are approximately 300
companies in Finland in the industry that suits our definition. Due to the vividly
growing nature of the sector, and to the multidisciplinarity of the solutions offered
by the innovative companies, estimating the number of currently active startups
that operate in the areas of health and wellbeing is challenging. Moreover, the
definitions of health and wellbeing startups often vary.
8
Methodology
The study combines quantitative and
qualitative methodologies. While taking
Upgraded’s (formerly HealthSPA)
knowledge of the ecosystem and the
findings of the report of 201511 into
consideration, the current research
consisted of the following two main
phases:
1. Distributing an online survey that focused on the operating
fields, background, experiences of the currently active
innovative health startups.
We have created our database of startups in the fields of health
and wellbeing industry in Finland before the distribution of the
survey. Based on the knowledge we acquired during this
process, we created a survey that was sent to three of our
member startups as a pilot. They were asked to fill it out and
give their comments on its elements. When the questionnaire
was finalized, we approached 262 startup companies who suited
our definition of a health and wellbeing startup out of which 62
of have responded to the survey.
2. Conducting six semi-structured in-depth interviews with
respondents of the questionnaire.
The participants of the in-depth interviews were selected by us,
based on the stage of their company, their field of operation
and their end-product to ensure that the interviews cover a
variety of areas within the startup community. The central
questions asked during the interviews were connected to the
informants’ answers to our survey.
11 For further reading: HealthSPA ry (2015). Health Technology
Industry.
9
Overview of the Companies
Location 3% 2%
58%5%
6%
16%
2%
8%
Central Finland (Keski-Suomi)
Häme
Metropolitan Area (Pääkaupunkiseutu)
Northern Ostrobothnia (Pohjois-Pohjanmaa)
Northern Savo (Pohjois-Savo)
Pirkanmaa
Satakunta
Southwest Finland (Varsinais-Suomi)
The survey has received 62 responses from companies
all over Finland.12 36 of the respondents were located
in the Metropolitan Area,13 all of them have their
headquarters in Helsinki or Espoo.14 The rest of the
respondents (26 companies) were from other areas of
Finland.
12 We have received 70 responses to the survey, but only 62 of them were
relevant based on the startup definition.
13 Helsinki, Espoo and Vantaa.
14 One of the respondents indicated, that they discontinued their activities in
Finland, due to the hardships they were facing (“We decided to leave Finland as
we could not find financing or customers there, and recruitment was difficult. Only
little public funding was available for us.”) on the Finnish market. We decided to
include their responses in our report, as they still have a registered in the trade
register (has a trade registry number - Y-tunnus) in Finland.
10
Years of Establishment
0
2
4
6
8
10
12
14
16
2007 2009 2010 2011 2012 2013 2014 2015 2016 2017
Most of the companies that
responded to our survey were
established after 2010.
11
Stage 1/2
48% of the respondents were in the stage of
“growth and scale,” 32% of them are going to
market with their products, whereas the rest
of them (20%) are currently working on their
product. None of the 62 respondents are in
the very early stage working only on their
concept. This may be due to the fact, that the
idea is usually created before the business
entity is established.
48%
32%
20%
Growth & scale
Going to market
Working on product
Concept only
12
Stage 2/2
0
2
4
6
8
10
12
2007 2009 2010 2011 2012 2013 2014 2015 2016 2017
Concept only Working on product Going to market Growth & scale
As expected, in most cases the
later a company was established,
the more advanced stage it is at.
The number of startups in the
stages of “Working on product”
or “Going to market” is higher
among companies established
after 2014.
13
Number of Employees
When asking about the number of employees of our
respondents, we were aware that many startups
cannot employ multiple full-time workers. Hence,
we asked them to indicate the number of their
workers equivalent to full-time (e.g., 2x50%
employees = one full-time employee). According to
the responses, 51 (83%) of the startups employ 10
or less than ten employees. 45% of the companies
provide salaries to all their workers, 11% of the
companies do not have any paid employees, 37% of
the companies have the majority of their employees
paid, and 7% of the companies did not indicate how
many of their employees receive payments for their
work. We did not ask for any specification on
whether the founders of our respondents consider
themselves as employees or not.
.
45%
37%
11%
7%
All employees paid
More than half of the employees paid
No employees paid
Did not answer
14
Funding Received 1/2
Applying for funding and receiving it are
often indicated to be the most challenging
things for the small-sized companies who
responded to our survey. Most of our
respondents have received some sort of
public funding from Finland. There were only
seven companies who did not receive any
public funding. Sixteen companies concluded
that they have received public funding up to
€50 000. The smallest group regarding public
funding was the one that indicated to have
obtained over €1 000 000 from public sources
- only three companies. When asked about
private funds received, twelve companies
indicated that they had not received any
private investment. There were only five
companies that have received funds up to
€50 000. Nine startups concluded that the
amount they have received from private
entities was over €1 000 000.
0 5 10 15 20
No funding
1 - 50 000 €
50 000 - 100 000 €
100 000 - 200 000 €
200 000 - 500 000 €
500 000 - 1 000 000 €
Over 1 000 000 €
Private funding Public funding
15
Funding Received 2/2
When looking at the stages of our
respondents, and the amounts of funding
they have received from public or private
funding entities, we can conclude, that
companies in “growth and scale” - stage
received larger amounts of investments. In
comparison, companies that are in the earliest
(“working on product”) stage, are more likely
to receive smaller public investments. 15 When
it comes to the question of private funding,
we can conclude that private funding
agencies invested greater amounts into
companies that are in the more advanced
stages. All the companies who have received
more than €1 000 000 were from the “growth
and scale”- stage. Similarly, the biggest
number of the companies who have received
investment between €200 000–500 000 were
in the same “growth and scale”- stage.
15 We did not inquire information about in which stage our respondents have received their funding.
0 5 10 15 20
Over 1 000 000 €
500 000 - 1 000 000 €
200 000 - 500 000 €
100 000 - 200 000 €
50 000 - 100 000 €
1 - 50 000 €
No funding
Working on product Going to market Growth and scale
16
Research Background
16 “Finland – The Land of Future Health” in Finlandhealth. Source: http://www.finlandhealth.fi/-/finland-the-land-of-future-health. Accessed: 13.10.2017.
66%
34%
Yes No
Research in the fields of genomics,
diagnostics, non-invasive measurements,
imaging, patient monitoring, digital health,
wearables, sensors, health services, elderly
care and hospital IT make Finland a thought-
leader in healthcare.16 This is also shown in the
background of the companies who responded
to our survey. 66% (41 startups) indicated that
they had a scientific research background in
the fields of their solution(s). 34% (21 startups)
stated that they do not have a research
background at all.
17
Fields of Operations 1/2
As the following chart shows, 56% of the
respondents (35 companies) that described
themselves as “medical”. The second biggest
group was on the field of wellness, with 29
startups – 47% of the responses. There were
nine respondents, who located their operations
in the medical field also located themselves on
the field of wellness. Nine companies did not
choose any of these options.
Based on the respondents’ self-description,
“medical” refers to all solutions that can be used
in places of medical operations including e.g.
“medical education”.
In several cases, startups operate in a
combination of fields and technologies when
providing their solutions. Hence, we decided to
ask about the fields and technologies of the
companies in a multiple-choice question, to
ensure that they can give an adequate
description of their operating circles. We
decided on the available options based on our
industry mapping. The mapping was made to
the health and wellbeing startups and medium-
sized companies both in Finland and abroad, to
gather information on the most common fields
of operations and technologies of our potential
respondents. The procedure of the mapping
consisted of internet research, using the already
existing knowledge and the network of
Upgraded, and contacting several relevant
players of the industry.
18
Fields of Operations 2/2
0 5 10 15 20 25 30 35 40
Medical
Wellness
Occupational healthcare
Big Data & Analytics
IOT
Telemedicine
Fitness & Sports
Diagnostics
Mental Health
Disease Management
Food & Nutrition
Artificial Intelligence
Biotech
Pharma
Database
Education
Genomics
Robotics
Insurance
Gaming
VR/AR
Preventative Health
Patient Engagement
Veterinary med
3D
Elderly Care
Surgical Device
19
End Products
0 5 10 15 20 25
Service
Hardware/Device
Software
Mobile application
SaaS
PaaS
Other
Similarly to the question about fields of
operations and technologies, we were
aware that companies might produce
several products when offering their
diverse solutions. Hence when we asked
them about their products, we allowed
them to choose multiple options. The two
most prominent groups of end products
were the groups of software and mobile
application. Sixteen companies indicated
that they both produce mobile apps and
software. Sixteen companies who
mentioned hardware/device being one of
their end products also offers other
products. Nine firms indicated that they
only produce service as a product. There
was just one company that only produces
hardware/device.
20
Purchasor of Products
In many instances, our respondents do
sell their products directly to their
customers. As it is visible in the following
chart, however, most of the purchasers in
our respondents’ cases are among
private health providers. The second
biggest group is the group of public
health providers. Governmental
institutions and organizations are among
the least frequent purchasers of these
products. Our respondents indicated
that public health providers,
governmental agencies, and
organizations often operate with lengthy
decision-making processes. Moreover,
they concluded that government officials
are hard to reach.
0 10 20 30 40 50
Private health provider
Public health provider
Other businesses
Consumer
Governmental
organizations/institutions
Insurance companies
Other
21
End User of Products
The majority of the respondents (44
companies) indicated that the end users of
their products are individual customers.
Almost half of these respondents (21
firms) exclusively indicated individual
consumers to be the only end user of their
products. Four startups concluded that
their end users might fall into all of the
groups: they are either medical, non-
medical companies, institutions, and
organizations or individual consumers. We
can conclude that the end users of the
products do not buy the goods directly,
but use them through third parties.
0 20 40 60
Individual consumers
Medical companies, institutions &
organisations
Non-medical companies,
institutions & organisations
Other
22
Finland as a Platform
In the recent years, cooperation models between the key players of
the public and private sectors have been introduced in the
ecosystem. Funding agencies, different testing and piloting
platforms, research and educational institutions opened to support
the health industry and the startups operating in it.17 The Finnish
competencies in research and technology drive the country to be the
pioneer in the field of health.18 Regional developments also started
in the industry resulting in the establishment of health hubs all over
the country. Despite the success of the sector, our informants often
pointed out; there are still opportunities for further enhancements.
17 “Health Sector Research Strategy for Research and Innovation Activities. Roadmap for 2016-2018.” Source:
http://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/75145/MEE_guidelines_8_2016_Health_sector_growth_strategy_17062016_
web.pdf?sequence=1. Accessed: 07.10.2017.
18 “Finland – The Land of Future Health” Source: http://www.finlandhealth.fi/-/finland-the-land-of-future-health. Accessed:
13.10.2017.
23
When asking startups about the Finnish platform
concerning health and wellbeing innovations, the
majority of them responded positively. According
to most of them, Finland provides a good platform
for the development of the health technology. The
often-mentioned positive aspects of the field in
Finland are the high level of research and
education, and the possibilities of receiving
funding from governmentally supported
organizations. Some respondents however also
pointed out, that the market is small, and specific
segments of it – e.g., the public sector – are hard
to enter.
“Working with public is something that
you need to have the right connections
for, and sell it for about a year, that they
understand. It should be the way, that first
the private sector is adopting it and then
next thing would be that you try to get it
into the public sector.”
24
Some of the respondents also concluded, that
personal networks play a rather significant role in
the piloting and testing processes as well. Some of
our in-depth interviewees have already had some
connections on the field even before officially
establishing their companies.
"The piloting in the hospital will be
easier because of the personal
connections...”
“Before we started the company we were already
talking with the doctors and we kind of agreed
with them, that we will set up the company with
this and this kind of product and let’s see if we
can do a clinical study together to speed up the
process a little bit, because it might take 6
months or even longer to write the study
protocol, to apply for permits for different places
and recruit patients and advertise….”
“Well, we have been piloting our pre-version
with [a university hospital]. It was quite hard to
get there, even though I had a connection...”
25
According to some respondents, the preventative
solutions are more difficult to get adopted by the
public sector, because the results of such products
are only seen in the long-term. Hence the
adaptation of them requires a more prominent,
long-lasting investment.
"To do preventive things, you need to
have a double budget. Budget for taking
care of medical, and if you want to do
preventive, you need to have a budget for
that too. Because to get benefits of that
preventive medicine...years to come.
Nobody is thinking that way. They don’t
have the money to put into the preventive
face.”
“Private is preventive and public is not. We
think that the public should be preventive,
but this is a long way to go. This is in our
pipeline, but that’s politics.”
“I think the idea of prevention is underrated in
governmental and higher levels. They speak
about it, but they don’t understand the value of
it. Startups understand it. We have figures and
hospitals are in the midway, they know the
prevention, but that’s something that is hard to
measure without doing a long-term pilot. The
only thing for them is the matter of costs.”
26
The Metropolitan Area
It was an often-mentioned concern - both of
startups inside and outside the Metropolitan Area
- that the conditions of startups located in the
capital area are better as the key players of the
field (including influential private companies,
governmental offices, and other public players)
are found in this area. Moreover, most of the
activities that target startups are organized in this
region.
“The major part of the business is here
[Helsinki] of course, because the bigger
cities are here. There is more people living
here.”
“I think that if you are there in the capital area, you
are in a quite good position. Everything is
happening there. All our clients are there. I don’t
have any clients here, so basically I have to travel
there a few times a month, and that’s actually one of
the problems. There is no such diversity [here].
Companies who actually need services that we
provide are all there [in the capital area].”
27
Some informants, however, did mention, that in
some instances - for instance when targeting the
public sector - the process is more
straightforward outside the metropolitan region,
as the decision-makers are more easily
approachable.
“Here [Metropolitan Area] we have the big cities and
they are moving very slow in the public sector. So then
actually it would be easier, if a company would be
somewhere in the middle of woods, because the
community would be so anxious to support their own
economy, that they would most likely take this, you
know they would start using our services.”
“We’ve had some difficulty accessing hospitals in the
Helsinki region. It was easier for us, to approach doctors in
smaller cities and regional hospitals. Maybe it is less busy,
or they are more open to new ideas, or I don’t know what
it is.”
“I think startups should address more small
hospitals than the central hospitals, because I think
they are faster in their actions and I know that the
startups would always want the ones for the
reference, like hey, we are working together with [a
university hospital], that’s why they try to address it,
but for example in [a smaller city],19 where I worked
it would be much easier, because they have less
people involved in the decision-making.”
“Looks like the whole city just loves us and our service. [...]
The money is budgeted to the local areas, and how you get
the decision, you get the local funding, it’s up to the people
who are making the decisions. In the capital area, they are
stricter and following the rules, and in other parts of Finland
they are closer to the people. Of course, we have to fit the
rules, but it’s still more personal.”19 We do not wish to exclude the name of the exact city.
28
Due to the often-mentioned small size of the Finnish market,
most of the companies who took part in this research hope to
expand their markets to abroad to bolster their opportunities
both regarding finding funding and acquiring customers.
Currently, 38% (27) of the companies operate only in Finland. The
rest of the respondents have already expanded their operations
to other countries. Just five respondents did not express their
interest in expanding to other markets.
Among the most targeted countries, the startups listed European
countries, such as Sweden, Denmark or Germany, but some of
them also indicated the place of expansion to be outside of
Europe, in the United States of America or China. While
consciously aiming at going international, our in-depth
interviewees, however, did conclude, that while operating
abroad, they still wish to run the company’s headquarters from
Finland.
“We are going to expand abroad.
When I talk about expanding I
don’t mean physically. We stay in
Finland....”
“Opening new markets is actually quite
interesting to us. We can scale our business
language-wise. [...] But we are going to go
international, we are not going to stay only
in Finland.”
Going International
29
When answering the question about what is the Finnish
Government doing to support the industry, most of the
respondents concentrated on the existence of funding
institutions or networking events.
“They [the Government] are
trying to do something, but
what’s directly involving us, is
funding. [...] I think one thing is to
create this kind of easy ways to
bring you technologies and new
treatments available. That’s what
the government could do. Right
now, it is difficult, it’s not well-
defined. ”
The Government and the Public Sector
“At least THL has been really helpful. What I have
needed from them is basically the data, and they have
been really helpful. Open data, and such resources, an
email or a phone call, and I got the data within one
week. Or guidance, or instructions on whom to ask.”
30
It is clearly shown in the responses received, that the
governmental discussions on revolutionizing national healthcare –
SoTe reform 20 – are either not being considered as important, or
not known at all. Only very few of our respondents addressed the
question of the upcoming reform. Their opinions were divided.
“SoTe will most likely benefit e-
health service providers.”
“I think change [the informant referred to the SoTe
reform] in these spaces is not very good. When
organizations face changes, they don’t do anything.
They freeze, and they just wait what’s going to
happen.”
“They [the government] provide support (ELY,
Tekes), but other than that, we have not seen
anything significant. Huge IT projects in ‘SoTe’
do not support healthtech.”
“...if we look at the health sector, the new reform,
SoTe uudistus [SoTe reform], that has handicapped
everything. They have such big projects [....], that
they cannot do anything. All their time goes to
planning. [....] When you are a startup of course you
cannot wait for years.”
20 For further reading: https://www.thl.fi/en/web/social-welfare-and-health-care-reform.
Accessed: 28.11.2017.
31
As mentioned above, respondents were aware of the existence
of the governmentally supported institutions. The responses to
the question about how do you experience the collaboration
between the different stakeholders of the industry show, that
some of the players in the industry are more present for startups
than others. The majority of the companies know about the
existence of Tekes (currently Business Finland) and they use their
services. The available funding possibilities, tasks, responsibilities
and decision-making processes of the governmentally financed
entities and organizations are often unclear for the respondents.
“Before I started [the company]
the industry area, where I was
consulting was in health and
welfare, so I was working for
some university hospitals, and
TTL, so I got to know all the
services, but most probably not
all the startups know what they
have.”
Stakeholders of the Industry
“But nowadays, healthcare has so many players. There
are so many players and sometimes it feels like they
don’t really talk to each other.”
“They [the governmentally funded entities]
should clarify what kind of funds are available
and where to start. A startup needs all the help
(and money) it can get and it's silly that we need
to spend hours of hours finding these services.
Or in the worst case you need to know the right
people to know about it.”
32
When elaborating on the responses given to the survey, our in-
depth interview respondents suggested, that acquiring help from
these organizations is significantly easier when having
connections to people who have already worked with them, or
who have the experience and the clear understanding of the
application processes.
“I’d be screwed if I would have just me starting the startup, and
applying to [a public funding institution].21 That would be really
hard, if you don’t have someone [who knows how does the
application process work]. It’s of course always good to have
someone from the business side, but yeah, it is hard for not
business people to apply for money [from this funding institution].”
21 We did not wish to disclose the name of the funding institution the respondent mentioned.
33
An often mentioned criticism towards these players was the
bureaucratic nature of their application and reporting processes.
The opinions on these processes varied among our respondents.
Generally, respondents who had the former experience with
similar tasks concluded that the application process was not
specifically problematic.
“...I understood that a reporting is
also a bit of a pain, but he [the
informant’s partner] has done it
before.”
“For me, it was easy. [...] Most
probably my background [the
informant’s background is in
economics] helps.”
“There is a lot of people who think it’s so
difficult. Of course, you need to have certain
basic things there. Tekes cannot be pouring
money to you, you have to obey some rules.
But you know I have been managing EU
projects, so with Tekes it is easy.”
34
Challenges
Startups
Face
When answering the question about the
most significant challenges on the sector in
Finland, our respondents gave a variety of
answers. When studying these responses in
connection to the field, stage and
geographical location of the startups, we
found out that there is no apparent
correlation between these variables and the
factor that was indicated to be challenging
for the companies. We decided to
elaborate on the 3 biggest challenges in
the continuation of this report.
0%
10%
20%
30%
40%
50%
60%
70%
80%
35
Revenue Growth
0
5
10
15
20
25
30
Achieving growth in the yearly revenue is
naturally the most significant challenge a
small-sized company faces. Revenue growth
is not only crucial for startups because it
illustrates sales increases and decreases, but
because it also helps investors identify
trends to measure revenue growth over
time. Positive changes in revenue can
significantly contribute to companies when
applying for financial aid from governmental
institutions or when pitching their ideas to
investors.
36
Finding Funding
Most of the respondents considered finding
funding challenging. When elaborating
about this issue, informants often concluded
that it is easier to receive early-stage funds
especially from governmentally funded
institutions, but in later stages, the lack of
reliable presence of the VCs and individual
investors is apparent. 0
5
10
15
20
25
30
37
Some respondents have also
concluded, that the funding
decision making processes are
slow, which can cause
significant difficulties for
startups.
“The business angels and investors
in Finland they are mainly interested
in very early funding, with really
small money. If you are growing is
not so easy to find such investors
who would be beneficial for you,
that you don’t lose so much
ownership and you really get the big
money that would help you.”
“...it’s very easy to get money in Finland for your idea. It’s very easy to get
money for the first stage, you know that you kind of testing your idea.
Easy to get money for the R&D, but then when you need to scale it up,
Tekes shuts down the money. And then it’s very difficult to get money. I
think a lot of startups - that’s when they are in, or next to the death valley
and they die. Lots of very good startups die, because when you are
suddenly in the situation when Tekes is closing the you know, you don’t
have any public money.”
“Finnish VC market, Finnish angel market is still
too small I think, the sizes of investments are
also quite small….”
“Our loan application has been in for two months. Two months,
waiting for a decision, they got all the information what they need
immediately when they asked. They have everything they need but it
has taken two months. Two months for waiting for a decision about
funding can be deadly for a startup.”
38
Recruiting Process
As a business grows, one of its key
objectives becomes the recruiting of the
talent that is needed to ensure the further
growth. Naturally, the lack of financing also
contributes to the problems small-sized
companies face when they are in need of
recruiting their professionals.
0
5
10
15
20
25
Very
challenging
Challenging Moderate Easy Very easy Not
applicable
“That’s the problem for startups.
We don’t have money for recruiting
people.”
39
22Finland is planning to introduce a new type of residence permit for startups”. Source:
http://valtioneuvosto.fi/artikkeli/-/asset_publisher/1410869/suomeen-suunnitteilla-uusi-startup-
oleskelulupa?_101_INSTANCE_3wyslLo1Z0ni_languageId=en_US
Accessed: 7.12.2017.
“...one thing that the government should do is to make it
easier to get visa for startup people. Because we also
want to attract people from abroad, and bring them as
soon as possible and have like some kind of fast track. For
them it would be great, because those who are brought in
are really highly skilled people and it really makes a
difference for a Finnish startup and they should
understand the value in that like…and I think it would be
easy to make changes for like working permits and visas
for startups, but I don’t know how the legislation is made
about that and how hard process it really is, but I think it
should be easy…”
The Finnish Government is
planning to introduce more easily
acquirable residence permits for
startups.22 One of our informants
also mentioned this aspect of
recruitment.
40
“We were lucky, because we managed to have one
international student from a university of applied
sciences. She made us a full international strategy.
[...] I already got the recommendations about
hiring some business or communication manager
to actually update that strategy, to drive that thing
more forward. [...] You can always find developers
like sub-contractors, but when you want to find
someone, who can actually understand your
company, it’s a hard task to find. That’s probably a
challenging part here now, to find a right person.”
Other informants suggested that by
establishing a secure collaboration
between educational institutions and
other players of the industry,
companies could get more interns who
later on might be interested in
becoming their employees.
41
Conclusions and
Discussion
We can conclude, that the often
mentioned difficulties startups face were
confirmed by the results of this report.
Nevertheless, similarly to the diverse
products and solutions of the companies
on the health and wellbeing field offer,
the challenges and difficulties these
startups face are also diverse. Most of
the issues our informants face, are
connected to funding and recruitment.
Generally, they are satisfied with the
resources Finland as a platform can
provide in the sector, however they did
mention some constructive comments,
that the stakeholders of health and
wellbeing sector should take into
consideration.
They stated that public players of the industry should provide
detailed information on their startup-related services, and on the
support, they can provide small-sized companies with. Moreover,
public and private players of the health and wellbeing industry
could synchronize their efforts to aid small-sized companies to
get their services and solutions to use.
Overall, respondents have positive views about the future
growth of the industry. The consumer needs and the
digitalization of the healthcare sector are the key factors of this
assumed growth. Views on the speed of this growth vary and the
respondents often pointed out that further financial help from
the government, internationalization, and faster decision-making
processes in the public sector are inevitable for the future
development. Our suggestion is to develop the Finnish
ecosystem on a further basis by placing it in the international
context. Our vision and recommendation are, to expand the
scope of this industry research to the Nordic level, in order to
better serve the requirements of the health and wellbeing
startups.
42
References
Economic Outlook. Technology Industries of Finland.
Source: http://teknologiateollisuus.fi/sites/default/files/file_attachments/t_talousnakymat_3-2017_eng.pdf
Accessed: 14.12.2017
Exports of Finnish health technology grew to over €2.1 billion in 2016
Source:
http://healthtech.teknologiateollisuus.fi/sites/healthtech/files/attachments/finnish_healthtech_trade_in_2016.pdf
Accessed: 01.11.2017
Health Sector Research Strategy for Research and Innovation Activities. Roadmap for 2016-2018.
Source:
http://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/75145/MEE_guidelines_8_2016_Health_sector_growth_strate
gy_17062016_web.pdf?sequence=1
Accessed: 07.10.2017
HealthSPA ry (2015). Health Technology Industry.
Invest in Finland
Source: http://www.investinfinland.fi/health-wellbeing
Accessed: 29.09.2017
43
Finland is planning to introduce a new type of residence permit for startups
Source: http://valtioneuvosto.fi/artikkeli/-/asset_publisher/1410869/suomeen-suunnitteilla-uusi-startup-
oleskelulupa?_101_INSTANCE_3wyslLo1Z0ni_languageId=en_US
Accessed: 7.12.2017
Finland – The Land of Future Health
Source: http://www.finlandhealth.fi/-/finland-the-land-of-future-health. Accessed: 13.10.2017
“Finland’s startups receive most venture capital in Europe”
Source: http://www.goodnewsfinland.com/finland-s-startups-receive-venture-capital-europe/
Accessed: 15.10.2017
SoTe Reform
Source: https://www.thl.fi/en/web/social-welfare-and-health-care-reform
Accessed: 28.11.2017
Statistics Finland (Tilastokeskus)
Source: http://www.stat.fi/meta/kas/pienet_ja_keski.html
Accessed: 15.11.2017
Tekes
Source: https://www.tekes.fi
Accessed: 14.12.2017
44
This report was created in collaboration with Uudenmaan Liitto
(Helsinki-Uusimaa Regional Council).

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The Finnish Health Startup Industry Report 2017

  • 2. About this report The following report was created by Upgraded – Health Startup Association of Finland, to map the Finnish health and wellbeing startup industry. The goal of this paper is to provide a better understanding on the current startup companies in this field and the challenges they face. 1
  • 3. In 2015, a similar cluster research was conducted by HealthSPA ry. The results of the study showed that the most significant challenges health and wellbeing startups in Finland were facing two years ago were related to funding, expansion of distribution channels, and to marketing. 1 When giving their insights, the informants of 2015 concluded that Finland is an excellent platform for companies of the sector, however, they did indicate that the better collaboration of the different industry players is a necessity for the further development of the industry. The following report aims to reflect on the challenges mentioned by the informants of 2015 and to present the situation of 2017 by creating an overall picture of the health and wellbeing startup industry in Finland, to promote the ecosystem and to strengthen Finland's position in the sector. By gaining insights into the experiences of these companies, we hope to understand their needs and acquire more information about the aid and contribution needed from the other players in the industry. Hence, this report functions as a tool for development of activities in the ecosystem.2 1 For further reading: HealthSPA ry (2015). Health Technology Industry. 2 Ibid. pp 19-21. 2
  • 4. About Upgraded (formerly known as HealthSPA ry) is the non-profit association for Finnish health startups. The organization is best known for its annual event called Upgraded Life Festival. Upgraded has 5 years of expertise in working with startup companies and other key players in the health ecosystem. This expertise consists of a great variety of factors, such as knowledge and insights about the currently available players present in the health and wellbeing industry in Finland. 3
  • 5. Contents Introduction: The Finnish Health Sector 5 Startup Definition 7 Methodology 9 Overview of the Companies 10 Finland as a Platform 23 Challenges Startups Face 35 Conclusion and Discussion 42 References 43 4
  • 6. Introduction The Finnish Health Sector Finland ranks among the three strongest health technology economies in the world. Multidisciplinary expertise and problem-solving has raised the country among the main players of digital health. 3 The country is home of a rapidly growing ecosystem of health and wellbeing startups. According to Healthtech Finland, the value of Finland’s exports of health technology products rose to €2.11 billion in 2016, an increase of 9.7% over the prior year. Imports of health technology products rose 8.0% to €1.10 billion. The net trade balance exceeded €1 billion for the first time in 2016. Health technology is a significant export segment of high-tech of Finnish industry. The sector made a positive contribution of €222 million to Finland’s balance of trade4 in 2016.5 3 “Finland – The Land of Future Health”. Source: http://www.finlandhealth.fi/-/finland-the-land-of-future-health. Accessed: 13.10.2017. 4 Please note, that is it stated in the quoted reference, that not all company activities are captured in trade statistics for goods: foreign-financed R&D, intellectual property transfers and services, healthcare related IT license and maintenance service exports are not included in the product trade statistics. Most products, that are related to the field of “wellness” are not generally considered to be health technology for trade purposes either. For further reading: http://healthtech.teknologiateollisuus.fi/sites/healthtech/files/attachments/finnish_healthtech_trade_in_2016.pdf 5 “Exports of Finnish health technology grew to over €2.1 billion in 2016”. Source: http://healthtech.teknologiateollisuus.fi/sites/healthtech/files/attachments/finnish_healthtech_trade_in_2016.pdf Accessed: 01.11.2017. 5
  • 7. These factors include: strengthening of co-operation between university hospitals, universities, and enterprises; establishing the National Genome Centre and National Cancer Centre Finland; strengthening the joint activities of biobanks; regulation supporting innovation; establishing national and regional centres of expertise; developing research infrastructures; commercializing research; lobbying at EU; promoting export and attracting investments; enabling the usage of social welfare services and health data for research use; innovative public procurement. It is among the plans to review the implementation by 2020 on whether the work can be finished in strategy format.8 The answers of startups who have taken part in the current research often echo on these points, when talking about factors to be developed in the industry. Growth has been one of the key traits in wellbeing and health innovation in Finland during the recent years. Finnish economic growth is supported by private consumption, exports and productive investments of companies, as well as by the long-term investments in education, innovation, and research infrastructures. 6 International investors have also identified the potential of Finnish startups, and according to recent information, the amount of venture capital obtained by Finnish startups and growth companies is the highest in Europe in relation to the GDP. 7 As one of the Finnish Government’s key aims is to accelerate growth in the health sector, in June 2016 they published a roadmap, entitled “Health Sector Growth Strategy for Research and Innovation Activities”. The roadmap identified the key factors that are necessary for the further innovation of the industry for the period 2016–2018. 6 Economic Outlook. Technology Industries of Finland”. Source: http://teknologiateollisuus.fi/sites/default/files/file_attachments/t_talousnakymat_3-2017_eng.pdf. Accessed: 14.12.2017. 7 “Finland’s startups receive most venture capital in Europe” Source: http://www.goodnewsfinland.com/finland-s-startups-receive-venture- capital-europe/ Accessed: 15.10.2017. 8 “Health Sector Research Strategy for Research and Innovation Activities. Roadmap for 2016-2018.” p.5. Source: http://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/75145/MEE_guidelines_8_2016_Health_sector_growth_strategy_17062016_web.pdf?s equence=1. Accessed: 07.10.2017. 6
  • 8. Startup Definition When defining what a health and wellbeing startup is, we considered a variety of factors. On the practical level, we based our definition on the information acquired from Statistics Finland.9 According to this10 categorization, we considered companies with: • no more than 50 employees • with the annual revenue are not exceeding €10 million • not more than 10 years of operations Moreover, we took the factor of when were the studied companies established into our consideration. Startups that operate in the field of health and wellbeing often face longer regulatory and validation processes (e.g., trials, testing, official permissions). Hence, we decided to include startups that were established maximum ten years before our research was conducted. We aimed to include enterprises, which focus on issues concerning health and wellbeing and identify themselves as startups in these fields. 9 Statistics Finland is the only Finnish public authority established specifically for statistics. Statistics Finland combines collected data with its own expertise to produce statistics and information services. For further information: http://www.stat.fi 10 Source: http://www.stat.fi/meta/kas/pienet_ja_keski.html. Accessed: 15.11.2017. 7
  • 9. Besides health- and medtech solutions, we also included startups who offer products and services that encourage their users to do physical activities, live a healthier life, or that help preventing injuries. We did explicitly exclude companies that have their core focus on enhancing sports performance or that provide solutions that can be used in a wide range of other industries. We did not include companies, which do not have their focus and operations primarily in the health and wellbeing industry. According to our estimate, there are approximately 300 companies in Finland in the industry that suits our definition. Due to the vividly growing nature of the sector, and to the multidisciplinarity of the solutions offered by the innovative companies, estimating the number of currently active startups that operate in the areas of health and wellbeing is challenging. Moreover, the definitions of health and wellbeing startups often vary. 8
  • 10. Methodology The study combines quantitative and qualitative methodologies. While taking Upgraded’s (formerly HealthSPA) knowledge of the ecosystem and the findings of the report of 201511 into consideration, the current research consisted of the following two main phases: 1. Distributing an online survey that focused on the operating fields, background, experiences of the currently active innovative health startups. We have created our database of startups in the fields of health and wellbeing industry in Finland before the distribution of the survey. Based on the knowledge we acquired during this process, we created a survey that was sent to three of our member startups as a pilot. They were asked to fill it out and give their comments on its elements. When the questionnaire was finalized, we approached 262 startup companies who suited our definition of a health and wellbeing startup out of which 62 of have responded to the survey. 2. Conducting six semi-structured in-depth interviews with respondents of the questionnaire. The participants of the in-depth interviews were selected by us, based on the stage of their company, their field of operation and their end-product to ensure that the interviews cover a variety of areas within the startup community. The central questions asked during the interviews were connected to the informants’ answers to our survey. 11 For further reading: HealthSPA ry (2015). Health Technology Industry. 9
  • 11. Overview of the Companies Location 3% 2% 58%5% 6% 16% 2% 8% Central Finland (Keski-Suomi) Häme Metropolitan Area (Pääkaupunkiseutu) Northern Ostrobothnia (Pohjois-Pohjanmaa) Northern Savo (Pohjois-Savo) Pirkanmaa Satakunta Southwest Finland (Varsinais-Suomi) The survey has received 62 responses from companies all over Finland.12 36 of the respondents were located in the Metropolitan Area,13 all of them have their headquarters in Helsinki or Espoo.14 The rest of the respondents (26 companies) were from other areas of Finland. 12 We have received 70 responses to the survey, but only 62 of them were relevant based on the startup definition. 13 Helsinki, Espoo and Vantaa. 14 One of the respondents indicated, that they discontinued their activities in Finland, due to the hardships they were facing (“We decided to leave Finland as we could not find financing or customers there, and recruitment was difficult. Only little public funding was available for us.”) on the Finnish market. We decided to include their responses in our report, as they still have a registered in the trade register (has a trade registry number - Y-tunnus) in Finland. 10
  • 12. Years of Establishment 0 2 4 6 8 10 12 14 16 2007 2009 2010 2011 2012 2013 2014 2015 2016 2017 Most of the companies that responded to our survey were established after 2010. 11
  • 13. Stage 1/2 48% of the respondents were in the stage of “growth and scale,” 32% of them are going to market with their products, whereas the rest of them (20%) are currently working on their product. None of the 62 respondents are in the very early stage working only on their concept. This may be due to the fact, that the idea is usually created before the business entity is established. 48% 32% 20% Growth & scale Going to market Working on product Concept only 12
  • 14. Stage 2/2 0 2 4 6 8 10 12 2007 2009 2010 2011 2012 2013 2014 2015 2016 2017 Concept only Working on product Going to market Growth & scale As expected, in most cases the later a company was established, the more advanced stage it is at. The number of startups in the stages of “Working on product” or “Going to market” is higher among companies established after 2014. 13
  • 15. Number of Employees When asking about the number of employees of our respondents, we were aware that many startups cannot employ multiple full-time workers. Hence, we asked them to indicate the number of their workers equivalent to full-time (e.g., 2x50% employees = one full-time employee). According to the responses, 51 (83%) of the startups employ 10 or less than ten employees. 45% of the companies provide salaries to all their workers, 11% of the companies do not have any paid employees, 37% of the companies have the majority of their employees paid, and 7% of the companies did not indicate how many of their employees receive payments for their work. We did not ask for any specification on whether the founders of our respondents consider themselves as employees or not. . 45% 37% 11% 7% All employees paid More than half of the employees paid No employees paid Did not answer 14
  • 16. Funding Received 1/2 Applying for funding and receiving it are often indicated to be the most challenging things for the small-sized companies who responded to our survey. Most of our respondents have received some sort of public funding from Finland. There were only seven companies who did not receive any public funding. Sixteen companies concluded that they have received public funding up to €50 000. The smallest group regarding public funding was the one that indicated to have obtained over €1 000 000 from public sources - only three companies. When asked about private funds received, twelve companies indicated that they had not received any private investment. There were only five companies that have received funds up to €50 000. Nine startups concluded that the amount they have received from private entities was over €1 000 000. 0 5 10 15 20 No funding 1 - 50 000 € 50 000 - 100 000 € 100 000 - 200 000 € 200 000 - 500 000 € 500 000 - 1 000 000 € Over 1 000 000 € Private funding Public funding 15
  • 17. Funding Received 2/2 When looking at the stages of our respondents, and the amounts of funding they have received from public or private funding entities, we can conclude, that companies in “growth and scale” - stage received larger amounts of investments. In comparison, companies that are in the earliest (“working on product”) stage, are more likely to receive smaller public investments. 15 When it comes to the question of private funding, we can conclude that private funding agencies invested greater amounts into companies that are in the more advanced stages. All the companies who have received more than €1 000 000 were from the “growth and scale”- stage. Similarly, the biggest number of the companies who have received investment between €200 000–500 000 were in the same “growth and scale”- stage. 15 We did not inquire information about in which stage our respondents have received their funding. 0 5 10 15 20 Over 1 000 000 € 500 000 - 1 000 000 € 200 000 - 500 000 € 100 000 - 200 000 € 50 000 - 100 000 € 1 - 50 000 € No funding Working on product Going to market Growth and scale 16
  • 18. Research Background 16 “Finland – The Land of Future Health” in Finlandhealth. Source: http://www.finlandhealth.fi/-/finland-the-land-of-future-health. Accessed: 13.10.2017. 66% 34% Yes No Research in the fields of genomics, diagnostics, non-invasive measurements, imaging, patient monitoring, digital health, wearables, sensors, health services, elderly care and hospital IT make Finland a thought- leader in healthcare.16 This is also shown in the background of the companies who responded to our survey. 66% (41 startups) indicated that they had a scientific research background in the fields of their solution(s). 34% (21 startups) stated that they do not have a research background at all. 17
  • 19. Fields of Operations 1/2 As the following chart shows, 56% of the respondents (35 companies) that described themselves as “medical”. The second biggest group was on the field of wellness, with 29 startups – 47% of the responses. There were nine respondents, who located their operations in the medical field also located themselves on the field of wellness. Nine companies did not choose any of these options. Based on the respondents’ self-description, “medical” refers to all solutions that can be used in places of medical operations including e.g. “medical education”. In several cases, startups operate in a combination of fields and technologies when providing their solutions. Hence, we decided to ask about the fields and technologies of the companies in a multiple-choice question, to ensure that they can give an adequate description of their operating circles. We decided on the available options based on our industry mapping. The mapping was made to the health and wellbeing startups and medium- sized companies both in Finland and abroad, to gather information on the most common fields of operations and technologies of our potential respondents. The procedure of the mapping consisted of internet research, using the already existing knowledge and the network of Upgraded, and contacting several relevant players of the industry. 18
  • 20. Fields of Operations 2/2 0 5 10 15 20 25 30 35 40 Medical Wellness Occupational healthcare Big Data & Analytics IOT Telemedicine Fitness & Sports Diagnostics Mental Health Disease Management Food & Nutrition Artificial Intelligence Biotech Pharma Database Education Genomics Robotics Insurance Gaming VR/AR Preventative Health Patient Engagement Veterinary med 3D Elderly Care Surgical Device 19
  • 21. End Products 0 5 10 15 20 25 Service Hardware/Device Software Mobile application SaaS PaaS Other Similarly to the question about fields of operations and technologies, we were aware that companies might produce several products when offering their diverse solutions. Hence when we asked them about their products, we allowed them to choose multiple options. The two most prominent groups of end products were the groups of software and mobile application. Sixteen companies indicated that they both produce mobile apps and software. Sixteen companies who mentioned hardware/device being one of their end products also offers other products. Nine firms indicated that they only produce service as a product. There was just one company that only produces hardware/device. 20
  • 22. Purchasor of Products In many instances, our respondents do sell their products directly to their customers. As it is visible in the following chart, however, most of the purchasers in our respondents’ cases are among private health providers. The second biggest group is the group of public health providers. Governmental institutions and organizations are among the least frequent purchasers of these products. Our respondents indicated that public health providers, governmental agencies, and organizations often operate with lengthy decision-making processes. Moreover, they concluded that government officials are hard to reach. 0 10 20 30 40 50 Private health provider Public health provider Other businesses Consumer Governmental organizations/institutions Insurance companies Other 21
  • 23. End User of Products The majority of the respondents (44 companies) indicated that the end users of their products are individual customers. Almost half of these respondents (21 firms) exclusively indicated individual consumers to be the only end user of their products. Four startups concluded that their end users might fall into all of the groups: they are either medical, non- medical companies, institutions, and organizations or individual consumers. We can conclude that the end users of the products do not buy the goods directly, but use them through third parties. 0 20 40 60 Individual consumers Medical companies, institutions & organisations Non-medical companies, institutions & organisations Other 22
  • 24. Finland as a Platform In the recent years, cooperation models between the key players of the public and private sectors have been introduced in the ecosystem. Funding agencies, different testing and piloting platforms, research and educational institutions opened to support the health industry and the startups operating in it.17 The Finnish competencies in research and technology drive the country to be the pioneer in the field of health.18 Regional developments also started in the industry resulting in the establishment of health hubs all over the country. Despite the success of the sector, our informants often pointed out; there are still opportunities for further enhancements. 17 “Health Sector Research Strategy for Research and Innovation Activities. Roadmap for 2016-2018.” Source: http://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/75145/MEE_guidelines_8_2016_Health_sector_growth_strategy_17062016_ web.pdf?sequence=1. Accessed: 07.10.2017. 18 “Finland – The Land of Future Health” Source: http://www.finlandhealth.fi/-/finland-the-land-of-future-health. Accessed: 13.10.2017. 23
  • 25. When asking startups about the Finnish platform concerning health and wellbeing innovations, the majority of them responded positively. According to most of them, Finland provides a good platform for the development of the health technology. The often-mentioned positive aspects of the field in Finland are the high level of research and education, and the possibilities of receiving funding from governmentally supported organizations. Some respondents however also pointed out, that the market is small, and specific segments of it – e.g., the public sector – are hard to enter. “Working with public is something that you need to have the right connections for, and sell it for about a year, that they understand. It should be the way, that first the private sector is adopting it and then next thing would be that you try to get it into the public sector.” 24
  • 26. Some of the respondents also concluded, that personal networks play a rather significant role in the piloting and testing processes as well. Some of our in-depth interviewees have already had some connections on the field even before officially establishing their companies. "The piloting in the hospital will be easier because of the personal connections...” “Before we started the company we were already talking with the doctors and we kind of agreed with them, that we will set up the company with this and this kind of product and let’s see if we can do a clinical study together to speed up the process a little bit, because it might take 6 months or even longer to write the study protocol, to apply for permits for different places and recruit patients and advertise….” “Well, we have been piloting our pre-version with [a university hospital]. It was quite hard to get there, even though I had a connection...” 25
  • 27. According to some respondents, the preventative solutions are more difficult to get adopted by the public sector, because the results of such products are only seen in the long-term. Hence the adaptation of them requires a more prominent, long-lasting investment. "To do preventive things, you need to have a double budget. Budget for taking care of medical, and if you want to do preventive, you need to have a budget for that too. Because to get benefits of that preventive medicine...years to come. Nobody is thinking that way. They don’t have the money to put into the preventive face.” “Private is preventive and public is not. We think that the public should be preventive, but this is a long way to go. This is in our pipeline, but that’s politics.” “I think the idea of prevention is underrated in governmental and higher levels. They speak about it, but they don’t understand the value of it. Startups understand it. We have figures and hospitals are in the midway, they know the prevention, but that’s something that is hard to measure without doing a long-term pilot. The only thing for them is the matter of costs.” 26
  • 28. The Metropolitan Area It was an often-mentioned concern - both of startups inside and outside the Metropolitan Area - that the conditions of startups located in the capital area are better as the key players of the field (including influential private companies, governmental offices, and other public players) are found in this area. Moreover, most of the activities that target startups are organized in this region. “The major part of the business is here [Helsinki] of course, because the bigger cities are here. There is more people living here.” “I think that if you are there in the capital area, you are in a quite good position. Everything is happening there. All our clients are there. I don’t have any clients here, so basically I have to travel there a few times a month, and that’s actually one of the problems. There is no such diversity [here]. Companies who actually need services that we provide are all there [in the capital area].” 27
  • 29. Some informants, however, did mention, that in some instances - for instance when targeting the public sector - the process is more straightforward outside the metropolitan region, as the decision-makers are more easily approachable. “Here [Metropolitan Area] we have the big cities and they are moving very slow in the public sector. So then actually it would be easier, if a company would be somewhere in the middle of woods, because the community would be so anxious to support their own economy, that they would most likely take this, you know they would start using our services.” “We’ve had some difficulty accessing hospitals in the Helsinki region. It was easier for us, to approach doctors in smaller cities and regional hospitals. Maybe it is less busy, or they are more open to new ideas, or I don’t know what it is.” “I think startups should address more small hospitals than the central hospitals, because I think they are faster in their actions and I know that the startups would always want the ones for the reference, like hey, we are working together with [a university hospital], that’s why they try to address it, but for example in [a smaller city],19 where I worked it would be much easier, because they have less people involved in the decision-making.” “Looks like the whole city just loves us and our service. [...] The money is budgeted to the local areas, and how you get the decision, you get the local funding, it’s up to the people who are making the decisions. In the capital area, they are stricter and following the rules, and in other parts of Finland they are closer to the people. Of course, we have to fit the rules, but it’s still more personal.”19 We do not wish to exclude the name of the exact city. 28
  • 30. Due to the often-mentioned small size of the Finnish market, most of the companies who took part in this research hope to expand their markets to abroad to bolster their opportunities both regarding finding funding and acquiring customers. Currently, 38% (27) of the companies operate only in Finland. The rest of the respondents have already expanded their operations to other countries. Just five respondents did not express their interest in expanding to other markets. Among the most targeted countries, the startups listed European countries, such as Sweden, Denmark or Germany, but some of them also indicated the place of expansion to be outside of Europe, in the United States of America or China. While consciously aiming at going international, our in-depth interviewees, however, did conclude, that while operating abroad, they still wish to run the company’s headquarters from Finland. “We are going to expand abroad. When I talk about expanding I don’t mean physically. We stay in Finland....” “Opening new markets is actually quite interesting to us. We can scale our business language-wise. [...] But we are going to go international, we are not going to stay only in Finland.” Going International 29
  • 31. When answering the question about what is the Finnish Government doing to support the industry, most of the respondents concentrated on the existence of funding institutions or networking events. “They [the Government] are trying to do something, but what’s directly involving us, is funding. [...] I think one thing is to create this kind of easy ways to bring you technologies and new treatments available. That’s what the government could do. Right now, it is difficult, it’s not well- defined. ” The Government and the Public Sector “At least THL has been really helpful. What I have needed from them is basically the data, and they have been really helpful. Open data, and such resources, an email or a phone call, and I got the data within one week. Or guidance, or instructions on whom to ask.” 30
  • 32. It is clearly shown in the responses received, that the governmental discussions on revolutionizing national healthcare – SoTe reform 20 – are either not being considered as important, or not known at all. Only very few of our respondents addressed the question of the upcoming reform. Their opinions were divided. “SoTe will most likely benefit e- health service providers.” “I think change [the informant referred to the SoTe reform] in these spaces is not very good. When organizations face changes, they don’t do anything. They freeze, and they just wait what’s going to happen.” “They [the government] provide support (ELY, Tekes), but other than that, we have not seen anything significant. Huge IT projects in ‘SoTe’ do not support healthtech.” “...if we look at the health sector, the new reform, SoTe uudistus [SoTe reform], that has handicapped everything. They have such big projects [....], that they cannot do anything. All their time goes to planning. [....] When you are a startup of course you cannot wait for years.” 20 For further reading: https://www.thl.fi/en/web/social-welfare-and-health-care-reform. Accessed: 28.11.2017. 31
  • 33. As mentioned above, respondents were aware of the existence of the governmentally supported institutions. The responses to the question about how do you experience the collaboration between the different stakeholders of the industry show, that some of the players in the industry are more present for startups than others. The majority of the companies know about the existence of Tekes (currently Business Finland) and they use their services. The available funding possibilities, tasks, responsibilities and decision-making processes of the governmentally financed entities and organizations are often unclear for the respondents. “Before I started [the company] the industry area, where I was consulting was in health and welfare, so I was working for some university hospitals, and TTL, so I got to know all the services, but most probably not all the startups know what they have.” Stakeholders of the Industry “But nowadays, healthcare has so many players. There are so many players and sometimes it feels like they don’t really talk to each other.” “They [the governmentally funded entities] should clarify what kind of funds are available and where to start. A startup needs all the help (and money) it can get and it's silly that we need to spend hours of hours finding these services. Or in the worst case you need to know the right people to know about it.” 32
  • 34. When elaborating on the responses given to the survey, our in- depth interview respondents suggested, that acquiring help from these organizations is significantly easier when having connections to people who have already worked with them, or who have the experience and the clear understanding of the application processes. “I’d be screwed if I would have just me starting the startup, and applying to [a public funding institution].21 That would be really hard, if you don’t have someone [who knows how does the application process work]. It’s of course always good to have someone from the business side, but yeah, it is hard for not business people to apply for money [from this funding institution].” 21 We did not wish to disclose the name of the funding institution the respondent mentioned. 33
  • 35. An often mentioned criticism towards these players was the bureaucratic nature of their application and reporting processes. The opinions on these processes varied among our respondents. Generally, respondents who had the former experience with similar tasks concluded that the application process was not specifically problematic. “...I understood that a reporting is also a bit of a pain, but he [the informant’s partner] has done it before.” “For me, it was easy. [...] Most probably my background [the informant’s background is in economics] helps.” “There is a lot of people who think it’s so difficult. Of course, you need to have certain basic things there. Tekes cannot be pouring money to you, you have to obey some rules. But you know I have been managing EU projects, so with Tekes it is easy.” 34
  • 36. Challenges Startups Face When answering the question about the most significant challenges on the sector in Finland, our respondents gave a variety of answers. When studying these responses in connection to the field, stage and geographical location of the startups, we found out that there is no apparent correlation between these variables and the factor that was indicated to be challenging for the companies. We decided to elaborate on the 3 biggest challenges in the continuation of this report. 0% 10% 20% 30% 40% 50% 60% 70% 80% 35
  • 37. Revenue Growth 0 5 10 15 20 25 30 Achieving growth in the yearly revenue is naturally the most significant challenge a small-sized company faces. Revenue growth is not only crucial for startups because it illustrates sales increases and decreases, but because it also helps investors identify trends to measure revenue growth over time. Positive changes in revenue can significantly contribute to companies when applying for financial aid from governmental institutions or when pitching their ideas to investors. 36
  • 38. Finding Funding Most of the respondents considered finding funding challenging. When elaborating about this issue, informants often concluded that it is easier to receive early-stage funds especially from governmentally funded institutions, but in later stages, the lack of reliable presence of the VCs and individual investors is apparent. 0 5 10 15 20 25 30 37
  • 39. Some respondents have also concluded, that the funding decision making processes are slow, which can cause significant difficulties for startups. “The business angels and investors in Finland they are mainly interested in very early funding, with really small money. If you are growing is not so easy to find such investors who would be beneficial for you, that you don’t lose so much ownership and you really get the big money that would help you.” “...it’s very easy to get money in Finland for your idea. It’s very easy to get money for the first stage, you know that you kind of testing your idea. Easy to get money for the R&D, but then when you need to scale it up, Tekes shuts down the money. And then it’s very difficult to get money. I think a lot of startups - that’s when they are in, or next to the death valley and they die. Lots of very good startups die, because when you are suddenly in the situation when Tekes is closing the you know, you don’t have any public money.” “Finnish VC market, Finnish angel market is still too small I think, the sizes of investments are also quite small….” “Our loan application has been in for two months. Two months, waiting for a decision, they got all the information what they need immediately when they asked. They have everything they need but it has taken two months. Two months for waiting for a decision about funding can be deadly for a startup.” 38
  • 40. Recruiting Process As a business grows, one of its key objectives becomes the recruiting of the talent that is needed to ensure the further growth. Naturally, the lack of financing also contributes to the problems small-sized companies face when they are in need of recruiting their professionals. 0 5 10 15 20 25 Very challenging Challenging Moderate Easy Very easy Not applicable “That’s the problem for startups. We don’t have money for recruiting people.” 39
  • 41. 22Finland is planning to introduce a new type of residence permit for startups”. Source: http://valtioneuvosto.fi/artikkeli/-/asset_publisher/1410869/suomeen-suunnitteilla-uusi-startup- oleskelulupa?_101_INSTANCE_3wyslLo1Z0ni_languageId=en_US Accessed: 7.12.2017. “...one thing that the government should do is to make it easier to get visa for startup people. Because we also want to attract people from abroad, and bring them as soon as possible and have like some kind of fast track. For them it would be great, because those who are brought in are really highly skilled people and it really makes a difference for a Finnish startup and they should understand the value in that like…and I think it would be easy to make changes for like working permits and visas for startups, but I don’t know how the legislation is made about that and how hard process it really is, but I think it should be easy…” The Finnish Government is planning to introduce more easily acquirable residence permits for startups.22 One of our informants also mentioned this aspect of recruitment. 40
  • 42. “We were lucky, because we managed to have one international student from a university of applied sciences. She made us a full international strategy. [...] I already got the recommendations about hiring some business or communication manager to actually update that strategy, to drive that thing more forward. [...] You can always find developers like sub-contractors, but when you want to find someone, who can actually understand your company, it’s a hard task to find. That’s probably a challenging part here now, to find a right person.” Other informants suggested that by establishing a secure collaboration between educational institutions and other players of the industry, companies could get more interns who later on might be interested in becoming their employees. 41
  • 43. Conclusions and Discussion We can conclude, that the often mentioned difficulties startups face were confirmed by the results of this report. Nevertheless, similarly to the diverse products and solutions of the companies on the health and wellbeing field offer, the challenges and difficulties these startups face are also diverse. Most of the issues our informants face, are connected to funding and recruitment. Generally, they are satisfied with the resources Finland as a platform can provide in the sector, however they did mention some constructive comments, that the stakeholders of health and wellbeing sector should take into consideration. They stated that public players of the industry should provide detailed information on their startup-related services, and on the support, they can provide small-sized companies with. Moreover, public and private players of the health and wellbeing industry could synchronize their efforts to aid small-sized companies to get their services and solutions to use. Overall, respondents have positive views about the future growth of the industry. The consumer needs and the digitalization of the healthcare sector are the key factors of this assumed growth. Views on the speed of this growth vary and the respondents often pointed out that further financial help from the government, internationalization, and faster decision-making processes in the public sector are inevitable for the future development. Our suggestion is to develop the Finnish ecosystem on a further basis by placing it in the international context. Our vision and recommendation are, to expand the scope of this industry research to the Nordic level, in order to better serve the requirements of the health and wellbeing startups. 42
  • 44. References Economic Outlook. Technology Industries of Finland. Source: http://teknologiateollisuus.fi/sites/default/files/file_attachments/t_talousnakymat_3-2017_eng.pdf Accessed: 14.12.2017 Exports of Finnish health technology grew to over €2.1 billion in 2016 Source: http://healthtech.teknologiateollisuus.fi/sites/healthtech/files/attachments/finnish_healthtech_trade_in_2016.pdf Accessed: 01.11.2017 Health Sector Research Strategy for Research and Innovation Activities. Roadmap for 2016-2018. Source: http://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/75145/MEE_guidelines_8_2016_Health_sector_growth_strate gy_17062016_web.pdf?sequence=1 Accessed: 07.10.2017 HealthSPA ry (2015). Health Technology Industry. Invest in Finland Source: http://www.investinfinland.fi/health-wellbeing Accessed: 29.09.2017 43
  • 45. Finland is planning to introduce a new type of residence permit for startups Source: http://valtioneuvosto.fi/artikkeli/-/asset_publisher/1410869/suomeen-suunnitteilla-uusi-startup- oleskelulupa?_101_INSTANCE_3wyslLo1Z0ni_languageId=en_US Accessed: 7.12.2017 Finland – The Land of Future Health Source: http://www.finlandhealth.fi/-/finland-the-land-of-future-health. Accessed: 13.10.2017 “Finland’s startups receive most venture capital in Europe” Source: http://www.goodnewsfinland.com/finland-s-startups-receive-venture-capital-europe/ Accessed: 15.10.2017 SoTe Reform Source: https://www.thl.fi/en/web/social-welfare-and-health-care-reform Accessed: 28.11.2017 Statistics Finland (Tilastokeskus) Source: http://www.stat.fi/meta/kas/pienet_ja_keski.html Accessed: 15.11.2017 Tekes Source: https://www.tekes.fi Accessed: 14.12.2017 44
  • 46. This report was created in collaboration with Uudenmaan Liitto (Helsinki-Uusimaa Regional Council).