The App on Your Phone That Not Everyone Has

Imagine two neighbours in the same city. One opens an app each morning to track her blood pressure, books a GP video call during her lunch break, and receives a personalised diabetes coaching nudge before bed. Her neighbour — older, less comfortable with smartphones, and with a slower internet connection — drives forty minutes to the clinic, waits three weeks for an appointment, and manages his condition largely by memory. Both live in the same country. Both pay the same taxes. But they are living in very different versions of European healthcare.

This is the digital health divide — and it is not a peripheral problem. It sits at the intersection of one of the fastest-growing technology markets in the world and one of the most pressing equity challenges in modern welfare states.

A Market Accelerating at Remarkable Speed

The numbers are striking. Europe's digital health market — encompassing telehealth platforms, mobile health (mHealth) apps, remote patient monitoring, wearable devices, and AI-driven diagnostics — has moved from a promising niche to a structural pillar of healthcare delivery in less than a decade.

Teleconsultations have become routine: across OECD Europe, they have stabilised at roughly 1.4 visits per capita, more than double the pre-pandemic rate of 0.6. Germany's DiGA framework — which allows digital health apps to be prescribed like medications and reimbursed by statutory health insurance — has become a global reference model. France's Doctolib now handles tens of millions of consultations annually. Across the continent, investment is flowing, startups are scaling, and governments are legislating: the European Health Data Space, which came into force in 2025, obliges providers to offer standardised electronic health records, creating the infrastructure for a truly continent-wide digital health ecosystem.

Three Floors of Exclusion

But beneath this momentum lies a more complicated story. Researchers studying digital health equity describe what they call a "three-level" model of the digital divide — and it is worth understanding each floor, because problems at any level cascade downward.

The first floor is access: whether you have a reliable internet connection and a smartphone or computer capable of running health apps. This sounds like a solved problem in Europe, but it is not. As recently as 2019, more than one in ten EU households had no internet connection at all. Rural areas, lower-income households, and migrant communities continue to face connectivity gaps.

The second floor is skills and trust. Even when devices and connections exist, people must feel confident using them — and confident that their health data is safe. Studies consistently show that older adults, people with lower educational attainment, those in low-skilled jobs, and people with physical or cognitive impairments are significantly less likely to use digital health services, even when access is available.

The third floor is outcomes: whether using these tools actually improves your health. This is the floor that matters most — and it is the one least often reached by the most vulnerable groups, because they rarely make it through floors one and two.

Who Gets Left Behind?

The portrait of digital health exclusion is consistent across European studies. Older adults are the most affected — in 2024, while nearly 93% of the general European population used the internet regularly, only around 76% of those aged 65 and over did so. And internet access is only the beginning: when it comes to using the internet specifically for health and care services, the gap is far wider. Online educational health services, for instance, were used by 33% of the general population but only 12% of those over 65.

These are not small numbers. Europe is ageing rapidly. Chronic diseases — precisely the conditions that digital health tools are best suited to manage — already absorb more than 70% of healthcare spending across the continent. The population most burdened by these conditions is also the population least likely to benefit from the digital tools designed to address them.

Add to this the socioeconomic layer. Low-income households are less likely to have high-speed internet, less likely to own a modern smartphone, and less likely to have the time or confidence to navigate health platforms. Migrant populations often face language barriers on top of digital ones. People with disabilities may find that apps are not designed with accessibility in mind. The result is a paradox: digital health holds extraordinary promise for reducing the burden on healthcare systems, but in practice, it risks delivering its benefits disproportionately to those who are already healthier, wealthier, and better connected.

The Pressure on Public Expenditure

This is where the story becomes a fiscal one — and it is a story that every European finance ministry should be paying close attention to.

The case for digital health investment, from a public expenditure perspective, rests on a straightforward logic: if patients can manage chronic conditions at home through apps, if teleconsultations replace expensive in-person visits, if AI diagnostics catch diseases earlier, then the overall cost of healthcare falls. European governments have bet heavily on this logic. Italy's National Recovery and Resilience Plan alone allocates €15.62 billion to community-based digital care. Germany invested €300 million in hospital digital transformation in November 2024. The European Commission launched a €1 billion "Apply AI" strategy in October 2025.

But here is the catch. If digital health tools are primarily adopted by those who are younger, healthier, and more educated, the efficiency gains will not reach the populations that drive the highest healthcare costs. The elderly diabetic who cannot navigate the remote monitoring app still shows up at the emergency department. The low-income patient who cannot access teleconsultation still misses the early intervention that would have prevented a costly hospitalisation. The savings are captured by those who least need them; the costs remain concentrated where the digital divide is deepest.

Worse, there is a real risk of what economists call a "two-tier trap." As digital pathways become the default — cheaper to run, more convenient for providers, increasingly incentivised by regulation — the analogue alternatives atrophy. GP surgeries reduce walk-in hours. Phone appointments are replaced by app bookings. Paper prescriptions are phased out in favour of e-prescriptions. For those who cannot go digital, the remaining options become scarcer, slower, and more expensive to maintain. The public system ends up cross-subsidising a digital ecosystem that benefits the better-off, while still bearing the full cost of serving those left behind.

What Must Change

None of this is an argument against digital health. The technology is genuinely transformative. Remote patient monitoring can keep a cardiac patient out of hospital. An AI triage tool can save lives. A diabetes coaching app can change habits in ways that no single appointment can. The goal is not to slow the market — it is to ensure that its benefits reach everyone.

That requires three things from policymakers. First, digital literacy must be treated as a public health infrastructure investment, not an afterthought. Countries that fund broadband rollout but not digital skills training are building a highway that millions cannot drive on.

Second, digital health regulation must include equity requirements. The EU's AI Act and the European Health Data Space framework are sophisticated pieces of legislation — but neither mandates that digital health solutions be accessible to those with limited digital skills, nor that they be evaluated for equity of outcomes across socioeconomic groups. That gap needs to close.

Third, analogue alternatives must be explicitly protected. As digital becomes the default, regulators must require that non-digital pathways remain genuinely functional — not as a reluctant concession, but as a core principle of universal healthcare.

A Divide That Will Not Close Itself

The digital health market will continue to grow. The projections are clear, the investment is committed, and the technology is genuinely improving lives. But markets do not, on their own, close equity gaps — they tend to widen them. The digital divide in health is not a temporary inconvenience that will dissolve as smartphones become cheaper. It is a structural problem, rooted in age, income, education, and geography, that requires structural solutions.

For European welfare states already under fiscal pressure — with ageing populations, rising chronic disease burdens, and constrained public budgets — the stakes could not be higher. If digital health delivers its efficiency gains only to the already-advantaged, the promise of lower public expenditure will remain exactly that: a promise. And the bill for those left behind will, as always, fall on everyone.

The app on your phone could transform European healthcare. The question is whose phone it is on.