The COVID-19 pandemic triggered a universal and unprecedented shift toward remote healthcare, but as the dust has settled, it is clear that the experience has not forged a unified digital path for Europe. Instead, it has exposed a deep and persistent divide. While some nations have embraced teleconsultations as a permanent pillar of their healthcare systems, others have largely reverted to traditional, in-person models, creating a fragmented landscape where access to digital care is a matter of geography. This divergence raises a critical question: what underlying forces are shaping these vastly different trajectories and defining the future of healthcare delivery across the continent? The answer lies in a complex interplay of deliberate strategy, financial structures, technological maturity, and deep-seated cultural attitudes.
The Post-Pandemic Telehealth Landscape
A New Elevated Baseline
Across the Organization for Economic Co-operation and Development (OECD), the data paints a clear picture of a permanent, albeit partial, transformation in healthcare delivery. Before the pandemic in 2019, remote consultations were a rarity, averaging just 0.5 per patient annually. This figure surged to a peak of 1.3 per patient in 2021 before settling at a new, elevated baseline of 1.0 in 2023. This stabilization is not a sign of failure but of integration. It indicates a deliberate “partial retreat from pandemic peaks while maintaining levels well above pre-pandemic baselines,” according to the OECD. Telehealth has successfully transitioned from a crisis-response tool to a durable component of routine care in many countries. This doubling of the pre-pandemic rate signifies that a significant portion of the population now views remote consultations as a standard option, fundamentally altering patient expectations and provider workflows for the long term.
A Tale of Two Europes Leaders and Laggards
Examining the proportion of healthcare delivered remotely reveals a continent starkly divided. Estonia stands out as the undisputed European leader, with an impressive 36% of all doctor consultations conducted via telehealth in 2023. This means that more than one in three doctor-patient interactions in the nation now occurs remotely, a testament to its successful integration strategy. A cohort of other high-adopting nations has also solidified telehealth’s role, with at least one in five consultations being remote. This group includes Portugal (26%), Sweden (25%), Denmark (25%), Spain (22%), Norway (21%), and Croatia (20%). In stark contrast, Europe’s two most populous countries lag significantly. Germany and France report telehealth shares of just 1% and 4%, respectively. This vast chasm highlights a major divergence in digital health maturity and policy, creating a two-tiered system where access to convenient, remote care is far from universal, depending heavily on national borders.
Measuring Success by Growth
An alternative metric for success—the growth in teleconsultations per person—offers a different perspective on which countries have most dynamically expanded their services. In this category, Spain and Lithuania lead the pack, both demonstrating a remarkable increase of more than one full teleconsultation per person between 2019 and 2023. Spain’s rate surged dramatically from 0.3 to 1.7, while Lithuania’s rose from 0.1 to 1.2. Other nations showing notable increases include Croatia, Portugal, Slovenia, and Norway. Curiously, Denmark, despite its high overall share of remote consultations, saw a slight per-person decrease. Experts clarify this is not a rejection of the model but rather a “careful normalization” based on clinical appropriateness. Denmark already had a robust tradition of telephone consultations before the pandemic, so its post-pandemic figures reflect a mature recalibration of a well-established system rather than a new, explosive growth phase.
The Core Factors Behind the Divide
Government Strategy and Financial Incentives
The significant variance in telehealth adoption is not arbitrary but is directly driven by a complex interplay of top-down policy and financial frameworks. Nations with the highest rates of adoption, such as Estonia and the Nordic countries, are distinguished by their long-term, coherent national digital health strategies. This proactive, visionary approach provides a stable structure for technological development, professional training, and outcome evaluation, transforming telehealth from an emergency stopgap into a high-quality, integrated service. Critically, funding and reimbursement policies have been identified as a decisive factor. As health experts at the World Health Organization note, usage remains high and continues to grow in countries where teleconsultations are fully and consistently reimbursed by health systems. Conversely, when these financial incentives disappear, usage drops sharply. This underscores a fundamental truth: without sustainable financial models that treat remote care as equal to in-person care, telehealth cannot be integrated into routine practice.
Technological Readiness
A nation’s ability to effectively deploy and scale telehealth services is fundamentally dependent on its existing digital infrastructure and maturity. The technological readiness of a country’s health system is paramount, extending far beyond the availability of a teleconsultation app. Leading nations possess well-developed, mature, and interoperable digital systems, including widespread electronic health records and robust platforms for seamless data exchange between providers. This interconnectivity allows for continuity of care and efficient workflows, making remote consultations a practical and safe option. At a more fundamental level, basic infrastructure such as reliable, high-speed broadband access for the general populace and the widespread availability of digital devices are non-negotiable prerequisites. Gaps in this foundational layer create significant barriers to access, effectively excluding portions of the population and preventing a telehealth system from achieving its full potential.
Cultural and Professional Mindsets
Beyond policy and technology, cultural factors play a significant and often underestimated role in telehealth adoption. In some nations, like Germany, there exists a “long-standing attachment to in-person visits,” with both medical professionals and patients viewing face-to-face examination as the gold standard of care. This cultural preference is often accompanied by lower trust in digital solutions, creating a powerful barrier to change. In contrast, populations that are more comfortable with digital tools and have higher levels of digital and health literacy have adopted telehealth services more readily. Furthermore, the successful integration of telehealth is tied to the existing healthcare model. Systems with strong primary care foundations and established protocols for managing chronic diseases are better able to incorporate remote consultations as an effective tool for ongoing patient management, follow-up appointments, and preventative care, making it a valuable addition rather than a disruptive force.
A Divergent Path Forward
The analysis revealed that the vast differences in telehealth adoption across Europe were not a random consequence of the pandemic but a reflection of pre-existing national priorities and capabilities. The crisis acted as a stress test, amplifying the strengths of digitally mature nations while exposing the foundational gaps in others. This divergence was shaped by a combination of deliberate government strategy, the presence or absence of sustainable funding models, the maturity of digital infrastructure, and the varying degrees of cultural and professional acceptance. It became clear that while the pandemic was a shared catalyst, the path forward was not. The result was the formation of a fragmented digital health landscape, one in which a patient’s access to modern, remote care was ultimately determined by their nation’s long-term commitment to a digital future.
