Since 2019, a doctor in Germany can write a prescription for a digital application and statutory health insurance pays. It is called DiGA — digitale Gesundheitsanwendungen — and it goes through a BfArM assessment with a fast-track route allowing provisional listing while evidence is produced.
France later created PECAN, an early-reimbursement route with similar logic: enter early, prove later.
In Portugal there is no equivalent. There is no national register of digital therapeutics, no reimbursement route, and not even the concept of a "prescribable application".
What this changes in practice
In a German institution, part of the conversation is about eligibility: it is on the list, it is prescribable, the insurer pays. In a Portuguese institution the conversation is entirely different: which budget does this come out of?
That is why almost all health technology buying in Portugal lands in the same problem we described in whoever pays is not whoever saves — one department carrying alone an expense whose benefits are spread. With no reimbursement route there is no third party sharing the cost, and every available route sits on the institution's side, as we listed in how to fund it.
What the German route demands in return, rarely mentioned
Those citing DiGA as a model usually forget the entry price. Getting in requires, among other things:
- being a medical device with CE marking, in a low class;
- demonstrating information security, data protection and interoperability requirements;
- and above all, presenting evidence of positive healthcare effect within a deadline — provisional listing is not permanent, and products have left the list for failing to demonstrate it.
In other words: it is not a subsidy, it is a contract. You enter with a promise of proof, and those who do not prove, leave.
Would RVer fit? No — and not out of modesty
This is the part worth stating clearly, because the temptation to pretend otherwise is strong.
The DiGA model was designed for applications the patient uses alone, at home, after prescription. It is a self-administration route.
RVer is the opposite by design: its intended purpose requires supervised use, the intended users are professionals and trained carers, and the system lives inside an institution with a team running it. It is not an application prescribable to a patient for their own use, and we will not bend the product to fit a funding route.
So if Portugal created a DiGA tomorrow, it would be excellent for the sector — and would probably change nothing for us.
What would make a difference in Portugal, and it is not copying the model
If the question is what would unlock adoption here, the answer is not a national list of apps. It is duller and more effective:
- Recognition in service contracts. While non-pharmacological activity counts towards nothing an institution reports, it competes with what does count — the same logic as what the system measures.
- Clear eligibility in existing funding. Continuing care, social support schemes, recovery funds: most doubts are about whether a budget line covers this, not about whether it is worth it.
- A route for small institutions. A thirty-bed care home has no structure to bid for funds, and it is where the per-resident difference would be largest.
What to ask anyone citing DiGA
If a supplier tells you their product is "aligned with the DiGA model" or "would be eligible in Germany", three questions settle it:
- Are you on the BfArM list? If so, the number. If not, it is a statement about the future.
- Is it self-administered or does it require a professional? That decides whether the comparison makes sense at all.
- What evidence of positive healthcare effect exists, and published where? It is the central requirement of the route being cited.
We are not on the list, we are not eligible, and we say so before being asked.
In short
- Germany (DiGA, since 2019) and France (PECAN) have reimbursement routes; Portugal has none.
- The German route is not a subsidy — it requires CE marking, technical requirements and proof of effect, with exit for those who fail.
- RVer would not fit it, because DiGA is for self-administered use and our intended purpose requires supervision.
- What would unlock Portugal is recognition in indicators and clear eligibility within funding that already exists.