The global market for mobile health products and services is expected to approach $23 billion by 2017, and much of the growth will not happen in the U.S. but rather in less-developed countries, according to a new report from PricewaterhouseCoopers.

That is because emerging markets such as South Africa, India and Brazil are "trailblazers" in mobile health today. "Patients in these markets are much more likely to use mHealth applications or services than those in developed countries. Similarly, more emerging-market doctors offer mHealth services than colleagues in developed countries, and more payers cover these costs," says the report.

PwC ran surveys of healthcare providers, patients and payers in Brazil, China, Denmark, Germany, India, South Africa, Spain, Turkey, the U.K. and the U.S. The consulting firm also conducted in-depth interviews with 20 senior healthcare executives and industry experts.

"The ability of [developing] countries to leap ahead lies in the paucity of existing healthcare: there is greater demand for change and, just as important, there are fewer entrenched interests to impede the adoption of new approaches," the report says. Conversely, resistance to change is much greater in the U.S. and Western Europe, where healthcare institutions are more firmly established.

In emerging markets, payers tend to be willing to cover more mobile healthcare services than in developed markets, according to the report. However, Chris Wasden, PwC's global healthcare innovation leader, notes an interesting paradox in the West. "Payers are willing to pay more than providers are willing to offer," he tells MobiHealthNews.

According to the study, only 27 percent of physicians surveyed encourage their patients to use mobile technologies to help manage their health, though only 13 percent actively discourage patients from doing so. Still, 42 percent of doctors expressed concern that m-health would make patients too independent. Surprisingly, 53 percent of younger physicians have this worry, suggesting that newly minted doctors might not be as disruptive as conventional wisdom holds.

"Healthcare's strong resistance to change will slow adoption of innovative mHealth," the report says. "Widespread adoption of mHealth will require changes in behavior of actors who are trying to protect their interests. The challenge will be even greater for innovators because the improvements that mHealth can bring – such as patient-centered care and a greater focus on prevention – will involve disruption of how healthcare is provided. To succeed, innovators must maneuver through culturally conservative, highly regulated and fragmented yet often monopolistic systems that often provide contradictory incentives."

Wasden sees five reasons why providers might be unwilling to change: they have never been trained in telehealth and m-health technologies; there is a "data dilemma" in that they are unsure whether to trust patient-generated information; there is a "liability dilemma" about whether new services open them up to malpractice suits; they are unsure if the technology is scalable; and they wonder if a reduction in office visits will cut their income.

More than likely, disruption will come from the outside, namely, patients with serious health issues seizing more control over their own care. "The only way we can address the healthcare issues that we have is for patients to become more independent and self-sufficient," Wasden says.

He alluded to a 2009 PricewaterhouseCoopers study on mobile health. "When we did our first report, we found that these early adopters of m-health solutions were healthy men," Wasden tells MobiHealthNews. Three years later, he sees some progress. "People who need it the most are using it more," he says. "We are starting to go into a more mature phase."

About half of patients surveyed said that mobile health will improve convenience, quality and cost of healthcare in the next three years. Among physicians and payers, 59 percent said that it is inevitable that mobile technologies will be widely adopted in the near future. While many of the experts interviewed tamped down the enthusiasm and cautioned against too much hype, Wasden predicts that mobile health "will be more transformational than the Internet."

(Ed. Note... Correction: While the headline was always correct, the original version of this post stated up front that the US would lead developing countries in growth, but the opposite is the prediction that PwC is making.)