For-profit health care services in France

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  • Detailed research report on health care services in France with marketshare and growth rates for 15 sectors (HBI Intelligence)
  • Database of the top 313+ private health care operators, including profile and major external investors across 18 sub-sectors from diagnostic labs to domiciliary homecare and from telehealth to hospitals (HBI Intelligence)
  • Merger and acquisition (M&A) intelligence showing likelihood of sale (HBI Intelligence)
  • News stories and interviews with operators and investors in France (HBI Deals and Insights)
  • Events that cover health care services globally including France (HBI 2020)
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Country Report
France Country

Updated: May 2020

Executive Summary

Executive Summary
 
Impact of Covid-19 
 
We are in the process of analyzing the impact of Covid all countries in HBI Intelligence and should have updates on market sizes by the end of May for the 5 largest economies and by the end of June for others. Meanwhile we are covering the impact of Covid in news stories. Recent examples include a detailed examination of the impact on French and German hospitals, an article on labs and imaging and a look at the broad elective sector. 
 
Background
 
For a country where the state spends 57% of GDP, the second highest in the OECD, France has a surprisingly large for-profit sector. The state controls it through rationing capacity (every elderly care bed or MRI machine installed needs a licence) and through control of tariffs which are centrally controlled and voted through every year by the National Assembly. Tariffs are generally falling for for-profit operators. And in elderly care and hospitals, for-profit operators accuse the government of freezing them out, excluding them from additional budgets or regional plans. So far little has changed under Macron.

Expenditure

France spent almost €198.5bn on healthcare in 2016, 8.9% of GDP and 2,970 euros per inhabitant. The real expenditure on healthcare is around 11%of GDP, after all costs are taken into account. This is 77% funded by social security payments that are pooled into statutory health insurance funds which are very tightly controlled by the state, while voluntary supplementary health insurance (VHI or PMI) contributed 13.3% to this amount with the remaining 8.3% paid by households. The latter two which make up private expenditure are likely higher but the private sector’s expenditure is generally not very well recorded in France.

Almost all French have some form of supplementary insurance which effectively extends the already good basic coverage to areas such as complex dentistry and ophthalmology.


Below are two example extracts from the sector breakdowns. See the report for full details on each sector. See the table of contents for information on which sectors are represented in the report.
 
Dentistry
The French market is large and 90% provided by dentists in private practice, which at first glance makes it look like a tempting target for consolidation. 90% of all private practices in the country are solo clinics and just 10% are dental centres.
Only a small percentage of dentists work in practices owned by municipalities or insurance companies.
While the market is hugely fragmented with many small acquisition targets, regulations are hugely off-putting. Dental centres (around 15 dentists) will be a more attractive target since non-dentists cannot own small group practices. Well-run dental centres have EBITDA margins of 10-15% and can be acquired for a 4-8x EBITDA multiple.
Dialysis
Like all healthcare services in France, dialysis facilities are commissioned according to the assessed local need. Private dialysis units can be set up and serve the surrounding area or compete in the cities for patients. Some so-called “limited care units” that work with a specific hospital to take care of its dialysis services can also be found in Paris.
The private for-profit sector has a one-third share of France’s roughly 40,000 dialysis patients but varies depending on the several different modalities by which modalities are classified. 
Public data shows that Diaverum has 18 clinics treating 1,900 patients (as of 2017), implying sales of at least €60m, Fresenius Medical Care has 41 clinics treating 2,700 (€85m), while B. Braun has 16 clinics treating around 1,000 (€35m). The latter two have overall sales of €116m and €350m in 2017 but this includes the supply of drugs and equipment.
 
See the report for full details on each sector, including further details on the two above. See the table of contents for information on which sectors are represented in the report.
 
What we offer
 
-       Instant overview of the French market This report gives you visibility of this fast-growing market detailed profiles of the Top 280 players.
-       Ever green!  Updated throughout your subscription As part of our HBI intelligence platform this report is updated throughout the period of your subscription. You will also receive additional news stories and interviews on France throughout the period.
-       Insights on business models The report looks at the main models – private hospitals and lab and dialysis outsourcing.
-       Identify national opportunities We assess opportunities at national level.
-  Size markets This report enables you to swiftly see market sizes and market shares at a sub-sector level
-       Save time and money This report will save you time researching this opaque market and enable you to swiftly identify investment opportunities, new partners and markets.
 
 

Table of Contents

 
Table of Contents
 
France – National overview
 
  • Expenditure
 
Dentistry
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Dialysis
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Fertility
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Hospital
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Imaging Services
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Laboratory Services
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Medicalised Homecare
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Nursing Homes
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Occupational Healthcare
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Oncology
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Post-acute Rehabilitation
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Psychiatry and Mental Health
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Telehealth primary
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Teleradiology
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
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France News & Interviews

Our indepth stories dig deep and cover profit multiples, revenue, EBITDA and CEO thinking.

615 news stories on France.

Doctolib setting up in Italy after telemedicine allowed 7d ago

French digital health unicorn Doctolib has its sights set on the Italian market as it looks to build a commercial team this month. The government finally lifted restrictions on telemedicine in December....

Korian enters long-term real estate partnership 7d ago

France-based pan-European Care group Korian has entered into a 15-year-partnership with BNP Paribas Cardif and EDF Invest, creating a real estate vehicle with Korian at the helm....

Icade Santé acquires nursing homes in France and Italy 2w ago

French property investor Icade Santé has contracted to acquire a portfolio of nursing home properties in Northern Italy, and three in France, bolstering its European footprint....

Fresenius Helios buys Eugin, Elsan buys C2S 4w ago

German and Spanish for-profit hospital operator Fresenius Helios has acquired global IVF operator Eugin from in-administration NMC Health, while French number two hospital group Elsan has bought smaller competitor C2S. What does the deal pricing for both say a...

HBI 2020: Zur Rose turns online pharmacy into a healthcare ecosystem 4w ago

The largest e-commerce pharmacy group in Europe, Zur Rose, set out its vision at HBI 2020 for turning its core business into a healthcare ecosystem that will remotely treat the chronically ill with advice, medications and apps....

HBI 2020: Regulatory and Political Risks post-COVID 4w ago

With increasingly strained public health systems firmly in the spotlight during COVID, and a reliance on for-profit providers to step into the breach and help, relations between for-profit groups and governments have been cordial recently - or at least thawing...

HBI 2020: Elsan and Mehilainen on in-house digitalisation of patient pathway 4w ago

Elsan and Mehilainen, top-two private hospital operators in France and Finland respectively, and both CVC portfolio companies, say their in-house investments in digitalising the patient pathway have increased customer loyalty, cross-selling revenues and insure...

HBI 2020: Propco deals to pick up in 2021 1mo ago

Healthcare property deals will accelerate in 2021 after refrain from sellers during a year of perceived depressed valuations. That is according to US REIT Medical Properties Trust (MPT), one of three investors who sat on HBI's 'Investing in Health Care Property' ...

HBI 2020: Care homes may never return to pre-COVID occupancy 1mo ago

The COVID-19 pandemic is driving regulatory changes in the care home sector across western Europe, said speakers on the 'Elderly Care: How big is the opportunity?' panel at HBI 2020. One said: "Do not assume you will ever see a return to pre-COVID levels of occup...

Database of 313 France service providers

HBI has built a unique database of the Top 4,000 operators globally in health care services. As part of this we have identified the top 313 operators in France.

Profiles include revenue/sales data as well as EBITDA and other profit margins where known. They also cover private equity ownership with dates and mergers and acquisitions.

Mergers & Acquisition (M&A) Intelligence

Our deal pipeline shows how likely all private equity and some privately companies are to sell based on algorithms and journalistic know-how.

HBI 2020 – the only CEO-level conference to cover healthcare services globally

HBI 2020 – the only CEO-level conference to cover healthcare services globally
 
In 2019 this event brought together 700 delegates from over 40 countries. Over 60% are CEO level and they included 150 specialist investors in health care services. The French market is present in many of HBI 2020s sessions, including Digital Health, Elderly Care, Psychiatry and Mental Health. Some of the French market speakers include speakers from Domus Vi, KRY (a Swedish company with operations in France), Rad-X and Inicea.
 
Other sessions look at trends in hospitals and labs as well as investment and merger and acquisition, plus digital health and telehealth.
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