For-profit health care services in France

You've come to the right place to understand health care services in France. Here is how we can help you:
  • Detailed research report on health care services in France with marketshare and growth rates for 15 sectors (HBI Intelligence)
  • Database of the top 281+ 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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    Wolfgang Hofmann, Senior Vice president, Fresenius Medical Care
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    Dr Mark Wadley, Fund Manager, Visio Capital Management
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    Irina Stamate-Rocha, Principal, Patron Capital Advisors
  • “Extremely useful view of what is happening in European healthcare”
    Laurent Ganem, CEO, G Square Capital
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    Rune Aresvik, Co-owner, Vardetun
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    Nancy Hollendoner, Industry Consultant, Senior Adviser to Hawkpoint Partners

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.

587 news stories on France.

French and Italian hospital groups' diverging recovery reflects COVID experience 6d ago

August activity levels for France's second-largest hospital group Elsan were ahead of 2019, while Italy's largest player San Donato is still 30% down due to a more gradual restart of electives and stricter contagion control in Lombardy, HBI can reveal. The cauti...

IK Investments to sell Colisée to EQT Infrastructure 4w ago

French nursing home operator Colisée is changing hands as IK Investments sells its majority stake to Sweden-based PE firm EQT's infrastructure arm. This is the first large transaction the sector has seen all year....

Services 'not a priority' for ArchiMed's €1bn healthcare fund 4w ago

A source close to ArchiMed's new €1bn healthcare fund tells HBI that services are 'not a priority' for the investment firm's new €1bn healthcare fund....

France's regional hospital groups consolidate as multiples increase 1mo ago

France's regional for-profit hospital operators have spent the last 12 months aggressively consolidating the c.65% of the sector not held by Ramsay Sante and Elsan who have been notably quiet on home turf. Vivalto, C2S and Doctegestio have added a collective ...

Interview: Stefan Nilsson, Colosseum Dental Group CEO 1mo ago

HBI talks to Stefan Nilsson, CEO of Colosseum Dental Group, the Swiss-based pan-European chain with a presence in Finland, Norway, Sweden, Switzerland, Italy, Denmark, Germany and the UK, about how it has weathered COVID, and its plans going forward as we all ...

Biogroup makes first acquisition outside of France - and plans more 1mo ago

Biogroup, France's largest lab group by revenue, has new Belgian shareholders after it acquired family-owned CMA-Medina, its first move outside of the home market. CEO Stephane Eimer tells HBI that the new Franco-Belgian group will make more acquisitions there ...

Post-mortem on elderly care - evaluating the true impact of COVID 2mo ago

As we begin to understand the true impact of COVID-19, large disparities of outcome are emerging between countries. HBI speaks to operators and consultants across Europe to investigate how markets have been hit....

Ardian takes French medicalised homecare player into Germany 2mo ago

French medicalised homecare operator Sante Cie has acquired German operator Aposan just six months after being acquired by private equity firm Ardian. Aposan seller IK Investment has reportedly scored a 4x return on the deal....

World's largest virtual care company will target Europe after $18.5bn merger 2mo ago

Europe's digital health companies could be run out of the market following a $18.5bn merger between Teladoc Health and Livongo. The newly formed largest virtual care company in the world has its sights set on a global market, and Chinese operators are likely to...

Database of 281 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 281 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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