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Detailed research report on health care services in Germany with marketshare and growth rates for 19 sectors (HBI Intelligence)
Database of the top 439+ 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 Germany (HBI Deals and Insights)
Events that cover health care services globally including Germany (HBI 2024)
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Country ReportGermany Country
Updated: May 2023
Executive Summary
Background
Germany has a large and generally well-protected for-profit sector. Under the constitution, for-profit hospitals have to receive the same tariffs as the public sector, nursing home prices are guaranteed far in advance. Germany's complex federal structure makes change very difficult leading to many odd anomalies and often high tariffs, particularly in inpatient care. Much of the outpatient sector is now opening up in areas such as imaging and dentistry.
But it is not all roses. Hospital privatisation has all but stopped and may no longer be politically acceptable, tariffs are favouring lower-margin outpatient treatment and onerous regulations on minimum nurses has forced operators to go on mass recruitment drives abroad.
The strong outpatient doctors lobby obstructs reforms that might produce effective chronic disease management programmes. The lab sector has seen the imposition of substantial budget ceilings.
The gradual outlawing of double bedrooms in nursing homes have placed a huge capex burden on operators who need to refurbish old buildings, while rehab hospitals face a huge staff shortage as regulatory changes to labour in hospitals and nursing homes attract more labour.
See the report for details on healthcare spending and trends, including data figures.
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. Domiciliary Care Market size, growth & composition
According to mid-market player SunaCare, 300,000 people use domiciliary care in Germany and most of this is on the unofficial market where carers cost around €1,000 a month. We estimate this unofficial market could be worth between €2-4bn. The for-profit market charges up to €2,500 a month and we estimate it to be worth around €3bn. We are told it is growing extremely rapidly at around 20% - though we would estimate a more conservative growth rate around 10% due to difficulties in sourcing and retaining staff. On top of this would be large public and not-for-profit sectors where we do not have any reliable numbers at this time. Prices & margins
Jörg Veil, managing director of Home Instead Germany, tells us most for-profits are very small with average revenues around €800,000 to €1m. They are operated by their owners, Veil estimates they make 10% EBITDA margins, a figure out of which they take their salary.
Though the for-profit sector charges around €2,500 a month, we are told this is a co-payment with clients paying €1,500 a month and the rest covered by insurers. Occupational Healthcare
Germany’s occupational activity market is awaiting legal reform as the current laws garner little respect. It’s big based on sheer scale at around €2bn - and growing quite slowly at around 2% - but there is a wider payor market worth a huge €15bn, according to official statistics. Background
The regulations around occupational healthcare in Germany are governed by one law introduced in 2008 and updated in 2013 - ArbMedVV. It lays out that employers must provide occupational care under three categories of: Pflichtvorsage, Angebotsvorsorge and Wunschvorsorge. Or in English: compulsory, recommended and elective. The law determines the requirement depending on the activity involved. For example, occupational care is compulsory for employees working with methanol, but is recommended for employees working with exposure to cereal and feed dusts. All specified areas of activity are listed in an annex to the law.
The big players working in the activity market are B.A.D Gruppe, which has about €260m sales in Germany. But most players come in far below that: the IAS Gruppe’s (Institute for Occupational and Social Hygiene Foundation) business arm is worth €7m. The market remains very fragmented.
The total payor market in Germany is a huge €15bn, national statistics show. The majority of this is cash in pharmacies (13%), dentistry (11%) and rehab (8%). Please note that we expect other European markets like France and the UK to have similarly large employer-paid cash markets but Germany’s official data captures this and other national data banks don’t. If somebody can create a one-stop-shop for all employers needs, then there is the potential to transform this cash market into a B2B contract one. 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 German 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 German 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
Germany – National overview
Background
Spending
Regulatory framework
Trends in 2018
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.
Domiciliary Care
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.
Ophthalmology
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.
HBI has built a unique database of the Top 3,700 operators globally in health care services. As part of this we have identified the top 315 operators in Germany.
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.
Germany News & Interviews
Our indepth stories dig deep and cover profit multiples, revenue, EBITDA and CEO thinking.
Germany's healthcare landscape is shifting at a speed unseen in a generation, as the government confronts a series of challenges in modernising a healthcare market known for its strong interest and advocacy groups and its resistance to reform....
The UK’s for-profit ophthalmology sector is heating up, with multiple groups likely to come up for sale this year. This is being driven by the long term increase in the amount of cataract surgeries the NHS is outsourcing. Meanwhile deal activity in Germany...
This infographic showcases Europe's top 5 ophthalmology players by revenue in the reporting period 2018–2022: Veonet Group, Sanoptis, Artemis Augenkliniken, Clinica Baviera, and Optegra....
Log My Care, a digital platform care management platform, has secured £3 million in funding from Mercia Ventures. This new investment boosts the company's total funding to over £7 million, and is not Mercia Ventures’ first investment in the business....
PE firm Nordic Capital has decided not to sell German nursing home group Alloheim, and instead to refinance it. Nordic Capital says it wants to hold onto the group “for the foreseeable future”....
Investment firms Swiss Life Asset Managers and Vesper Infrastructure Partners have acquired RAD-x, a diagnostic imaging platform operating in Germany and Switzerland. The deal is the latest in a series of major acquisitions by infrastructure funds within the ...
US-based PE firms Advent International and Carlyle Group are reportedly interested in bidding for Sanecum, a doctor-led network of outpatient clinics focused on internal medicine in Germany. If it goes ahead the sale could value the group at around €1.5bn....
Doctors are becoming increasingly interested in setting up clinics and running them as proper businesses. We spoke to Romesh Angunawela, who has recently completed an MBA especially for physicians in the US, and is the co-founder of OCL Vision, a three-clinic ...
Consolidation has been the primary way that PE-backed private health care groups have grown in Europe. A lot of the low hanging fruit has now been picked. But canny investors are adopting new models to open up new consolidation opportunities....
Database of 439 Germany 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 439 operators in Germany.
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 2024 – 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. HBI 2020 sessions include a session dedicated to DACH, with a panel of operators and advisors from companies in the market discussing the trends and opportunities. Germany is present across many other sessions.
Other sessions look at trends in hospitals and labs as well as investment and merger and acquisition, plus digital health and telehealth.
Contact us in the UK on 0207 183 3779 for more information.
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