For-profit health care services in Germany

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  • Detailed research report on health care services in Germany with marketshare and growth rates for 16 sectors (HBI Intelligence)
  • Database of the top 381+ 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 2020)
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Country Report
Germany Country

Updated: May 2020

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.

816 news stories on Germany.

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....

Waterland buys Priory, plans €2bn Median merger after propco sale 2w ago

PE firm Waterland is buying UK mental health and adult specialist care operator The Priory Group from American Acadia Healthcare for €1.2bn and will merge it with existing portfolio company German rehab chain Median to create a c.€2bn revenue group, the si...

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: Lessons on reaching the patient 4w ago

An insurer, an integrated healthcare provider and a telehealth player are three providers with very different experiences of being able to reach the patient. HBI looks at four tangible lessons from Aetna, Medicover and Kry from HBI 2020....

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: Non-COVID lab volumes recover in Q3 but M&A model may be redundant 4w ago

Non-COVID lab volumes reached their pre-pandemic levels in Q3. But does the pandemic signal the end of the sector's reliance on M&A, and what are the implications of new B2C markets? Operators Unilabs, amedes, Medicover and Dr Lal Pathlabs, B2C platform Daslab ...

HBI 2020: The future of domiciliary homecare - meeting an insatiable demand 4w ago

In many markets there is a growing, perhaps even an insatiable demand for unskilled homecare. Is it a sector where it is possible to make money, and how? Is reimbursement sufficient? How do you attract and retain staff? And what effect is COVID having on the m...

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...

Database of 381 Germany service providers

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.

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

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.