For-profit health care services in Spain

You've come to the right place to understand health care services in Spain. Here is how we can help you:
  • Detailed research report on health care services in Spain with marketshare and growth rates for 15 sectors (HBI Intelligence)
  • Database of the top 225+ 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 Spain (HBI Deals and Insights)
  • Events that cover health care services globally including Spain (HBI 2020)
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Country Report
Spain 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
Spain has an impressive for-profit sector thanks to high levels of private medical insurance. It is slowing destroying the greatest experiment in outsourcing health care to the private sector - the Alzira model. Its for-profit lab and fertility sectors are perhaps the most efficient in Europe and there are major consolidation plays in elderly care and dentistry. Major international operators - Helios Fresenius, Orpea and NMC - have entered the market over the last two years. 

Market size
Spain provides universal public healthcare funded by taxation and about 70% of the total healthcare spending is accounted for by the public payor, according to Eurosta. But there is a strong private insurance market and many middle-class people have retained these policies despite the recession. Spain has an NHS system, although much is decided according to regional elections. Socialist areas such as Andalusia have little to do with the private sector, whilst regions like Madrid and Valencia, traditionally controlled by the rightist-PP have favoured the private sector.

A swing to the left in Valencia means that this is now being destroyed. Hospitals in Spain take up most of government healthcare budget, although the financial distribution in the acute care sector varies across the 17 autonomous communities or regions in the country. 
 
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.
 
Nursing Homes
The sector is estimated at €5bn with the private providers accounting for a quarter of the market, while the remaining are public or not-for-profit operators. At a growth rate of 2.5% we estimate the sector to be worth €1.3bn in 2018.

There are 375,000 nursing home beds in Spain and, according to Jorge Guarner, former CEO of SarQuavitae and founder of Activos investment, occupancy rates stand at 95%.
According to Orpea, average daily revenue per bed is €60, and Guarner tells us this is covered by a copayment of around 70% resident pension and 30% public. The amount varies depending on the pensioners’ economic condition.
It is estimated that up to 65% (€3.25bn) of the nursing home market is publicly funded while out-of-pocket payment account for the remaining 35% (€1.75bn).
Spaniards have the highest life expectancy in Europe of 83 years, and about 40% of public hospital beds are occupied by chronically ill patients, many of them old. There is a government strategy to move the care of this group of people from hospitals to nursing homes, so specialist facilities will need to be built.
Telehealth Primary

Private healthcare insurers are the only for-profit bodies providing doctor-to-patient telemedicine in Spain. We estimate that the 2018 market is worth €5m but could be worth €30m by 2020, as the country reaches around 1.2m consultations. The largest growth will come from the PMI market until the government starts to reimburse telemedicine. 

Bupa’s Sanitas offers digital consultations to around 115,000 people through its Blua and Sanitas Pymes Digital products and charges a €10-20 supplement for those on other plans. With just 19% of the population signed up to private insurance, penetration is limited. We estimate that the total primary telehealth market is worth around €5m. 

Spain’s strong public health system is unlikely to outsource telemedicine contracts (many primary care doctors are civil servants), so the only other market opportunities are in the integration of services into private primary care facilities or a product that expects the customer to pay out-of-pocket. Llorbachs says it would be easy to turn his rating platform into a telemedicine service, but he’s worried that doctors and patients won’t take the service seriously in a country so dedicated to the local family doctor. But in ten years 30% of them will be retired, so a solution must be found from somewhere.
 
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 Spanish market This report gives you visibility of this fast-growing market detailed profiles of the Top 221 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 Spain 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
 
Spain – National overview
 
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.
 
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.

Spain News & Interviews

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

435 news stories on Spain.

Eugin process enters second-round - but will COVID impact valuation? 6d ago

Sell-side advisors Perella Weinburg have shortlisted a dozen second-rounder bidders for Eugin, the global IVF arm of NMC Health, according to reports in Spain. A source tells HBI Eugin's recent figures have been significantly impacted by COVID - will it impact ...

PWC on M&A drivers in Spanish healthcare sector 6d ago

The Spanish private healthcare market has been one of Europe's most attractive for institutional investors of late with strong organic and inorganic growth opportunities. PWC Spain's deals leader for Healthcare & Pharma Jose Zarzalejos talks us through the drive...

Diversification helps Grupo 5 grow despite COVID 6d ago

Grupo 5 has carved out an unusual but successful niche for itself in Spain, balancing a mix of healthcare services (predominantly mental health and treatment for patients with brain injuries) with social emergency care for the homeless, children, and people wi...

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....

Macquarie in talks to buy middle market Spanish hospital player 4w ago

Macquarie Infrastructure and Real Assets (MIRA) is reportedly in talks to buy a majority stake in Viamed Salud, Spain's ninth-largest for-profit hospital operator by revenue. Why is a top 50 global asset manager buying a middle-market operator?...

Advent rekindles Dentix bid 1mo ago

Advent, the owner of Spain's largest dentistry group Vitaldent, has emerged as the leading bidder for the market's second player, Dentix, despite earlier reports that it had frozen a rescue package....

Spanish hospital M&A resumes in July 2mo ago

Spain's private hospital groups have resumed their pre-COVID M&A binge in July, with three of the five largest striking deals to acquire smaller competitors. It comes as private hospital activity levels across Europe recover more quickly than previously forecas...

What does a good post-COVID outpatient clinic look like? 2mo ago

Outpatient activity all but came to a standstill as the COVID crisis tightened its grip. A panel of experts comprising Richard Banks, Chief Strategy Officer at international fertility player Virtus Health, Martin Bundschu, Director at Germany-based optical spe...

Big buy makes Atrys world's fourth-largest teleradiology/cardiology provider 2mo ago

Spain-listed small-cap diagnostics and radiotherapy group Atrys Health has agreed to buy Chile's largest teleradiology provider. Atrys' CFO tells HBI the deal makes Atrys the fourth-largest provider of teleradiology/telecardiology by volumes, globally....

Database of 225 Spain 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 225 operators in Spain.

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.
 
HBI 2020 include sessions which look at trends in hospitals and labs as well as investment and merger and acquisition, plus digital health and telehealth.
 
In the wake of Covid, HBI has launched HBI 365, an exciting series of digital events. 
Contact us in the UK on 0207 183 3779 for more information.