Europe’s for-profit hospital market in 2026
We’re about to publish an updated Market Overview for Europe’s for-profit hospital sector on HBI Intelligence.
This delves into the major on-going trends, challenges and opportunities facing the sector, and includes dedicated country sections including key data points such as market sizes, (CAGR) growth rates, payor splits, and top players and their market shares for some of the biggest and most interesting hospital markets: Germany, France, the UK, Italy, Spain, Portugal, Poland, Greece, and Ireland.
The major takeaway is that most of the big themes affecting for-profit hospitals are the same regardless of the country, but the way they’re playing out differs by country, with notable patterns across different types of market. And some of these differences are material enough to be driving investors towards or away from specific countries.
Medical inflation is a problem everywhere, for example, and one that has become particularly pressing since covid as it has trended up towards double-digit annual percentage rates, driven by tight labour markets for healthcare workers and expensive new treatments and technology. Because hospitals can’t cut costs through automation in the way a diagnostic laboratory or a factory can, the extent to which inflation in inputs can be passed through to payors has become an existential concern.
Markets that are mostly private pay-funded tend to have a huge advantage here, over ones that get most of their funding through a statutory insurer or public payor.
Germany and France have by far the largest for-profit healthcare markets in Europe, each with a dozen or so for-profit chains with over €100 million in revenue. But the same feature which has enabled this is now causing financial problems: operators get 80–90+% of their revenue from statutory insurance, which covers for-profit hospital services as well as those provided by public and non-profit facilities. But operators have almost no negotiating power when it comes to statutory reimbursement rates; they are price-takers. Most of the French and German groups are consequently struggling to maintain profitability in the face of rising costs and flat tariffs, and investors have for the most part lost interest in these markets.
Other markets that are primarily funded through PMI and/or out of pocket (OOP) payments are faring a lot better. This includes most countries which have an NHS system such as the UK, Spain and Portugal, although not Italy. Italy has a significant for-profit hospital sector which is funded mostly through NHS outsourcing rather than PMI. Its ‘accredited’ private hospitals are being squeezed even more than Germany and France’s, due to a reimbursement reform at the end of 2024 which meant hospitals in effect got a significant tariff cut for most procedures.
Greece is another country that is faring better. Despite having a statutory insurance system, for-profits typically only get a base rate reimbursed by this for procedures, and are free to set their own top-up co-pay fee. This feature has attracted international investors. Last year UAE healthcare giant PureHealth bought Greece’s largest group, Hellenic Healthcare Group, from Luxembourg-based private equity firm CVC, who had owned it since 2017.
Poland’s market is also doing a lot better despite having a statutory insurance system (the same goes for other Eastern European countries). This is explained by two tailwinds present here which Western European markets have long been bereft of: sustained economic growth in the overall economy, filling the coffers of the statutory insurer and allowing reimbursement rates to rise; and the fact that public authorities have been willing to privatise failing public hospitals. Privatisations fuelled much of the expansion of the two largest Polish groups, Penta and American Heart of Poland, in the 2010s, although this trend slowed in the 2020s.
Regardless of country-specific headwinds or tailwinds, however, the factors which determine success for individual groups are largely the same across Europe. For-profit hospitals are always competing in some form with public hospitals, even if they’re getting most of their revenue from private pay. Those that can maintain as good or even higher medical quality standards than the public sector whilst achieving higher efficiency, speed and convenience for patients are almost guaranteed to succeed, even in an unfavourable tariff environment.
We would welcome your thoughts on this story. Email your views to Martin De Benito Gellner or call 0207 183 3779.
