The sheer size of the for-profit health care services sector isn’t really appreciated. So if it were a country, which country would it be?
The answer is that in 2019 HBI Intelligence estimates aggregate revenue for health care services in Europe at at least €500 billion. That makes it a fifth larger than total German health care expenditure at €410bn according to the German Federal Statistical Office. We got to that €500bn figure by aggregating data from our 17 sector reports, adding two-thirds of primary care expenditure and adding 20% to cover extra sectors that we have yet to research such as cosmetic surgery and contract research organisations and smaller countries where we don’t have data yet. (Our largest hospital report now covers 26 countries but still doesnt cover Austria or Luxembourg, other reports typically cover 10-15 countries). So this is a pretty conservative estimate.
There are a few surprises. Apart from for-profit hospitals where aggregate revenue came to €82bn in 2019, the two largest sectors, dentistry and family doctors/GPs, both at €80bn, are the least consolidated. The OECD estimates European expenditure on the latter at around €120bn. We’ve assumed that two-thirds of that, or €80bn, counts as for-profit insofar as the practices are run as small businesses reimbursed on a per capita or activity basis rather than the doctors being directly employed as public servants.
Of course, the big question for investors and for these sectors is can they be consolidated? Quite a few people are having a good crack at this. There are several Pan-European dentistry platforms, for instance, and Praktikertjanst, the big Swedish dentistry/primary doctors cooperative had sales of 10bn SEK (€980m) prior to Covid. The picture is less clear with family doctors/GPs. But the sector is being consolidated in Switzerland, Sweden and the UK. Large chunks have been outsourced in Finland and the big Finnish and CEE groups all include a substantial slug of primary care. Note that new telehealth players like Babylon and Kry have both now bought physical primary care practices.
Other big sectors include nursing homes at €50bn followed by imaging at €20bn and diagnostic labs at €19bn. None of these sectors are consolidated to any great degree in most countries. The top five players in for-profit hospitals together have 22%, in nursing homes 20% and in imaging 7%. Labs is the most consolidated at 30%. That compares to a two-thirds marketshare for the top five in the motor car industry and roughly 50% in edible grocery retail.
We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.