Investing in Europe’s healthcare energy transition – interview with Andrey Maramzine, Chief Sustainability Officer, BNP Paribas Leasing Solutions
Healthcare generates about 5% of global carbon emissions, with hospitals among the most energy-intensive buildings. Ageing infrastructure, high energy costs, and strict EU decarbonisation targets make upgrades essential, but tight budgets mean the key challenge is not just what to improve, but how to fund it.
For-profit hospitals such as Ramsay Santé, Elsan, and Fresenius Helios are increasingly using ESG-linked financing tied to outcomes like CO₂ reduction, patient satisfaction, and staff wellbeing. Private equity firms are also incorporating ESG into healthcare investments. For example, Luxembourg-based CVC Capital Partners arranged a €1 billion loan for Finnish hospital provider Mehiläinen, with the funding conditional on meeting targets to improve care quality and reduce carbon emissions. The firm has also pledged to align a large share of its investment portfolio with science-based emissions reduction goals. Other PE firms, including Ardian, KKR, Nordic Capital, and Primo Capital, have structured ESG-linked loans or funds connecting financing to environmental and social KPIs.
Andrey Maramzine, Chief Sustainability Officer at BNP Paribas Leasing Solutions, says Europe needs innovative approaches to financing green infrastructure. He highlights the Product-as-a-Service (PaaS) model, which enables customers to access products via subscription, for example leasing heat pumps or energy systems through flexible agreements, allowing sustainable upgrades without relying solely on public funding.
BNP Paribas Leasing Solutions, a fully owned subsidiary of the BNP Paribas Group, France-based second largest bank in Europe, offers green finance for hospital decarbonisation through sustainability-linked loans, green bonds, and leasing. In 2024, the bank arranged a €1.45 billion sustainability-linked loan for Ramsay Santé. It also invests in nearly 80 ESG-focused healthcare properties.
HBI spoke with Maramzine to learn more about the PaaS model and explore the investment opportunities in Europe’s green healthcare infrastructure.
HBI: Could you explain what PaaS models are?
Maramzine: Product-as-a-Service (PaaS) models flip the traditional ownership model by turning products into ongoing services. Under a PaaS model, companies pay for the service or outcomes provided by a product, rather than owning the asset itself. This means predictable monthly payments replace large initial capital outlays. Additional services such as maintenance, upgrades, and insurance are often bundled into the contract, reducing operational complexity and ensuring optimal performance throughout the product’s lifecycle.
In healthcare, this might mean a diagnostics company offering imaging equipment like MRIs or CT scanners on a pay-per-use or subscription basis, bundling maintenance, upgrades, and analytics. For providers, it’s a capital-light way to stay current with cutting-edge tech while aligning costs with patient volumes.
Andrey Maramzine, Chief Sustainability Officer at BNP Paribas Leasing Solutions
HBI: How is subscription pricing set in healthcare PaaS, and how do you manage cost changes?
Maramzine: Subscription pricing in healthcare PaaS can take a few forms. It might be usage-based, for example per scan, fixed monthly fees, or capacity-based tiers depending on the provider’s needs and the vendor’s offering. Typically, vendors choose a model that aligns incentives with patient throughput and equipment utilisation.
As for handling cost changes during multi-year contracts, most providers include clauses that allow for price adjustments based on factors such as inflation, changes in regulatory requirements, or increased demand for services. These clauses are often tied to specific benchmarks, such as a percentage increase in cost or a fixed rate of change aligned with market conditions.
HBI: How are leasing and PaaS models helping decarbonisation in healthcare? How do returns compare with traditional equipment loans?
Maramzine: Leasing and PaaS make it financially viable to install green technologies without large upfront costs, shifting investment risk to vendors or financing partners. Providers can modernise infrastructure and reduce carbon emissions while preserving cash for clinical priorities.
Bundling maintenance, upgrades, and performance monitoring supports longer equipment lifespans and circular use, incentivising manufacturers to design repairable equipment.
Traditional equipment loans typically focus on fixed repayments with predictable risk, PaaS models enable us to share in the long-term performance and utilisation of the equipment, often resulting in stable, annuity-like returns. Our approach is to structure PaaS financing to ensure returns are aligned with ongoing client engagement, equipment reliability, and sustainability outcomes, ultimately supporting both our clients’ operational efficiency and our own financial resilience.
HBI: How effective are public-private partnerships in promoting green tech in healthcare?
Maramzine: They are essential because they share investment, risk, and innovation. The New Karolinska Solna hospital in Sweden is a standout example, delivered through a long-term partnership between Stockholm County Council and a consortium led by Skanska, a Swedish construction and development company, and Innisfree, a private equity and investment firm specialising in public-private partnerships. The first phase ensured that 99.7 per cent of energy came from renewable sources, including district heating, cooling, geothermal systems, and recycled ventilation energy. Additionally, the design of the hospital is adaptable, enabling the integration of emerging green technologies.
Leasing and PaaS further support energy efficiency and decarbonisation by aligning vendor incentives with long-term sustainability goals.
HBI: Where are the biggest untapped investment opportunities in Europe’s healthcare energy transition, and where do you see the strongest potential for private equity?
Maramzine: The biggest untapped opportunities lie in transforming Europe’s healthcare infrastructure into energy-efficient, low-carbon ecosystems. Hospitals, clinics, and care facilities consume vast amounts of energy, yet many operate with outdated equipment and inefficient systems. Retrofitting buildings with renewable energy technologies, implementing smart energy management, and upgrading medical devices to greener alternatives are high-impact investment areas.
For private equity, opportunities lie in projects that combine patient care improvements with measurable environmental impact, from energy-efficient hospital renovations to renewable-powered diagnostic centres. Investing in smart building technologies, electrified transport, and sustainable waste management can deliver strong returns while meeting ESG goals.
HBI: How mature is Europe’s green healthtech market?
Maramzine: It is still growing. In Q1 2025, healthcare and biotech received $4 billion in venture capital, nearly a third of all European VC activity that quarter. Most investment is in early-stage ventures.
Green healthtech companies, especially in sustainable diagnostics, low-carbon infrastructure, or circular medtech, benefit from capital-light models like leasing or PaaS. These approaches provide flexibility while promoting efficiency, asset lifecycle management, and long-term sustainability.
Summary: Europe’s green healthcare market is growing but still maturing, with significant opportunities in projects that combine patient care improvements with measurable environmental impact. Leasing and PaaS models can unlock these opportunities by removing high upfront costs, extending asset lifespans, and aligning all stakeholders around sustainability goals. Even modest efficiency gains in healthcare can deliver meaningful emissions and cost savings, making the sector an important contributor to Europe’s net zero targets and an attractive area for private equity investment.
We would welcome your thoughts on this story. Email your views to Rakshitha Narasimhan or call 0207 183 3779.
