We map out 2018’s international expansion – and retreat – by healthcare operators in one infographic. It reveals clear trends, like; which regions are the most attractive, where sluggish growth is forcing expansion abroad and which sectors are internationalising fastest. But many big players have also cut their losses in foreign markets this year, so was it, on balance, a positive year for proponents of international diversification?
Some 18 deals including greenfield investment, M&A and Memorandums of Understanding with promises to invest in facilities and significant strategic partnerships are covered in the map below. Hover over the solid lines, each of which represents a deal, to see our coverage (with a full list of links to our subscriber-accessible articles at the bottom of the page).
We’ve excluded private equity or institutional investment as capital is more international than healthcare and expansion in existing countries is also excluded. Click the full-screen icon in the top right for a clearer view and see the pie chart in the top left for a summary of how regions and sectors are represented in the map’s activity.
Inevitably there have also been several significant retreats, especially by large US and South African groups cutting their losses in unfamiliar markets; the nine cases are visible on the map with dotted lines (one case is both an entry and a retreat, with NMC’s acquisition of US group Tenet’s majority in Aspen Healthcare in the UK).
Operators in highly consolidated sectors had a busy year looking abroad, with German, French, UAE-based and Swedish groups active in expanding into new territories. The UK had a busy year with significant entries and exits but no UK group expanded into a new country.
In fact, by market value you could argue the above map shows a de-internationalisation of the sector as the retreats were massive – BMI in the UK has around €1bn in sales while the three Indian exits are likely to total a few hundred €m. And many of the international entries here have been small with operators dipping their toes before committing. But add on expansion in existing international portfolios for these and other groups and you would certainly arrive at an increasingly international sector in 2018.
What data would you like to see added to the map?
List of articles mapped out in the infographic:Cameron Murray or call 0207 183 3779.