HBI Deals+Insights / Business Models and Strategy

Private care home market share varies widely across Europe

Private sector penetration of care home markets varies widely across Europe. This week’s infographic shows how care home ownership divides between the for-profit, non-profit and public sectors in European countries.

Click here to see the HBI Intelligence nursing home report, and here to see the top nursing home companies by revenue.

Historically European countries have adopted very different methods of providing residential care to the elderly. For example, the UK care home market is unlicensed, so operators can largely build as they please, and local authorities have mostly ceded the responsibility of running care homes to private for-profit companies who now control at least 85% of the market. Compare this to France, where the market is heavily licensed, and over half of care homes are still publicly owned.

In all European countries, the care home sector looks set to grow in the coming years, as the percentage of the population over 80 increases rapidly across the continent.

For the purpose of this infographic, ‘private sector’ includes both for-profit (FP) and not-for-profit (NFP) provision.

As you can see private/for-profit sector’s market share varies wildly across Europe. The UK, Germany and the Netherlands all have very large private sectors making up at least 80% of their markets, but breaking that down further it becomes clear the markets are quite different. In the UK, the for-profit sector is very dominant, while in Germany and the Netherlands not-for-profits continue to own more care home facilities than for-profits. In the Netherlands in particular, there is a lot of suspicion from the public towards the profit motive being active in any healthcare industry.

Over the last ten years, most European countries have seen the for-profit sector grow rapidly. Even in countries like France, which heavily restricts the number of new licenses for private care home operators, the private sector has gained market share. This is a trend that looks set to continue as public homes continue to struggle with mounting demand and cost pressures. On top of this, the for-profit sector usually has an easier time accessing funding and attracting investment than not-for-profits, so it has grown faster in most countries.

Scandinavian countries buck the trend and continue to have a large level of public ownership in the care home sector. In general, across Europe the for-profit sector has grown in the last 10 years, however in Norway this trend has been reversed. Since local municipalities refused to work with for-profit operators in 2019, most for-profit care home providers have divested from the market. It is likely there won’t be any for-profit care homes left by the end of 2021.

Across Eastern Europe, the private for-profit sector has been growing rapidly, due mostly to the growth of small local operators. Though, some large pan-European players have entered the market. For example, Orpea operates in the Czech Republic under the brand Senecura. We have recently seen a growth in private-public partnerships in the Czech Republic, with local governments partnering with operators to build new nursing home capacity.

We would welcome your thoughts on this story. Email your views to James Elliott or call 0207 183 3779.