You've come to the right place to understand Dentistry services in Europe and Emerging Markets. Here is how we can help you:
Detailed research report on Dentistry services with marketshare and growth rates for 20 countries and information on a further 369 (HBI Intelligence)
Database of 369 Dentistry service providers, including profile and major external investors (HBI Intelligence)
Merger and acquisition (M&A) intelligence showing likelihood of sale (HBI Intelligence)
News stories and interviews with Dentistry operators (HBI Deals and Insights)
Events that cover healthcare services globally including Dentistry (HBI 2024)
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Sector ReportDentistry Sector
Updated: March 2024
Executive Summary
EXECUTIVE SUMMARY
Impact of Covid-19
We are in the process of analyzing the impact of Covid on the sector and we should have updates for every country’s growth forecasts for 2020 and 2021 by end of May. This is a partially elective sector and there has been a strong short-term impact which we have already reported in news. A serious recession will further hit demand and leave many investors breaking their bank covenants. Exciting opportunities in an unconsolidated market
The European dental sector represents one of the biggest and most exciting opportunities for private operators and investors in health care today. Dentistry is unconsolidated across Europe and many countries are relaxing rules on external investors.
Some in private equity have seen dentistry as, fundamentally, a safe bet. But this is not universally true. Low cost models in Spain have posed huge problems for the likes of Weston Hill backed iDental, which had a business model which included a Madrid-based practice supporting 100 dental chairs, and Funnydent. In the UK, exposure to NHS payments has caused difficulties. None of the big players seem able to hit production targets and face severe clawbacks.
And yet - there are a lot of opportunities for the informed investor and observant operator - if they know where to look.
So where are the truly pan-European operators? We are yet to see one emerge in the €80bn European-wide market. But the door is ajar – and half a dozen groups are now knocking on it. Germany – the one to watch
By far the largest market is in Germany – which was worth €27bn in sales. That and the high level of fragmentation is attracting a lot interest from consolidators and Germany is unquestionably seen as ‘the one to watch’. The large private equity-based groups beginning to build pan-European groups certainly have it in their sights.
After that, by size, Italy is the second largest by revenue – and considered by many the second most attractive – market. It is also one of the slowest growing.
When it comes to less attractive countries, the UK is problematic for groups reliant on the NHS for payment for the reasons set out below. And France is not currently investable.
But generally, good opportunities can be found in most European countries. Drivers
Even in countries where the involvement of the private sector in healthcare is seen as unwarranted creep towards privatisation, dentistry is often seen as an exception.
Drivers are common across many markets. Populations are aging and becoming more affluent. Advances in dental procedures mean a greater range of treatments are available. So, demand is rising, particularly for cosmetic and facial aesthetic treatments – and these are usually exclusively in the hands of private practitioners. See the report for full details on drivers in the dentistry sector. How do you add value - the benefits of consolidation
Consolidation can take two routes - it can be used to cut costs or add value (or both).
Historically, the profession has offered poor access, restrictive opening hours and long wait times. So, making dentists accessible, freeing up their time to practice and not forcing them to do admin is key to adding value.
With procurement, benefits include better purchasing of capital equipment, consumables and outsourced services like work from dental labs. Patient management systems and patient health records are also very scalable.
And chains also need to ask themselves how much they want to integrate vertically. Do you own your labs for example, as MyDentist does in the UK? Centralised labs can improve both speed and costs. The PE groups most likely to consolidate
There are half a dozen PE groups looking to consolidate in this large, fragmented market. But while opportunities, generally, are plentiful, there are only a few large practices available to buy.
Large chains only exist in a few countries and rarely come up for sale. When they do, they attract plenty of bidders, and strategic investors are usually priced out. And there are too few large targets in a single country for, say, private equity to simply roll it up – which is why many look to expand into other countries. See the report for full details of major players, including data. Below are two examples: EQT
EQT has approximately €50bn in raised capital across 27 funds, including Caraeos, the Dutch dentistry group which has expanded into Belgium, Denmark, Germany and Italy, who they purchased in 2016.
Curaeos has said with EQT backing, it will expand through a buy-and-build agenda in its current regions. They have said publicly that they are looking to quadruple their business over the next 3-4 years. Nordic Capital
In February 2018, Nordic acquired majority stakes in Top Mondzorg BV, the owner of Dental Clinics Nederland and TopOrtho (Dental Clinics) in the Netherlands, and Adent Cliniques Dentaires in Switzerland from the pan-European dentistry platform Hesira.
Separately, Nordic Capital has been making significant inroads into Germany, Europe’s largest and most fragmented dental market, including acquiring DPH Dental Partner Holding and purchasing SFE Beteiligungsgesellschaft, the owner of Zahnstation, a Cologne-based Payor Mix
As the market changes, new models are springing up to take advantage of it. Across Europe, dentistry is provided by both public and private providers, and paid for through taxation, statutory insurance, PMI, out of pocket or any combination of these.
In the report, we have a breakdown of the some of the key markets, an explanation of how they are funded, and our opinion on the best and least attractive to investors / operators. Below is an example of one of the most attractive and least attractive markets. Most attractive: Germany - exclusively private market
Europe’s largest and most fragmented market is the one to watch, a € 25.8bn market where public insurance covers 53%, private insurance 17%, and out-of-pocket 31%. Least attractive: The UK - a mix of public and private work
The UK finds itself in the bottom category because of its funding model - NHS sales are 48% of the value of the £8.1bn market but 73% of the volume. A lack of dentists and unachievable NHS targets leading to clawbacks makes this increasingly unattractive for those more exposed to the NHS. NHS-alone is uninvestable. Add the uncertainty of Brexit into the mix and, for now, this is a market we would suggest anyone thinking short term avoid, unless able to minimise NHS exposure. See the report for full details, including data and marketshare of major players, on another 18 countries and details on recent significant deals in the sector.
What we offer
- Instant overview of the EMEA dentistry market and players This report gives you visibility of this important, fast-growing market across 18 countries with market data as well as detailed profiles of the Top 50 players.
- Ever green! Updated throughout your subscription As part of our HBI intelligence platform this report is updated throughout the period of your subscription. You will also receive additional news stories and interviews on dentistry throughout the period.
- Insights on business models The report is based on in-depth interviews with many operators. The report also looks at how dentistry players can best build customer loyalty.
- Identify national opportunities We assess opportunities at national level based on the regulatory environment and proposed reforms.
- Size markets This report enables you to swiftly see market sizes and market shares.
- Save time and money This report will save you weeks researching these opaque markets and enable you to swiftly identify investment opportunities, new partners and markets.
Table of Contents
Table of Contents
EMEA overview
Datasets Size of EMEA market 2018 Marketshare of major EMEA players 2018 Comparison of market sizes 2018 Comparison of market growth rates 2016-2020
Introduction
Definition, methodology and sources
Provider Types Germany – the one to watch - Breakdown of the German dentistry sector - Comparison to other European countries Specific drivers for the dentistry sector How do you add value - the benefits of consolidation The PE groups most likely to consolidate - Breakdown of major players in sector - Payor mix
Most and least attractive countries
A breakdown of most, least and middling attractive countries for investment in Europe
It’s a seller’s market The path to consolidation Significant details - Breakdown of recent significant deals in sector
Belgium
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Czech Republic
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Denmark
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Finland
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
France
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Germany
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Greece
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Ireland
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Italy
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Netherlands
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Norway
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Poland
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Romania
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Russia
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Sweden
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Sweden
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Switzerland
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
United Kingdom
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Dentistry News & Interviews
Our indepth stories dig deep and cover profit multiples, revenue, EBITDA and CEO thinking.
Who are the biggest dentistry groups in the UK? In this infographic we look at the UK's top 5 for-profit dentistry groups, using 2022 and 2023 revenue figures....
Doctors are becoming increasingly interested in setting up clinics and running them as proper businesses. We spoke to Romesh Angunawela, who has recently completed an MBA especially for physicians in the US, and is the co-founder of OCL Vision, a three-clinic ...
Consolidation has been the primary way that PE-backed private health care groups have grown in Europe. A lot of the low hanging fruit has now been picked. But canny investors are adopting new models to open up new consolidation opportunities....
Pan-European imaging and diagnostics firm Affidea has bought an advanced dental services clinic in Spain - the first such acquisition by the group - as well as two polyclinics in Italy. HBI understands the dental acquisition is part of the group's long-term str...
Gulf Islamic Investments (GII) has acquired an equity stake worth SR600m ($160m) in Abeer Medical Company, a large affordable healthcare provider in Saudi Arabia....
Capital investor Gilde Healthcare acquires a majority stake in Swiss Dental Solutions (SDS) through its private equity fund. SDS aims to accelerate its growth in both Europe and the US and become a world leader in the emerging market of ceramic dental implants...
Multiple sources tell HBI that Nordic Capital-owned multinational European Dental Group (EDG) will be back on the market in Q1 ’24. HBI also hears Mehilainen could be back in the shop window soon too....
Multinational investment bank and financial services company Jefferies published its 2023 Healthcare Temperature Check report this week, to coincide with its healthcare conference which ran between Tuesday and Thursday this week....
It seems Dutch dentistry consolidation could be over before it had really begun, with a consultant source telling HBI the pool of top targets is drying up....
Database of 369 Dentistry service providers
HBI has built a unique database of the Top 4,000 operators globally in health care services. As part of this, we have identified the top 369 Dentistry operators in Europe and will soon add the major players in Emerging Markets.
Profiles include revenue/sales data as well as EBITDA and other profit margins where known. They also cover private equity ownership with dates and mergers and acquisitions.
Mergers & Acquisition (M&A) Intelligence
Our deal pipeline shows how likely all private equity and some privately companies are to sell based on algorithms and journalistic know-how.
HBI 2024 – the only CEO-level conference to cover healthcare services globally
HBI 2020 – the only CEO-level conference to cover healthcare services globally
In 2019 this event brought together 700 delegates from over 40 countries. Over 60% are CEO level and they included 150 specialist investors in health care services. HBI 2020 includes a facilitated discussion on dentistry with major dentistry operators and facilities from India, Chile and the UK. Topics will include regulatory change, payor mix, demand, new treatments and internationalization. Other sessions look at trends in the investment and merger and acquisition, digital health and telehealth.
The Covid crisis means we now offer a series of digital events throughout the year, HBI-365. This includes sessions on dentistry, workforce and brand.
Contact us in the UK on 0207 183 3779 for more information.
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