You've come to the right place to understand Oncology (Outpatient) services in Europe and Emerging Markets. Here is how we can help you:
Detailed research report on Oncology (Outpatient) services with marketshare and growth rates for 10 countries and information on a further 116 (HBI Intelligence)
Database of 116 Oncology (Outpatient) 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 Oncology (Outpatient) operators (HBI Deals and Insights)
Events that cover healthcare services globally including Oncology (Outpatient) (HBI 2024)
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Sector ReportOncology (Outpatient) Sector
Updated: February 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.
Introduction
One in six deaths globally are cancer-related, and that figure is growing. Oncology - the branch of medicine that diagnoses and treats cancer - is one of the fastest growing acute care specialities as gaps in public coverage make way for for-profit operators, and globally cancer diagnoses continue to grow at 2.8% CAGR (The Lancet).
The disease is expensive for healthcare payors. Yet, especially in the West, penetration of the for-profit market is limited, and the bulk of cancer is still treated in the public sector. For-profit penetration is deepest in outpatient oncology, mainly radiotherapy and chemotherapy. In general, for-profit hospitals do relatively little oncology surgery. In countries with substantial private medical insurance such as Spain, and to a lesser extent the UK, for-profit hospitals are moving into oncology surgery. Scope of this survey
This report looks at EMEA’s largest markets: France, Germany, Spain, the UK and Italy, as well as some of the fastest growing: Romania and the UAE to give an overview of business models there. We’ve thrown in India as well for good measure. Methodology
To prepare the report, HBI spoke to oncology providers in all of these markets and collected data from operators’ annual reports, national statistics and elsewhere on the HBI Intelligence centre to bring you market size and growth rates, a historical overview of each market and opportunities and challenges.
How is cancer treated?
Oncology can be divided into three broad treatments: surgery, chemotherapy and radiotherapy. In most markets, not all treatments are offered as comprehensive packages. Surgery is mostly performed inpatient in a general or specialist hospital. A notable exception here is early stage melanoma, which can be excised in outpatient dermatology clinics. HBI has not included this treatment in its market size estimations. Chemotherapy is the treatment of cancer using chemicals. Despite it being an outpatient activity, it is mostly delivered from the outpatient wings of general and specialist hospitals. There is certainly no national or pan-European consolidator of chemotherapy services and there is no trend towards it becoming a pureplay independent sector. It is an expensive form of treatment due to the high costs of the pharma, based on statistics from national payors. Radiotherapy is the use of radiation to kill cancer cells. It is provided outpatient in hospitals or independent radiotherapy clinics. There are many operators across Europe delivering pureplay radiotherapy. It is also the most capex heavy of the three branches of treatment. The service is sometimes incorporated with diagnostics.
Note that HBI does not include the maintenance of radiotherapy machines in its market estimations, except where it is included on an operations contract. See the full report for further details on the different forms of cancer treatment.
What are the different markets?
HBI has identified four main markets for the delivery of oncology services. 1) the for-profit multi-speciality hospital market, 2) the for-profit specialist hospital market, 3) the for-profit outpatient radiotherapy market and 4) the operation of radiotherapy machines by for-profit providers in public hospitals. 1) The multi-speciality hospital market
Virtually all of Europe’s large for-profit hospital groups offer oncology services, and they own a large share of the for-profit market. Spanish hospitals take a 65% share of the total Spanish for-profit oncology market and UK hospitals an 80% share of the total UK for-profit oncology market. The treatment available tends to be comprehensive and that breadth of coverage is leading the trend of private hospitals taking market share away from the outpatient radiotherapy networks across Europe. Germany and France are notable exceptions to this trend.
Many of the hospitals are capitalising on increased demand by launching new specialist centres.
This market is mostly funded through PMI (a notable exception is Italy where it is public pay), with some overflow patients being funded publicly and a small percentage of OOP payments since treatment costs can reach into the hundreds of thousands of euros. Insurers say that they feel increasingly compelled to pay out for oncology since it’s one of the main reasons that people pay premiums.
outpatient networks as described above. See the report for full details on each of the markets.
How is oncology funded?
The for-profit oncology market is funded through a mix of public and private pay. Public pay is highest where either statutory insurers support for-profit outpatient networks or where NHS organisations outsource outpatient work. PMI funds the majority of inpatient surgery in the hospital market. Out-of-pocket payments are common in emerging markets like Romania and India, although it remains a minority funding source elsewhere. Interestingly, operators in Europe are seeing a rise in OOP payments as public waiting lists grow and the cost of radiotherapy treatment reduces due to hypofractionation. See the report for full details on how oncology is funded in different countries.
Growth drivers
1. Increasing cancer rates. Research from The Lancet shows that cancer diagnoses are increasing internationally at a rate of 2.8% CAGR, putting increased demand on services. Five types of cancer - lung, breast, colorectal, prostate and stomach - comprise almost half of diagnoses. In Europe, prostate cancer rates are expected to increase by 12% between 2014 and 2035 and breast cancer by 2%. Stomach cancer is expected to fall by 17% and lung cancer by 7%. Rates of lung, colorectal and cervical cancer are also expected to see big increases in emerging markets. An ageing population and changing lifestyles both contribute.
Challenges
1. Payor adaptation
In markets where comprehensive care is reimbursed, oncology, as a whole, hasn’t been subject to the same payor pressures that are forcing hospitals away from inpatient care. Radiotherapy and chemotherapy have traditionally been outpatient activities and although tariffs are subject to fluctuation there is no move to significantly increase or decrease them. HBI sees that payors are trying to shift some surgery from inpatient to outpatient. The tariff in France for inpatient surgery on malignant tumours on the eyes, nose, throat or mouth decreased by 6% from 2018-2019, and the outpatient tariff for the same surgery increased by 60%.
A greater concern for operators in predominantly public pay markets is that the payors aren’t adapting tariffs fast or well enough to cope with emerging technology. Romania only introduced reimbursement for radiotherapy a couple of years ago. For treatments like proton therapy, machines like MRI-LINACs and medical advances like hypofractionation operators often have to make individual contracts with private or statutory insurers.
See the report for full details on growth drivers and challenges in the oncology sector. See the table of contents for further details on what the report contains.
What we offer
- Instant overview of the EMEA oncology services market and players This report gives you visibility of this important, fast-growing market across 8 countries with market data on all 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 oncology services throughout the period.
- Insights on business models The report is based on in-depth interviews with many operators. The report also looks at how oncology services 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 - Scope of this survey
- Methodology
How is cancer treated?
- Surgery - Chemotherapy
- Radiotherapy
What are the different markets?
- The multi-speciality hospital market
- The speciality hospital market
- Outpatient oncology market
- Operating cancer services in public hospitals
How is oncology funded?
- Public pay
- PMI
- Out-of-pocket payments
Growth drivers
- Increasing cancer rates
- Gaps in provision
- Outsourcing
- Consolidation opportunities
Challenges
- Payor adaption
- Going greenfield or buy and build? 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.
India
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.
Romania
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
Spain
Data sets For-profit /private market size and growth rates 2016-2020 Marketshare of major players 2018
Market description and trends.
United Arab Emirates
Data sets For-profit /private market size and growth rates 2016-2020
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.
Oncology (Outpatient) News & Interviews
Our indepth stories dig deep and cover profit multiples, revenue, EBITDA and CEO thinking.
Pan-European diagnostics group Affidea has continued to drive its position in Romania forward by acquiring MedEuropa Romania, a prominent cancer care provider....
Digital and artificial intelligence is poised to disrupt the healthcare sector, but is Europe prioritising regulation over innovation? HBI speaks to Loick Menvielle, director of management in innovative health research chair at French business school EDHEC, ab...
Global investment banking firm Goldman Sachs has closed one of the largest first-time private life sciences growth funds. Its West Street Life Sciences I raised "$650 million in equity commitments from a global, diverse group of institutional, strategic and hig...
The UK is seeing a boost in private cancer care provision driven by the state of the UK NHS, expanding offerings and a wider availability of convenient drugs – but a radiotherapy source tells HBI not all NHS markets are so lucky....
Regulatory changes are one of the major concerns among players in healthcare services. A busy panel of lawyers, operators and investors considered this thorny issue at HBI 2023, with a general feeling that even the strictest of regulations can provide some kin...
The workforce shortage affects all types of service providers, but not all groups deal with it in the same way. HBI 2023 heard the views of operators from a radiotherapy group, a hospital group, and a social services organisation on "how to solve the workforce ...
Our annual conference took place earlier this week in London. Over a jam-packed three days of HBI 2023, an impressive array of delegates from across Europe and beyond gathered in the heart of London and shared their insights into the myriad challenges and abun...
Last week HBI reported on the South African parliament approving a national / statutory health insurance scheme, which would bring universal healthcare to the rainbow nation at the expense of private providers. HBI speaks to a South African operator to find out...
Database of 116 Oncology (Outpatient) 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 116 Oncology (Outpatient) 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.
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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.
Sessions will look at trends in the investment and merger and acquisition, digital health and telehealth.