You've come to the right place to understand Oncology services in Europe and Emerging Markets. Here is how we can help you:
Detailed research report on Oncology services with marketshare and growth rates for 9 countries and information on a further 141 (HBI Intelligence)
Database of 141 Oncology 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 operators (HBI Deals and Insights)
Events that cover healthcare services globally including Oncology (HBI 2024)
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Sector ReportOncology 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 News & Interviews
Our indepth stories dig deep and cover profit multiples, revenue, EBITDA and CEO thinking.
Stingray Healthcare Group, the UK’s largest private oncology provider operating in eight countries, has acquired the Centre de Cancérologie de la Porte de Saint-Cloud (CCPSC), a radiotherapy and oncology centre in Paris, France through its French subsidiary...
RadNet, the biggest outpatient imaging company in the US, has bought London-based cloud-native imaging platform CIMAR UK, to grow its AI-focused health division, DeepHealth, across the UK and Europe. The financial details of the deal were not shared....
Two of Europe’s three largest private oncology groups are being merged into a single entity, creating continental Europe’s largest oncology player. Private equity firm Fremman Capital has acquired Stingray, an oncology group with a presence in France and G...
Pan-European oncology group Amethyst has entered the Portuguese market. It has acquired Júlio Teixeira, a private Portuguese oncology provider consisting of two clinics....
With France’s healthcare market facing sweeping reforms and tightening reimbursement rules, asset prices have dropped, presenting a rare opportunity for private equity investors and foreign healthcare providers to enter at a discount, provided they can navig...
US diagnostic imaging services and digital health solutions firm RadNet has announced it has acquired See-Mode Technologies, a global AI ultrasound imaging company, to become part of its current wholly owned subsidiary DeepHealth, a health informatics company...
The first phase of ‘Saudization’ in Saudi Arabia’s healthcare sector is now underway, effective from 17 April. Saudization is a government policy to increase the number of Saudi nationals employed and reduce the reliance on expats in the workforce. ...
The Australian branch of bankrupt radiotherapy group GenesisCare is having its balance sheet restructured by its new owner, alternative asset manager and PE investor Oaktree Capital....
Large scale healthcare services M&A has been mostly on hold in Europe for almost three years now. Despite all the economic and geopolitical uncertainty the world is currently facing, 2025 will probably see more activity. ...
Database of 141 Oncology 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 141 Oncology 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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