Post-acute Rehabilitation sector across EMEA

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  • Detailed research report on Post-acute Rehabilitation services with marketshare and growth rates for 24 countries and information on a further 180 (HBI Intelligence)
  • Database of 180 Post-acute Rehabilitation 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 Post-acute Rehabilitation operators (HBI Deals and Insights)
  • Events that cover healthcare services globally including Post-acute Rehabilitation (HBI 2020)
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Sector Report
Post-acute Rehabilitation Sector

Updated: September 2020

Executive Summary

Detailed research overview on the post-acute rehabilitation services sector
 
Impact of Covid-19 
We are in the process of analyzing the impact of Covid on the care sector and we should have updates for every country’s growth forecasts for 2020 and 2021 by end of May. There has been a strong short-term impact with costs rising and demand falling which we have already reported in news. A serious recession may further hit demand and tariffs and leave many investors breaking their bank covenants.
 
EXECUTIVE SUMMARY
Successful post-acute rehabilitation is perhaps the most important goal for the patient, and it saves society money in the medium- and long-term.
For a whole host of reasons, post-acute rehabilitation is a fragmented sector and one where outcomes are often barely measured. The private post-acute rehab sector across EMEA is generally small, fragmented and opaque.
Outside of these, rehab is often badly or loosely defined, large rehab hospitals tend to be found in the public sector only and budgets allocations can be ever-changing. Rehab services also tend to be low-margin, have minimal coverage under private medical insurance (PMI) policies, and can suffer a lack of willingness from acute hospitals (public or private) to refer post-acute cases onward.
There is no real out-of-pocket (OOP) market anywhere for inpatient rehabilitation, except perhaps in some developing markets where public provision is really dire. On the insurance side, both public and private payors often need to be convinced of the need for intensive rehab now versus the risk and costs of long-term disability.
Definition
Post-acute rehabilitation can be either inpatient or outpatient and aims to restore patients to full mobility and capabilities; physical, sensory and mental. Rehab also includes services aimed at helping those with a permanent injury or disability regain independence as far as possible.
Medical professionals that populate inpatient or outpatient rehab facilities are a mix of physiotherapists, occupational therapists, speech/language therapists and psychologists, as well as qualified nurses and doctors.
The main ways that patients end up in inpatient rehab facilities are for post-surgical care, post-stroke recovery, post-trauma (injury), geriatric cases (falls, deterioration in mobility etc) as well as psychosomatic disorders. For outpatient services, the above plus MSK (musculoskeletal) ailments are the most common.
We exclude acute psychiatric hospitals, which are covered within our psychiatry report, though psychosomatic rehabilitation generally falls within rehab so there may be some overlap.
We’re also excluding addiction treatment, which is a narrow but widely-used definition of the word ‘rehab’. We’re also generally excluding the independent physiotherapy clinic sector because it is opaque and un-investable, though we say when it is included.
What’s changed and where is growth coming from?
The big growth areas for for-profits (and operators generally) are now post-stroke, thanks to advances in detection and treatment; geriatric rehab, because of an ageing population; and psychosomatic because of increasing prevalence and funding. MSK conditions are also on the rise because of increasingly sedentary lifestyles.
What does the private sector look like?
Private for-profit sectors look different from place-to-place and can be categorised in four ways (there are exceptions within and overlaps with each but generally this is where for-profits play).
Specialised rehab hospitals/clinics: Germany, France, Switzerland and Italy, where for-profit markets totalled €6.5bn, €3bn, €500m and €2.3bn in 2018, growing 2.5-3% and mostly public payor-funded. The German market has grown off privatisations and the pension funds; willingness to pay for rehab, the Swiss through the country’s historic high healthcare spend, the French through turning acute hospitals into post-acute ones, and the Italian thanks to the country’s developed integrated care pathways meaning most big groups have sites to cover the spectrum of post-primary care. But each is facing significant headwinds, which we go through in the country entries.
See the full report for details on the other three categories, including market data. See the table of contents for further details on what you can expect in the report.
Barriers to growth
One fundamental barrier to the growth of standalone rehab within private markets is the fee-for-service model hospitals operate on, while growth off the public sector is held back by hospitals unwillingness to pass patients on to a private provider. The general siloing of healthcare sectors and lack of data-sharing also prevents proper, joined-up post-acute care.
Some healthcare systems have effectively decided to deal with the costs of long-term disability, rather than invest in specialised post-acute rehab now. The UK and Italy would fall into this category.
See the full report for further details on barriers to growth in the post-acute rehabilitation sector.
Opportunities
So, while it hasn't really had a look-in by private operators, across EMEA we are told and see signs that there is a big opportunity because of the lack of provision. Alongside post-stroke, geriatric, psychosomatic and MSK which are growing everywhere, there are country-specific opportunities.
Turkey and Saudi Arabia, both countries undertaking massive healthcare reform projects, have singled out inpatient post-acute rehab as an area for international operators to come and play (though there are few takers in Saudi currently – Turkey’s has seen more interest albeit from domestic operators). Vamed has set up a German-style rehab hospital in the UK in partnership with local outfit Circle Health, the first of its kind there, evidently seeing an exploitable gap in the market. Schoen has also entered the UK market.
See the report for full details on opportunities in the post-acute rehabilitation sector, including country specific details.
New technology
A wealth of new tech is helping to deliver better rehabilitation while new platforms are hoping to ‘join up’ care pathways to prevent patients falling through the cracks.
Wearables can monitor vitals and detect signs of improvement in mobility, linking the continuously accumulating data to the doctor’s computer. They can track patients’ progress virtually and encourage adherence to care plans.
Exoskeletons to help regain mobility have also started to appear in the last decade, but these are expensive and have little market penetration outside big spenders like the US and Japan.
We also see the emergence of digital platforms that aim to join up care and follow the patient along the care pathway, from pre-acute to acute to post-acute care, like Auron in Finland.
Results/poverty of ambition
The case for rehabilitation is clear but sadly short-term planning and a poverty of ambition mean payors ending up opting to save money in the short-term and pay out for long-term disability. 
Sample report pages and data
 
What we offer
 
-       Instant overview of the EMEA post-acute rehabilitation market and players This report gives you visibility of this important, fast-growing market across 23 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 post-acute rehabilitation 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 post-acute rehabilitation 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
 
Definition
 
What’s changed and where is growth coming from?
 
What does the private sector look like?
 
                                    - Specialised rehab hospitals/clinics
                                    - Care hotels/hotel-hospitals
                                    - Spa facilities designated as ‘medical hotels’
                                    - Nascent market/outpatient physiotherapy clinics or rehab within acute hospitals
                                    - Outpatient physiotherapy/osteopathy
 
Barriers to growth
 
Opportunities
 
New technology
                                   
Results/poverty of ambition
Albania
 
Data sets
For-profit /private market size and growth rates 2016-2020
 
Market description and trends.
 
Bulgaria
 
Data sets
For-profit /private market size and growth rates 2016-2020
 
Market description and trends.
 
Croatia
 
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.
 
Hungary
 
Data sets
For-profit /private market size and growth rates 2016-2020
 
Market description and trends.
 
Ireland
 
Data sets
For-profit /private market size and growth rates 2016-2020
 
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
 
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
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.
 
Saudi Arabia
 
Data sets
For-profit /private market size and growth rates 2016-2020
 
Market description and trends.
 
Serbia
 
Data sets
For-profit /private market size and growth rates 2016-2020
 
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.
 
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.
 
Turkey
 
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
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.
 

Post-acute Rehabilitation News & Interviews

Our indepth stories dig deep and cover profit multiples, revenue, EBITDA and CEO thinking.

174 news stories on Post-acute Rehabilitation.

Darzalas kickstarts pan-Southeast European rehab platform 4w ago

Darzalas Capital, the investment firm of Ilian Grigorov, has begun the creation of a Southeast European post-acute rehab and elderly care platform with the acquisition of Greece's largest specialised rehabilitation hospital for nominal €1 plus liabilities. We...

Kaia Health eyeing France and UK launch 2mo ago

German digital therapeutics (DTx) app Kaia Health tells HBI it will soon launch in France and the UK after completing Europe's largest randomised control trial (RCT) for DTx focused on a chronic disease. ...

Interview: Arjan Toor, CEO, Cigna Europe 2mo ago

Cigna now describes itself as “a global health service company” rather than an insurer and has reorganised its European operations. Toor has recently been promoted to CEO Europe. He says that the insurer, which has 15% (US$840m) of its revenue in Europe, d...

Romanian post-acute hospital in difficulty 3mo ago

Romania's only substantial specialised rehabilitation hospital looks to be in financial difficulty, after it reportedly laid off the majority of its staff. Should it close, it would spell the death of a nascent market....

Interview: André Schmidt, CEO, Median Kliniken 3mo ago

Dr Schmidt gives HBI the inside view of Germany's €9-10bn rehabilitation sector in the pandemic months, from how activity dropped to what financial support it got, to its medium-term outlook. Are digital therapeutics apps like Kaia Health, which recently rais...

Post-COVID care providers see effect of GCC diabetes crisis 3mo ago

A GCC-based post-acute and long-term care provider tells HBI about the plethora of rehabilitation needs his clinic is seeing amongst COVID-19 survivors. The region has a high rate of type 2 diabetes, the key pre-existing condition that predisposes people to a ...

Median looking at France, UK and GCC as Waterland stays put 3mo ago

Private equity firm Waterland has no current plans to put German rehabilitation group Median Kliniken up for sale again, and is focusing on internationalising the business into the UK, France and the GCC, Median CEO Andre Schmidt tells HBI....

NMC Health goes into administration 6mo ago

Listed NMC Health has been placed into administration by a London court today (Thursday, April 9), following an application by Abu Dhabi Commercial Bank (ADCB). HBI talks to a UAE market expert about what may need to be sold off quickly to keep it afloat....

Interview: Shirley Ryan AbilityLab 7mo ago

Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago, claims to be the largest rehabilitation hospital in the USA, and works with groups from Bulgaria to UAE. HBI talk to Kelly Cox Watkins, Vice President, Market Development and Barry Fle...

Database of 180 Post-acute Rehabilitation 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 180 Post-acute Rehabilitation 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 2020 – 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 session on nursing homes, where the deputy CEO and COO of Orpea will discuss some of the challenges facing their post-acute rehabilitation centres across 14 countries.
 
Other sessions look at trends in the investment and merger and acquisition, digital health and telehealth.
Contact us in the UK on 0207 183 3779 for more information.