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The HBI Top 100 largest groups in EMEA by revenue 2022 edition

This EMEA Top 100 is extracted from HBI Intelligence which, as well as containing 470 reports on 33 countries and 23 sub-sectors, also includes a database of the top 5,000 health care services operators across Europe, the Middle East and Emerging Markets across Asia and Latin America. The Top 100 shows these companies’ sales relating to health care service activities in EMEA only.

The Top 100 mainly prospered in 2021, despite Covid, which, of course, made it a bumper year for the lab sector. Eurofins Scientific, which (annoyingly) doesn’t break out its diagnostic labs sales, and is global, says that Covid globally led to a €1.425bn boost in sales in 2021. We assume half of that was in France where it has national champion status and so we estimate EMEA sales rose 66% to €1.5bn, which could be an underestimate. 

Synlab definitely saw sales rise 34.2% thanks to Covid plus an organic growth rate of 9.6%, including its big contract at South East London Pathology.

Covid had a negative impact on the big care home groups as occupancy recovered but they still grew in 2021. And almost all the hospital groups also achieved sales growth. 

We are about to see another wave of consolidation. KKR looks set to buy Ramsay and is likely to then go on a buying spree – there are plenty of family-owned groups around. Centene has said it regards its European assets with revenue of €2bn – BMI/Circle in the UK and Ribera Salud In Spain – as non-core. 

The Top 100 is mainly dominated by labs, hospitals and nursing homes, but there are many Pan-European platform consolidations of sectors such as imaging, ophthalmology and dentistry that are bubbling just under. 

How consolidated is the sector? We calculate that for-profit health care services in EMEA, covering everything from oncology to domiciliary care and adult care to imaging, had revenue of €370bn in 2020. 

Note that this is not “the addressable market” – a term used by investors and operators which actually means “the unaddressable market”: i.e. “if we could outsource the entire public sector, how large would the market be?” It is instead based on the ACTUAL size of for-profit services across all the 23 sub-sectors we cover in 33 countries. It is also true that we do not have statistics on every sector in all the 33 countries we cover so the real for-profit market size in 2020 was probably 15% higher at €425bn.  

So the Top 100, with 2021 aggregate sales of €129bn, have just 30% of the actual market.  

One company that we should perhaps have included is Pure Health, a 2021 merger of the healthcare interests of IHC’s healthcare interests and the interests of sovereign wealth fund ADQ (SEHA and the National Health Insurance Company. That should IPO later in 2022 and will probably have revenue of over €1bn. 

This Top 100 comes from the HBI Intelligence database of the top 5,000 health care service operators across Europe, Middle East, Africa, Latin America and Asia and in 23 sub-sectors. HBI Intelligence members also get access to 470 reports on 33 countries and 23 sub-sectors. 

Members can effortlessly generate lists such as the Top 50 German for-profit hospitals or the Top 200 Nursing Home groups in Europe. 

HBI Intelligence also covers 1,207 active health care service investors and tells you which operators are likely to be for sale. We also analyse market share and market growth at country/sector level in EMEA. 

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