HBI Deals+Insights / News

The HBI Top 100 largest groups in EMEA by revenue 2024 edition

 
 
 

HBI members gain exclusive access to comprehensive news, analysis and data.

Members uncover valuable insights and gain a competitive edge , to find out more about how a membership can help your business Enquire now

Introduction

Healthcare Business International has published its fourth annual ranking of EMEA’s largest healthcare service providers, drawn from its database of over 4,000 providers. The list, which tracks EMEA-only healthcare service revenues, shows German hospital giant Fresenius Helios maintaining its market leadership with revenues of €12.3bn in 2023.

The Top 100 revealed significant shifts in market dynamics, with diagnostic laboratories experiencing the most notable revenue adjustments. Several major players undertook strategic rebranding, with French elderly care providers emeis (formerly Orpea) and Clariane (previously Korian) both retaining top-five positions despite governance challenges, each posting revenues in excess €5 billion.

Middle Eastern operators demonstrated impressive growth, particularly in Saudi Arabia and the UAE, where government initiatives are accelerating private sector expansion.

 


Top 10 companies

Germany-based conglomerate Fresenius Helios (which owns hospital giants Helios in Germany and Quirónsalud in Spain) takes the top spot in 2023 EMEA revenues, with €12.3 billion. Multinational Australian hospital group Ramsay Health Care takes second place with revenue of €5.9 billion, while German hospital group Asklepios Kliniken completes the top three with €5.5bn.

France’s pan-European nursing home giants emeis (formerly Orpea) had revenue of €5.2 billion and Clariane (formerly Korian) had €5 billion, making up the top five.

For Fresenius, the start of 2023 saw then new CEO Michael Sen preparing to deconsolidate its struggling dialysis subsidiary Fresenius Medical Care (FMC). This was completed in November as part of the ‘#FutureFresenius’ program, to restructure as a two-tier German stock corporation for better flexibility and autonomy.

Shareholders were originally unconvinced, but when its shares rocketed to a one year high, there were more positive predictions.

The year also saw Fresenius sell its 70% stake in Peruvian hospital Clínica Ricardo Palma, Eugin (the fertility group it owned) sold for €500m to KKR, its rehab clinics being put up for sale, and its digital health subsidiary Curalie discontinued from the end of 2023.

Come 2024, Sen said #FutureFresenius was ‘delivered’.

Ramsay Health Care experienced an extremely strong year, with over 14% growth in across 2023.

Asklepios was involved in the acquisition of Robert Janker clinic by Mercurius Health from MEDICLIN AG (Asklepios Group). 

The year saw Orpea (now emeis) announce a financial restructuring as it set out to recover after charges of malpractice at its homes. However, related to its dealings with Lipany (owned by former Orpea management) and allegations of ‘money laundering’, a French court opened a preliminary investigation of three former senior executives.

Meanwhile, Clariane changed its name from Korian in an attempt to put its own scandals behind it (Orpea later changed to emeis in March 2024).

Other businesses in the top 10 include international hospital group Mediclinic International with revenue of €4.2 billion, integrated healthcare provider in the German-speaking region Sana Kliniken with €3.3 billion, French private healthcare provider Elsan with €3 billion, UAE integrated healthcare network PureHealth with €2.9 billion and French hospital group Vivalto Sante with €2.5 billion.

 
Top 100 — Sector Analysis

 

Revenue by sub sector split

 

 

The sector which saw the most companies fall a significant number of places is diagnostic labs. Of the 23 companies which fell five or more places, nine were labs groups. And the company which dropped by far the most number of places was French labs group Inovie, down 36 places to 87th place. This is unsurprising given that most major labs groups were still doing a significant amount of covid testing in 2022, boosting their revenues, but in 2023 this was more or less completely wound down.  

The only other sub sector which saw multiple companies fall a significant number of places is elderly care. Four elderly care companies saw significant drops: French provider Groupe Maisons de Famille fell 10 places, to 81st place, rival French group Almaviva Sante dropped seven places, to 82nd place, German group Kursana also dropped seven places, to 95th place, whilst Domidep, another French group, fell six places, 92nd place. 

The fact that three of these four are French providers is no coincidence: France’s for-profit elderly care sector has suffered a significant reputational and financial blow in the wake of the scandal which engulfed the country’s largest player, emeis (formerly Orpea), throughout 2022 and 2023. 

Half of the 18 companies which rose five or more places were hospital groups. But this doesn’t mean hospitals had a particularly good year; more than anything it is just a reflection of the fact that 42 of the Top 100 are hospital groups. 

What is notable — if unsurprising — is that six of the nine hospital groups which climbed at least five places were Middle Eastern hospital groups, with three being Saudi groups, two being Turkish groups, and one being a UAE group. 

The two Turkish hospitals appeared to perform particularly well, with their reported revenues doubling compared to last year. New entrant MLP Care jumped the most places of all the groups in this year’s Top 100, climbing 60 places, to 49th place. Acibadem Healthcare Group, the other Turkish group, is the third biggest climber overall, up 29 places to 23rd place. However, this is just a reflection of Turkey’s issues with hyperinflation, rather than actual real-term growth.

The fact that three of the high-climbing hospital groups are Saudi groups is more significant. Saudi Arabia’s government is attempting to transfer most of the responsibility for healthcare delivery to the private sector.


Revenue by ownership type split

 

In terms of ownership type, slightly more than half of the revenue of the Top 100 is accounted for by listed groups. Whilst they account for a tiny portion of private healthcare services groups, and even in the Top 100 only 37 groups are listed (in almost any other sector of the economy this figure would be higher), it is still the case that the biggest groups tend to be listed. Of the top five groups — Fresenius Helios, Ramsay Health Care, Asklepios Kliniken, emeis and Clariane —- only one (Asklepios) is not listed.


Top 100 — Country Analysis

Germany has the largest representation with 19 companies across various healthcare sectors, followed by France with 17, the United Kingdom with 14, Switzerland with 7, and both Italy and Sweden with 5 companies each. The remaining countries have fewer than 5 companies on the list.

 

Country sectors

The ageing population is a key driver of healthcare activity in countries like Germany, France, the UK, and Saudi Arabia.

In Germany, by 2035, 31% of the population will be over 65, increasing care dependency and chronic disease costs, which account for 80% of healthcare spending. A recent reform passed by the Bundestag may result in the closure or restructuring of smaller inpatient facilities, converting them into outpatient centres. For-profit organisations are expected to benefit from the sale of struggling public and non-profit hospitals as part of these changes. M&A activity in 2023 and 2024 remained strong in Germany, especially in outpatient care, digital health, AI, and biotech. For more on Germany, click here.

In France, there is growing investor interest in e-health, biotech, medtech, and diagnostics, driving consolidation. For more on France healthcare, click here.

Switzerland also saw strong healthcare M&A activity in 2023, particularly in digital health, with hospitals seeking digital innovations to tackle budget and staffing challenges. For more on Switzerland, click here.

In Saudi Arabia, the tele-consultation market is projected to hit $0.7 billion by 2026, and the medical devices sector is expected to grow from $2 billion in 2022 to $3.1 billion by 2030, driven by government initiatives under Vision 2030. For more on the KSA healthcare sector, click here.

 

Summary

The HBI Top 100 2024 rankings reveal an industry in transition, with Germany leading representation (19 companies), followed by France (17) and the United Kingdom (14). 

While traditional Western European providers remain dominant, emerging market operators are gaining ground, particularly in the Middle East and Turkey.

Laboratory groups saw the most significant declines, with nearly half of Top 100 companies falling five or more places —  much of this can be explained by a transition back into a post-Covid market. 

The elderly care sector also faced headwinds, particularly in France. However, hospital groups, the largest cohort in the Top 100, showed resilience, with half of the companies that rose five or more places operating in this segment, reflecting strong fundamentals in the acute care market.

 

We would welcome your thoughts on this story. Email your views to Chris O'Donnell or call 0207 183 3779.