The HBI Top 100 largest hospital groups in EMEA by revenue 2025 edition
Introduction
HBI’s fifth annual ranking of the largest healthcare companies operating across EMEA is here. This year’s list is different from previous years: we’ve focused exclusively on the Top 100 for-profit hospital groups, rather than all healthcare services groups, ranking them by their 2024 sales.
In 2024, the for-profit hospital sector in the EMEA region experienced a transformative year marked by notable increases in admissions, strategic investments, and growing engagement from private equity and commercial healthcare operators.
There was a surge in new hospital project launches, digital health initiatives, medical tourism developments (especially in the UAE), and speciality clinic expansions throughout the region. Private equity and commercial chains increased involvement in outpatient and primary care, fueling debates about quality, costs, and long-term impact on health systems.
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Top 10 companies:
In 2024, our top 10 for-profit hospital groups reported significant developments including strong financial performance, strategic initiatives, and corporate restructuring efforts.
Fresenius Helios (Germany only) came out at the top of the list, with German revenue of €7,662 million. Although Fresenius Helios also includes Quirónsalud in Spain, we treat Quirónsalud separately here because its scale (revenue of €5,077 million) is large enough to merit a standalone ranking. Quirónsalud ranks number four on our list. The combined group achieved organic revenue growth of about 6%, giving a total revenue of €12,739 million.
Fresenius Helios is part of the Fresenius Group, a major healthcare conglomerate which recently finalised a group-wide restructuring that involved selling off non-core parts of the business to focus on hospital division Helios and its hospital pharmaceuticals division Kabi. Earlier in the year, Fresenius Group sold four of their businesses to the US-based healthcare company DaVita for €263.8 million. Quirónsalud added new high-tech services and facilities in 2024, including plastic surgery, cancer diagnosis, and high-resolution dental imaging. Helios implemented a strategy in Germany to form specialised clusters of hospitals by integrating administrative and medical functions.
Second on our list is Asklepios Kliniken, another German group which reported a revenue growth of 9%, from €5,452 million in 2023 to €5,963 million in 2024. The group also moved forward with new financing strategies focused on sustainability, and refinanced €500 million for social healthcare infrastructure.
The third largest group is French multinational hospital group Ramsay Santé. It successfully refinanced its €1,650 million senior debt facilities in August, extending maturities to 2029-2031, which strengthens its long-term financing and supports key strategic initiatives. Revenue rose 6.5% year-over-year to €5.0 billion, with organic growth at 7.5%, driven by increased activity and price adjustments, especially in France and Sweden. They also implemented the “Yes We Care 2025” strategy, broadening its portfolio with new imaging facilities, primary care centres, mental health day clinics, and the acquisition of Cosem in France. Despite growth, EBITDA decreased 1.7% due to lower subsidies and higher salary costs, and continued facility portfolio cost restructuring.
Fifth in our ranking, PureHealth, based in Abu Dhabi and reporting €4,227.57 million in revenue, is listed separately from UK hospital group Circle Health Group. Although PureHealth acquired Circle Health in late 2023, Circle Health’s revenues are reported independently and thus appear separately in our list, at number 17. PureHealth’s acquisition of the UK’s Circle Health Group, valued at €1,010 million and adding 53 British hospitals, significantly expanded its international footprint, making the UK its largest foreign market. Consolidated revenues increased approximately to €5,160 million after PureHealth acquired Sheikh Shakhbout Medical City in Abu Dhabi.
South Africa-headquartered Mediclinic International, in at sixth, is the first non European group in the list. They showed modest improvement in the financial year, with revenue increasing from €4,188 million in 2023 to €4,209 million amid post-pandemic challenges. Revenue growth was driven by inpatient (+0.9%) and day-case (+1.6%) admissions, with efforts focused on expanding care outside hospital settings.
The seventh largest group is another German group, Sana Kliniken with a revenue of . The group opened the “S | Medical Center” focused on primary and specialist GP care in Neckarsulm in January 2025, a project initiated in 2024. This expanded their services and corporate client healthcare solutions with pioneering partnerships.
Eighth on our list is Elsan, a France-based hospital group, faced challenging operating conditions in 2024 with inflationary pressures, staff shortages, and absenteeism impacting profitability. Despite this they raised their revenue to €3,200 million.
Italy’s Gruppo San Donato is in ninth place, achieving a record revenue of €2,570 million in 2024, up 30% from 2023, with EBITDA growing 40% to €323 million. Growth was supported by a surge in private (solvent) patient activity, acquisitions in Poland (American Heart of Poland and Scanmed).
In tenth place is Medicover, which has operations across several European and Asian countries. The group’s revenue rose from €1,746.40 million in 2023 to €2,090 million in 2024, an increase of 19.8%, with organic growth of 16.7% and operating profit (EBITDA) of €73.2m for the year. Medicover accelerated both organic and inorganic growth, integrating new diagnostic and hospital assets in Germany, Poland, and Central Europe.
Notable M&A deals
Life Healthcare based out of South Africa ranked twelvth on our list, revenue rose from €1,081.90 million to €1,236.45 million, driven partly by strategic acquisitions of 41 renal dialysis clinics from Fresenius Medical Care in South Africa in 2024. This deal significantly expanded Life Healthcare’s renal dialysis network from 31 to 72 clinics across six South African provinces, plus clinics in Namibia and Eswatini. The strategic sale of Alliance Medical Group for approximately €1 billion, combined with structural realignment efforts, improved Life Healthcare’s operational focus, enhanced financial flexibility, and helped mitigate market volatility, sustaining revenue momentum in an uncertain healthcare landscape.
Dr Sulaiman Al Habib Medical Group (Saudi Arabia) ranked elevnth expanded both through new hospital launches and secured long-term financing worth €295 million in 2024 to fund projects including Sehat Al Hamra Hospital and Women’s Health Hospital, driving revenues from €1,705.80 million in 2023 to €1,953.48 million in 2024.
Top 100- Country Analysis
Germany maintains the largest representation with 12 hospital groups spanning multiple healthcare sectors. It is followed by France with 9 hospital groups, the United Arab Emirates with 8, the United Kingdom with 7, and Saudi Arabia with 6. Other notable countries include Italy, Spain, Switzerland, and Finland.
This breakdown by country shows the geographic distribution of the top 100 private hospital groups headquartered in the EMEA region. It highlights which countries have the highest concentration of these major healthcare providers, reflecting the maturity and scale of their healthcare sectors. For example, Germany leads with 13.3% of the groups, followed by France (10%) and the United Arab Emirates (8.9%). The UK accounts for 7.8%, with Saudi Arabia and Italy each holding around 6.7%. Countries with a smaller share may indicate emerging markets or more niche healthcare sectors with growth potential.
The pie chart below aggregates the 2024 total revenues of the top 100 hospital groups across the EMEA region, segmented by country, exposing distinct concentrations of market size and investment intensity. Germany commands a dominant position with €22.6 billion in hospital revenues, over 30% of the region’s total, underscoring its mature healthcare ecosystem and significant private sector scale. France, with €12.8 billion, and Spain, with €9.1 billion, further illustrate the concentration of healthcare capital in Western Europe, reflecting strong demand, advanced infrastructure, and high private spending. Meanwhile, Saudi Arabia’s €7.7 billion signals rapid expansion driven by privatisation and foreign investment.
The revenue figures presented in this chart are attributed to the countries where each hospital group is headquartered. This means that if a hospital group operates across multiple countries within the EMEA region, its total revenue is assigned to its home country rather than being split according to its geographic revenue sources. While this approach highlights the economic scale of healthcare providers by their base of operations, it does not reflect the detailed distribution of revenues by individual country markets.
Germany
Germany’s private hospital market is highly competitive and mature. The for-profit hospital industry in Germany had a 2019-2023 CAGR of 6.4%. Germany’s population aged 65 and older is about 23% in 2025, projected to exceed 27% by 2035, fueling demand for elder care, chronic disease management, and long-term care. Digital health adoption and value-based care models are growing trends shaping the market.
France
France’s private hospital sector is mature and growing, evidenced by a 2019-2023 CAGR of 9.1% for top hospital groups. According to the World Bank, over 22% of France’s population was aged 65 or older in 2024, highlighting demographic drivers of rising healthcare demand. This combination of market scale and ageing trends creates evolving opportunities and challenges for providers adapting to diverse patient needs.
United Arab Emirates
The market is projected to grow with total healthcare revenue exceeding €14,875 million in 2025. Drivers include rising chronic diseases, increased demand for specialised and preventive care, and technological adoption in digital health and AI integration.
United Kingdom
The UK private hospital group market has experienced robust growth, averaging a 5.8% CAGR from 2019 to 2022 and for major players in our top 100 a 2022-2023 CAGR of 13.1%. Drivers include rising demand for timely, personalised care amid NHS capacity constraints, long waiting lists, and limited service availability. Increased private medical insurance uptake and out-of-pocket spending further support this expansion across hospitals, ambulatory care, and diagnostics.
Saudi Arabia
Saudi Arabia’s private healthcare sector is rapidly expanding, driven by Vision 2030 goals to increase private sector share from 40% to 65% by 2030. Key initiatives include the privatization of over 290 hospitals and 2,300 primary care centers, unlocking significant investment.
Methodology
To produce the financial and operational figures presented here, we sourced 2024 actuals from official company reports in approximately 60% of cases where data was available and published in company filings. For the remaining 40% of companies that do not release or have not yet published their reports, we estimated sales using statistical modelling. These estimates drew on historical revenue trends, applying compound annual growth rates (CAGR), and benchmarking against variables such as bed numbers, staff counts, and facility size. We used regression modelling and comparative industry analysis to further refine our calculations, seeking to ensure accuracy in representing current performance across the sector.
Summary
Throughout 2024, for-profit hospitals in the EMEA region capitalised on rising demand, large-scale investments, and new care models to drive record growth and strategic realignment. Country-specific factors, including population ageing, public sector pressures, workforce shortages, changes in insurance uptake, and technological adoption, shaped both challenges and opportunities for major operators.
M&A activity was a critical growth driver across the EMEA private healthcare sector, facilitating rapid revenue expansion, geographic diversification, and strategic repositioning for leading operators.
The trends we’ve covered underscore a year of robust financial performance, new strategic focus, and investments in both digital and physical health infrastructure for these major healthcare operators. These regional growth drivers and challenges translate into distinct market opportunities and competitive landscapes in leading countries such as Germany, France, the UAE, the UK, and Saudi Arabia, which we explore below.
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