HBI Deals+Insights / M&A/IPOs

What are Germany’s biggest for-profit healthcare markets?

Germany spends more on healthcare in real terms than any country in Europe. Alongside France, it also has the highest spending ratio for healthcare at 11.2% GDP. Here, we show you how the German for-profit healthcare market breaks down by sector and give you some insight into M&A in its three biggest markets.

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For a full breakdown of market sizes and in-depth insight, visit HBI’s Intelligence Centre.


Germany is Europe’s largest and most fragmented dental market. It is attracting a lot of interest from consolidators and is seen as ‘the one to watch’. The large PE-backed groups beginning to build pan-European businesses all have it in their sights. Historically, small practices in Germany have sold for around 3-5x EBITDA but larger domestic businesses can attract double-digit bids (pan-European groups can be 15x to an eye watering 19x, by way of comparison).


As for the hospital market, growth is stagnating and margins are falling due to tariff cuts to inpatient work, especially in cardiology. Budget ceilings on statutory insurance-reimbursed work are also posing a problem, as well as onerous staffing requirements. This is driving the big groups to move further into outpatient work and to start looking for growth opportunities abroad. As it stands, this market is largely consolidated.

Nursing homes

Everyone is wanting to snatch market share when it comes to nursing homes and providers are highly acquisitive. A recent newcomer is KOS Group, Italy’s second-largest provider by revenue, which bought EQT’s Charleston in July. Germany is an attractive market to expand to for large groups looking to spread regulatory and reimbursement risk. Multiples on this market are in the 13-14x EBITDA region.

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