Private healthcare, profitability down but revenues above pre-crisis levels
(Teleborsa) – Le healthcare facilities operating in Italy they were 28,980 in 2021 (57% private and 43% public), an increase of 2,898 units on 2010, cumulative increase in private (+2,519 units) and public (+379 units). As regards the type of assistance, both have a negative balance hospital (-170 units) and the specialist outpatient (-857), with the latter object of an important consolidation in the decade. By contrast, theresidential community assistance (from nursing homes to centers specializing in Alzheimer’s or other pathologies) grew by 1,831 units, while other territorial assistance by 1,550. This is what emerges from a new report from theMediobanca Research Area on the topic.
Analysts point out that the assisted living sector (RSA) it is widely parceled out, with the prevalence of small operators and a large presence of structures managed by non-profit organizations, cooperatives and ecclesiastical bodies. In Italy, the ranking by number of beds sees Segesta (Korian Group) on the podium with 7,000 beds (estimated figures), followed by KOS (Cir Group) with 6,200 beds and SO Holding with around 5,600.
Who are the big names in Italy
Excluding the consortium companies, the report has identified 28 player private individuals active in hospital and district care with individual turnover exceeding 100 million euros in 2021. Among these, 19 are specialized in hospital care, three in the management of nursing homes (KOS, Segesta and SO Holding), three in medical diagnostics ( Cerba Healthcare Italia, Synlab and CDI) and three in functional rehabilitation (Don Gnocchi, Maugeri Clinical Scientific Institutes and the San Raffaele in Rome).
Al first place in revenues it fits Papiniano (1,633 million, holding of the San Donato Hospital Group and San Raffaele Hospital in Milan) which precedes Humanitas (1,084 million), GVM – Villa Maria Group (798 million), A. Gemelli University Hospital (787 million) and KOS (660 million).
Geographical and foreign diversification
The widest geographical diversification belongs to KOS, SO Holding and Don Gnocchi, present in at least nine Italian regions, albeit with greater roots in the Nord. Among the hospitals, GVM and Gruppo stand out Garofalo with activities, respectively, in nine and eight regions. Papiniano and Humanitas are instead concentrated in Lombardywith the first also active in Emilia-Romagna, where it develops 5.1% of revenues, and the second also present in Piedmont and Sicily where it generates approximately 21% of turnover.
Only eight of the selected operators manage facilities beyond the bordermostly dealing with presences marginal. The exceptions are GVM, with 13 foreign branches (of which one in Ukraine and one in Russia) which generate 14% of revenues in 2021, and KOS with 47 RSAs in Germany responsible for 27% of total turnover.
The accreditation regime
The division of activities between accreditation regime and solvency highlights a varied situation among operators. In 2021, the minimum incidence of accreditation is marked by CDI whose diagnostic services are mostly intermediated by supplementary funds and insurance companies (41.8% of total revenues), by private individuals (22.4%) and by companies ( 11.4%). Among the other players, the expense of solvents recorded a greater incidence for KOS (36%) and IEO (35.4%), while the San Raffaele in Rome generates 94% of revenues in accreditation.
The turnover
In 2021 i aggregate revenue of the 24 operators for which complete analytical financial statements are available, they amounted to 8.8 billion euros, up by 15.2% on 2020 and by 6.3% on 2019. These changes follow the annual decline of 7, 8% in 2020, due to the partial suspension of healthcare activities and the deferment of non-urgent scheduled hospitalizations. However, the overcoming of pre-crisis levels was not generalized: revenues rose by 6.7% for hospital operators and 44.1% for diagnostics, while the recovery did not materialize for rehabilitation players (- 0.3% on 2019) and for RSA managers (-0.2%).
Il aggregate value of the workforce it increased by 4.5% in the three-year period 2019-2021, reaching almost 72,000 units in 2021. The numerous calls for employment announced by the ASL during the pandemic caused a shortage of medical and paramedical personnel among private operators. The aggregate labor cost of the major private operators thus increased by 13.6% over the three-year period, by virtue of the widespread use of temporary staff and the provision of additional fees aimed at retaining healthcare workers compared to the more attractive offers in the public sector.
The profitability it is recovering, but still lower than pre-pandemic levels: the measures to combat the epidemic have caused a significant increase in production costs, only partially covered by the refreshments provided for by specific emergency regulations. The aggregate Ebit margin was thus negative in 2020 (-0.6%), but the intense vaccination campaign and the lower virulence of Covid-19 allowed the recovery of clinical activity and the improvement of the EBIT margin which rose to 3.7% in 2021, albeit still lower than 6.0% in 2019.
At the level of single companyfive groups closed 2021 in the red, compared to ten in 2020. The aggregate ROE decreased from 7.2% in 2019 to 4.1% in 2021. The highest values are those of Humanitas (17.2%) , of the Molise Pro.Med (16.6%) and of the San Raffaele of Rome (12.6%).
The asset structure in 2021 it remains solid overall, with financial debt at 107.7% of equity (111.4% in 2019). Cash and cash equivalents remain particularly high, exceeding 1.8 billion at the end of 2021, equal to 39% of financial debt. The most solid positions are those of the IEO, Auxologico Italiano, CDI, Salus, Istituto Don Calabria and Humanitas groups, with almost no financial debt for the first and less than 30% of the shareholders’ equity for the others
Expectations for the sector
The end of the state of health emergency in March 2022 and the simultaneous reduction of the limitations that characterized the two-year period 2020-2021 led to a progressive recovery of activities in the health sector and the simultaneous recovery of the waiting lists accumulated during the pandemic period. The first evidence for the 2022 allow for an estimation aggregate turnover growth of the major private healthcare operators in the order of 4% on 2021, which however cannot be generalized to all sectors: this is the case of the assisted healthcare residence sector for which a return to saturation of beds is estimated at pre-Covid levels, not before of 2025.