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Summary of our market study
Annual consumption of ambulance services exceeds 2 billion euros.
Major market players such as Transdev and Keolis are expanding, while regional operators are forming strategic groupings to maintain their market presence.
Staff shortages are significant, with an estimated 15,000 vacancies for ambulance drivers.
One of the main growth drivers is the ageing population. The number of people aged over 60 is expected to grow by around 33% between now and 2050.
The market is also influenced by the "ambulatory shift", a trend towards outpatient care that reduces hospital stays and brings healthcare services closer to patients' living environments. The number of inpatient beds is around 400,000 and falling, while partial hospitalization capacity is increasing and now stands at over 85,000
Healthcare expenditure exceeds 230 billion euros.
Sector regulations demand strict compliance, with companies required to obtain approval from the Agence régionale de santé (ARS) and comply with health insurance fund agreements.
Industry players
- TRANSDEV is a multi-dimensional transportation giant, encompassing not only emergency medical services, but also a wide range of mobility solutions.
- KEOLIS marks its presence by focusing on public transport services, and as part of this, provides vital ambulance services.
- The VYV GROUP presents a multi-faceted healthcare ecosystem that goes beyond the provision of ambulance services.
- ETOILE SECOURS, a specialist provider in this field, emphasizes its commitment to emergency medical services.
- VAR ASSISTANCE makes a significant contribution to communities in the south of France.
- The GROUPEMENT AMBULANCIER DU GRAND NORD has a strong presence in northern France.
- GROUPE LOUDANE is recognized in the industry for the reliability and responsiveness of its ambulance services.
- tRANSPORTS SANITAIRES D'OCCITANIE operates with a regional footprint, emphasizing its role in its community's healthcare pathway.
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Summary and extracts
1 Market overview
1.1 Market definition and scope
An ambulance is a vehicle specially equipped and fitted out for the rapid, safe transport of patients requiring emergency medical care or medical assistance during their transfer to a healthcare facility. These vehicles are fitted with advanced medical equipment, such as vital signs monitoring equipment, resuscitation devices and emergency medicines.
The ambulance services market is part of the broader sector of medical transport services. This highly competitive sector also includes light medical vehicles (VSL) and contract cabs, which have recovered market share over the years to the detriment of ambulances.
The sanitary transport market has grown at an average annual rate of 3.57% between 2011 and 2021representing cumulative growth of 47% in 11 years. On the other hand, the ambulance services market grew at an average annual rate of 2,69% over the same period, for cumulative growth of almost 34%.
Several factors, both cyclical and structural, have stimulated ambulance service activity. These includean ageing population, the increase in chronic diseasesand the "ambulatory shift " offer sustainable, assured growth for this sector. The Covid-19 pandemic accentuated these phenomena, highlighting the pressure under which medical services operate in France.
However, current inflation, which has led toan increase in the minimum wage of over 12% in two yearsas well as rising petrol and diesel prices, have led to a significant increase in operating costs over the past few years. With the inability to pass on these rising costs to our fixed fares, this has led tolower operating margins ambulance services sector, which must adapt to this reality.
Scope of the study :
Ambulance services are listed by INSEE under NAF code 86.90A. Entitled "Ambulances", this class covers :
- Patient transport by any mode of transport (including air). These services are sometimes provided in the event of a medical emergency;
- the activity of intensive care ambulances.
On the other hand, NAF code 86.90 A excludes patient transfers without operating equipment or medical personnel (NAF 49, 50 and 51), as well as mobile operating theatres (NAF 86.10Z).
1.2 Domestic market
To assess the size of the ambulance services market in France, we have opted for an approach based on demand for medical transport services, as published by DEES (***). most of the sales generated by players in this sector derive from this demand for transport, which is largely reimbursed by health insurance ...
1.3 The global market
Globally, the outlook for the ambulance services market is as follows:
According to data from Market Business Insights, the global ambulance services market is forecast to generate revenues reaching $**.** billion by ****, with an estimated compound annual growth rate (***) of *.*% for the period **** to ****. By ****, this market is expected to reach $**.** billion, ...
2 Demand analysis
2.1 An aging population: Growth in ambulance services structurally guaranteed
Number of people aged ** and over France, ****-****P INSEE forecast: ****-**** Source: ****
Between **** and INSEE projections for ****, the number of people aged ** and over is expected to increase by around **% in the number of people aged over **bringing this figure to **.* million. It should be noted that between **** and ****, this ...
2.2 Prévalences des affectations de longue durée en augmentation constante
Le sigle « ALD » désigne l'expression « affection de longue durée ». Ce dispositif vise à couvrir les frais de traitement prolongé et onéreux associés à certaines pathologies. Il existe plusieurs catégories d'ALD, à savoir les ALD exonérantes et les ALD non exonérantes, chacune conférant des droits différents. ...
2.3 "Virage ambulatoire": An increase in demand for medical travel services
Number of full and partial hospital beds in France (***) France, ****-****, Number of beds Source: ****
over the period from **** to ****, there will be a significant reduction in full hospitalization capacity, with over **,*** fewer beds, i.e a decrease of *%. At the same time, partial hospitalization capacity has grown by around **,*** places, ...
2.4 Steadily rising consumption of healthcare and medial goods
Consumption of healthcare and medical goods in France (***) France, ****-****, billion euros Source: ****
over the period from **** to ****, spending on medical care and products has grown significantly, from ***.* billion euros to ***.* billion euros, representing an increase of around ** billion over a decade, representing growth of **%. This upward trend can be attributed ...
3 Market structure
3.1 Value chain
Ambulance companies are private entities specializing in transporting patients between their homes and various care facilitiesprivate entities specialized in transporting patients between their homes and various care facilitieswhether for scheduled medical interventions or recurrent treatments such as dialysis, chemotherapy or radiotherapy. Their activity is based exclusively on medical prescriptionsthey can also ...
3.2 A still highly fragmented French market
The ambulance services market is currently significantly fragmented, but there is a persistent trend towards consolidation over the years. Regional ambulance operators are moving towards strategic groupings to counter the growing influence of industry leaders. A prime example of this dynamic is the formation of an economic interest group in July ...
3.3 A highly competitive sector
in France, there are three main types of medical transport, depending on the patient's state of health: The VSL (***) and the CPAM-approved cab are the two most commonly used means of transporting seated patients. unlike the VSL, which is reserved exclusively for medical use, the CPAM-approved cab can be used to ...
4 Offer analysis
4.1 Very little fluctuation in conventional rates
The rates charged by medical carriers are establishedadministrativelyaccording to the type of vehicle used. In the case of ambulances and VSLs (***), these rates are defined at national level within the framework of theagreement with the health insurance funds. For cabs, on the other hand, rates are determined locally within the framework ...
4.2 Operating margins in perdition
Gross monthly minimum wage in France (***) France, ****- **/****, € Source: INSEE Employee remuneration within companies is partly influenced by fluctuations in the SMIC (***). In ****, the SMIC underwent four revalorizations, with a further increase of *.**% on January *ᵉʳ, ****. This change initially impacts the lowest salaries, but is also reflected across all pay levels. Between ...
5 Regulations
5.1 Regulations
The medical transport sector is characterized by a rigorous regulatory framework. To operate in this field, companies must obtain accreditation from the Agence Régionale de Santé (***) and sign an agreement with the Assurance Maladie. In addition, they must have a fleet of at least two vehicles, one of which must ...
6 Positioning the players
6.1 Player segmentation
- ETOILE SECOURS
- VAR ASSISTANCE
- GROUPEMENT AMBULANCIER DU GRAND NORD
- GROUPE LOUDANE
- TRANSPORTS SANITAIRES D'OCCITANIE
- Keolis
- Transdev
- VYV Groupe
List of charts presented in this market study
- Number of establishments providing ambulance services in France.
- Number of employees in establishments providing ambulance services in France.
- Number of people over 60
- Nombre de personnes en affectation longue durée
- Number of full and partial hospital beds in France (2014-2021)
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Latest news
Transdev yields to the lure of international business - 20/03/2024
- -Total sales in 2023: up 21% to 9.33 billion euros
- - Share of business in France in 2023: 29.3% of sales, versus 35.2% in 2022
- - Acquisition of First Transit in the United States: adds 1.1 billion in sales
- - Share of US business in 2023: 25%, versus 15% last year
- - Investment in France in 2022: 135 million, rising to 250 million in 2023
- - Net profit: stable at 20 million euros
- - Change in network ridership after the health crisis: France virtually equivalent to pre-Covid (-2%), Germany +15%, Ile-de-France -9% compared to 2019, Netherlands -20%, Stockholm region -16%, United States -25%
Transdev's plan for the Marseille-Toulon-Nice TER line - 24/11/2023
Opening up regional trains to competition
- The new train will run on the Marseille-Toulon-Nice line from July 2025.
- Transdev's ridership objectives: to increase annual passenger numbers on the Marseille-Toulon-Nice line from 3.4 million to 5.5 million in the medium term.
- The region has written Alstom a cheque for 250 million to purchase sixteen Regio 2N Omneo trainsets, and will pay Transdev 50 million a year to operate the line and another 50 million to build a new rolling stock maintenance site in Nice.
- The Caisse des Dépôts subsidiary, which will operate the route for ten years (2025-2035), will provide 15 round trips between Marseille and Nice, twice as many as today.
- Two Regio 2N Omneo trainsets attached to each other will offer 800 seats, including 100 on folding seats, compared with 600 today.
- transdev is beginning to build up its team, which will comprise 180 to 200 employees to operate this line.
Keolis reshuffles its staff - 30/08/2023
- Keolis has 68,000 employees in 13 countries.
Bernard Tabary, former head of international operations at Keolis, died accidentally in March 2023. - He has been replaced by Laurence Broseta.
Metro: Keolis breaks RATP monopoly to operate two lines in Greater Paris - 01/06/2023
- Metro lines concerned: lines 16 and 17 of the Grand Paris Express
- Operator selected: Keolis
- Starting date: October 2026
- Contract duration: 7 years, extendable to 10 years
- Contract value: 300 million euros
Marie-Ange Debon, the discreet Keolis boss who challenges RATP - 31/05/2023
- The company manages a public transport network with sales of 7 billion euros.
- The company has 68,000 employees worldwide.
- SNCF owns 70% of the company.
- RATP will lose part of its monopoly on Parisian transport in 2026.
- Bus lines in Paris and the inner suburbs will be open to competition from 2026.
- Tramway lines will be open to competition from 2030.
- Metro and RER lines will be opened to competition between 2030 and 2040.
- The company is one of the world leaders in mobility, and number 1 in automatic metro systems, with 330 kilometers of lines in operation.
- The company's main competitor is RATP.
- The company has been operating Dubai's automatic metro since 2021.
Keolis wins international contracts - 28/04/2023
- 680 million euros in annual sales for Keolis in France last year.
- Contract in California to operate 209 buses in Orange County, with annual sales in excess of 50 million euros.
- Renewal of contract in Foothill Pomona, northeast of Los Angeles, until 2027
- Contract in Sweden for 10 years to operate part of the Greater Stockholm bus network (54 urban and suburban lines), with annual sales in excess of 50 million euros.
- Contract in the Netherlands from December 2023 to operate the Valleilijn trains and 7 trains, for 13 years and total sales of 150 million euros over the duration of the contract.
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the ambulance services market | France
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