The home medical assistance market - France

1.2 A growing global market

The home care market is a growing market globally. The market is estimated to be worth $*** billion globally in **** and is expected to grow at an average rate of *.*% per annum to ****.

The ageing of the population is a major factor in this growth, as is the access of more and more people to health services (***).

Size of the home healthcare market World, **** - ****, in billion US$ Source: ****

In Europe, market growth was driven by the public policy support and the development of new medical devices.

The increase in government initiatives (***) has made home health care more affordable for the population. This will help the market to grow.

1.3 A dynamic French market

In ****, Les Echos estimated in **** the market to be worth €*.* billion, with an average annual growth rate of *% in recent years.

In ****, according to the Federation of home care providers (***), the market size is to be €* billion, proof of the strong growth of the sector in recent years.

The Federation also gives a breakdown of this turnover according to activities, based on a consolidated turnover of the sector of €*.* billion (***). The * main segments represent almost */* of the market in value.

Respiratory (***) CPAP (***) Insulin pump therapy for diabetes treatment (***) The beds

We conclude that the pathologies that generate the most turnover for the sector's players are respiratory problems (***) sleep apnoea and diabetes.

Revenues of home health care providers France, ****, % of sector revenue Source PSAD  

1.5 The ambivalent impact of the Covid-19 crisis

The positive impact related to the management of Covid-** patients:

From the beginning of the health crisis to November ****, **,*** Covid-** patients were managed by PSAD. The home health care providers also helped the nursing homes with their services.

Players have also sought to integrate remote monitoring processes with connected medical devices.

The investment effort was consequent to face the demand: €*m were spent to increase the stock of material of the PSAD in oxygen therapy with ** *** new concentrators.

Impact of the Covid-** crisis on PSAD France, ****, in thousands of patients and concentrators and in millions of € Source: ****

The home health care providers thus played a key role in managing the health crisis.

The negative impact of deferring benefits for the chronically ill

However, PSAD activity has been reduced in other segments, as many treatments have been de-scheduled due to the health crisis - particularly for certain chronic diseases. Thus, the Federation estimates a loss of turnover of €***m to be distributed between **** and ****.

Source: ****

2.1 Patients managed by home health care

Approximately * million people a year use the services of the home health care providers (***).

The reasons for using PSAD services are diverse, but dominated by a few types of pathologies:

**% of patients have sleep apnoea ** % are dependent elderly people (***) *% are patients with disabilities

Patients treated by home medical assistance by type of assistance France, ****, in % Source: ****

We can thus group the pathologies concerned by PSAD into * categories according to the PSAD Federation:

Chronic diseases:

Diabetes Sleep apnoea syndrome Respiratory insufficiency (***) Cancer Undernutrition Rare diseases

Age-related dependence:

Parkinson's disease Incontinence, pressure sores Undernutrition Reduced mobility

Disability:

Undernutrition Reduced mobility Pressure sores

Acute diseases:

Infectious pathologies Undernutrition Temporary mobility impairment Pain

The number of diseases that can benefit from PSAD is increasing every year with the technological progress in the medical field (***), where in the past a hospitalization was mandatory.

The number of patients being treated is increasing each year, by * to *% each year, according to Fedepsad.

2.2 The ageing of the French population and dependent persons

A structural dynamic: the ageing of the population

The first reason for the good health of the home health care sector is the ageing of the French population.

Indeed, life expectancy in France in **** was **.* years compared to ** years in ****, an increase of about *% in ** years.

In ****, ** million people are expected to be over ** years old. In addition to this, one out of two people over ** years old has multiple pathologies, according to the UPSADI.

An increase in the need for medical services by the elderly is, as a consequence, likely to happen. According to Les Echos, **% of people over the age of ** remain at home. This appears to be an important growth lever for the years to come.

Finally, as shown in the graph below, the number of family practitioners per elderly person will decrease in the coming decades, which will mechanically stimulate the need for home care services.

Change in the proportion of French people aged over ** France, ****-****,% Source: ****

The increase in the number of dependent elderly people:

The increase in the number of dependent elderly people can be seen in the graph below, which illustrates the increase in the number of the personalized autonomy allowance beneficiaries. The ...

2.3 Chronic diseases or health problems in France

Chronic or long-lasting diseases or health problems develop mainly in the oldest people and among people in the most precarious living conditions.

Thus, on average, **.*% of the French middle and upper classes have chronic or long-lasting illnesses or health problems, in comparison to the **.*% of French people from the more working classes.

In addition, **.*% of the over-**s have chronic or long-lasting illnesses or health problems, compared to **.*% of the under-**s.

It is therefore clear that the ageing of the population favours the development of chronic diseases, which suggests that the management of these diseases by home health care providers will increase in the future.

Share of people reporting a chronic or long-term illness or health problem France, ****, by age and household living arrangements Source: ****

According to the WHO, the presence of chronic diseases in the world is likely to increase by **% in the next decade and would represent the cause of **% of all deaths worldwide. The main chronic diseases are diabetes, cardiovascular disease, chronic respiratory disease, and cancer. These diseases are not transmissible, but they affect the quality of life and require intensive and long-term medical treatment.

2.4 French people's perception of home health care providers

Harris-interactive conducted a survey for Orkyn' in **** among *,*** people in October **** using the quota method in order to perceive the French people's knowledge and vision of home health care providers.

Confused knowledge of the areas and diseases covered by home health care providers:

The survey below highlights that the French do not really know what is behind the home health care providers.

Many people mistakenly think that PSAD includes "home care", "personal services", "blood tests", ... Only **% believe that sleep apnoea management is part of PSAD, even though it is the most commonly managed condition

In your opinion, can PSADs cover the following areas and diseases? France, ****, in % Source: ****

However, the French would like to learn more about PSAD, with nearly **% wanting to have more information, particularly among the elderly or those who have relatives involved. Better knowledge of PSAD could contribute to its future development.

Little knowledge of the market players

We note that the companies in the sector are relatively unknown to the public.

Do you know these home health care providers? France, ****, in % Source: ****

However, although knowledge of home health care providers is confused, their image is positive in several respects: their contribution is thus recognized and appreciated.

Do ...

2.5 Focus on sleep apnoea: the largest market segment

Sleep apnoea is also called obstructive sleep apnoea-hypopnea syndrome (***) breathing during sleep, depending on Ameli.

This causes a lack of oxygen, which causes the person to wake up to catch their breath. Sleep is then no longer restful, which can cause significant health problems.

Approximately *% of French people suffer from OSA, i.e. about *.** million people. However, as seen in *.*, less than half of them have home treatment via a PSAD.

Furthermore, it is an under-diagnosed disease since according to Orkyn's almost **% of those affected are unaware of it.

Population affected by sleep apnea France, ****, in % Source: ****

This disease particularly affects obese people (***), the elderly and is sometimes associated with other diseases such as diabetes according to Orkyn'.

3.1 Forces at work

Home health care providers (***).

Among the home health care providers that have received the label are:

Bastide Orkyn AADAIRC Agir à domicile Alliance Soins Proximed Santélys Santélynes

They offer a wider range of services than the rental or purchase of medical equipment. They provide personalized support, taking into account the specificities of the patient. The national union of home health care providers (***) distinguishes between three types of services provided by PSAD:

Home management of chronic pathologies, mainly through the implementation of services intended for the treatment of respiratory pathologies: oxygen therapy system (***) ventilation by continuous positive pressure for the treatment of sleep apnoea. The implementation of specific ambulatory treatments at home, in particular by providing services and equipment for infusion or nutrition by vein or gastric route (***) The provision of technical aids to dependent or disabled people in order to maintain them at home. This field covers in particular: equipment for home use (***)

Players on the market

For a long time, the PSAD sector was occupied by associations, but nowadays, there are mostly private companies on the market.

Private structures in France have taken advantage of policy and regulatory changes and technological innovations to diversify their offer and provide new ...

3.2 Stakeholder strategy

The following are some (***) examples of competitive strategies pursued by the players.

M&A: to enter new markets (***) or to strengthen the treatment of a disease

In ****, Air Liquide (***) while developing "Chronic care connect ": a system for remote home medical monitoring and support for patients suffering from chronic diseases.

Partnership with nursing homes:

Since ****, Elivie has developed partnerships with clinics and health facilities and in particular with retirement home managers. This notably allows the group to expand its activities.

Franchise development:

The development of new franchise facilities is a marked trend for the major medical assistance service providers. Rationalizing the network of existing brands is also a priority for groups that are already well established, such as Bastide. The structuring of most PSAD companies as franchises has many advantages: it allows the development of brand value and awareness and a greater gain in market share, franchises reduce capital requirements, they allow for an increase in volumes at the level of the central purchasing office and economies of scale, and they generate a positive contribution to operating income.

3.3 ADSP Value Chain

The various PSAD stakeholders

The chain of stakeholders involved in PSAD can vary greatly in size and nature.

In the treatment of complex chronic diseases such as cancer, the chain of medical actors involved in the PSAD can be very important prescribing oncologists, coordinating physicians, pharmacists from in-house pharmacies, health managers, salaried and private nurses, transporters, etc.

Home assistance is first and foremost prescribed by the doctor The patient must then find a provider and establish a care sheet Once the patient's needs have been defined, the material and service are provided to the patient with a therapeutic follow-up The information on the service and the results are then forwarded to the physician.

Installation of medical devices

The installation of any medical devices is done by professional technicians working for the provider in a fairly close geographical area (***) in order to guarantee a close follow-up.

Individuals can choose to purchase or lease some medical devices directly necessary for their health condition at "medical e-commerce". These sites, like La Vitrine Médicale, often guarantee lower prices to patients and a wider choice of models.

Financial aid, subject to conditions

In the case of the maintenance at home, certain aids can be offered ...

3.4 Employment dynamics and structure in the sector

According to Fedepsad, there are more than **,*** employees in the PSAD sector, of which approximately **% are health professionals, divided between:

Pharmacists Dieticians / nutritionists Nurses Masseurs - physiotherapists

The need for personnel is growing, especially for health professionals, according to the PSAD federation. This is *% per year on average.

These employees are distributed among more than *,*** local companies and associations throughout the country.

Distribution of employment in the PSAD sector France, ****, in % Source FederationdesPsad Annual growth: *%

3.5 Home help: evolution of companies and employees in the sector

Home help is not part of the home health care providers sector, but is a complementary activity that some companies in the sector can (***) provided to the elderly and disabled. It also includes assistance in collective accommodation and in rural areas. Both companies and employees have seen a sharp increase in their numbers in recent years.

Evolution of the number of enterprises registered under the code "**.**A Aide à Domicile France, ****-****, in number of companies Source: ****

Evolution of the number of persons registered under code **.**A "Home help" France, **** - ****, in thousands of employees Source: ****

4.1 Pricing according to the type of structure and care

The French government is banking on the development of the home medical assistance sector thanks to the reimbursement of medical services included in the LPPR list (***) and thanks to the aid offered in certain cases.

The objective of the State, behind the development of this sector, is to fight against overcrowding in public hospitals and the reduction in the cost of reimbursement of health insurance benefits. The market has benefited from government incentives to the reduction of the length of stay in hospital, as a hospitalization at home costs up to * times less expensive than a stay in hospital for the same duration. On average, home care is ** to **% less expensive than hospitalization.

Percentage of the PSAD sector's turnover covered by the Assurance Maladie France, ****, in % Source: ****

A downward trend in regulatory prices imposed by the CEPS in recent years

The margins of the PSAD industry are traditionally quite high: on the whole a bit higher than **% of revenue. In ****, Air Liquide's operating margin was **.* % against *.*% for Bastide.

The latter could nevertheless be reduced with the evolution of pricing policies. According to HOSPIMEDIA, the price cuts imposed by the CEPS since **** have cost the players around €*** million, which has put pressure ...

4.2 Services and care

The various business segments of the home health care providers can be grouped into four categories below.

Home support:

The market for home care services is therefore more essential than ever to guarantee a comfortable life and medical assistance to dependent people. The maintenance of the person at home is done by medical-technical aids this can be disability management (***), prevention and treatment of bedsores, incontinence management, palliative care and parenteral nutrition.

This type of service includes home care several times a week. The costs are covered at ***% by the National Health Insurance Fund if prescribed by a doctor.

This sector includes the provision of medical devices in the home (***). Home care can go beyond simple medical assistance and include home help services such as home maintenance, nutrition and daily support, particularly for the elderly.

Respiratory support:

The most common procedure for dealing with these problems is oxygen therapy, consisting in bringing oxygen in the blood thanks to a mask conveying a mixture of medical oxygen by the respiratory tracts of the patient. The remote monitoring is becoming the norm in this type of pathology. In ****, Bastide anticipates that ***% of its patients treated for sleep apnoea will be monitored remotely.

Nutrition-perfusion:

The ...

4.3 A market driven by technological innovation

E-health and technological progress as growth drivers

The e-health sector has been very dynamic in recent years. There is a **% growth between **** and **** worldwide, with more numerous fundraising events. According to a study by the start-up Health, all the young players in the sector had raised over $** billion in *** fundraisings in **** worldwide. However, the latter figure is down from **** (***).

Many home health care providers are now focusing on integration of digital solutions to enhance their offer with telehealth equipment (***). The French company E-device markets this type of connected medical device.

The sector is able to integrate innovations from telemedicine, home automation, robotics and connected objects.

Telemonitoring is on the rise, particularly due to financial incentives from the State. In ****, companies in the PSAD sector negotiated with the French government to obtain a re-evaluation of their fee schedules. Thus, since ****, PSAD companies can increase their rates if there is a remote monitoring of the patient (***). The State has therefore encouraged PSAD companies to make greater use of remote monitoring in the interests of efficiency.

Technological progress can affect different facets of patient treatment, making the impact of R

Better monitoring of patient progress Better treatment of diseases Lower cost of treatment and ...

5.1 Regulations in force

Article L.***-* of the Social Security Code defines the List of Reimbursable Products and Services (***). To be reimbursed by social security, a medical service must be considered essential in the therapeutic process. The registration of a service on the LPPR must have a proven therapeutic interest and be approved by the Minister of Social Affairs and Health after receiving the opinion of the High Authority for Health. Registration on the LPPR must comply with the technical specifications, the place of the product in the therapeutic, diagnostic or disability compensation strategy and the conditions of use. Registration is valid for a maximum of * years.

In order to be reimbursed under the LPPR, medical services must be prescribed by a medical professional (***) on a separate prescription.

The Federation of Home Health Providers has published a code of good practice for PSAD. This code defines the practices to be implemented by home health care providers in the exercise of their functions.

The three components are:

The relationship with the patient (***) The relationship with health professionals (***) The relationship with paying organizations (***).

Artificial respiration is subject to the **** Good Oxygen Dispensing Practices (***). This text provides for the training and graduation necessary to provide artificial respiration ...

6.1 Segmentation

• Isis Medical
• Orkyn (Air liquide)
• Bastide Groupe
• LVL Medical (Air liquide)
• Vitalaire (AIR Liquide)
• SOS Oxygène
• Homeperf
• Bestens umsorgt (KORIAN Group)
• Laboratoires Euromedis
• Medic Alliance
• e-device
• Cap Vital Santé
• La vitrine médicale
• MyMobility
• Air Liquide
• Linde
• Vitame
• DomusVi Domicile
• Proximed Services
• Vitalliance
• Domaliance
• Dinno Santé
• Ypsomed France