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Summary of our market study
The global homecare market is experiencing significant growth, driven by an aging population and an increase in chronic illnesses. valued at $282 billion, the market is expected to grow at a compound annual growth rate of +7.8% until 2026. Growth in Europe is driven by favorable public policies and the development of healthcare infrastructures.
North America remains the largest market, with Western countries accounting for over 70% of global market share. However, growth prospects are promising in low- and middle-income countries, where the population is ageing rapidly and the middle class is emerging. The market offers both homecare equipment and services, with major players such as F Hoffmann La Roche AG and Koninklijke Philips N.V.
Germany, in particular, has seen its market prosper, with a CAGR of 2.8% between 2010 and 2020, and is expected to maintain this trend due to its aging population requiring ongoing care. The German market is characterized by advanced healthcare and competitive innovation, and projections suggest a continued increase in demand for homecare services.
Emerging trends in the German homecare market
The German homecare market is a dynamic sector, attracting interest from companies and investors alike due to a combination of factors shaping supply and demand. Observations from the analysis provided indicate that the main factors influencing this market are the aging population, the increase in chronic illnesses, supportive government initiatives, the adoption of homecare devices by the population and comprehensive insurance coverage.
Germany, with its highly developed and innovative healthcare industry, ranks third in the world, behind the USA and Japan. This competitive edge is evident in the fields of health technology, pharmaceuticals and biotechnology. When it comes to spending on patient care, Germany exceeds the EU average in all categories, underlining its commitment to healthcare services. The market, valued at over 30 billion USD in 2018, is expected to grow at a rate of around 5.6%, which could increase its size to between 40 and 45 billion USD by 2030. This growth is largely attributed to the increase in the number of elderly people and chronic diseases, such as diabetes, heart conditions and respiratory ailments.
Increasing demand for home healthcare can be anticipated in the near future, supported by public policies and reliance on homecare devices for health management. An examination of the German demographic landscape reveals a sharp increase in the elderly population, with a projection of around 20% of the population reaching the age of over 67 by 2020, and it is estimated that this figure will rise to almost 23% over the following decade. This demographic shift is closely linked to the growing need for healthcare, particularly long-term care. For example, almost half of all homecare beneficiaries require level 2 care, which provides a moderate degree of assistance, while a small percentage require the most intensive level 5 care. The demand for homecare medical staff is critical, and efforts to meet the need have been paramount, including the recruitment of nurses and healthcare workers from other European nations. While the number of healthcare staff is increasing, the vast majority remain female, with women outnumbering their male counterparts in this sector by more than fifteen to one. In addition to conventional home care, Germany is experiencing a boom in assisted living, an attractive option for older people wishing to be independent while still having access to care and services.
Some regions, particularly city-states and areas such as Mecklenburg-Western Pomerania, are seeing a notable number of places available for assisted living, suggesting a growing market for alternative senior living options. If the above trends are taken into account.
Key players shaping the German homecare landscape
The German homecare market is a cornerstone of the country's strong healthcare sector, with a number of influential players driving innovation and providing a range of services and equipment to patients. Below, we present some of the key players in this market, each contributing to the diversity of homecare offerings designed to meet Germany's growing demand.
- F Hoffmann La Roche AG: This global healthcare company is known for its commitment to research and development in the pharmaceutical and diagnostic fields. In the homecare segment, Roche offers a plethora of home diagnostic tools and equipment that facilitate the monitoring and management of various health problems, enabling patients to retain a degree of independence in the management of their health.
- Sunrise Medical: A leading producer of home mobility and seating solutions, Sunrise Medical's products, such as wheelchairs and walkers, enable people with reduced mobility to move around their homes and communities more easily. The company's focus on user-centered design ensures that its products are not only functional, but also enhance users' quality of life.
- Almost Family Inc: As a provider of home nursing services, Almost Family caters for a wide range of needs, from care for the elderly to rehabilitation services for those recovering from injury or surgery. The company is renowned for its patient-centered approach, which emphasizes personalized care plans to promote healing and independence at home.
- National HealthCare Corporation: With a long-standing presence in the long-term healthcare sector, this company is extending its expertise to home care. Offering a wide range of services such as skilled nursing care and therapies, National HealthCare Corporation ensures that patients receive comprehensive care in the comfort of their own homes.
- Acelity L.P.: Acelity focuses on advanced wound care and regenerative medicine, with products that are integral to post-surgical care and chronic wound management in the home. Its innovative solutions play an essential role in the healing process, helping to improve outcomes for patients at home.
- Koninklijke Philips N.V.: Philips, a world-renowned brand, offers a multitude of healthcare technology products. In the homecare market, its offering includes a range of monitoring devices, respiratory care solutions and telehealth services that facilitate remote care and medical consultations. These key players, with their diverse and specialized contributions, form a strong, interconnected network that supports the ever-expanding German homecare market. Their innovations in homecare equipment and services help not only to provide essential care, but also to maintain Germany's reputation for quality.
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Summary and extracts
1 Market summary
1.1 Introduction
Home medical assistance is a market in the health industry. In order to help patients thrive at home, health service providers have gradually expanded their services by visiting patients and developing a range of home support services.
Home health care or home medical assistance is the treatment provided to patients in their homes and generally involves the use of medical equipment. However, it is important to distinguish between home medical assistance (home care) from home hospitalization (otherwise known as the home hospitalization program), the second requiring more intensive care.
In general, home medical assistance aims to help people 3 types of patients following:
- Patients with disabilities or chronic diseases (such as those requiring recurrent treatment);
- The elderly who can live at home but need regular monitoring of their health status;
- Patients recovering from an accident or injury and who require physiotherapy (EA) or regular occupational therapy.
The German market has been growing rapidly, at a CAGR of 2.8% from 2010 to 2020, and it is expected to continue on this trend in the following years. It is mainly driven by the ageing population and increasing of long-term conditions which require comprehensive, continuous care.
As demand increases, the government has faced the issue of understaffed nursing homes and hospitals by implementing provisions in order to appropriately care for the elderly.
1.2 Key figures of the world market
In Europe, market growth is driven by public policy support and the development of healthcare infrastructure. Rising healthcare costs and increasing government initiatives (***) have made home healthcare more affordable for the population, thereby driving the market growth.
Globally, it was valued at *** billion in ****, according to Grand View Research, and is expected to grow at a CAGR of +*.*% over the period ****-****.
Size of the home health care market World, **** - ****, in billions of USD Source: ****
In terms of geography, the North American market is by far the largest in this industry, and developed Western countries account for more than **% of the global home healthcare market.
These markets are indeed more mature and represent important opportunities due to existing facilities, the historical importance of public policies for access to care, and the aging of their population. Nevertheless, according to the WHO, the world's population is expected to continue to age, with the number of people over ** increasing from **% to **% of the population between **** and ****, reaching * billion by the end of the period.
There is significant room for growth in low- and middle-income countries in-home health care due to the formation of a middle class and the rapid aging of their populations, ...
1.3 The German home healthcare market
Germany has a highly developed and innovative health industry and ranks third after the United States and Japan. German industry stands out in particular in the fields of health technology, pharmaceuticals and biotechnology.
This can also be observed by comparing German expense on patient care with the EU average one. As the graph below shows, Germany spends considerably more than other countries in all categories.
Expense on inpatient and outpatient care Germany and EU, ****, in euros PPP per capita Source: ****
The market has been valued at more than ** billion USD in **** and is projected to grow at a CAGR of *.*%, reaching **.* billion USD by ****. Within this industry, the home healthcare market segment has attracted the attention of businesses and investors. The increase in the number of seniors, chronic diseases, government support, acceptance of home devices, awareness of home health care, and support insurance coverage have contributed to the leadership of Germany in the home care market.
With the increase in the number of people diagnosed with chronic diseases such as diabetes, heart disease, and respiratory diseases, the demand for home health care is expected to increase further in the near future.
Market volume in outpatient and inpatient care Germany, ...
1.4 Covid Impact
The coronavirus outbreak has affected the market in several ways. The people involved in the home healthcare market are by definition the most vulnerable to the virus, therefore, countries had to develop appropriate responses to protect them.
From a human point of view, the situation had major consequences for caregivers and the elderly. A study was conducted by Johannes Gutenberg Universität to shed light on the effects of the pandemic on the market. The first results of the study on home-based care for the elderly show that the Corona pandemic has affected the situation of family caregivers and those in need of care in many ways. In summary, the following findings should be mentioned in particular: more than half of the family caregivers feel that caregiving is more stressful than before the outbreak of the Corona pandemic and more than one-third stated that they felt overburdened in the current care situation.
Percentage of survey respondents who experienced a worsening in the caregiving job Germany, ****, in % Johannes Gutenberg Universität
This situation of stress has enhanced a problem that Germany was facing before the pandemic: the lack of staff in the sector. The number of caregivers in the country dropped, as ...
2 Demand analysis
2.1 Determinants of demand
The main driver of the home healthcare market is clearly the progressive seniorization of the population, a trend that has been a constant of the last decades in the countries of the Western world. Germany is among the first countries in Europe for a percentage of the population over **, and the trend has been increasing sharply. In ****, only **% of the total German population was older than **, while in **** the figure reached almost **%, and is predicted to hit **.*% by the end of the next decade.
Evolution of the population older than ** years old Germany, ****-*****, in % Source: ****
This is obviously strictly connected to health issues and conditions that lead the population to require home healthcare. The graph below shows the percentage of the population in need of long-term care by age group. The figure is highly exponential, starting at *% for people under ** and reaching **.*% for the population over **.
Long-term care rate, by age group Germany, ****, in %
Long-term care is also directly connected to home healthcare since conditions of this severity require full medical assistance.
People in need of long-term care, by type of care Germany, ****, in % Source: ****
According to the Commonwealth organization which includes all information on the health systems of the ...
2.2 Market trends
The health industry in Germany is traditionally very strong and competitive worldwide, and as such paves the way for innovation. Thus, these general characteristics also affect the home care segment and influence trends in this market.
The trends in the German home healthcare market can be summarised in three main aspects: demographic and social changes innovation, e-health, and one change in the government's role.
Demographic and social changes
The population profile is changing as the proportion of elderly people is increasing compared to that of young people. With age, people become more and more dependent on outside help and care, even if individuals become more and more dependent later than in previous generations [***].
In addition to this context of an aging population, the European Union offers citizens the opportunity to live and work in another Member State. This mobility of European citizens and the change in social attitudes, values, and behavior contribute to increasing the demand for home care services as a result of the fragmentation of the traditional family into smaller units.
Furthermore, the expected changes in the age structure of the population will affect both the financing of public services and the availability of home care service providers in ...
2.3 Pathologies leading to home-care needs
In Germany there are around * million patients who receive homecare services. The two largest areas are wound treatment and pressure ulcer prophylaxis (***).
Breakdown of the pathologies of home care patients Germany, ****, in % Source: Pflegemarkt
The number of enteral nutrition supplies is *.* million patients and parenteral nutrition *.* million patients. In the large area of wounds, * million patients are cared for in institutions and at home. Another big area is incontinence. Over * million patients are cared for with products for drainage and absorbent incontinence care. The area of long-term oxygen therapy and home ventilation, on the other hand, is comparatively small. The information on this form of therapy is based on estimates. Accordingly, approximately ***** people are ventilated regularly. It can be assumed that this form of care will increase rapidly in the next few years, as lung diseases are one of the three most common causes of death.
People in need of care receiving domiciliary care, by care level Germany, ****, in % Source: ****
The pie chart shows the breakdown of people receiving home healthcare by levels. This means that a care level * will require minimum assistance, while a care level * will require full, **/* assistance for the patient.
As we can notice, ...
2.4 The boom of assisted living
When talking about assisted living, in German Betreutes Wohnen, we are referring to a form of living for senior citizens in old age alongside classic nursing home accommodation or outpatient care at home. This way of living enables people with special needs to live independently and, depending on their individual needs, to make use of care, nursing, and other services.
This new solution is becoming increasingly attractive, as it allows seniors to conduct a good life in a private environment. This concept also makes it possible to take advantage of other services and care offers that significantly increase the individual security and thus the quality of life of senior citizens. As part of the open elderly care, assisted living for seniors can be organized within their own home or as a form of living that is organizationally or structurally connected to an outpatient or inpatient facility.
The map below shows the spots available for every ***** inhabitants over ** in German Federal states.
Places available for every ***** inhabitants over **Germany, ****, in units
Source: ****
When looking at the supply in the individual federal states, the city-states of Hamburg, Berlin, and Bremen stand out in addition to Mecklenburg-Western Pomerania, which is also above average. ...
3 Market structure
3.1 Market structure
Health insurance in Germany is compulsory and therefore offers almost universal coverage. The German medical system is divided into public social health insurance (***), and there are many criteria to determine who is insured. Employees typically have insurance at SHI, but people whose income exceeds a fixed threshold or belongs to a certain professional group, such as the self-employed or civil servants, can choose to join PHI for comprehensive insurance. The SHI multipayer system currently consists of *** disease funds, covering **% of the population, and approximately **% of the population is insured by one of ** private health insurance companies.
Other specific groups (***).
In terms of funding, the German healthcare system is primarily supported by statutory health insurance, as the graph below outlines. However, there is some supplementary private care insurance that consists in protecting additional risks for public health insurance, including care insurance.
Health expenditure by sources of funding Germany, ****, in % Source: ****
Compulsory long-term care insurance covers only a fraction of the costs and, therefore, supplementary health insurance can cover the financing gap if necessary. Some of the usual supplementary insurances in Germany are:
Caregiver's pension insurance: it is offered in the form of a life insurance policy, under which, depending on the deposits ...
3.2 Providers of home care devices
Homecare consists of a service and of multiple devices, especially in long-term care scenarios.
Device providers can be medical supply stores, pharmacies, medical retailers or the industry, or the manufacturers of the products themselves.
Since the supply of products is always closely related to the provision of assistance-related services, the supply is complicated. In order to be able to represent this effort economically, the number of patients treated must be sufficient to provide professional personnel and logistics services.
The professionalization of providers in the home care field has led to very large units, such as Fresenius Kabi Germany or GHD Gesundheitsdienste Deutschland GmbH in the field of enteral nutrition. Both companies provide supply nationwide, so they can gain market share from smaller suppliers on site. This allows the supply to provide non-profit services to regional medical supply stores and pharmacies. Large home care providers not only provide services at home, but also work in inpatient and semi-hospital facilities.
Products and devices for home care include:
Briefs, diapers Catherers, bags, liners care bags Parental and enteral nutrition Various wound dressings Equipment and supplies for respiratory care
3.3 Shortage of medical staff and home care workers
In ****, according to the OECD, the number of home medical staff for long-term care in Germany was just under * per *** people over ** years of age, which places it among the countries with the lowest density of home medical staff.
To address the supply shortage, government measures have been put in place in Germany to attract nurses and health workers from other European countries such as Bulgaria, Portugal or Spain according to the German magazine Hesamag, allowing them to have a gross monthly salary of about ****€.
Health personnel in home care services Germany, ****-****, in units Source: ****
As the graph shows, health personnel has been growing rapidly, also due to the provisions taken by the government to face the shortage of medical staff.
Regarding the segmentation of the supply, we can notice that female workers are more than ** times more than male workers, as in **** on a total of almost *** workers, *** were women.
4 Analysis of the offer
4.1 An overview of prices
The home healthcare market includes a wide range of products (***) and services. This means that prices in this market vary depending on the equipment and services required for the patient's condition. Nevertheless, the Commonwealth organization believes that home medical assistance can help to reduce the costs of the same treatment in a health care facility by **%.
Home diagnosis and monitoring devices are more likely to be purchased since they tend to be used more often. The price of a blood glucose meter can vary from ** to ** euros depending on the brand and model. As for the cardio-frequence meters, prices vary from ** euros to more than *** euros depending on the brand and model.
Concerning therapeutic home care devices, they can be purchased, rented, or provided with a service. Nebulizers, for example, can be purchased between ** and *** euros or rented on prescription.
For services such as ambulatory home care, costs depend mainly on whether the person is cared for by a mobile ambulatory care service or by a relative. In addition, the service provided and the price will then depend on the patient's needs and the level of assistance required.
In Germany, by paying long-term care insurance contributions, the citizen automatically acquires a ...
4.2 Products and services
As explained before, the home healthcare market is mainly made up of products and services.
The products on the market can be segmented into:
Home diagnosis and monitoring devices; Therapeutic devices for home care; Home mobility devices Medical supplies.
Home diagnosis and monitoring devices consist of products of testing, screening, and surveillance for different ailments. It includes pedometers, pulse oximeters, pregnancy test kits, coagulation monitors, sleep apnea monitors, temperature monitors, heart rate monitors, blood pressure monitors, and blood glucose monitors.
Therapeutic devices for home care are subdivided into dialysis devices, intravenous devices, respiratory therapy devices (***), wound care products, and insulin injection devices.
Medical supplies s, as their name suggests, include equipment, materials, and other types of medical supplies. This is the second-largest segment of home health care on a global scale and is expected to grow in the near future, both globally and in Germany.
Home mobility devices consist of cranes, crutches, and wheelchairs. This segment had a lower market share in the global market.
With regard to services the home healthcare market is segmented into unqualified home care services (***), respiratory therapy services, infusion therapy services, telehealth and telemedicine services, and rehabilitation services which account for **% of the home medical services ...
4.3 Innovation
Innovation and e-health
Germany's technological tradition has already reached the home healthcare market and is increasingly accepted by the population. In ****, investments in e-health amounted to *** million euros and in the medium term are expected to increase by **% per year. Innovations in software and equipment for home medical care are not a new trend, for example, blood glucose meters for diabetes that do not require finger pricking.
However, the market still requires changes and innovation. The German government has approved an act respecting medical applications which came into effect in December ****, the law on secure digital communications and applications in healthcare (***).
The purpose of this law is to use the possibilities of digitization for healthcare and to allow a faster introduction of medical applications for patients. It also focuses on promoting telemedicine i.e. online video consultation, advice on the evaluation of radiographs, among others. This type of innovation may take longer to spread across the country.
Until ****, telemedicine was a service in conflict with the code of conduct of German doctors but provided by the other EU Member States, which could access the German market through the Single Market. In mid-****, the General Assembly of German Physicians voted in favor ...
5 Rules and regulations
5.1 Regulations in force
Germany operates on the basis of an insurance system, with health professionals working for private companies for-profit. In the German health system, hospitals are companies, often owning hospital chains and related ambulatory and aftercare services. However, Germany has a public regulated health insurance system. German legal regulations directly influence the home healthcare market. And regulation in some segments of this market is still evolving.
Regulatory changes concerning the establishment of a secure infrastructure and the introduction of medical applications are supported by the **** Law on Secure Digital Communications and Applications in the Health Sector (***), which entered into force on **.**.****.
However, in the case of online consultation and prescription, other laws apply. As for online consultation, it is the code of conduct for German doctors which, until recently, prohibited remote treatment (***). This means that for initial treatment, disease notes, and prescriptions, a visit to the doctor is therefore inevitable in Germany.
The change in the Telehealth Act concerning telemedicine services is that telemedicine services provided by a doctor are only lawful as a follow-up treatment after an initial and prior personal examination by the same doctor. To this end, the Online Health Act includes video consultation in the catalog of health insurance ...
5.2 Covid-related regulations
The Krankenhauszukunftsgesetz (***), or Hospital Future Act, brings about legal changes for family carers and those in need of care. It was passed by the Bundestag on September **, **** and does not require the consent of the Bundesrat.
It has been written in order to support people in need during this time of pandemic. The provisions include information about
Care level assessment Consultation Nurse training State aids
A more detailed overview can be found at Pflegemarkt.
6 Positioning of the actors
6.1 Segmentation of actors
The German market for home medical assistance is a heterogeneous market: it includes large high-tech companies but also of small and medium-sized care and assistance companies. As this market involves a diversified range of products and services depending on the patient's situation, this difference within the segment is understandable.
In addition, Germany is the country of origin of some leaders of the market in this segment, such as the Linde group, and counts with the presence of other important players in the European and global market.
- Fresenius Medical Care
- VIVISOL Home Care Services
- BAYADA Home Health Care
- Pflegetiger (Caretiger) GmbH
- Home Instead GmbH & Co. KG
- Bonitas Holding GmbH
- Compassio GmbH & Co. KG
- Deutsche Fachpflege Holding GmbH (Advent International Group)
- Bestens umsorgt (KORIAN Group)
- Renafan GmbH
- Advita Pflegedienst GmbH
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