The private clinic market - France (2024)

1.2 Private hospitals worldwide

The OECD publishes the number of hospitals in its member and non-member countries. Here, we take a look at the distribution of private, not-for-profit hospitals worldwide.

Number of private for-profit hospitals World, ****, in units Source: OECD *****

In terms of private for-profit establishments, Colombia and Mexico are well ahead of the USA, with **** and **** establishments respectively. The American giant has *,*** establishments, followed by Germany (***).

Number of private for-profit hospitals per * million inhabitants World, ****, in units Source: OECD However, if we take into account the population of the various countries, the rankings are reversed: Colombia is still in the lead with *** hospitals per * million inhabitants, but the USA is at the bottom of the ranking with * hospitals per * million inhabitants. The Netherlands and Bulgaria come in *nd and *th respectively, with ** and ** hospitals per * million inhabitants. Germany and France have around ** and ** hospitals per * million inhabitants respectively.

1.3 A promising market in France, driven by short-stay care

Sales of all private for-profit clinics France, ****-****, in millions of euros Source : DREES Private for-profit clinics, which differ from private not-for-profit clinics, have seen steady growth in sales over recent years: between **** and ****, sales rose by almost **% to reach **,*** million euros in ****.

Sales breakdown France, ****, % DREES Clinics whose main activity corresponds to short-stay care, i.e. medicine, surgery, obstetrics and dentistry (***) clinics, meanwhile, account for **% of sales, far ahead of psychiatric clinics, which account for just *% of the latter. These data date from ****, but are still considered valid in ****, as the segmentation of clinics has remained balanced.

1.4 Coronavirus: successful public/private cooperation

Covid-** care in **** represented a significant proportion of hospital activity: *.*% of all full hospital stays and *.*% of partial hospitalization days

During the crisis, cooperation between the public and private sectors was essential to meet care needs. After a few dysfunctions during the first wave of the pandemic, this cooperation worked well in the end. Private and public establishments pooled available beds: the most serious cases were mainly taken care of by establishments with intensive care units, and private clinics, which are usually responsible for follow-up care or scheduled procedures, took in less serious cases, or patients "at the end of their lives". [***]

Frédéric Valletoux, president of the FHF (***) from **** to ****, asserted during the crisis that "the private sector is doing its part, supporting us as much as it can, and that's going well". Indeed, at that time, **% of Covid-** patients in intensive care were cared for by the private sector.[***]

The intervention of private establishments also made it possible to absorb non-coronavirus activity, such as surgical and medical emergencies, while public establishments took care of cases affected by the virus.

In the face of this crisis, we have seen that both the public and private sectors can face the ...

2.1 Health care consumption

Consumption of healthcare and medical goods has risen steadily in recent years, from ***.* billion euros in **** to ***.* billion euros in ****, or *.*% of GDP.

This represents an increase of *.*%, following a *.*% rise in ****, when the health crisis was still raging. This growth rate is the highest recorded in the last thirty years.

Structure of CSBM (***) France, ****, in Source: ****

In ****, the CSBM is made up of consumption of hospital care (***). [***]

Various factors may explain this increase in the consumption of medical care and goods. These include the aging of the population and theexplosion in chronic diseases.

An aging population: already a reality...

Proportion of French population aged ** or over France, ****-****, in % Source: ****

...which will continue to driveconsumption of healthcare and medical goods Population projections to **** in millions of inhabitants, France, ****-****, as % of total population Source: CNSA (***) based on INSEE The aging of the French population is real, as this graph shows. While those aged ** and over will represent only *.*% of the population in ****, their weight in the French population will double to **.*% in ****. This ageing is linked to longer life expectancy and the arrival of the baby-boomers at retirement age: * factors favoring the number of consumers of medical care and ...

2.2 A positive view from patients

The various surveys studied date back to **** or ****. Private clinics have not been particularly lacking since then, so we consider that the data received is still meaningful in ****. Generally speaking, private clinics and hospitals enjoy a good image overall: **% of French people had a good image of private clinics and hospitals in ****. Among them, **% even had a very good image. [***] This breakdown is confirmed by the Odoxa survey in ****, which shows that the French have a better opinion of private hospitals and clinics than of public hospitals : **% of French people had a good opinion of private hospitals and clinics versus **% for public hospitals[***] Satisfaction levels reached **%[***] among people who had been hospitalized in this type of structure. Indeed, these structures are renowned for their professionalism and seriousness, as well as the quality of their staff: staff are considered more available, friendlier and also more qualified. The presence of leading specialists is particularly appreciated. "Overall, do you feel that clinics are able to..." France, **** IPSOS **% of respondents consider that clinics are able to offer a good quality of care, **% say that they offer a personalized welcome and a quality stay to patients. On the other hand, respondents are more mixed when it ...

2.3 The patient base

Hospitalizations in the public and private sectors

In ****, French healthcare establishments (***) admitted **.** million patients. Of these, **.*% were hospitalized in MCO, *.*% in SSR, *% in psychiatry and *.*% in home care.

Breakdown of hospitalized patients France, ****, in Source: ****

Given that **.*% of patients are hospitalized in the MCO segment, we are studying the patient base in this segment to get a general idea of the profile of hospitalized patients.

age

Hospitalization is more frequent in the older part of the population . In ****, **% of MCO stays will involve patients aged ** and over, compared with **% of the French population. Patients aged ** and over, who make up just *% of the French population, accounted for **% of hospital admissions. By contrast, children under ** accounted for **% of hospital admissions, despite representing **% of the population. Among the under-**s, infants and children under * year of age were by far the most frequently hospitalized.

The distribution of activity by age group in ****, after experiencing a jolt in ****, has returned to the stability of ****.

Utilization rates by age group France, ****/****, in number of stays per **** inhabitants Source : ATIH *utilization rate for a given age group: annual number of hospital stays for the population concerned, divided by the population in that age group.

Zoom: MCO ...

2.4 Reasons for hospitalization vary by sector

The public and private healthcare systems coexist, but the specialties of each sector vary: while the main reason for a stay in the public sector is to carry out a session, i.e. a follow-up visit such as chemotherapy or dialysis, in the private sector this is the main reason for a stay.rapie or dialysis (***). These statistics date from ****, but give an idea of the distribution of reasons in ****, although the figures are no longer exactly the same.

Breakdown of hospital stays in the public sector by main reason for stay France, ****, % DREES

Breakdown of hospital stays in the private sector by main reason for stay France, ****, % of total DREES, sheet **

3.1 Facilities and their full hospitalization capacity on the decline

Typology of healthcare establishments

Today's French hospital sector is a varied one, with three types of legal status coexisting: public establishments, private not-for-profit establishments and private for-profit establishments, more commonly known as private clinics.

Breakdown of healthcare facilities by sector France, ****, number of facilities INSEE

The public sector remains predominant in France, with *,*** establishments in ****, closely followed by the private for-profit sector with *** establishments in ****. Next come private not-for-profit establishments, numbering *** in ****. The number of healthcare establishments is falling, especially in the public sector: from *,*** in **** to *,*** in ****, a drop of *.*%. In the same year, there will be *,*** private clinics, ** fewer than in **** (***).

Number of establishments in the private sector France, ****, INSEE It can be seen that the majority of establishments in the for-profit private sector are dedicated to acute care (***).

Characteristics of private-sector facilities France, ****, number of beds and number of places INSEE A distinction is made between full hospitalization and partial hospitalization. The number of beds reflects the capacity of healthcare establishments for full hospitalization. It is equal to the number of beds able to accommodate patients. The number of places reflects the capacity of partial hospitalization facilities. It is equal to the number of patients who can be ...

3.2 Personnel

The total number of employees in the private hospital sector, both for-profit and not-for-profit, was ***,*** in ****, down from ***,*** in **** . It has therefore fallen by *.*% in * years.INSEE only provides us with the number of healthcare professions in ****, but as the change is slight two years later, this gives us an idea of the distribution of staff in for-profit healthcare establishments in ****, before Covid-**.

Different types of professions are involved in ensuring the smooth running of a for-profit private healthcare facility: administrative, medical, nursing, educational and social, medico-technical and technical staff.

Personnel in private for-profit healthcare facilities France, ****, thousands of full-time equivalents INSEE, DREES

There is a large majority of self-employed doctors: there were **,*** in ****, while salaried doctors numbered just *,***.

Medical staff in private for-profit establishments France, ****, number of jobs DREES

Nurses and orderlies predominate among care staff: there were **,*** and **,*** respectively in ****.

Nursing staff in private for-profit establishments France, ****, in thousands of full-time equivalents INSEE

3.3 The financial situation of private clinics

According to DREES estimates for ****, private for-profit clinics are experiencing an improvement in their financial situation. Their net income stands at *.*% of revenues, recording an increase of *.* points compared to ****, bringing them back to historically high levels similar to those observed between **** and ****.

Source: ****

This table shows the income statements of private clinics, based on the accounts of **** clinics. This means that in ****, the average private clinic generated sales of **.* million euros (***), with a net income of *.*%, i.e. around ***,*** euros .

3.4 Diversification and consolidation of the sector

While the public sector offered generalist services, private clinics tended to be more specialized. However, the private sector has decided to turn to general medicine in order to attract new patients. Indeed, the development of new activities is essential to ensure the survival of clinics, which until now have offered services that have struggled to be profitable, not least because of costs that exceed the agreed tariffs granted by the state. [***]

So, in ****, leader Ramsay Santé opted for vertical integration by launching new primary health care centers. This business model is based on the capitation payment of an Article ** , under which doctors and caregivers will be salaried. Experimentation began in the Île-de-France region, for a five-year period. At the same time, the group also decided to take part in a trial of episode-based payment for certain pathologies. [***]

There was also a restructuring of the sector in the post-Covid-** period (***), which continues today as some clinics remain vulnerable * years after the pandemic. Indeed, the year **** saw ** major external growth operations in the private clinic sector, with Elsan becoming the largest operator in France. By ****, nearly half of all clinics will be owned by Elsan, Ramsay Santé, Korian and Clinéa. [***]

3.5 Geographical disparities

Source: ****

on a national scale, public healthcare establishments account for a majority share of **% of available beds and places, while private not-for-profit establishments account for **%, and private for-profit clinics for **%. However, it is important to note that this distribution varies considerably from one département to another.

In ** départements, * of which are in the Grand-Est region, private clinics are a minority, accounting for less than **% of total capacity. conversely, in * of the ** departments in Occitanie, as well as in the * departments in Corsica, and * of the * departments in PACA, private clinics account for over **% of total capacity in beds and places.

Source: ****

In ****, the distribution of beds and places in healthcare establishments varied significantly from one region and department to another. In terms of density, the number of beds per ***,*** inhabitants ranged from *** in Mayotte to *** in Cantal, even reaching *,*** in Hautes-Alpes, whatever the criterion taken into account, including long-term care.

Some départements stood out for their high bed density, notably * in Nouvelle-Aquitaine, * in Bourgogne-Franche-Comté, * in PACA, as well as * in the Auvergne-Rhône-Alpes region.it is important to note, however, that the amplitude of disparities in terms of beds and places varies according to medical discipline (***).

4.1 A quality offering at the cutting edge of innovation

Quality of care Clinics were the first to offer single rooms and to pay particular attention to the quality of the hotel and restaurant services, as well as to the presence of ancillary services such as a crèche, restaurant and conference center. [***] Research and technological innovation Rapidly evolving technologies are revolutionizing medicine and our healthcare system. Medical innovation is a major challenge for the private hospital sector, as it fosters the emergence of new therapeutic and diagnostic strategies for patients. Clinics are involved in clinical research, and are at the forefront of new minimally invasive surgical techniques such as laparoscopy (***), digestive and biliopancreatic endoscopy, and video-endoscopic diagnosis. They are also acquiring innovative equipment (***) and investing in surgical robots. From an organizational point of view, they are keeping pace with societal development by offering innovative care methods such as telemedicine and the use of connected health applications.

4.2 A variety of care options

The majority of private clinics provide MCO care (***).

Breakdown of private clinics by type of activity France, **** DREES, sheet **

Among clinics offering MCO care, a large majority are multidisciplinary (***) clinics.

ATIH has not published figures for ****, but assuming that the distribution of specializations has remained the same as in ****, we obtain the following data.

MCO clinics France, ****, number of establishments DREES, sheet **

4.3 Digitizing care services

Private clinics are part of the trend towards digitalization in the healthcare sector, and meet the expectations of a large majority of French people, who are in favor of hospital digitalization and the introduction of digital services by hospitals and clinics : indeed, **% of them consider these to be useful, enabling them to save time (***)

Lamine, Gharbi, president of the FHP (***), even states that: "In December ****, we counted *** private hospitals and clinics that had benefited from financial support from Hôpital Numérique, i.e. almost one in three private establishments. In all, **% of the projects selected and funded by the Hôpital Numérique program came from private hospitals and clinics."[***]

As a result, private clinics are increasingly offering digital services. For example, one of the sector's major players, Ramsay Générale de Santé, offers a platform accessible from their website, which enables patients to book appointments online, fill in a satisfaction questionnaire, and benefit from post-hospitalization follow-up. [***]

Share of hospitals and clinics with the following digitalized services France, ****, in % Source: ****

According to a BVA survey for Orange (***) are increasingly carried out online. **% of hospitals and clinics surveyed have set up an information and communication portal for their patients, **% offer ...

5.1 Certification of healthcare facilities

Every four years, public and private healthcare establishments undergo a quality of care assessment by the French National Authority for Health (***). The ultimate aim is to improve the quality of services provided by hospitals and clinics.

There are several phases to this process, the two main ones being :

A self-assessment by the facility's professionals, based on a set of guidelines drawn up by the HAS. The certification visit, conducted by expert surveyors. The expert-visitor is an experienced healthcare professional (***) working in a healthcare establishment, who is appointed by the HAS to carry out certification visits. [***]

5.2 The authorization system

Clinics are not free to choose their care activities (***). These authorizations are valid for a limited period of * years, with no guarantee of renewal.

The ARS coordinates activities and issues authorizations for the creation of healthcare and medical-social establishments and services, with the aim of developing a global vision of healthcare and decompartmentalize healthcare pathways, while ensuring the quality, efficiency and safety of care and support within the healthcare system.

Underarticle L.****-* of the French Public Health Code, the ARS must authorize :

the creation of any healthcare establishment, the creation, conversion and grouping of care activities, including alternative hospitalization and home hospitalization, installation of heavy equipment, changes to the location of an existing facility, renewal of authorizations (***).

5.3 The question of tariffs

In ****, taking into account compliance with the pluriannual protocol and salary adjustments under the Ségur plan, the average rate increase will be *.*% for public and private not-for-profit hospitals, and*.*% for the private for-profit sector.[***]

Yet in ****, the government planned to lower the tariff for private clinics, by *.**%. A "tariff cut" in the context of private clinics generally refers to the practice of lowering or limiting the costs billed to patients for medical services. In ****, **** and ****, the reduction in rates for stays had been limited to -*%, -*.*% and -*.*% respectively. [***]

The pricing campaign continued to exist within the framework of the **** Social Security Financing Act, which provided for an increase in deexpenses for healthcare facilities by *%, or *.* billion euros, bringing total spending to **.* billion euros. [***]

Changes in tariffs and funding allocations generally take into account changes in activity during the year in question, and whether or not forecasts are met.

6.1 Positioning the players

• Ramsay Générale de Santé
• Elsan Groupe
• SantéCité Groupe
• Vivalto Santé
• Orpéa Emeis
• Clinéa (Orpea Groupe)