Private healthcare grows by 3.7 per cent, whilst operators of residential care homes see their growth double

The turnover of Italy’s leading private healthcare providers is expected to grow by a combined 3.7 per cent in 2025, with variations across the sectors: ranging from more than double the growth in turnover (+7.9%) for operators of care homes for the elderly to +3.9% for hospital care, and from +2.8% for diagnostics (tests and consultations) to +2.6% for rehabilitation. This is according to a report recently published by Mediobanca’s research department, which also notes that profitability is recovering in 2024, though margins remain below pre-Covid levels – not so much due to a decline in business volumes as to the increased proportion of costs (from labour to energy to services) and the burden of interest expense.

The analysis by Mediobanca’s Research Department focuses on the 38 leading groups with individual turnover in excess of 100 million. In 2024, these players’ revenues totalled 13.4 billion euros, up 5.5 per cent on 2023 and 22 per cent on 2019: these changes follow a 6.5 per cent decline in 2020, a 14.1 per cent rebound in 2021, a more modest recovery in 2022 (+2.6 per cent) and a 6.1 per cent increase in 2023. In particular, residential care home operators saw growth of 25.9% compared with 2019, driven by an improvement in bed occupancy rates and the continued opening of new facilities (although Italia has only half the number of long-term care beds compared with OECD countries); Next come diagnostic service providers (+22.9%), despite contractions in 2022–23 linked to the decline in swab and serological tests, and hospital operators (+22.8%). Rehabilitation providers bring up the rear (+10.1% compared with 2019). In 2024, Papiniano, the holding company of the San Donato Group and Ospedale San Raffaele (2,163 million), ranked first in terms of revenue, ahead of Humanitas (1,260 million), GVM – Gruppo Villa Maria (968 million), Policlinico Gemelli (946 million) and Kos (799 million).

Looking more closely at the financial figures following the setback in 2022, the net operating margin continues to grow (+24.9% compared with 2023): the EBIT margin thus rose to 3.6% from 3.1% in 2023, though it remains some way off the 5.4% recorded in 2019 during the pre-pandemic period, with the highest figures recorded in medical diagnostics (9.4%), followed by elderly care (5.1%), whilst players in hospital care and rehabilitation recorded lower figures, below 2019 levels but showing an improvement on 2023. Among the individual operators with the highest EBIT margins in 2024 are Pro.Med (11.5 per cent) and GHC (9.4 per cent) in hospital care, Affidea (14.4%) and Synlab (11.2%) in diagnostics, as well as La Villa (12.0%) and Sereni Orizzonti Holding (9.9%) in elderly care. In 2024, the aggregate profit of the 38 operators returned to positive territory, standing at 34.6 million, following the losses recorded in 2020 and the two-year period 2022–23. Consequently, aggregate ROE returned to positive territory in 2024 (0.6%, compared with -3.1% in 2023), but remains far from the 5.6% recorded in 2019. ROI stands at 4.7%, up from 3.9% in 2023 but still some way off the 2019 level (6.3%). The top performers by ROI in 2024 are: Affidea (16.4%) in diagnostics, Humanitas (13.2%), Pro.Med (12.9%) in hospital care, and Sereni Orizzonti Holding (12.6%) and Gruppo Gheron (12.2%) in elderly care.

More generally, the capital structure remains sound, although it has deteriorated slightly compared with 2023, with financial debt standing at 124.6 per cent of equity (119.7 per cent in 2023). The strongest positions are those of IEO, Istituto Don Calabria, Humanitas, Auxologico Italiano and La Conchiglia (Mantova Salus), with the former having no financial debt and the others with financial debt ranging from 10 to 20 per cent of equity.