private healthcare runs with almost 9 billion in revenues – Corriere.it

A patrol of 24 Italian private healthcare companies, with an aggregate turnover of almost 9 billion and growing: +15.2% in 2021, an expansion rate that also marks the recovery compared to 2020, the toughest year of the pandemic . The champion on the podium was the San Donato-San Raffaele group of the Rotelli family, with its 1.63 billion in turnover, closely followed by Humanitas of the Rocca dynasty. The Villa Santa Maria group of entrepreneurs Sansavini from Ravenna qualified third. The Garofalo Health care group stands out in the top ten, with a turnover of 280 million, which has grown thanks to the boost of the liquidity collected with the IPO which has allowed this reality to invest in acquisitions, about ten since the landing on Piazza Affari.

Growth

The 24 champions score a +6.3% compared to 2019. The overcoming of the pre-crisis levels was not for generalized: revenues rose by 6.7% for hospital operators and by 44.1% for the diagnostics, while the recovery did not materialize for rehabilitation players (-0.3% on 2019) and for RSA managers (-0.2%). the picture that emerges from the fourth survey on the healthcare supply chain carried out by Mediobanca’s research area which this time analyzed the major private healthcare operators in Italy with individual turnover exceeding 100 million. Three sectors: hospital, RSA and long-term hospitalization, diagnostics. The first numbers for 2022 – Mediobanca analysts say – make it possible to estimate an increase in turnover at the aggregate level of the major private healthcare operators in the order of 4% on 2021, which however cannot be generalized to all sectors: the case of sector 4 of assisted healthcare residences for which a return to saturation of beds to pre-Covid levels is estimated not before 2025.

A slow return to profitability

The health facilities working in Italy were 28,980 in 2021 (57% private and 43% public), up by 2,898 units on 2010, cumulative increase in private (+2,519 units) and public (+379) units. Profitability recovering, but still lower than pre-pandemic levels: the measures to combat the epidemic have caused a sharp increase in costs, only partially covered by the refreshments provided for by emergency regulations. The aggregate Ebit margin is so negative in 2020 (-0.6%), but the intense vaccination campaign and the lower spread of Covid-19 allowed the recovery of clinical activity and the improvement of the Ebit margin which rose to 3, 7% in 2021, albeit still lower than 6.0% in 2019. At the individual company level, five groups close 2021 in the red, compared to ten in 2020. The aggregate return on equity, i.e. the return on investment , down from 7.2% in 2019 to 4.1% in 2021. The highest values ​​are those of Humanitas (17.2%), Pro.Med from Molise (16.6%) and San Raffaele in Rome (12.6%).

Public spending

There is obviously a correlation between the growth of private healthcare groups and the slowdown in public spending. The overall slowdown in healthcare spending in the last decade is the result of legislative measures aimed at reducing the public burden in the healthcare sector, among which Mediobanca recalls Legislative Decree 6 July 2012, n. 95 (so-called Spending review). The launch of a certain number of Recovery Plans (PdR) by the Regions in financial imbalance acted as a further control of public health expenditure. The study highlights some structural and dynamic aspects. Among the first: compared to its European peers, Italy qualifies for the lower incidence of public health expenditure on GDP. This is 7.3% in 2020, a level that keeps it at a distance from Spain (7.8%) and above all from Germany (10.9%) and France (10.3%). From the second point of view, between 1999 and 2020 Italy recorded the lowest growth rate (+2.1 pp) of the public component, after the expansion between 1999 and 2011 gave way to a prolonged phase of containment.

The health crisis

The last two years once again marked an evident expansion linked to the health crisis (+5.1%). Expenditure disbursed by accredited private structures shows a higher growth than that of public facilities over the entire period (+3.2% against +2.4%) and in each sub-period, with the sole exception of the last glimpse marked by various regulatory interventions to strengthen the NHS to deal with the pandemic (staff recruitment, optimization of services provided and adaptation of infrastructures).

The San Donato group on the podium

San Donato Hospital Group and San Raffaele Hospital are headed by Papiniano, a holding company of the Rotelli family based in Bologna, which controls a total of 18 hospital structures (16 in Lombardy and 2 in Emilia-Romagna) of which 3 scientific hospitalization and treatment institutes (IRCCS), as well as 18 centers for dental care. The main hospital societies are: San Donato Polyclinic (San Donato M.se-Mi), San Raffaele Hospital (Mi), Galeazzi Orthopedic Institute (Mi), La Madonnina Nursing Home (Mi), Zucchi Clinical Institutes (Monza), Bergamaschi Hospitallers (Osio Sotto-Bg), Brescian Hospital Institutes (Bs), Clinical Institutes of Pavia and Vigevano (Pv), Villa Erbosa (Bo) and Villa Chiara (Casalecchio di Reno – Bo). The Papiniano group is the first accredited private operator in Lombardy, which owns about 11% of the accredited beds in the region, while Villa Erbosa represents the largest accredited private hospital in Emilia-Romagna. The origins of the Papiniano group date back to 1957 when the doctor Luigi Rotelli, together with other colleagues, founded the current Clinical Institutes of Pavia and Vigevano. In May 2012, the group took over the 100% stake in the newly established Ospedale San Raffaele srl, transferee of the homonymous hospital branch, from the Fondazione Centro San Raffaele del Monte Tabor for 406.7 million euro. In 2015, the San Donato Hospital Group acquired Pentadent (now Smart Dental Clinic), operating in the dental care sector.

Humanitas, second in the standings

Humanitas, based in Milan, belongs to the Rocca family whose entry into the hospital sector dates back to the mid-1980s and led in 1996 to the inauguration of the IRCCS Istituto Clinico Humanitas in Rozzano (Milan) which in the following years flanked by the Gavazzeni Clinic (Bg), the Cellini Nursing Home (To), the Catanese Oncology Center (Ct), the Mater Domini Clinical Institute (Castellanza-Va), the Gradenigo Health Center (To), the Nursing Home San Pio X (Milan) – acquired in February 2016 for 54.1 million euros and, in January 2018, the Castelli Clinic in Bergamo (incorporated in the following March by the Gavazzeni Clinics). In December 2017 Immobiliare Mirasole (placed in liquidation in April 2020) sold its real estate compendium to the Axa Group, consisting mainly of land and buildings where the Humanitas Clinical Institute, the Gavazzeni Clinic, the Casa di Cura Cellini and ECAS (Clinica Fornace), for a consideration of 277.5 million euros. At the same time as the operation, the Humanitas Group and the Axa Group signed a 30-year lease on the same properties. The Humanitas Group is the second accredited private operator in Lombardy, after the Papiniano Group.

New champions

The Villa Maria Group, based in Lugo (Ra), the holding controlled by the Sansavini family. The origins date back to 1973 when Ettore Sansavini took over the management of the Casa di Cura Villa Maria (Cotignola-Ra) making it one of the first private cardiac surgery centers in Italy. In 1992 Sansavini took over the control of the Casa di Cura Villa Maria, launching, through the GVM holding company set up in 1978, an intense activity of acquisition of both cardiological and multi-specialist hospital structures in various Italian regions. In 2003, the GVM took over the management (with a stake that subsequently rose to 86%) of the Castrocaro spa, 30 The Habilita Group has 322 health and 71 welfare beds in 5 hospitalization facilities, an analysis laboratory which performs 2 million of exams per year, 4 polyclinics, 10 rehabilitation robots, 5 hyperbaric chambers and performs 600 refractive surgery operations and 1,700 joint prosthesis operations every year. 26 with annexed wellness center and the historic “Grand Hotel”. Since 2005, the group has extended its activity abroad: there are 8 structures in Poland, 2 in France and 1 each in Albania, Russia and Ukraine. In 2016, the GVM Group acquired the Santa Maria di Bari hospital and the Ruesch nursing home in Naples; in 2017 it took over the control of the Villa Tiberia nursing home and of the RSA Beata Vergine del Rosario in Rome and in 2018 of the Villa Serena in Genoa. Again in 2018, the Group was awarded the procedure for the future management of the S. Charles Hospital in Bordighera (Im). The GVM group now controls 30 hospitals, polyclinics and hemodynamics centers in Italy (8 in Emilia-Romagna, 5 in Puglia, 4 in Lazio, 3 in Tuscany, 2 each in Sicily, Lombardy, Piedmont, Campania and Liguria) and abroad (13). The Group also carries out social welfare activities for the elderly in Albuzzano (Pv), Palermo, Turin and Rome and controls Eurosets, a manufacturer of biomedical devices for autotransfusion, cardiac surgery and orthopedics located in the Medolla district (Mo) . In December 2021, the GVM Group and Fondo Salute Italia signed a preliminary sale & lease back agreement for 4 properties used for healthcare activities.

Solid groups

The capital structure in 2021 remains solid overall, with financial debt at 107.7% of equity (111.4% in 2019). Liquid assets remain particularly high, exceeding 1.8 billion at the end of 2021, equal to 39% of financial debt. The most solid positions are those of the IEO, Auxologico Italiano, CDI, Salus, Istituto Don Calabria and Humanitas groups, with almost no financial debt for the first and less than 30% of the shareholders’ equity for the others

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