In an aging Italy, where healthcare spending stops at 8.4% of GDP while demand is rising, the giants of private healthcare – analyzes Mediobanca’s Research Area – consolidate their perimeter among billion-euro revenues and profitability that, although recovering, still nostalgically looks back at pre-pandemic times. The sector is preparing for a 2025 of further expansion, driven by the needs of a population where those over sixty-five already represent 24.5% of residents.
ECONOMIC SCENARIO AND GROWTH FORECASTS
The total turnover of the 38 largest private healthcare operators in Italy, reports Mediobanca’s Research Area, reached 13.4 billion euros in 2024, marking an increase of 5.5% compared to the previous year and a leap of 22% compared to 2019 levels.
For 2025, projections indicate a further rise in aggregate revenues of 3.7%, with particularly lively dynamics for elderly care facility operators, expected to grow by 7.9%, followed by hospital care at 3.9%.
Despite the improvement in net operating margin, rising to 3.6% in 2024 compared to 3.1% in 2023, profitability remains distant from the 5.4% recorded in the pre-Covid period. The aggregate ROI settled at 4.7% in 2024, recovering from 3.9% the previous year but still far from 6.3% in 2019.
MARKET LEADERS
According to Mediobanca’s analysis, the 2024 revenue ranking sees Papiniano, holding company of the San Donato Group and San Raffaele Hospital, in first place with 2,163 million euros, followed by Humanitas at 1,260 million and GVM – Gruppo Villa Maria with 968 million. Completing the top five are the A. Gemelli University Hospital with 946 million and KOS with 799 million.
In terms of profitability measured by EBIT margin, in hospital care PRO.MED stands out with 11.5% and GHC with 9.4%, while in diagnostics Affidea excels at 14.4% and Synlab at 11.2%. Regarding elderly care, the highest margins were recorded by La Villa with 12% and Sereni Orizzonti Holding with 9.9%.
The best ROI results in 2024 belong to Affidea (16.4%), Humanitas (13.2%), PRO.MED (12.9%), Sereni Orizzonti Holding (12.6%) and Gruppo Gheron.
BUSINESS MODELS BETWEEN ACCREDITATION AND SOLVENCY
The revenue composition highlights different strategies among the main players regarding their relationship with the National Health Service. ICS Maugeri and San Raffaele of Rome record the highest incidence of accreditation revenues, respectively 96% and 87.2%, followed by GVM (78.9%), Papiniano (78.5%) and Don Gnocchi (78.4%).
Conversely, Centro Diagnostico Italiano – CDI bases 76.3% of its revenues on solvency, of which 45% comes from supplementary funds and insurance. Other groups with significant shares of private revenues are Lifenet (50%), Istituto Auxologico (41.7%), KOS (41%) and Istituto Europeo di Oncologia – IEO (35.3%).
Total private healthcare spending in Italy is estimated at nearly 78 billion euros in 2025, including accreditation, intermediated spending, and direct family purchases.
TERRITORIAL PRESENCE AND STAFF STRUCTURE
The geographical distribution, notes the analysis, sees groups like KOS, Segesta, Sereni Orizzonti Holding and Don Gnocchi operating in nine or more regions, predominantly in Northern Italy, while among hospital players GVM is present in ten regions and GHC in eight. Papiniano and Humanitas maintain a strong concentration in Lombardy, with the latter also active in Piedmont and Sicily for 20% of its turnover.
The overall workforce exceeded 102 thousand units in 2024, with an increase of 17.5% compared to 2019. There is also significant use of external freelancers in facilities such as CDI (57.0%), GVM (55.2%) and Istituto Auxologico (50.5%). The average per capita labor cost stands at 43 thousand euros, ranging from 33.8 thousand euros in long-term care to 47.9 thousand euros in hospital care.
FINANCIAL SOLIDITY AND DEMOGRAPHIC CHALLENGES
The financial structure of the major operators, according to Mediobanca’s study, appears solid, although financial debts rose to 124.6% of equity in 2024 compared to 119.7% in 2023. The most balanced positions are those of IEO, which has no financial debts, Istituto Don Calabria, Humanitas, Auxologico Italiano and La Conchiglia (Mantova Salus), whose debts range between 10% and 20% of net equity.
However, the system must face availability of long-term care beds of about 22 per thousand inhabitants over 65, a value that represents about half the OECD average. Furthermore, while Italy allocates 0.9% of GDP to long-term care against an OECD average of 1.7%, demographic pressure is set to increase, with the forecast of the over-sixty-five incidence reaching 34.1% by 2062.
