The ambulance services market - France

1.2 Domestic market

To assess the size of the ambulance services market in France, we have opted for an approach based on demand for medical transport services, as published by DEES (***). most of the sales generated by players in this sector derive from this demand for transport, which is largely reimbursed by health insurance schemes.

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Annual consumption allocated to ambulance services. France, ****-**** Source: ****

annual expenditure on ambulance services, equivalent to sales in the ambulance sector, has increased by *** million over ** years. This amount has risen from *.* billion in **** to * billion in ****, equivalent to an increase of **%. Calculating the average annual growth rate, we thus obtain an increase of *.*% per year on average. It is also reasonable to conclude that this growth is mainly the result of an increase in the volume of requests for ambulance services, given that service charges have not changed between **** and ****. Growth in demand for medical transport services in France. France,****-****, million euros Source: DREES (***) In the field of medical transport services in France, other competitors to ambulance services are present, notably VSL (***) and contracted cabs. Between **** and ****, this activity as a whole will have grown by around *.* billion euros, equivalent to an increase of **% over an ...

1.3 The global market

Globally, the outlook for the ambulance services market is as follows:

According to data from Market Business Insights, the global ambulance services market is forecast to generate revenues reaching $**.** billion by ****, with an estimated compound annual growth rate (***) of *.*% for the period **** to ****. By ****, this market is expected to reach $**.** billion, with an anticipated CAGR of *.**% for the period **** to ****.

These developments are influenced by global trends similar to those observed at national level, including:

An increase in the incidence of chronic diseases, such as heart disease, stroke and cancer, driving demand for ambulance services due to the need for emergency medical care associated with these conditions. The aging of the world's population, driving up demand for ambulance services due to more frequent medical emergencies among the geriatric population. Growing demand for emergency medical services due to factors such as traffic congestion, terrorism-related threats and natural disasters, which necessitate the rapid transport of patients to healthcare facilities.

In addition, several key trends in the ambulance sector:

The growing adoption of the growing adoption of advanced technologies, such as on-board computers, GPS and vital function monitoring systems, is enhancing the quality of patient care. The increasing specialization of ambulance services, with intensive ...

2.1 An aging population: Growth in ambulance services structurally guaranteed

Number of people aged ** and over France, ****-****P INSEE forecast: ****-**** Source: ****

Between **** and INSEE projections for ****, the number of people aged ** and over is expected to increase by around **% in the number of people aged over **bringing this figure to **.* million. It should be noted that between **** and ****, this age group has already recorded an increase of around **%. This increase is even more marked among the oldest individuals, with a forecast rise from *.* million people aged ** or over in **** to **.* million in ****, while the number of people aged ** or over is expected to rise from *.* million to *.* million over the same period.

The proportion of people aged over ** is expected to rise to around one-third of the population, compared with around one-quarter today.

Demographic trends marked by an ageing population favours the activity of ambulance service providersas it is accompanied by an increase in the number of people requiring regular medical follow-up and care.

Attached is the age pyramid for ****, compared with the INSEE projection for ****:

Age pyramid in **** and ****

Source: ****

2.2 Prévalences des affectations de longue durée en augmentation constante

Le sigle « ALD » désigne l'expression « affection de longue durée ». Ce dispositif vise à couvrir les frais de traitement prolongé et onéreux associés à certaines pathologies. Il existe plusieurs catégories d'ALD, à savoir les ALD exonérantes et les ALD non exonérantes, chacune conférant des droits différents. Le nombre de personnes bénéficiant du statut ALD constitue un indicateur permettant d'estimer le nombre de personnes en état de santé précaire nécessitant périodiquement des services de transport sanitaire, tels que les ambulances.

En France, en ****, selon l'assurance maladie, environ ** millions de personnes se prévalent du statut ALD en ****.

Nombre de personnes en affectation longue durée France, ****-****, Million de personnes Source: ****

Le nombre de personnes bénéficiant du régime « ALD » a connu une progression linéaire entre **** et ****, passant de * millions à **,* millions, ce qui équivaut à une augmentation de ** % sur une période de ** ans.

Le nombre de bénéficiaires de ce dispositif connaît une croissance ininterrompue, en raison du vieillissement de la population, de l'amélioration du dépistage de certaines pathologies, ainsi que de l'augmentation de la prévalence des maladies chroniques.

Dans le tableau suivant, voici ...

2.3 "Virage ambulatoire": An increase in demand for medical travel services

Number of full and partial hospital beds in France (***) France, ****-****, Number of beds Source: ****

over the period from **** to ****, there will be a significant reduction in full hospitalization capacity, with over **,*** fewer beds, i.e a decrease of *%. At the same time, partial hospitalization capacity has grown by around **,*** places, i.e an increase of almost **%. This development, often referred to as the "ambulatory shift", is part of a drive to reduce the length of hospital stays and optimize the use of hospital resources, while bringing healthcare services closer to patients' living environments.

This transition to more frequent outpatient care and shorter hospital stays has naturally led to increased demand for mobility servicesthese include light medical vehicles (***) and contracted cabs. The latter have become essential for transporting patients between home and hospital, helping to speed up medical procedures and improve the overall efficiency of the healthcare system.

2.4 Steadily rising consumption of healthcare and medial goods

Consumption of healthcare and medical goods in France (***) France, ****-****, billion euros Source: ****

over the period from **** to ****, spending on medical care and products has grown significantly, from ***.* billion euros to ***.* billion euros, representing an increase of around ** billion over a decade, representing growth of **%. This upward trend can be attributed to a number of factors, including medical advances that have improved access to care, and an ageing population that has led to increased demand for medical services.

In addition, the COVID-** pandemic and its various variants have had a significant impact on the consumption of medical care and products in ****, resulting in a notable increase of *.* billion euros in just one year. This increase can be explained by the need to respond to health needs linked to the pandemic, which has led to a significant rise in spending in this sector.

Breakdown of healthcare consumption since **** France, ****-****, % (***) Source: ****

Since ****, we have seen a clear increase in marked increase in the consumption of medical care and goods (***) to almost *% today. Despite a reduction in the share devoted to drugs and an increase in the portion allocated to hospital care, the share earmarked for medical transport has remained relatively stableat around ...

3.1 Value chain

Ambulance companies are private entities specializing in transporting patients between their homes and various care facilitiesprivate entities specialized in transporting patients between their homes and various care facilitieswhether for scheduled medical interventions or recurrent treatments such as dialysis, chemotherapy or radiotherapy. Their activity is based exclusively on medical prescriptionsthey can also be called upon by hospitals to transfer patients between different healthcare facilities, or at the request of the emergency services.

In the latter case, private ambulance drivers make an ad hoc contribution to public rescue operations, notably by evacuating patients to hospital emergency services. It is important to emphasize, however, that under no circumstances do private ambulance services extend to interventions on the public highway.

3.2 A still highly fragmented French market

The ambulance services market is currently significantly fragmented, but there is a persistent trend towards consolidation over the years. Regional ambulance operators are moving towards strategic groupings to counter the growing influence of industry leaders. A prime example of this dynamic is the formation of an economic interest group in July **** by the TSI and SG*A companies . This unified entity now boasts a fleet of *,*** vehicles and employs a workforce of *,***. At the same time, other players in the field have chosen to join forces with investment funds, seeking substantial financial resources to consolidate their market position

Number of establishments providing ambulance services in France. France, ****-****, unit Source: ****

Notwithstanding a slight tendency towards consolidation, the number of companies will remain stable over the ****-**** period, with a reduction of around * % in the number of establishments (***).

Number of employees in establishments providing ambulance services in France. France, ****-****, Number of employees Source: ****

Over the period from **** to ****, the number of companies fell by *%, while the number of employees the number of employees grew by a significant **.*%, showing a steady annual upward trend. However, it should be noted that the ambulance sector is facing a major challenge in terms of staff ...

3.3 A highly competitive sector

in France, there are three main types of medical transport, depending on the patient's state of health: The VSL (***) and the CPAM-approved cab are the two most commonly used means of transporting seated patients. unlike the VSL, which is reserved exclusively for medical use, the CPAM-approved cab can be used to transport both sick and healthy patients. They offer greater comfort and are better equipped. Ambulances, on the other hand, are reserved for situations of extreme necessity. It is a medical transport vehicle primarily intended for patients requiring transport in a recumbent position or emergency intervention. Ambulances are equipped with advanced medical equipment to administer first aid when necessary, such as maintaining respiratory rhythm or stopping bleeding. They are also staffed by at least two qualified professionals holding the Diplôme d'État d'ambulancier. This classification enables the most appropriate means of transport to be chosen according to the patient's state of health and specific needs. Breakdown of expenditure by mode of transport in **** France, ****, % Source: ****

Breakdown of medical transport expenditure France, ****, % of total income Source: ****

in ****, consumer spending in the transport sector totaled *.* billion euros. Spending on ambulances accounted for **% of this total, while spending on cabs and VSLs represented ...

4.1 Very little fluctuation in conventional rates

The rates charged by medical carriers are establishedadministrativelyaccording to the type of vehicle used. In the case of ambulances and VSLs (***), these rates are defined at national level within the framework of theagreement with the health insurance funds. For cabs, on the other hand, rates are determined locally within the framework of agreements signed with each departmental health insurance fund, while respecting the limits set by a prefectoral decree which establishes the rates for all cabs operating in the department.

Conventional rates have risen for the first time since ****, with an increase of between *% and *% for flat-rate fares and around **% for short-haul fares.

Source: ****

The "forfait départementalapplies to transport in all communes, except those covered by the agglomeration flat-rate charge and the "prise en charge". It covers the first * kilometers of transport.

As for theagglomeration passis intended for transportation exclusively within cities or urban agglomerations specifically designated in each département (***). It also includes the first * kilometers covered by the load.

Pick-upis billed by companies located in certain communes in the Paris region (***) and for transport within this zone. In this case, kilometers traveled under load are billed from the first kilometer.

The kilometric rate is based on the distance ...

4.2 Operating margins in perdition

Gross monthly minimum wage in France (***) France, ****- **/****, € Source: INSEE Employee remuneration within companies is partly influenced by fluctuations in the SMIC (***). In ****, the SMIC underwent four revalorizations, with a further increase of *.**% on January *ᵉʳ, ****. This change initially impacts the lowest salaries, but is also reflected across all pay levels. Between **** and ****, the SMIC rose by an average of *.**% per year, totaling a cumulative increase of almost *% over a decade. However, due to the significant increases in inflation observed in **** and ****, the SMIC was revalued to reach €****.** gross per month at the end of **** and €****.* in September ****, representing an increase of *% in **** and *% in ** ** respectively. However, as mentioned in section *.*, contractual rates are rarely adjusted, and even when they are, as in November ****, their increase is well below that of inflation (***) Personnel costs make up the lion's share of operating expenses for companies operating in the medical transport sector. These personnel costs are rising significantly, while the agreed tariffs are not increasing at the same rate. The inevitable consequence of this situation is a reduction in operating margins.

Average quarterly diesel pump price in France World, **** Source: ****

With the crisis in Ukraine and the embargo on Russian oil, oil prices have ...

5.1 Regulations

The medical transport sector is characterized by a rigorous regulatory framework. To operate in this field, companies must obtain accreditation from the Agence Régionale de Santé (***) and sign an agreement with the Assurance Maladie. In addition, they must have a fleet of at least two vehicles, one of which must be an ambulance, and guarantee an adequate number of properly trained staff.

It should also be pointed out that the Agences Régionales de Santé (***) in each département, based on a national index of need, expressed in terms of the number of vehicles per inhabitant, established by the Minister of Health.

Companies providing prescribed medical transport services eligible for reimbursement must sign an agreement with the local health insurance fund, setting out the applicable rates and the terms and conditions of reimbursement.

With regard to the composition of their fleet of vehicles, in accordance with a decree in force since August **, ****, approval from the Agence Régionale de Santé (***) will only be granted to the company subject to the following conditionsdelivered to the company only on condition that it has at least two vehicles, all of which are authorized to be put into service, and at least one of ...

6.1 Player segmentation

• ETOILE SECOURS
• VAR ASSISTANCE
• GROUPEMENT AMBULANCIER DU GRAND NORD
• GROUPE LOUDANE
• TRANSPORTS SANITAIRES D'OCCITANIE
• Keolis
• Transdev
• VYV Groupe
• Abc Ambulances
• Actions Ambulancières Associées Et Connexes (Aaac)
• Agv
• Allo Ambulances Meusiennes
• Alsace Secours Ambulancier (Asa 67)
• Ambulanc Cantonal Pompe Funèbre Cantonal
• Ambulance 27
• Ambulance Ajr
• Ambulance Aux 2 B (Keolis Sante Nouvelle Aquitaine Nord)
• Ambulance De L'Angélique
• Ambulance Du Serein
• Ambulance Lacuesta
• Ambulance Saint Bernard
• Ambulances 2001
• Ambulances 24 24 (Keolis Sante Nord Gironde)
• Ambulances Abraham
• Ambulances Alizé
• Ambulances Asur
• Ambulances Bel Air Willy Spitz & Fils
• Ambulances Côte De Beauté
• Ambulances Calaisiennes
• Ambulances Chaperon (Keolis Sante Nouvelle Aquitaine Sud)
• Ambulances Chesnaysiennes Sanitran (Keolis Sante Yvelines)
• Ambulances Choletaises
• Ambulances Clovis
• Ambulances Colaisseau
• Ambulances Coquet
• Ambulances Dagnicourt
• Ambulances Davin
• Ambulances De L'Estuaire
• Ambulances De Trouville Deauville
• Ambulances Didier
• Ambulances Du Pont De L'Arc (Pdl)
• Ambulances Elbeuviennes
• Ambulances Et Taxis Porcher
• Ambulances Etoile
• Ambulances Etoile Bleue
• Ambulances Favier
• Ambulances Gaillacoises (Aaat)
• Ambulances Golfe Fontonne
• Ambulances Havraises
• Ambulances J Raoulx
• Ambulances Jounieau
• Ambulances Leblatier
• Ambulances Métivier
• Ambulances Martégales
• Ambulances Mulhousiennes
• Ambulances Paciello
• Ambulances Pierroz
• Ambulances Provence Secours
• Ambulances Riviera
• Ambulances Rouiller
• Ambulances Roussel
• Ambulances Saint Christophe
• Ambulances Taxis Aat Dabout
• Ambulances Zephyr
• Anille Braye Transports
• Atlantique Côte De Lumière (Aact Et Pf)
• Avl
• Bellamy Salmon
• Castel Ambulances David Et Fils
• Centre Ambulancier
• Clémente (Aa)
• Conflans Ambulance
• Derossi
• Dewitte Frères
• Ets Bancillon
• Ets Coudonneau Nuit Et Jour
• Euro Star
• Europe Ambulance 45
• Gaillard Médical Services
• Garnier
• Groupe Azur
• Groupement Ambulancier Du Grand Est (Gagest)
• Groupement Ambulancier Du Grand Est (Keolis Sante Pays De Retz)
• Harmonie Ambulance
• Kéolis Santé
• Leraillez Luc
• Midi Ambulance
• Multi Trans Services
• Ouest Ambulances (Keolis Sante Nord Finistere)
• Pla
• Service D'Ambulances Varois
• Soissons Ambulances
• Sté D'Exploitation Ambulances La Mimetaine
• Sté D'Exploitation Des Ets Jacomet
• Sté Exploitation Ambulances M Huet
• Sté Gainville Et Benard
• Sté Nouvelle Medisud
• Sté Nvelle Ambulances Hyéroise
• Transport Sanitaire Montlucon Ambulances (Tsm Ambulances)
• Transports Guy Lopez
• Urgentis