The private clinic market - France

A private hospital or clinic is a healthcare facility run by a private operator (commercial group or association).private operator (commercial group or association), which participates in medical care in the same way as public establishments. In France, this cohabitation of the public and private sectors within the hospital system is a historical exception, often referred to as the "dual model", to which citizens are deeply attached. This duality guarantees freedom of choice of doctor and hospital, a fundamental value in the French people's perception of their healthcare system. In 2023, according to DREES data, private for-profit clinics will account for around a third of all healthcare establishments in France. Of the 2,907 establishments surveyed, 960 are in the for-profit private sector, confirming their position as the second pillar of the hospital system after the public sector (1,313 establishments), but far ahead of the not-for-profit private sector (634). This distribution reflects their strong structural roots, within a hospital landscape that is constantly changing. These clinics are overwhelmingly specialized: more than 60% of them are concentrated on Medical-Surgical-Obstetric (MCO) activities, in other words, technical, programmed and often short-term care, in line with the most frequent needs of the care pathway. This is followed by follow-up and rehabilitation care (SSR ) and psychiatric facilities, which remain in the minority despite growing needs. This specialization, coupled with a focus on efficiency, enables them to reduce treatment times and attract patients seeking speed, comfort and fluidity in their care. This attractiveness is also based on a favorable public perception: private clinics are often seen as more accessible, more "humane" and even better equipped than public establishments, particularly in urban and suburban areas. This is all the more true in a context where access to a general practitioner is getting longer and longer: nearly one French person in three takes more than 4 days to get an appointment, according to the 2024 Ipsos-EDHEC study. conversely, private establishments are perceived as more responsive and sometimes more flexible in their organization. From an economic standpoint, private-sector hospital sales continue to grow, reaching €28.4 billion in 2023, compared with €25.3 billion in 2021 and €18.1 billion in 2009. Although the private sector remains a minority in terms of volume (23.3% of hospital spending, compared with 76.7% for the public sector), it is growing steadily, reflecting its relative ascendancy in the architecture of the healthcare system. This dynamic also reflects the impact of an ageing population, which continues to fuel demand for care, particularly in scheduled surgery, orthopedics and post-operative care. Private clinics are financed by the Frenchhealth insurance system on the basis of their activity (tarification à l'activité - T2A). What's more, 87% of their doctors are self-employed, which influences their internal organization, their business model and the nature of the relationship between caregiver and patient. This gives them organizational flexibility, but also makes them more vulnerable to the vagaries of pricing and structural costs. For while the sector has long benefited from a favorable environment - notably via the French tax credit for competitiveness and employment (CICE) - its equilibrium is now under threat. In 2025, a regulatory turning point is reached: the +0.5% rate increase announced in the April 7 decree does not cover actual inflation (estimated at 1.5%). After deduction of the prudential coefficient, the actual increase is virtually nil, or even negative. According to the Fédération de l'Hospitalisation Privée (FHP), more than half of all private hospitals could be in deficit this year, in the absence of new mechanisms to reduce the cost of care. e, in the absence of compensation mechanisms equivalent to those available to public hospitals (debt forgiveness, exceptional aid, etc.).). At the same time, other weaknesses are emerging: only 28% of the funding for the rider 33, a structuring wage agreement, has been paid to private clinics (80 million out of the 280 million planned), and many national packages (gynecological emergencies, drug administration, etc.) remain below cost.) remain below the real costs borne by the establishments. This regulatory crisis, denounced by both the FHP and several senators, is undermining a sector that must play a growing role in absorbing the demand for care. Faced with these challenges, clinics are trying to diversify their activities (outpatient care, general medicine, territorial partnerships), but the fragilityhowever, the fragility of their business model and the absence of sustainable structural reforms raise many uncertainties about their future. Against this backdrop, the market remains promising in terms of volume, but tense in financial terms, with high-potential opportunities, provided there is a clear regulatory and budgetary rebalancing.