Healthcare

Bank of Ireland’s commitment to the health sector and our appetite for lending remain strong.

At Bank of Ireland we have in depth understanding of the complexities and realities of healthcare and the insight required to support healthcare businesses to anticipate, adapt and thrive. We understand the unique funding requirements of the sector and our specialist sector experience combined with the extensive business and banking knowledge of our local Business Relationship Managers ensures that Bank of Ireland is uniquely positioned to anticipate and support the needs of our customers and provide the necessary banking solutions.

A positive outlook continues with a very active transaction market

A positive outlook for the long term sector continues in 2019 with an active pharmacy and nursing home transaction market; greenfield nursing home development, refurbishment and extensions to homes.

Market Outlook:

  • €16,050m in funding was provided to the HSE for the provision of health and social care services in 2019; an increase of €848m or 5.6% from 2018.
  • The 2018 public allocation of €16.2bn was the highest in the history of the State. This average annual increase of €560m represented a 338% increase in health spending over a twenty year period.
  • The number of people aged 65 years and over is projected to increase by a further 21,969 (3.3%) in 2019. Adults aged 85 years and over are projected to increase by 3,116 (4.3%) in 2019.
  • The projected growth in people aged >80 will have a profound impact on the demand for healthcare services with the Department of Health projecting demographic changes will increase health costs by between 1.4% and 1.6% annually. In addition, health spending will continue to be driven by our growing populations, clinical and technology innovation, and competitive labour market.

Nursing Homes:

  • Currently long-term residential care services are provided by the private sector, the not for profit (NFP) sector and the public sector. In 2018 there were 578 public, private and NFP nursing homes with c. 30,757 beds, registered by HIQA in Ireland
  • 2018 Registered Nursing Home / Bed Census
    2018
    Public
    Private
    Voluntary
    Nursing Homes
    122
    384
    72
    Beds
    6,015
    21,350
    3,392
  • In 2018, 98 beds were closed and 696 new beds were added, a net increase of 598 beds.

National Nursing Home Supply/Demand:

  • In order to understand the future bed requirements, Bank of Ireland analysed and projected future nursing home bed demand on a county by county basis up to 2026 – drawing from each county’s unique demographic profile, existing beds, those in planning, under construction and those that may be decommissioned.
  • This review projects a shortfall up to 7,500 nursing home beds by 2026. However, it should be noted that this is a dynamic review and is dependent on supply and demand in each county.

Retail Community Pharmacy

  • Ireland’s population is living longer and increasingly there are more treatment options available. With this ageing population there will be an increased use of multiple medications by patients. As a result the medicines bill will increase each year and the State will seek to increase controls and drive value and reduce the per capita cost of health.
  • 2018 was a busy year in the pharmacy transactions market with 53 pharmacy acquisitions with pharmacies trading at an average of 5.13 x EBITDA (Earnings Before Interest, Taxes, Depreciation and Amortisation). Pharmacies in large urban centres or those with significant turnover scale are achieving higher multiple. There were 36 greenfield pharmacies opened in 2018 with an average investment per unit of €227k.

Market Activity

  • Nursing Homes: Strong pipeline of re-finance, extension and upgrade proposals will continue to develop in 2019. Quality ‘fit-for-purpose’ nursing homes will continue to achieve price multiples of 8-10 times adjusted EBITDA as international and domestic investor entrants increase their portfolio.
  • Retail Community Pharmacy: A busy transaction market with continued consolidation accompanied by extensive due diligence to establish the sustainability of EBITDA.

References

  • Bank of Ireland / Fitzgerald Power: Pharmacy Watch: Shining a Light on the Pharmacy Transactions
  • HSE National Service Plan
  • HIQA

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Hilary Coates – Head of Health and Life Sciences
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Email:
hilary.coates@boi.com
Mobile: 087 255 3314

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