At a glance
- 24,140 corporations are active in healthcare. The largest group, with 9,248, consists of outpatient care and support services, followed by diagnostics and therapy (4,760), medical care centres (3,721), inpatient care (3,593) and hospitals (2,137).
- Healthcare is far more strongly organised in groups than the rest of the economy. Among medical care centres, 16.7% are contractually bound to a parent company, in inpatient care 13.8%, among hospitals 12.0%. Outpatient care, at 2.6%, remains a domain of independent owners.
- Medical care centres are a creation of legislation. Since their introduction in 2004 they have been founded in two surges; the second followed the admission of single specialty centres in 2015 and gave rise to the dental care centres, of which 688 exist today.
- Insolvencies came in waves. Inpatient care was hit in 2023 with a rate of 14.0 ‰, outpatient care in 2024 with 15.4 ‰. Among hospitals, the number of cases has been rising since the beginning of 2026.
- In the eastern German states, health services are particularly often provided by corporations. Saxony Anhalt, Thuringia and Saxony have the highest density, Bavaria the lowest.
Question and design
German healthcare is provided by public, non profit and private operators alike. Over the past two decades the weight has shifted towards companies organised as a GmbH or stock corporation: municipalities have transferred their hospitals into companies, private groups have taken over hospitals and care homes, and with the medical care centre (MVZ) a form has emerged in which outpatient medicine can be operated by corporations. The public debate about investors in medical practices and care homes has brought this development into focus in recent years.
This report describes the corporations of the healthcare sector in six segments. It asks how many there are, how strongly they are bound into groups and concentrated in a few hands, how medical care centres have developed, where the insolvencies of the years 2021 to 2026 occurred and how density and management differ regionally.
The population comprises 24,140 corporations in the database, 2.1% of all companies.
Population and segments
The six segments differ considerably in size and structure. Hospital companies are old and large: they have existed for a median of 20.2 years, 34.2% have a share capital of EUR 100,000 or more, 39.9% have registered power of attorney. Inpatient care is close to them in structure. Outpatient services, practices and therapy facilities, by contrast, are young and small; a large part of them was incorporated after 2020, and in diagnostics and therapy roughly one in six companies is an entrepreneurial company (UG).
| Segment | Companies | Age, median | Incorporated since 2020 | Capital EUR 100,000 or more | With power of attorney |
|---|---|---|---|---|---|
| Hospitals and clinics | 2,137 | 20.2 yrs | 17.7% | 34.2% | 39.9% |
| Medical care centres | 3,721 | 7.9 yrs | 44.0% | 8.5% | 28.8% |
| Medical and dental practices | 1,050 | 8.9 yrs | 41.7% | 5.1% | 15.4% |
| Inpatient care | 3,593 | 17.0 yrs | 21.1% | 16.5% | 34.8% |
| Outpatient care and support | 9,248 | 8.2 yrs | 43.4% | 5.8% | 21.6% |
| Diagnostics, therapy and other health professions | 4,760 | 6.9 yrs | 49.7% | 4.0% | 12.8% |
A company may belong to several segments. Power of attorney relates to active companies with recorded management.
Source: HDH Group, database as of the reference date, own calculation.
The figures describe only the share of corporations in healthcare provision. Hospitals run by churches, care homes of registered associations and the great majority of medical practices, which are run as individual practices or group practices, do not appear here.
Groups and parent companies
7.7% of healthcare companies are bound to a parent company through a domination or profit transfer agreement, compared with 2.6% in the total population. The rate is highest among medical care centres (16.7%), in inpatient care (13.8%) and among hospitals (12.0%). Hospital operators bind their medical care centres, care groups their homes, and hospital chains run their facilities as subsidiaries.
Total population: 2.6%
Source: HDH Group, database as of the reference date, own calculation.
Contractual affiliation is only one part of group formation. Another shows in management. 27.2% of medical care centres have a management in which at least one person runs five or more medical care centres, 18.0% one with ten or more. In inpatient care the share is 22.2%, among hospitals 18.3%. In outpatient care (3.5%) and among practices (5.9%), such concentration is the exception.
Relative to companies with recognised management.
Source: HDH Group, database as of the reference date, own calculation.
| Parent company | Registered office | Segment of subsidiaries | Subsidiaries, at least |
|---|---|---|---|
| inoges Holding GmbH | Krefeld | Hospital | 9 |
| Celenus-Kliniken GmbH | Offenburg | Hospital | 5 |
| Helios Kliniken GmbH | Berlin | Hospital | 5 |
| Gesellschaft für Mikroneurochirurgie mbH | Gensingen | Medical care centre | 15 |
| Deister-Süntel-Klinik GmbH | Bad Münder | Medical care centre | 9 |
| Klinikum Hann. Münden GmbH | Hann. Münden | Medical care centre | 6 |
| ze:ro Praxen Dienstleistungs GmbH | Schwetzingen | Medical care centre | 5 |
| amedes Medizinische Dienstleistungen GmbH | Göttingen | Medical care centre | 5 |
| Alloheim Senioren-Residenzen SE | Düsseldorf | Inpatient care | 13 |
| CURA Kurkliniken, Seniorenwohn- und Pflegeheime AG | Hamburg | Inpatient care | 9 |
| CURA Seniorenwohn- und Pflegeheime Beteiligungs-GmbH | Hamburg | Inpatient care | 8 |
| Frank Wagner Holding Hanseatische Management GmbH | Hamburg | Inpatient care | 4 |
| Cosiq GmbH | Berlin | Inpatient care | 4 |
Only domination and profit transfer agreements with a clearly identified parent company. Large groups that hold their facilities through shareholdings without such an agreement do not appear or appear with too low a number.
Source: HDH Group, database as of the reference date, own calculation.
Medical care centres
The medical care centre was introduced by the Statutory Health Insurance Modernisation Act on 1 January 2004. It allows outpatient medical care to be provided in a facility with employed physicians, also operated by a GmbH. Such a centre may be founded by licensed physicians, hospitals and certain other providers; through the acquisition of a hospital, the route is also open to financial investors.
Incorporations came in two surges. The first followed the introduction and peaked in 2008 with 113 incorporations. The second began in 2015, when the Statutory Health Insurance Care Strengthening Act also admitted centres with only one medical specialty. Incorporations rose from 60 in 2014 to 207 in 2016 and reached 298 in 2021.
Companies still registered today, by year of incorporation.
Source: HDH Group, database as of the reference date, own calculation.
The opening for single specialty centres changed dentistry above all. Before 2015, hardly more than five dental care centres were founded a year; in 2016 there were 51, in 2021 83. The restriction introduced by the Appointment Service and Care Act in 2019 on the founding of dental centres by hospitals slowed this development; incorporations continued at a lower level. Today, 688 dental care centres exist as corporations.
Medical and dental centres are structured differently. 18.5% of medical centres are contractually bound and 47.3% have a management of several people; for dental centres the figures are 8.7% and 29.6%. The medical centre is frequently the outpatient subsidiary of a hospital, the dental centre more often the company of an individual dentist who expands the practice with employed colleagues.
Insolvencies
Insolvencies in healthcare followed no common rhythm; each segment had its own year of crisis. Inpatient care was hit in 2023. Its rate rose from 2.9 ‰ in 2022 to 14.0 ‰. Since 1 September 2022, care facilities have been obliged to pay at least collectively agreed wages; at the same time, energy and material costs rose, and many homes were unable to fill places for lack of staff. The higher costs were reflected in remuneration only with a delay.
Outpatient care followed a year later. Its rate reached 15.4 ‰ in 2024 with 115 cases, after 4.6 ‰ in 2022, and fell back to 8.4 ‰ in 2025. Medical care centres and practices remained below the total population throughout.
| Segment | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|
| Hospitals and clinics | 0.0 | 2.1 | 5.6 | 5.0 | 5.8 |
| Medical care centres | 1.7 | 1.1 | 4.7 | 4.4 | 2.4 |
| Medical and dental practices | 4.4 | 2.7 | 5.0 | 7.0 | 4.3 |
| Inpatient care | 3.7 | 2.9 | 14.0 | 8.1 | 8.7 |
| Outpatient care and support | 3.3 | 4.6 | 7.7 | 15.4 | 8.4 |
| Diagnostics, therapy and other health professions | 2.6 | 2.2 | 5.2 | 6.2 | 8.9 |
Companies with their most recent insolvency entry in the respective year per thousand companies incorporated before the beginning of the year. Small segments fluctuate strongly.
Source: HDH Group, database as of the reference date, own calculation.
Among hospitals, the number of cases is small, but it is rising. In the first half of 2026, 14 insolvencies of hospital companies were recorded, after 6 in the first half of 2025. The hospital reform that entered into force at the end of 2024 reorganises services and requires many hospitals to concentrate their offering. For smaller hospitals with a thin capital base, the transition becomes a test.
Total population: 8.6 ‰
Source: HDH Group, database as of the reference date, own calculation.
Regions
Measured against all companies in a state, healthcare corporations are most frequent in Saxony Anhalt (29.1 per thousand), Thuringia (28.7) and Saxony (26.3), and least frequent in Bavaria (15.7). The lead of the east probably lies in the structure of operators. After 1990, hospitals, polyclinics and care facilities there were in many cases transferred directly into limited liability companies, whereas in the west church and non profit operators in other legal forms have retained greater weight.
Outpatient care is most densely represented in Mecklenburg Western Pomerania and Saxony Anhalt, with 13.6 and 13.5 companies per thousand, inpatient care in Lower Saxony (6.6).
| State | Companies | per thousand | Hospitals | Medical care centres | Inpatient care | Outpatient care |
|---|---|---|---|---|---|---|
| Saxony Anhalt | 557 | 29.1 | 50 | 69 | 88 | 259 |
| Thuringia | 534 | 28.7 | 52 | 80 | 84 | 212 |
| Saxony | 1,119 | 26.3 | 88 | 136 | 135 | 464 |
| Brandenburg | 742 | 25.6 | 73 | 91 | 96 | 323 |
| Mecklenburg Western Pomerania | 244 | 25.6 | 31 | 28 | 17 | 129 |
| Lower Saxony | 2,289 | 24.8 | 182 | 286 | 610 | 877 |
| North Rhine Westphalia | 5,927 | 23.6 | 452 | 835 | 858 | 2,456 |
| Schleswig Holstein | 573 | 23.3 | 39 | 78 | 120 | 240 |
| Saarland | 242 | 22.5 | 19 | 37 | 35 | 85 |
| Rhineland Palatinate | 884 | 21.0 | 80 | 139 | 110 | 355 |
| Bremen | 220 | 20.7 | 15 | 27 | 54 | 78 |
| Berlin | 1,877 | 20.6 | 145 | 268 | 267 | 658 |
| Hesse | 1,939 | 20.5 | 211 | 313 | 254 | 758 |
| Hamburg | 960 | 17.9 | 65 | 223 | 119 | 318 |
| Baden-Württemberg | 2,877 | 17.2 | 320 | 497 | 372 | 963 |
| Bavaria | 3,156 | 15.7 | 315 | 614 | 374 | 1,073 |
Per thousand companies of the respective state.
Source: HDH Group, database as of the reference date, own calculation.
Management
Management in healthcare more often consists of several people and is more often supplemented by registered power of attorney than in the rest of the database: 36.9% of companies have more than one person in management (total population 29.3%), 24.0% have power of attorney (14.1%). In hospitals, the separation of commercial and medical responsibility is the rule.
A succession question arises above all in practices. In 13.4% of practice companies, the entire management has reached the age of 65, compared with 10.6% in the total population. In outpatient care the figure is 6.9%; the youngest member of management there has a median age of 48 years. Many outpatient services were founded by nursing staff who are now in the middle of their working lives.
Assessment
In healthcare, two forms of enterprise exist side by side. Hospitals, inpatient care and medical care centres are predominantly organised in groups, contractually bound and concentrated in their management. Outpatient care, practices and the therapeutic professions, by contrast, are characterised by independent owners, young and small. The debate about the influence of investors concerns above all the first group; economic vulnerability has shown itself in both in recent years.
For providers of medical technology, software, staffing and services, this results in a dual market structure. In groups, decisions are made centrally and for many facilities at once; in independent services, the owner on site decides, often under considerable cost pressure. For financiers and suppliers, the situation of care and of the smaller hospitals will remain the most sensitive part of the sector in the coming years.
Method and limitations
Data basis
The basis is the HDH Group database of registered corporations with their registered office in Germany as of 23 October 2026, with 1,158,810 companies.
Definitions
- Hospitals and clinics: companies in the hospital class of the classification of economic activities, including rehabilitation and specialist clinics.
- Medical care centres: companies whose corporate purpose names a medical care centre. Dental centres are those whose corporate purpose also names dentistry.
- Medical and dental practices: companies of general, specialist and dental practice that are not a medical care centre.
- Inpatient care: care homes and assisted living facilities for older people and people with disabilities.
- Outpatient care and support: companies providing nursing and elderly care without accommodation.
- Concentrated management: at least one member of management runs five or more companies of the same segment.
- Insolvency rate: companies with an insolvency entry in the observation period per thousand companies incorporated before its beginning.
Limitations
- The study covers corporations. Facilities run by associations, foundations, public law bodies and partnerships are missing. The figures describe the share of corporations in healthcare provision.
- The assignment to a segment follows the classification of economic activities, for medical care centres the corporate purpose. Companies with several activities may belong to several segments.
- Contractual affiliation covers domination and profit transfer agreements. Groups that run their facilities solely through majority shareholdings are not included.
- Case numbers for small segments are low; annual rates for hospitals and practices are based on few cases and should be read with corresponding caution.
Literature
- Gondi, S. and Song, Z. (2019): Potential Implications of Private Equity Investments in Health Care Delivery. JAMA 321 (11), pp. 1047 to 1048.
- Scheffler, R. M., Alexander, L. M. and Godwin, J. R. (2021): Soaring Private Equity Investment in the Healthcare Sector: Consolidation Accelerated, Competition Undermined, and Patients at Risk. American Antitrust Institute and Petris Center, University of California, Berkeley.
How to cite
HDH Group (2026): Hospitals, medical care centres and care services. Structure, ownership, management and insolvencies of the companies in the German healthcare sector. HDH Group Research, as of 23 October 2026. https://hdhgroup.de/en/reports/healthcare
The results may be used freely provided the source is acknowledged. For questions on method and data, for analyses to your own definition and for press enquiries, please reach us via the contact page.