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Healthcare real estate in Germany,
Belgium, France and the Netherlands
Sources: Cushman & Wakefield, E&Y, Healthcare Property.
Population trends in Europe
The ageing of the population is a growing trend in most European
countries. In Europe, people over age 80 are expected to represent
approximately 10% of the total population in 2050. Although the num-
ber of independent seniors is up within this category, the ageing of the
population will be accompanied by a considerable increase in the num-
ber of dependent elderly persons. This situation will simultaneously
generate a growing need for specialised accommodation establish-
ments and, consequently, beds.
In Belgium, the growth is estimated at 45,000 additional beds by
2025-2030. In France, the same trend is seen with estimated growth
of 36,000 additional beds. In addition to these beds, more than 110,000
obsolete beds will need to be reconstructed.
At the same time, spending in the healthcare sector represents
a growing share of GDP: in Belgium, France, the Netherlands and
Germany, this share is between 10% and 12% depending on the country.
In a context of budgetary restrictions, private players must increas-
ingly often take over from the public sector. There is also a tendency
to redirect long-term patients or less complex cases to less techni-
cal, less expensive institutions. In the Netherlands, the segment of
“Zelfstandige BehandelCentra”, or private clinics specialising in uncom-
plicated medical disciplines (dermatology, ophthalmology, orthopae-
dics, etc.), is booming in the Netherlands.
Operators in the healthcare sector
There are three types of operators in the healthcare sector: public
operators, non-profit operators and private operators. The break-
down of market shares among these different types of players varies
from one country to another. In the nursing and care home segment,
Belgium offers the most balanced situation: each type of operator
represents one-third of its market. Conversely, in the Netherlands,
the non-profit sector has a near-monopoly position. The situations of
Germany and France lie in the middle.
In the private sector, there is significant fragmentation, with many
players operating a single establishment. However, in Belgium and
France, there is a trend towards consolidation. The most emblematic
example is the 2014 merger of Korian and Medica, two French opera-
tors together operating more than 57,000 beds across 600 sites in four
countries. Consolidation ensures that the operators have better risk
distribution, easier access to financing, a more frequent relationship
with the public authorities and certain economies of scale. In 2015,
this trend towards consolidation was confirmed particularly on the
Belgian market with Armonéa’s acquisition of the healthcare operator
Soprimat, manager of around 15 healthcare establishments.
Healthcare investment property
More than 13 billion EUR was invested in healthcare real estate in
Europe between 2007 and 2014. However, this trend is on the rise with
significant differences in price and yield depending on the observed
countries. Investment funds account for 39% of these investments,
listed real estate companies 25% and insurance companies and
pension funds 13%. In addition, although most of the investors are
located in Belgium, foreign investors from France and Germany are also
showing interest in this sector.
In Benelux, the vast majority of investments in healthcare real estate
have focused on nursing and care homes. In Germany and France,
other healthcare assets (rehabilitation clinics, psychiatric clinics, hos-
pitals, etc.) represent the largest share of investments.
The breakdown between “sale and leaseback” transactions and
traditional investments has changed over the past seven years: in
2007, the two transaction types accounted for equal shares of the
investment market, whereas in 2013, 80% of the transactions were
“traditional investments”.
The Brussels office market
Sources: CBRE, Cushman & Wakefield, JonesLangLasalle.
Sub-segments of the Brussels office market
The Brussels office market breaks down into several sub-segments.
The first four are often grouped together under the name “Central
Business District” (“CBD”).
Brussels Centre:
historical heart of the city.
Occupants: Belgian public authorities and medium/large-sized Belgian
private companies.
Leopold District:
European district of the city.
Occupants: European institutions and delegations or organisations
working with them.
Brussels North District:
business area.
Occupants: Belgian and regional public authorities, semi-public com-
panies and large private companies.
Louise District:
prestigious district.
Occupants: law firms, embassies and medium-sized private
companies.
Decentralised Brussels:
the rest of the territory of the 19 municipalities
of the Brussels Capital Region.
Occupants: medium/large-sized private companies.
Brussels Periphery & Satellites:
area located in the immediate vicinity
of the Brussels Capital Region and the Ring.
Occupants: private companies of all sizes.
MARKET CHARACTERISTICS
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Property Report /
Market characteristics