The key figures for the German hospital market in 2017 show: - The number of hospitals continued to decrease, especially public and non-profit hospitals, while private hospitals increased. - The number of inpatients declined for the first time in years by around 90,000 patients across 14 of 16 states. - Despite fewer patients, the number of hospital employees grew by 1.6% to around 900,000, with the largest increases in medical and other staff. - Average length of stay remained steady at 6.3 days for somatic patients but capacity utilization declined slightly, remaining below targets.

1. An overview of the latest key
figures of the German hospital
market
Stuttgart, November 2018
Consolidation of the
German hospital
market continues

2. 2
Summary
After years of continuous growth, the number of patients in Germany
treated in inpatient setting has unexpectedly decreased by c.90 k
patients. The number of patient decreased in 14 out of 16 federal
states. The number of hospitals, especially public hospitals (-10) and
those owned by non-profit organizations (-12) continued to decrease
while the number of private hospitals continued to increase (+13).
Bed occupancy stagnated in 2017 at around 75% in somatic
departments, which is well below hospital planning targets. Length of stay
continued to decrease slightly and has reached an average of 6.3 days in
somatic departments.
Despite a decrease in patient numbers, the number of employees
increased significantly in 2017 with a growth rate of 1.5%.Almost
900,000 full-time employees were employed in the hospital sector
in Germany.
Source: Federal Statistical Office; Roland Berger

3. 3
Number of
hospitals
Number of
inpatient
beds
Number of
inpatients
Length of
stay
Capacity
utilization
rate
The number of hospitals continued
to decrease, especially those in
public ownership (-10) and non-
profit ownership (-12), while the
number of hospitals in private
ownership continued to increase
(+13).
The number of inpatient beds
continued to see a decline in 2017.
Although the number of patients
has increased significantly since
2013, an unexpected slight
decrease (c.-90 k patients)
occurred for the first time in 2017.
The average length of stay
reduced only minimally in 2017.
In particular, due to the decline in
patient numbers, the capacity
utilization rate of inpatient beds
has decreased slightly for the first
time since 2013.
Overview of German hospital data, 2013-2017
The consolidation of the German hospital landscape has
continued – Unexpected decline in patient numbers in 2017
Comment
2017
-0.5%1,942
-0.3%497 k
-0.5%19.4 m
-0.3%7.3 days
78% -0.1%
∆ 2016-20172013
1,996
501 k
18.8 m
7.5 days
77%
2016
1,951
499 k
19.5 m
7.3 days
78%
Source: Federal Statistical Office; Roland Berger

4. 4
Total
number of
FTEs
Number of
medical
FTEs
Number of
nursing
FTEs
Number of
other FTEs
The increase in hospital
personnel is accelerating. After
continuous moderate growth in
recent years, the number of full-
time employees increased by
c.1.6% in 2017. Almost 900 k
full-time employees are
employed in German hospitals at
the end of 2017.
The number of medical
employees and that of other
employees saw the largest
increase (c.1.9% each). The
number of nursing employees
also grew, but at a lower level
than average.
Overview of German hospital data, 2013-2017
Despite declining patient numbers, the number of full-time
employees increased in 2017 to c.900 k
Comment
2017
+1.6%894 k
+1.9%161 k
+1.0%328 k
+1.9%405 k
2013
850 k
147 k
316 k
387 k
20162016
881 k
158 k
325 k
397 k
∆ 2016-2017
Source: Federal Statistical Office; Roland Berger

5. 5
A. Key data of
hospitals in
Germany

6. 6
The decline in the number of
public and non-profit hospitals is
slight. The number of private
hospitals continues to increase
slightly.
For the first time in years, the
number of inpatients has
declined by c.-0.5% (c.-90 k
patients).
The total number of days spent
in hospitals decreased
proportionally to the decrease in
the number of patients.
Key data of hospitals in Germany, 2013-2017
Hospitals by ownership [#] Hospital beds [# k]
Inpatients [# m]
+1.3% p.a.
Total number of days spent in hospitals [# m]
+0.2% p.a.
In addition to a decrease in the number of hospitals and
beds, the number of patients also declined for the first time
Comment
694 695 700 707 720
706 696 679 674 662
596 589 577 570 560
-0.5%
2017
1,942
2016
1,951
2015
1,956
2014
1,980
2013
1,996
PrivateNon-profitPublic
-0.9% p.a.
170 169 168 167 165
240 241 239 239
9393919190
241
2014
501
2013
501
-0.3%
2017
497
2016
499
2015
499
-0.1% p.a.
3.3
19.4
2017
-0.5%
6.6
9.5
2016
19.5
3.3
6.7
9.5
2015
19.2
3.2
6.6
9.5
2014
19.1
3.2
6.5
9.4
2013
18.8
3.1
6.4
9.2
-0.7%
2017
25.6
2016
46.8
25.1
141.3
2015
69.8
142.2
25.6
69.5
46.1
141.2
46.5
69.5
24.8
141.3
2013
69.6
46.8
25.1
141.5
2014
69.7
47.0
Source: Federal Statistical Office; Roland Berger

7. 7
After an increase in inpatient numbers from 2013 to 2016, the
number of patients decreased for the first time in most states
Development of inpatient numbers
Increase in inpatient numbers Decrease in inpatient numbers
Despite a slight increase in the
total population in Germany and
a further increasing average age
of the population, the number of
inpatients declined from 2016 to
2017 for the first time in many
years.
While 15 of the 16 federal states
experienced positive growth
from 2013-2016, 14 of the 16
federal states saw a decline or
stagnation in the number of
inpatients in 2017.
Comment
+1.2%
+1.3%
+2.4%
+0.9%
+1.1%
+2.3%
+1.4%
+1.0%
+1.3%
+1.6%
+1.6%
+1.8%
+0.9%
+0.6%
Lower
Saxony
Sachsen
Hamburg
Bremen
North Rhine-
Westphalia
Rhineland
Palatinate
Saarland
Baden-
Württemberg
Bavaria
Hesse
Saxony-
Anhalt
Thuringia
Brandenburg
Berlin
Mecklenburg
Western Pomerania
Schleswig-
Holstein
+0.1%
Saxony
-0.3%
-0.2%
+1,2%
-0.8%
-1.2%
-0.6%
-0.6%
-0.6%
-0.5%
-1.5%
-1.6%
-0.3%
-0.3%
-1.4% Sachsen
-0.6%
2013-2016 Ø development p.a. 2016-2017 development
0.0%
0.0%
Hamburg
Bremen
North Rhine-
Westphalia
Rhineland
Palatinate
Saarland
Baden-
Württemberg
Bavaria
Hesse
Saxony-
Anhalt
Thuringia
Brandenburg
Berlin
Mecklenburg
Western Pomerania
Schleswig-
Holstein
Source: Federal Statistical Office; Roland Berger

8. 8
In 2017, the average length of
stay remained constant at c.7.3
days for the second year in a
row.
The bed capacity utilization rate
also remained stable at c.78% -
typically, a utilization rate of
more than 80% is necessary to
ensure sustainable profitability.
While the overall number of
patients is declining, the number
of patients per hospital and per
bed was stable or slightly
declining.
Key data of hospitals in Germany, 2013-2017
Ø Length of stay [# days] Bed capacity utilization1) [%]
+0.3% p.a.
Inpatients per hospital [# k]
+2.1% p.a.
Inpatients per bed p.a. [#]
+1.5% p.a.
The average bed capacity utilization rate of German hospitals
remained at c.78%
Comment
-0.1% p.a.
77.3
2013 2017
77.4
-0.1%
77.5 77.8
20152014 2016
77.97.3
2017
-0.3%
20162013 2014
7.47.5
2015
7.3 7.3
10.0
2016
10.0
2015
0.0%
2017
9.79.4
2013 2014
9.8
2013
37.5 38.2
2014 2015 2017
-0.2%
39.1
2016
39.238.5
1) Based on all inpatient beds and including somatic and psychiatric patients
Source: Federal Statistical Office; Roland Berger

9. 9
The average length of stay in
somatic departments remained
constant at c.6.3 days. The
average length of stay in
psychiatric departments
increased slightly to c.27.5 days
– thereby remaining almost four
times higher than the average
length of stay in somatic
departments.
The bed capacity utilization
declined slightly for somatic as
well as psychiatric departments.
The capacity utilization rate of
somatic beds (c.75%) remains
far below the capacity utilization
rate of psychiatric departments
(c.94%).
Key data of hospitals in Germany, 2013-2017
Ø Length of stay, somatic1) [# days] Ø Length of stay, psychiatric2) [# days]
+1.4% p.a.
Bed capacity utilization, somatic1) [%] Bed capacity utilization, psychatric2) [%]
In somatic departments, bed capacity utilization rate
remained at only c.75%
Comment
-1.2% p.a. +1.2%
2017
26.1
2013
27.226.4 26.6 27.5
201620152014
6.6 6.5
2013
6.4
2014 2017
-0.2%
6.3
2016
6.3
2015
-0.5%
2017
75.0
2016
75.4
2013 2014
74.874.874.7
2015 2014
93.4
-0.2%
93.593.3 93.7
201720152013 2016
93.3
+0.3% p.a. +0.1% p.a.
1) Somatic departments 2) Psychiatric departments incl. psychosomatics and child and adolescent psychiatry
Source: Federal Statistical Office; Roland Berger

10. 10
Key data of hospitals in Germany, 2013-2017
While the number of inpatient surgeries continued to increase,
the number of outpatient surgeries remained almost constant
Comment
Inpatient surgeries [# m] Outpatient surgeries [# m] The number of inpatient
surgeries has increased by c.2%
p.a. since 2012 indicating that
c.1 m additional inpatient
surgeries were performed in
2017 compared to 2013.
The number of outpatient
surgeries has remained stable
since 2014 at c.2 m surgeries.
This is also reflected in a further
increase in the inpatient/
outpatient surgery ratio.
The number of surgeries per
inpatient case has remained
constant at c.0.9 since 2015.
+1.7% p.a.
Surgeries per inpatient [#] Inpatient/outpatient surgery ratio
+1.9% p.a. +0.4%
2016
2.0
20172014
2.0 2.02.0
2015
1.9
2013
16.215.8
2013
16.7
20162014 2017
+1.2%
16.916.4
2015
+1.4%
20172016
0.8 0.90.9
2014
0.90.8
20152013
8.3
2017
8.5
20162015
8.3
20142013
8.3
+1.2%
8.6
+4.0% p.a. +0.8% p.a.
Source: Federal Statistical Office; Roland Berger

11. 11
Almost 900,000 FTEs work in
German hospitals – c.44,000
additional full-time jobs have
been created since 2013.
Although the growth rate of
medical FTEs has slowed to
c.1.9% in 2017, it is still above
the average overall growth of
FTEs of c.1.6%.
The increase in the number of
nursing FTEs was significantly
lower and remained constant at
c.1.0% in 2017.
Similiar to the growth of the
medical FTEs, the number of
other FTEs increased by c.1.9%
in 2017.
Key data of hospitals in Germany, 2013-2017
Total number of full-time employees [# k]
+1.2% p.a.
Medical FTEs [# k]
+2.4% p.a.
Nursing FTEs [# k]
+0.9% p.a.
Other FTEs [# k]
The number of employees – particularly the number of medical
doctors – continued to rise
Comment
161158154151147
+1.9%
20172013 2014 20162015
894881868859850
+1.6%
2014 2015 2016 20172013
328325321319316
20142013 2015
+1.0%
2016 2017
405397393390387
2017
+1.9%
20152013 20162014
+0.9% p.a.
Source: Federal Statistical Office; Roland Berger

12. 12
Key data of hospitals in Germany, 2013-2017
Employee productivitiy and inpatient bed days per FTE
continued to decline in 2017
Comment
Inpatients per FTE [#] Inpatient bed days per FTE [#]
+0.2% p.a.
Despite the decrease in patient
numbers, the productivity per
FTE fell by c.2.3% in 2017 due
to the rising number of
employees.
This decline is also reflected in
the decline in inpatient bed days
per FTE.
After a rather stable ratio of
inpatients per nursing FTE in
recent years, this ratio declined
in 2017.
158161163165166
2013 2014 20162015 2017
-1.9%-2.3%
201720162013
22.2 21.7
2015
22.2
2014
22.322.1
-1.0% p.a.
Inpatients per nursing FTE [#] Inpatient bed days per nursing FTE [#]
430437440444447
2013 20152014 2016 2017
-1.6%
2013
60.159.4 59.2
2016
60.1
2015
-1.5%
60.0
2014 2017
+0.4% p.a. -0.8% p.a.
Source: Federal Statistical Office; Roland Berger

13. 13
B. Your contacts at
Roland Berger

14. 14Source: Roland Berger
Roland Berger is advising hospitals on a range of topics
including strategic and operational questions
Our expertise in the hospital sector
> Location, network strategy and
structural reports
> Medical strategy and portfolio
optimization
> Medical focus consultation/
formation of center strucutre
> Digitalization strategies
> Earnings imrpovement
programs
> Restructuring
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> Concepts for securing financing
> Cooperations
> Mergers/Acquisitions
> Leadership organization
> Change management
Strategy
Topics
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15. 15
Your contacts
Source: Roland Berger
Oliver
Rong
Roland Berger GmbH
Am Sandtorkai 41
20457 Hamburg
Germany
E-Mail: oliver.rong@rolandberger.com
Phone: +49 (0) 160 744-4423
Head of Healthcare
Germany, Austria,
Switzerland Region
Senior Partner
Roland Berger GmbH
Löffelstr. 46
70597 Stuttgart
Germany
E-Mail: peter.magunia@rolandberger.com
Phone: +49 (0) 160 744-3587
Dr. Peter
Magunia
Head of Healthcare
Germany
Partner