Healthcare & Medtech

In brief: Medical technology companies in the DACH lower mid-market are currently valued at 5.9-10.0x EBITDA, practice groups, care services and medical aids suppliers at 4.0-9.7x (based on DUB KMU-Multiples Q3/2026, analysis SourcingClub). The German healthcare market recorded 240 transactions in 2025. Among office-based providers and laboratories, 59 of 68 deals involved private equity (PwC Transaktionsmonitor Gesundheitswesen, spring 2026). A sale takes 6 to 12 months, and for practices the succession procedure comes on top.

Market overview: healthcare and medical technology in the DACH region

Healthcare is one of the few sectors where the number of transactions held steady in 2025. PwC counts 240 transactions in Germany, after 237 the year before (PwC Transaktionsmonitor Gesundheitswesen, spring 2026). The split says more than the total: 79 deals were in care operators, 68 in office-based providers and laboratories, 48 in care real estate, 33 in hospitals and specialist clinics, and 12 in rehabilitation.

This page covers medical technology manufacturers and suppliers, laboratories and diagnostics, practices and MVZ including dental and veterinary medicine, outpatient and out-of-hospital intensive care, and medical supply stores and medical aids supply. Non-medical healthcare services such as billing, practice BPO or hygiene compliance are covered under Business services, practice and clinic software under Software.

Fragmentation in the sector is very uneven. In medical technology, 93% of manufacturers have fewer than 250 employees. The industry generates around €55bn in revenue, employs more than 210,000 people and has an export share of 68% (BVMed, Zahlen und Fakten 2026). In veterinary medicine, 10,385 practices compare with 11,216 self-employed vets, and the number of practices has fallen by 3.5% over ten years (Vetline, analysis of the BTK statistics 2025). The laboratory market runs the other way. Besides Sonic Healthcare, Synlab, Amedes and Dr. Limbach operate nationwide, and when clearing the LADR acquisition on 6 February 2025 the Bundeskartellamt noted that the merger reinforces the trend towards more concentrated laboratory medicine markets.

Succession pressure is now visible in the registers. At the end of 2025, 191,875 doctors and psychotherapists with a statutory health insurance licence were in practice, 2,324 more than a year earlier. Over the same period the number in their own practice fell by 849 to 122,903, the number of employed doctors rose by 3,273 to 58,877, and the average age is 53.9 years (KBV, 12 March 2026). In veterinary medicine there have been more employed than self-employed vets for a few years now (Bundestierärztekammer, 31 December 2025). So anyone handing over today is less likely to find the single successor who carries on the practice personally. Across the Mittelstand as a whole, around 545,000 companies plan a succession by the end of 2029 (KfW Research, January 2026). Details are in the succession statistics for the DACH region (in German).

The picture of sponsoring structures has shifted. On 31 December 2024, 5,085 MVZ were licensed, after 4,897 a year earlier. A hospital was involved as sponsor in 2,507 of them, contract doctors in 2,319 and other sponsors in 751, and one MVZ can have several sponsors (KBV data, compiled by gesundheitsmarkt.de, 2026). In dentistry, on 31 December 2023, 468 of 1,554 licensed MVZ could be attributed to an investor from outside the healthcare sector, around 30%, and the largest chain had 96 sites (KZBV, as of 31 December 2023). On 18 March 2026 the Bundestag rejected further regulation of investor-run MVZ. The transparency obligations on ownership structures announced in the coalition agreement of 9 April 2025 are still pending (CMS Legal Update, 17 July 2026).

In care, consolidation runs differently from outpatient medicine. 2025 was the most active year with 79 transactions, 30 of them out of insolvency (PwC Transaktionsmonitor, spring 2026). Between January and July 2026, 266 outpatient services with a combined 16,342 patients closed, along with 81 day care facilities and 50 residential care homes (pflegemarkt.com, as of July 2026). At the same time the residents' own contribution in a care home is rising to €3,364 a month in the first year of stay, €256 more than a year earlier (vdek, 14 July 2026). If you sell from a stable position, you negotiate in a market where many others are selling out of necessity. That is a position, not a disadvantage.

Austria and Switzerland follow their own patterns. In Tyrol, 52 of 228 dental positions contracted with the health insurers were vacant in October 2025, and 46% of Austrian contracted dentists will reach retirement age in the next ten years (Forbes Österreich, 2026, citing ORF Tirol; Österreichische Zahnärztekammer, 2026). The Swiss healthcare M&A market reached 74 transactions with a volume of CHF 46.6bn in 2025 (Chambers Healthcare M&A 2026, Switzerland), but that volume is carried by large pharma deals, not by the Mittelstand. The overall market phase is put in context in the overview of DACH M&A trends (in German).

Who is buying right now

In the outpatient segment, financial investors now clearly dominate: in 2025, 59 of 68 transactions among office-based providers and laboratories involved private equity, compared with 40 a year earlier (PwC Transaktionsmonitor, spring 2026). How the motives of investors and strategics differ is shown in the comparison PE investor vs. strategic buyer. Publicly documented examples from 2025 and 2026:

• CORIUS Gruppe (dermatology, shareholder Ufenau Capital Partners): According to its own figures, 91 sites in Germany, Switzerland and the Netherlands with 320 doctors and 1,562 employees (corius.de, accessed 08/2026). PwC lists the group as a particularly active consolidator in dermatology in 2025.
• medermis clinics (dermatology, phlebology, aesthetics, shareholder EOS Partners): alongside Corius, the second particularly active buyer in the specialty in 2025 (PwC Transaktionsmonitor, spring 2026).
• ORTIVITY (orthopaedics, shareholder Apheon): a network of practices, outpatient surgery centres, physiotherapy and medical supply stores. Unigestion came in with a minority stake, and together with other investors around €200m of fresh capital went into the platform. Apheon remains lead investor (Apheon, press release 2025; ortivity.de, accessed 08/2026). So consolidators raise equity for further acquisitions instead of selling themselves.
• RAD-x, LifeLink and Quartz Healthcare (radiology): the three most active consolidators in the specialty in 2025. RAD-x explicitly targets practice succession (PwC, spring 2026; rad-x.eu, accessed 08/2026).
• Sonic Healthcare (laboratories, Australia): On 6 February 2025 the Bundeskartellamt cleared the acquisition of the LADR group Dr. Kramer & Kollegen and noted a trend towards more concentrated laboratory markets. In Germany, Sonic operates Bioscientia, Diagnosticum and Labor Staber, among others. Below a target revenue of €17.5m, merger control usually does not apply at all, so smaller laboratory acquisitions go ahead without the authority (Bundeskartellamt, press release 6 February 2025).
• Domidep (care, shareholder I Squared Capital): The European Commission cleared the acquisition of the Vitanas group on 29 January 2026. The merger had been notified on 5 January 2026 (European Commission, merger case DOMIDEP/VITANAS, 2026). Vitanas operates 41 care homes with 5,447 places, and with it Domidep grows to more than 8,000 residential places in Germany (pflegemarkt.com, cited in Altenheim, 2026).
• Augustinum Gruppe (care, non-profit operator): acquired facilities from DKV in early 2026 (PwC, spring 2026).
• APELOS Therapie (physiotherapy, shareholder GENUI): took over around 60 sites from Athera (shareholder Waterland) as of 1 August 2025, a whole package of practices passed between two financial investors (Bundesverband elektronischer Datenaustausch, report 2025; PwC, spring 2026).
• Intensive care: GHO Capital and Ares entered a financing partnership for the Linimed Gruppe in 2025. Lafayette Mittelstand Capital as well as Apheon and Sofina (opseo) were among the investors active in the care market in 2025 (PwC, spring 2026).
• Medical technology: TA Associates acquired Nexus AG, and Teleflex acquired the Vascular Intervention business of Biotronik. Healthcare IT and digital health are seen as particularly sought-after segments (Steinbeis Mergers & Acquisitions, Medtech M&A Market 2025/2026).
• Veterinary medicine: The largest operators of veterinary practices in Germany in 2026 are Evidensia (IVC Evidensia), AniCura (Mars Petcare), VetPartners Germany, Tierarzt Plus and VetGruppen Deutschland (gesundheitsmarkt.de, 2026). These groups do not disclose their site numbers.

Strategics from the same specialty, hospital operators and family offices also buy, usually without a press release. They are approached directly and confidentially. How that works is described in What is deal origination.

EBITDA multiples in the sector

DUB lists the sector in two separate rows, and this difference decides where you land. In Q3/2026, healthcare & medical technology reaches 5.9-7.6x in micro cap, 7.0-9.0x in small cap and 8.2-10.0x in mid cap. Healthcare: care & service providers sits below that at 4.0-6.0x, 6.0-7.7x and 7.9-9.7x (based on DUB KMU-Multiples Q3/2026, analysis SourcingClub). A manufacturer of medical devices is valued differently from an outpatient care provider with identical earnings.

Data basis: DUB KMU-Multiples (dub.de/kmu-multiples), Q3/2026, sectors healthcare & medical technology and healthcare: care & service providers. Subsegment classification and analysis: SourcingClub. The EBITDA bands smooth out quarterly swings and are therefore not identical to the raw DUB values in every segment (methodology, in German). Full ranges by size class: EBITDA multiples DACH.

Two areas have no row of their own at DUB. Veterinary practices and clinics fit into the healthcare: care & service providers band, so 4.0-7.7x with a focus around 6.0x, because their value logic follows outpatient services and not medical technology (classification SourcingClub). Specialist medical technology trading sits at the lower end of the micro cap band of 5.9-7.6x, because pure trading has no approval asset of its own behind it (classification SourcingClub).

As context, not as an SME reference: the DACH market for medtech and digital health sees a steady 160 or so transactions a year, with observed EBITDA multiples of 6.0-13.0x and rising (Steinbeis Mergers & Acquisitions, Medtech M&A Market 2025/2026). The values above the DUB bands come from platform and large transactions such as Nexus to TA Associates. For an owner-managed company in the lower mid-market, the DUB bands remain the anchor.

What raises the multiple and what lowers it

Between the lower and upper end of the band lie around two years of EBITDA (based on DUB Q3/2026). These points decide your position within it:

How these factors feed into a valuation methodically is shown in the comparison of valuation methods (in German).

Valuation example: a medical technology manufacturer worked through

A fictitious but typical example: an owner-managed manufacturer of single-use instruments for minimally invasive surgery, southern Germany, 42 employees, own MDR certificates with three years remaining, ISO 13485, €9.0m revenue. Three customers account for 46% of revenue.

Source for the multiple band: DUB KMU-Multiples Q3/2026. The split in step 5 illustrates a structure, it is not a market statistic.

The same adjusted earnings of €1.40m would put an outpatient care group in the small cap band healthcare: care & service providers, so at 6.0-7.7x (based on DUB Q3/2026). At 6.5x that would be €9.10m instead of €10.92m, a difference of around €1.8m on identical earnings.

The sale process in the sector

6 to 12 months from process start to closing is realistic. The stages are the usual ones: preparation and valuation, anonymous teaser, approach to selected buyers, NDA, meetings, indicative offers, due diligence, contract negotiation, closing. The full process is described on the page selling a company (in German). In healthcare, four particular features come on top, and they shape timeline and structure.

First, the licence. For practices it is the actual asset and cannot be sold freely. In closed planning areas, the admissions committee first decides, on application, whether a succession procedure takes place at all (Section 103(3a) SGB V). The KV then advertises the seat, draws up a list of applicants, and the committee selects the successor at its due discretion. If it rejects the application, the KV pays compensation equal to the market value of the practice. The circle of buyers for an MVZ is limited too: Section 95(1a) SGB V only allows licensed doctors, hospitals, non-profit operators and municipalities as founders.

Second, billing. Buyers check billing compliance, open cost-effectiveness and plausibility audits, and whether all licences really survive a change of sponsor (CMS Legal Update, 17 July 2026). Then there are hygiene and reprocessing under the Medical Devices Operator Ordinance and RKI recommendations, and access to patient data, which is not automatically settled on a change of sponsor. Sellers regularly underestimate this block.

Third, the MDR for medical technology. Buyers review the remaining term of certificates, the capacity of the notified body and the state of technical documentation and clinical evaluation. 65% of the companies surveyed name higher certification costs due to the MDR as a cost driver, 80% the bureaucratic burden (BVMed autumn survey 2025). The rules are currently in motion: on 16 December 2025 the European Commission presented a proposal to revise the MDR and IVDR with COM(2025) 1023, including halved notified body fees for SMEs, the removal of the certificate expiry date and a new classification for software (European Commission, 16 December 2025). The legislative process is still running, so you cannot plan on it today. A valid certificate is therefore a hard asset, because a buyer would otherwise have to build it up themselves. For Swiss manufacturers there is the additional point that the EU does not recognise the Swiss Medical Devices Ordinance (Chambers Healthcare M&A 2026, Switzerland).

Fourth, merger control, which applies in the Mittelstand too as soon as the buyer is a chain. Documented cases are the clearance of Sonic Healthcare and LADR by the Bundeskartellamt on 6 February 2025, and the clearance of Domidep and Vitanas by the European Commission, notified on 5 January 2026 and cleared on 29 January 2026. If you plan these steps early, you do not lose months at the end. What discreet support covers here is described under for business owners (in German).

Typical deal structures

• Share deal for an existing MVZ GmbH: The buyer acquires the shares, and licences, permits and contracts stay with the sponsoring company. Since the MoPeG took effect on 1 January 2024, a practice partnership (GbR) can register as an eGbR and then convert into a GmbH. So you can still set up your MVZ GmbH yourself and sell afterwards (CMS Legal Update, 17 July 2026).
• Asset deal plus succession for a single practice: Assets and goodwill are sold, and the licence goes into the succession procedure under Section 103 SGB V or is given up in favour of employment. A share deal is precisely not the standard structure here.
• Hospital vehicle as sponsoring structure: Because Section 95 SGB V does not name financial investors as founders, they use a licensed hospital as the formal shareholder of the MVZ GmbH. The negotiating partner at the table is therefore often not the beneficial owner (CMS Legal Update, 17 July 2026).
• Continued work of the outgoing doctor: For employment after giving up the licence, BSG case law requires that at least three years of employment are intended. In effect, these three years are the lower limit of the commitment (CMS Legal Update, 17 July 2026).
• Earn-out tied to revenue or patient retention: Standard where earning power depends on individual people. There are no reliable public ranges for the DACH lower mid-market. The percentages in circulation come from US reporting and do not transfer.
• Escrow for billing and recourse risks: A purchase price retention over the warranty period follows directly from the review priorities in healthcare (CMS Legal Update, 17 July 2026).
• Property held separately: The practice, laboratory or care home property often stays with the outgoing owner and is leased back long term. The rent has to be normalised to market level before applying the multiple, otherwise EBITDA is artificially high or low. In care, operations and property are often sold separately anyway: 48 of the 240 deals in 2025 were pure real estate transactions (PwC, spring 2026).

The buy-and-build thesis from an investor's perspective

The thesis rests on three sources. Demographic demand grows independently of the economic cycle: maintenance contracts, care services and laboratory diagnostics are in demand even in a recession. The licensing logic acts as a barrier to entry, because KV seats, prequalifications and MDR certificates cannot be replicated at will. And supply pressure is rising, because the number of practice owners is falling despite a growing number of doctors (KBV, 12 March 2026).

The valuation lever lies between the size classes, not in a premium above the market. A single site in care sits at 4.0-6.0x, a multi-site group in mid cap at 7.9-9.7x (based on DUB Q3/2026). In medical technology the range runs from 5.9-7.6x in micro cap to 8.2-10.0x in mid cap. Whoever builds a managed platform out of single operations earns this difference plus the economies of scale in purchasing, billing, IT and quality management. The mechanics are described in the article on the buy-and-build strategy in the DACH region (in German), and the role of private equity in succession in the article on business succession and private equity in the Mittelstand (in German).

Two caveats belong here. Exits of larger MVZ groups remain hard to achieve (PwC Transaktionsmonitor, spring 2026). And the momentum is segment-specific rather than across the board: it is concentrated in dermatology, radiology, orthopaedics, physiotherapy and intensive care. The bottleneck is rarely capital, it is access to owner-managed targets before they enter structured processes. What systematic sourcing delivers there is set out on the page for investors.

From my sourcing work

In healthcare, a different question almost always comes before price: does the business run without the owner? A practice where two employed doctors treat most of the cases is negotiated completely differently from one where everything depends on one person, and that difference weighs more than any multiple point. I also notice how strongly regulation drives the willingness to talk here: as soon as a certificate or a licence has a foreseeable remaining term, the time horizon changes on both sides. And I regularly see sellers underestimate their billing history and their staff metrics, even though those are exactly what gets checked first.

Next step

Whether your handover is two or five years away: your position within the valuation band can be prepared, and the active buyers are known by name. A confidential match against concrete acquisition profiles shows, without obligation, which buyer groups fit your business, without your name circulating in the market early.