Bulgaria’s Commission for Protection of Competition has ruled to approve the proposed acquisition of Tokuda hospital in Sofia and City Clinic, another leading private healthcare provider in Bulgaria, by Turkey’s Acıbadem Sağlık Hizmetleri ve Ticaret.
The regulatory approval comes a month after Malaysia’s IHH Healthcare Berhad, the majority shareholder in Acıbadem, announced that it agreed to buy 100 per cent in Tokuda hospital for 65 million euro and about 11 million euro for nearly one-third of City Clinic. The two providers would merge into a new entity, in which Acıbadem would have 76.5 per cent and the rest would be held by City Clinic’s current operating partners.
The regulator said that the proposed merger and Acıbadem’s entry on the market would not have a negative impact on the competition in the two key areas of operation for the new entity – hospital services and out-patient care.
Bulgaria’s healthcare services market was very fragmented and highly-regulated, with the National Health Insurance Fund (NHIF) being the main source of income for hospitals, meaning that no one operator could acquire a dominant position on the market. With prices for medical services set by the state, the main area of competition was in the quality of services provided, the regulator said.
In geographic terms, the biggest impact would be on the market in Sofia, the only area where Tokuda and City Clinic were in direct competition. The new entity would have between 10 per cent and 20 per cent market share in the Sofia area, comparable in size only to the Pirogov emergency hospital, the largest in the Bulgarian capital city.
Tokuda Group is the largest private hospital operator in Bulgaria, with a state-of-art tertiary hospital with 550 beds, an outpatient medical centre, clinical research centre, pharmacy and an hospice, all located at the same site in Sofia. City Clinic, founded in 2010, is a leading high-quality integrated healthcare provider in Bulgaria, operating in Sofia, Varna and Bourgas with three hospitals and three outpatient centres.
The combined entity will be Bulgaria’s largest private hospital provider, with four hospitals totalling approximately 750 beds and four medical centres. It will also boost Acıbadem to more than 3500 beds across 22 hospitals in three countries (it also has a general-purpose hospital in Macedonia).
(Tokuda hospital in Sofia. Photo: Georgi Hristozov/Wikimedia Commons)