According to the Ministry of Health of the Russian Federation and Rosstat, at the end of 2023, there were 21,146 ambulatory-polyclinic and hospital organizations in the Russian Federation, 14.8% of which were not state-owned.
Non-state ownership, according to the All-Russian Classifier of Forms of Ownership (OKFS OK 027-99), includes private and municipal ownership, ownership of public and religious organizations (associations), ownership of state corporations, consumer cooperatives, mixed ownership, as well as ownership of citizens of the Russian Federation permanently residing in a foreign country. Statistical data up to 2023 do not single out private property from the total amount of non-state property. At the same time, its share in the total number of non-state ambulatory and polyclinic organizations according to the data of 2023 is 73.2%.
Figure 1: Dynamics of the number of medical organizations in the Russian Federation by type of ownership, pcs.
Source: Rosstat, Ministry of Health of the Russian Federation
Moscow is the region with the largest number of non-state medical organizations both in terms of the number of ambulatory-polyclinic organizations and the number of hospital organizations. In 2023, their total number reached 601 organizations, which is 19.2% of the total Russian number.
Figure 2: Top 10 regions of the Russian Federation in 2023 by the number of non-state medical organizations, pcs.
Source: Rosstat, Ministry of Health of the Russian Federation
Ambulatory and polyclinic organizations
The total number of ambulatory and polyclinic organizations in the country at the end of 2023 decreased by 22% to 16,289 organizations. Despite the relative stability of their number in previous years, in 2023 there were significant changes in the market of medical services. The changes are primarily associated with a significant reduction in the number of non-state institutions, the number of which decreased by 59% during the year due to the market reorganization in the new economic post-covid conditions.
Among 89 Russian regions, only 2 regions (the Kabardino-Balkar Republic and the Republic of Ingushetia) saw a slight increase in the number of non-state ambulatory and polyclinic organizations.
The reduction in the number of non-state organizations also significantly affected their share in the total number of ambulatory and polyclinic organizations. If until 2023 the share of non-state organizations fluctuated between 29-32%, in 2023 it decreased to 16%.
Figure 3. Dynamics of the number of ambulatory and polyclinic organizations in the Russian Federation by type of ownership, pcs.
Source: Rosstat, Ministry of Health of the Russian Federation
Moscow is the leader among Russian regions in terms of the number of non-state ambulatory and polyclinic organizations. In 2023, there were 530 such organizations in the capital, which is one fifth of the total number of such organizations in the country. The second and third places are occupied by St. Petersburg and the Sverdlovsk Oblast, where 186 and 148 organizations were operating in 2023, respectively.
Table 1: Top 5 regions of the Russian Federation in 2023 by number of non-state ambulatory and polyclinic organizations
| Region | Number of non-state ambulatory and polyclinic organizations | Share of the total number of non-state ambulatory and polyclinic organizations in the Russian Federation, % | Change over the year, pcs | Change over the year, % |
| Moscow | 530 | 20,4 | -220 | -29 |
| Saint-Petersburg |
186 |
7,2 | -222 | -54 |
| Sverdlovsk region | 148 | 5,7 | -160 | -52 |
| Moscow region | 123 | 4,7 | -166 | -57 |
| Krasnodar Krai | 104 | 4,0 | -116 | -53 |
| Others | 1505 | 58,0 | -2817 | -65 |
| Total | 2596 | 100 | -3701 | -59 |
Hospital organizations
Unlike ambulatory and polyclinic organizations, the number of hospital organizations in 2023 remained practically unchanged and amounted to 4,857 organizations. And unlike ambulatory and polyclinic organizations, the share of non-state hospital organizations has increased annually. If in 2019 there were 328 institutions and their share was 6.5%, in 2023 there were 530 organizations with a share of 11%.
Figure 4: Dynamics of the number of hospital organizations in the Russian Federation by type of ownership, pcs.
Source: Rosstat, Ministry of Health of the Russian Federation
Moscow is the leader among Russian regions in terms of the number of non-state hospital organizations in 2023: 71 organizations were located in the capital, which is 13.4% of the total number of non-state hospital organizations in the Russian Federation. The top five also include Krasnodar Krai (32 organizations), Moscow region (31), Sverdlovsk Region (25), St. Petersburg (25).
Table 2: Top 5 regions of the Russian Federation by the number of non-state hospital organizations in 2023
| Region | Number of non-state hospital organizations | Share of the total number of non-state hospital organizations in the Russian Federation, % | Change over the year, pcs | Change over the year, % |
| Moscow | 72 | 13,4 | 17 | 31 |
| Krasnodar Krai | 32 | 6,0 | 15 | 88 |
| Moscow region | 31 | 5,8 | 7 | 29 |
| Sverdlovsk region | 28 | 5,3 | 8 | 40 |
| Saint-Petersburg | 25 | 4,7 | 1 | 4 |
| Others | 343 | 64,7 | 24 | 8 |
| Total | 530 | 100 | 72 | 16 |
Source: Rosstat, Ministry of Health of the Russian Federation
The share of non-state hospital organizations in Russia in 2023 was 10.9%. In 19 Russian regions there is still no private sector of hospital organizations.
Market growth drivers
The private non-state healthcare market in Russia is growing at a steady pace. The main drivers of this growth include the following factors:
- Increasing health expenditure. Russian consumers are paying more attention to their health, especially after the pandemic. The need for access to quality healthcare services has increased, driving demand for private clinics. The sector of paid services such as diagnostics, checkups and medical care is growing steadily due to this interest.
- Decrease in the availability and relative quality of public medicine. The shift of some services to the private sector is due to the limited capacity of public health facilities. As state polyclinics and hospitals reduce budget financing, many patients choose private clinics where they can expect a higher level of service.
- Development of telemedicine. In recent years, telemedicine has become an integral part of private healthcare. This segment has grown since the pandemic and continues to develop due to its convenience and accessibility for patients, especially in regions where the shortage of medical specialists is felt most strongly.
According to preliminary results for 6 and 9 months of 2024, the largest clinics, such as Medsi Group, EMC, Mother and Child, record revenue growth not only due to the average check, but also due to the growth in the volume of services provided. The growth factors include increased utilization of clinics, opening of new clinics, development of digital services, and high standards of comprehensive medical care. The factors influencing the market can be expected to continue next year.
Key market trends
Among the main trends determining the current development of private medicine in Russia are:
- Mergers and acquisitions. The market continues to move towards consolidation, which facilitates the creation of network clinics with a unified quality of care. Companies seek to optimize costs and benefit from synergies by combining assets and strengthening market positions.
- Adoption of high technology. The use of artificial intelligence and telemedicine platforms has become an important part of private medicine. Some clinics offer remote monitoring services, allowing patients to receive diagnostics and medical consultations from the comfort of their homes. This is especially relevant for remote regions.
- Segmentation and specialization. To increase competitiveness, many clinics focus on highly specialized areas, such as cosmetology, orthopedics, cardiology and pediatrics. This approach allows them to attract quality-oriented clients and effectively serve specific patient needs.
- Small clinics, like monoclinics, are becoming smaller every year. Already now more than two thirds of the market is occupied by large chain companies, and this trend is only increasing.
Wide diversification of areas and services helps large players to stabilize revenue, patient flow and increase the average check. Network activities allow cost savings due to economies of scale, standardization, staff rotation, and a common customer base. It is easier for large players with a well-known brand and reputation to attract specialists, retain patients, increase the average check, negotiate better terms with companies on voluntary health insurance programs, as well as with suppliers of materials and equipment.
In order to survive, small players have to adapt to market conditions: expand the list of services, open new areas and clinics, and increase the number of specialists. However, it cannot be said that small businesses will die out under the pressure of large network players. Market experts are confident that small players will continue to exist. As a rule, they occupy their narrow niche at the expense of rare services, specialists, as well as author's methods.
Financial constraints of small businesses
The development of small and medium-sized businesses is limited by financial resources: own funds are insufficient for meaningful competition with the major players in the form of expansion, modernization and opening of new clinics. At the same time, high interest rates on bank loans prevent small players from taking advantage of debt financing. Raising loans or borrowing at high rates significantly increases the clinic's costs, reducing the potential for competitiveness.
In contrast, large businesses are generally better positioned both in terms of available equity capital and the availability and terms of debt financing, which is influenced by both the availability of collateral and bank account turnover, including volume and regularity.
Investors, including larger medical organizations interested in expansion, diversification and synergy from such investments, are taking the leading role as a source of financing for small businesses. In the case of small business problems, such as low profitability, high borrowing, lack of resources in the implementation of long-term investment projects, attracting external investment or even the complete sale of the business becomes a priority solution.
Prospective directions of private medicine
The trends of 2023 and 2024 are expected to continue in the future. According to experts, the key areas of private medicine will be laboratory research, dentistry, ophthalmology, radiology, cosmetology, diagnostics, and surgery. These areas are traditionally basic and are stably in high demand.
In addition, the market can be further developed by enhancing the following trends:
- Telemedicine. The segment is actively supported by legislation, and the government is considering new regulatory opportunities that will enable private clinics to provide more services remotely, including diagnosis.
- Genetic tests and innovative diagnostics. Clinics have started offering genetic tests and advanced diagnostic programs. This is a promising trend that allows for the development of treatment and prevention programs based on the individual characteristics of the body.
- Personalized medicine and checkups. Clinics are developing programs for personalized care of patients, which allows to improve the quality of treatment and prevention of diseases. Checkups and preventive diagnostics are also becoming an important element of private medicine as patients are increasingly interested in comprehensive health care.
- Expansion of voluntary health insurance. Many companies are increasing investments in voluntary health insurance, including as a factor of competition against the background of a shortage of employees on the labor market, which provides private clinics with more stable patient flows and expands their audience.
- Market experts also note that an additional impetus to private medicine could be given by an increase in mandatory health insurance tariffs, improvement of the use of the mechanism of public-private partnership and concessions.
Potential new growth points for private medicine in Russia could be:
- Medical tourism. In recent years, Russia has become attractive for medical tourism due to the quality of services and relatively low prices. The influx of medical tourists from the CIS, Asia and the Middle East has a positive impact on the market, and this trend is likely to continue.
- Development of specialized services for the elderly. The trend of increasing average age of the population is global and irreversible. The development of the age (elderly) economy - first of all, concerns the healthcare system. Many clinics are already beginning to offer specialized programs for the care of older people. This trend includes gerontology, rehabilitation and support in everyday life. Another consequence of the “silver economy” trend is the increasing demand for reproductive technologies from a younger but nonetheless adult population.
- Mental Health Programs. Demand for psychologists, psychotherapists and psychiatric support in the private sector is steadily increasing. Many clinics have already opened specialized departments to work with patients experiencing stress and emotional problems.
