When you’re looking at the real estate allocation in an investment portfolio, there are a few decisions to make.
- How much to allocate to real estate – weighing its potential for regular income, capital growth, and portfolio diversification benefits.
- Which area of real estate to invest in – whether it’s residential property or commercial property, which allows investors to gain exposure to various sectors like retail, office or industrial.
- Which investment vehicle to use – options like Australian Real Estate Investment Trusts (A-REITs) can offer easy access and liquidity, while unlisted property funds may provide more stable valuations and access to institutional-grade assets.
But have you considered healthcare real estate? Here are three benefits healthcare assets can potentially offer.
3 benefits private healthcare can offer investors
- Stable occupancy and long leases | Healthcare tenants typically sign leases spanning 10 to 15 years or more, which delivers predictable cash flows. They have historically exhibited lower default rates and higher occupancy rates than retail or office tenants. Matthew Strotton, Executive Director and Head of Real Estate at Real Asset Management (RAM) says, “Longer leases mean investors can get to enjoy quality income with annual increases, which provides income assurance with lower volatility.”
- Lower volatility and capital risk | Triple net leases are particularly common in healthcare real estate. In such arrangements, tenants are responsible for property taxes, insurance and maintenance. This means the healthcare operators as tenants are not only responsible for delivering the services but also need to maintain the building. And the cost of maintenance falls back on them as the triple net leaseholder of that property. Strotton says, “Single tenants on triple net leases can mean very attractive income with limited to no capital expenditure risk for investors.”
- Diversification and growth potential | When you think of healthcare assets, bigger overnight hospitals might immediately spring to mind. But at the other end of the spectrum are allied health services – everything from pathology to surgical specialists to X-Ray. They’re becoming more prevalent, as hospital operators become more localised and provide more community-based services. Strotton says, “This can provide investors with crucial diversification across a range of health sub-sectors and geographical regions.”
A sector in rude health…
If you’re investing in healthcare assets, you’ll naturally be concerned about the broader health of the private healthcare sector.
The Federal Government recently ran a comprehensive health check on the private sector, looking at patient demand, workforce supply and profitability.
Let’s take a look at the findings and how RAM has responded in the way it manages its extensive portfolio of healthcare properties.
| Factor | Federal Government review | RAM’s perspective |
| Private hospital demand | Hospitalisations in private hospitals increased to represent 41.2% of the market in 2022-23, up from 40.3% pre-COVID (2018-19). | Private hospitals are increasing their market share. |
| Patient type | Over 74% of patients in private hospitals stayed for less than 24 hours. | Demand for private day procedures is increasing. |
| Changing demand | Same-day visits grew by 2.66% pa from 2018/19 to 2022/23, significantly more than overnight stays (0.22% pa). | There’s significant growth in lower acuity same-day procedures. We’ve aligned our real estate solutions with this long-term trend. |
| EBITDA margins | Estimated weighted average EBITDA margin was between 7-8% in 2022/23. | Margins, while tighter than pre-pandemic levels, are improving. |
| Private maternity | Private maternity and obstetric services have been under pressure due to out-of-pocket price inflation, reduced birth rates and workforce constraints. | Caution needed when considering investment in private maternity services. |
| Private mental health | Workforce constraints have put pressure on private mental health operations. | We partner with strong operators aligned with a specialist workforce. Psychiatry registrar numbers increased by 7.42% annually from FY19 to FY23, which should provide workforce relief. More broadly, record levels of immigration have eased staff shortages in healthcare as they have in other sectors. |
The review indicates strong growth in same-day surgeries with a watch on average sustainable margins across the broader hospital sector. There’s increasing reliance on the private sector for hospitalisations as operating margins stabilise post COVID.
Around 70% of elective surgeries take place in private facilities and most private hospital patients (an all-time high of 74%) stay less than 24 hours. This is reflected in the diversified portfolio of RAM Essential Services Property Fund (REP), which only has limited exposure to overnight private hospitals.
…with robust earnings
The most recent Australian Bureau of Statistics report revealed that Private Healthcare and Social Assistance had the eighth-highest EBITDA margin out of 19 industry categories — a healthy 16.3%1. While slightly down from pre-COVID levels (18.2% in June 2018), margins have remained largely stable since 2014.
If we exclude Social Assistance (aged care and childcare) and focus on Hospitals (psychiatric and non-psychiatric), Medical and Other Health Care Services (pathology, allied health, general and specialist services and other healthcare services), this margin increases to 25.2%, lifting it to third behind Mining and Real Estate Services.

Uncovering hidden healthcare gems
Strotton says RAM takes a dynamic approach to securing healthcare assets. “At RAM our preference in different sub-sectors of healthcare can evolve throughout the cycle – from larger acute, overnight hospitals with public, private and not-for-profit operators to community-based, ancillary health and day hospitals, incorporating secondary and tertiary care”, he says.
“We’re directing our efforts to unearthing those unique opportunities – something that distinguishes RAM as a unique provider of healthcare real estate investment solutions now and into the future.”
RAM offers a variety of entry points for healthcare real estate investors, including the listed RAM Essential Services Property Fund (REP), which is in the process of recalibrating from a 50/50 split between neighbourhood retail and healthcare towards a pure healthcare REIT. The fund offers stable and secure income with the potential for capital growth through exposure to a high-quality portfolio of assets with favourable sector trends.


