The investigation, authored by the Center for International Corporate Tax Accountability and Research, digs into the financial structure and assets of Ramsay Santé, one of France's largest private hospital operators, exposing a troubling pattern of financial extraction that threatens healthcare quality and working conditions.

The report uncovers how healthcare companies such as Ramsay are increasingly selling their buildings to third-party landlords, then paying substantial rental payments for years afterward. This practice has created a lucrative market for property investors who extract enormous profits while bearing minimal risk and responsibility.

Key findings include:

• Just four property investment vehicles receive over €400 million annually in rents from French healthcare establishments

• These investors are generating profit margins between 41-129%, far exceeding even highly profitable tech companies

• An estimated €2.5 billion was paid to private property investors by French healthcare facilities in 2023 - equivalent to annual salaries for more than 82,000 nurses

• Special tax regimes allow many of these property investment funds to pay extremely low tax rates of just 1-6% on their profits

This report alleges no impropriety or illegality on the part of Ramsay Santé or the investment funds mentioned herein; indeed, they exemplify a widespread system incentivised by government decisions and tax incentives.

Responding to the report findings, PSI General Secretary Daniel Bertossa said: “Our member unions in the health sector are exposing the huge leakages of public funds away from hospitals and health worker wages and into private bank accounts. It’s time to finally get profit out of healthcare make sure public funds are used to boost public health - not private profits.”

The report highlights how this financial extraction is occurring at a time when France's health system faces multiple crises, including:

• Systemic pressure from the COVID-19 pandemic aftermath

• Growing challenges from an aging population

• Increasing prevalence of chronic diseases requiring intensive hospital care

• Serious inequalities in healthcare access between regions and social classes

There are alternatives to this leakage of public funds to private property speculators. In other European countries, public authorities own or have repurchased the buildings within which both for-profit and non-profit providers of public services operate.

Other countries, such as Norway, recently introduced transparency requirements which require certain public service providers to show their rental and purchasing costs, and ensure they are in line with market prices. Furthermore, ending tax subsidies for property investment funds would level the playing field, encouraging a mix of ownership models for the bricks and mortar of the French health system