The European hospital model is going through a crisis that is no longer a matter of budget management alone, but of structural deadlock. In France, the Fédération Hospitalière de France (FHF) estimated the deficit of public hospitals at €2.7 billion in 2025, illustrating the inability of traditional structures to absorb rising costs (energy, salaries, etc.) within a constrained revenue framework. The situation is similar in Germany, where three out of four hospitals ended 2024 in the red, while nearly 89% of public institutions face significant financial difficulties.
Beyond finances, hospitals are also facing a structural shortage of human capital. In the United Kingdom, although the NHS has managed to increase its number of healthcare staff, 112,000 healthcare positions were vacant in 2023. In France, several thousand beds are closed every year, partly due to a lack of care staff, and more than 40,000 beds have disappeared in the past ten years (DREES). Hospitals can no longer afford the luxury of “inpatient stays”: every avoidable night uses scarce resources and limits access to care for other patients. Beyond bed capacity, performance is now also measured by how quickly operating rooms and technical platforms turn over.
In this context, ambulatory surgery centers are emerging not merely as an organizational option, but as a potential response to the system’s growing efficiency constraints. By isolating certain scheduled surgical activities and limiting inpatient stay costs, they optimize patient flows through a more specialized and standardized model.
Their development, already well proven in the United States, now raises a question for European health systems: to what extent can this model be transposed, and how? Beyond this organizational question, the entire value chain could be reconfigured, particularly for medtech players. Will the value of a medical device tomorrow be judged on its clinical performance alone, or on its ability to fit into workflow logics , efficiency, and patient pathway optimization?
In this article, Alcimed analyzes the dynamics at play and their implications for industry players.
The American model is today’s benchmark for ambulatory surgery centers. Ambulatory surgery in the United States has developed around independent, single-specialty centers covering a broad range of surgical disciplines, with recent strong growth in cardiology (6.3%) and orthopedics (18.9%). These centers rely on an industrial logic combining specialization of procedures, standardization of processes, and optimization of patient flows. This organization achieves higher levels of operational efficiency than traditional hospitals, thanks to predictable schedules and fast turnover between patients. American ambulatory surgery centers thus perform more than 22.5 million procedures every year, and their operation generates more than $4.2 billion in annual savings for Medicare.
Beyond the efficiency and cost gains, the American model developed in a very specific context. Many ambulatory surgery centers are owned or co-financed by surgeons themselves, and the sector is strongly backed by private equity funds. This configuration, which fosters a culture of performance and operational optimization, is harder to imagine in Europe, where most hospitals remain public and heavily regulated.
In Europe, ambulatory surgery remains mostly integrated within hospitals, but new dynamics are beginning to emerge. Saturated facilities and economic pressure are creating a need to rationalize costs and better manage patient flow, pushing care toward outpatient settings. This movement is accelerating thanks to maturing technologies (minimally invasive surgery, portable robotics, fast-acting anesthetics) that now make it possible to perform procedures that once required a long hospital stay. This trend is also supported politically and financially. The European Commission has launched calls for projects under Horizon Europe to promote the creation of specialized ambulatory surgery centers, notably in orthopedics and cardiology, with funding of up to several million euros per project, illustrating that Europe is actively exploring the ambulatory surgery center model and hybrid solutions to improve care efficiency.
In this context, Europe is moving toward a hybrid model: in the short term, a strengthening of integrated structures (outpatient services that are an integral part of hospitals but provide day care), and in the medium to long term, the gradual emergence of specialized, autonomous ambulatory surgery centers. Adoption remains uneven. Pioneers (United Kingdom, Germany, Scandinavia) already have independent centers and incentive-based flat-rate payments, while other countries (France, Italy, Spain) see development held back by regulation, even though investment from large private groups is speeding up the transformation. This shift redistributes the balance by outsourcing schedulable activities that require little or no inpatient stay, and by refocusing general hospitals on care that requires full hospitalization and prolonged monitoring.
Ambulatory surgery centers no longer buy just a medical device, but a seamless care pathway. Manufacturers must now offer complete, ready-to-use solutions, for example sterile kits that reduce the need for on-site sterilization. While pharmacists, surgeons, and purchasing directors already take part collectively in purchasing decisions in traditional hospitals, the surgeon plays an even more central role in these centers, and with that role, the center’s overall profitability becomes the deciding criterion.
Beyond the purchase price alone, it is the entire economic equation that matters: operating time, operating room turnover, complication risk, and total cost of the care pathway. The decision-maker is no longer only the hospital pharmacist or purchasing director, but often the surgeon or the manager of a private network.
Finally, logistical constraints demand excellence in just-in-time delivery and consignment stock management, as ambulatory surgery centers have limited storage capacity.
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Ambulatory surgery centers are a prime setting for adopting high-value innovations that are practical, high-performing, and carry medico-economic benefits. The technologies with the greatest potential are those that simplify the surgical workflow, reduce time per procedure, ensure patient safety, and minimize the risk of recurrence or complications, while making it possible to shift surgeries once performed in hospitals to an ambulatory format.
Ambulatory surgery centers create the conditions for repositioning one’s offering. Manufacturers able to offer an integrated solution combining a device, consumables, and post-operative follow-up software move past unit sales to address the overall performance of the care pathway, which is now what purchasing departments seek.
At the same time, the rise of ambulatory surgery centers opens new opportunities for digital players, with tools for scheduling, telemedicine, and care pathway coordination, offering an integrated ecosystem around ambulatory surgery.
The emergence of autonomous ambulatory surgery centers in Europe is more than an organizational change. It reflects a shift toward more industrialized medicine, increasingly specialized structures, and a logic of greater efficiency. For medtech players, this means three priorities:
Alcimed can support you in anticipating this transformation and securing your position in this new care environment. Don’t hesitate to contact our team!
About the author,
Virgile, Consultant in Alcimed’s Life Sciences team in France
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