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April 30, 2024

Getting the right healthcare property exposure: why medical centres

Colin Mackay, Research and Investment Strategy Manager, Cromwell Property Group


Healthcare property encompasses a range of asset types such as hospitals, medical centres, and aged care facilities. As outlined in the previous article of this series, the healthcare industry is benefitting from several demand tailwinds. However, it’s not all smooth sailing, as evidenced by recent news of private hospital closures1. In this article, we’ll explain why we believe medical centres is the specific property segment investors should prioritise.


A necessary care model

As the population ages, the supply of health services is struggling to keep up with demand, resulting in higher costs and longer wait times. Inadequate financial and labour resources are available to improve care standards or wait times under the status quo – a more efficient and cost-effective system is required.

public hospital elective surgery wait times

Part of the required shift includes moving treatment out of hospitals and towards GPs and other primary or secondary care facilities. Focusing on primary healthcare and out-of-hospital care can result in better health outcomes2, reduced risk of infection and improved patient comfort, convenience, and satisfaction3,4. From a funding perspective, out-of-hospital care can be cheaper due to lower overheads compared to when a hospital bed is occupied4.

Avoidable emergency department presentations are clogging the hospital system, with an estimated 1.9 million preventable patient days per annum from those aged 65+ alone5. It would be more appropriate to provide this care in an efficient, fit-for-purpose medical centre environment, saving costs and freeing up hospital resources for actual emergency care and complex cases.

The shift from hospital to non-hospital care is already underway and evidenced by growth in primary healthcare spending outpacing spending on hospitals, as well as government policies putting greater emphasis on primary care and preventive health. For example, the Federal Government has announced a $99m initiative to connect frequent hospital users with a GP to reduce the likelihood of hospital re-admission, and $79m in funding to support the use of allied health services for multidisciplinary care in underserviced communities6.


Attractive investment characteristics

In addition to demand and funding tailwinds, medical centres offer several attractive investment characteristics:

High quality cashflow
derived from a reliable tenant base
A hedge against inflation
via CPI-linked or fixed rental escalations
Long leases (typically 5-15 years)
sometimes on a triple net basis
Higher rates of lease renewal
compared to traditional office7

Compared to private hospitals, medical centres may be preferred due to deriving income from a typical commercial lease structure, rather than a percentage of operator EBITDAR. Land also typically comprises a greater proportion of asset value, which can provide downside protection and aid long-term development or change of use potential.

Private Hospitals
Medical Centres
Lease term 20-30 years 5-15 years
Basis of income Percentage of operator EBITDAR, quoted on per bed basis Typical commercial lease structure, quoted per sqm
Tenant profile Single operator One or several tenants
Capital intensity Very high Moderate to high

Summarised from Exploring Australian healthcare opportunities, JLL (Jun-23)

An increasingly important part of the healthcare landscape

Medical centres are an increasingly important part of the healthcare landscape, representing efficient and fit-for-purpose facilities that can help alleviate the capacity constraints of hospitals and improve the sustainability of the health system.

We believe medical centres’ alignment with demand trends and Government healthcare spending priorities, together with attractive investment characteristics such as CPI-linked income and defensive land holdings, puts them in a favourable position compared to other healthcare property investments.


  1. Ramsay Health Care warns of hospital closures as costs blow out, AFR (Feb 29th, 2024)
  2. How much of Australia’s health expenditure is allocated to general practice and primary healthcare?, M. Wright; R. Versteeg; K Gool (Sep-21)
  3. Out-of-hospital models of care in the private health system, Australian Medical Association (Oct-23)
  4. There’s no place like home: reforming out-of-hospital care, Private Healthcare Australia (May-23)
  5. Health is the best investment: shifting from a sickcare system to a healthcare system, Australian Medical Association (Jun-23)
  6. Federal Budget 2023-24, Treasury (2023)
  7. Exploring Australian healthcare opportunities, JLL (Jun-22)

Cromwell Healthcare Property Fund

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