It is interesting to look at how far many very large healthcare service groups in Europe are controlled by what we could refer to, politely, as gerontocrats. Many of whom seem to have no clear succession plans.

In Germany, Asklepios, Europe’s largest private hospital group, is, of course, owned by its founder, lawyer and accountant, Bernard gr. Broermann.
At Asklepios’s largest rival Rhoen Klinikum, founder Eugen Muench, chairman of the Rhoen Klinikum board and his family, own a 16% stake which gives him blocking rights in the event of a takeover. An analyst said: “He has his own agenda, which sometimes seems to have little to do with profitability, but rather with building a parallel system to the public healthcare sector.”

In France, Orpea, the largest care home group, which also has several psychiatric hospitals, is run by the sprightly Dr Jan-Claude Marian who is 70. He owns a 20% stake and his friends hold a further 30%. He shows no sign of wanting to quit.

But Italy is in a class of its own, according to Professor Francesco Longo, director of health policymaking unit Cergas: “Companies are heavily dependent on bank debt and are still family owned. Many are owned by men in their 70s and 80s, for whom their hospital chain is a badge of self-identity. When you ask about the future they say ‘what do you mean? I’ll still be around!’ The reality is that these groups will be taken over by the banks eventually.”

Prof Rotelli, owner of Gruppo San Donato, the largest for-profit group, is 70. But Father Don Verzè, the priest who is president of San Raffaele, is 90, and held a workshop last month on living to 130, which was also attended by controversial premier Silvio Berlusconi.