What EBITDA multiple does a clinic sell for?

There is no single number. On this site we use an indicative range of 5x to 9x EBITDA for clinics and laboratories, pending review by the person who signs our valuations. The position within the range depends on scale, insurer concentration, dependence on the founder and the quality of the financial records.

Is a clinic that depends on its founding doctor worth less?

Usually, yes. If patients come because of the founder and he or she signs a large share of reports or procedures, the buyer fears losing revenue after the founder leaves. This tends to lower the multiple or move part of the price into an earn-out with a transition period.

What should a foreign buyer check when buying a clinic in Brazil?

Beyond the numbers: health insurer contracts and their renewal terms, the history of claim denials (glosas), health surveillance licenses and the CNES registration, the tax regime (Lucro Real or Lucro Presumido), and the labour risk of doctors hired as independent contractors through their own companies (PJ).

Is the building included in the value of the clinic?

Usually not. It is common for the partners to own the property and lease it to the company. That is why rent must be set at market terms in the calculation: if it is below market today, adjusted EBITDA goes down.

Healthcare business valuation: how much is a clinic worth in Brazil?

Short answer

A clinic or laboratory in Brazil is usually worth its adjusted EBITDA times an industry multiple, cross-checked with a discounted cash flow, minus net debt. On this site we use an indicative range of 5x to 9x EBITDA for healthcare, still under review. Where a business lands in that range depends on risk: concentration in one health insurer, dependence on the founding doctor, claim denials, equipment age and how the medical staff is contracted.

How a clinic is valued

The starting point is adjusted EBITDA: operating profit for a normal year, without the partners’ personal expenses, without one-off items and with salaries and rent at market levels. That figure is multiplied by a multiple that reflects the size and risk of the business. The result is enterprise value (EV). Net debt (loans, tax installment plans and equipment leases, minus cash) is then subtracted to reach equity value, which is what the shareholders actually receive.

A multiple should never be used alone. We also run a discounted cash flow, which projects the cash of the coming years and brings it to present value. When the two methods point to very different figures, an assumption needs a second look.

For a first estimate, try the business valuation calculator. It applies the indicative healthcare range of 5x to 9x EBITDA shown on the EBITDA multiples by industry page. That range is a working reference, still under review by the person who signs our valuations, and not a market statistic.

What moves the multiple in healthcare

Two clinics with the same EBITDA can be worth very different amounts. A buyer pays for future cash and discounts the risk that it will not arrive. In Brazilian healthcare, these points weigh the most:

Health insurer concentration. Most private patients in Brazil are covered by health plans (convênios). If one insurer accounts for a large part of revenue, a fee renegotiation or a contract termination changes the business. Revenue spread across insurers and private-pay patients is worth more.
Dependence on the founding doctor. Patients who come for the founder, reports and procedures concentrated on one person, and insurer relationships handled only by the founder all lower the multiple.
Claim denials and receivable terms. Insurers in Brazil routinely deny or cut part of the billed amount (glosas) and pay on long terms. High denials tie up cash and signal weak billing processes.
Equipment age and capex. Equipment near the end of its useful life means investment right after the deal. That amount comes off the price, one way or another.
Licenses. Health surveillance permits (vigilância sanitária), the national health facility registry (CNES), a designated technical director and professional council registrations. A missing license can stop the closing.
Doctors hired through their own companies (PJ). This is common practice, but in due diligence the buyer measures the risk that these contracts are treated as employment and may ask for part of the price to be held back.
Rent on the partners’ property. If the partners own the building and rent is below market, today’s EBITDA is higher than it will be under a normal lease. The calculation corrects for it.
Number of locations. Several units under standardised management reduce single-site risk and appeal to buyers building a network.

What raises and what lowers the multiple

Raises the multiple	Lowers the multiple
Revenue spread across several insurers and private-pay patients	One insurer with a large share of revenue
Medical staff that works without depending on the founder	Founder who concentrates patients, reports or procedures
Low, controlled claim denials and predictable payment terms	High denials and late receivables
New equipment or a planned replacement schedule	Equipment at the end of its life, deferred investment
Licenses, CNES and technical director in order	Expired permits or open issues with health surveillance
Well-structured contracts with doctors	PJ doctors working like employees
Several units with standardised management and systems	A single unit without professional management
Audited or well-organised financials	Personal and company accounts mixed together

Typical EBITDA adjustments in a clinic

Founder compensation set at the market cost of a doctor and a manager who would do the same work.
Rent on partner-owned property brought to market level.
Personal expenses paid by the company (cars, travel, family health plans) added back.
One-off costs such as a renovation, a closed lawsuit or a system migration.
Claim denials and bad debt taken at the historical average, not the best year.
Equipment maintenance and replacement, which is a real cost of running the business even if it does not show in EBITDA.

Every adjustment needs supporting documents. A buyer will not accept one without them.

Illustrative example: a diagnostic imaging network

Our sample valuation report uses a fictional company: a diagnostic imaging network with adjusted EBITDA of R$ 6.2 million and a 16% margin. The largest insurer accounts for 31% of revenue, the founder signs 14% of the reports and the partners’ buildings are rented below market. With those points, the implied multiple came out between 5.6x and 6.6x, below the middle of the indicative range. The report also shows what could raise that figure before a sale. The numbers are illustrative and do not represent a client.

Who buys clinics and laboratories in Brazil

Regional networks that want to enter a new city or gain share where they already operate.
Sector consolidators that acquire several businesses and standardise management, purchasing and insurer negotiations.
Investment funds, local or foreign, that buy a platform to grow through acquisitions and exit after some years.
Doctors and medical groups, in smaller deals or when buying out a partner.

For foreign buyers, the points above sit alongside Brazil-specific checks: the tax regime, currency exposure and labour liabilities that can follow the company after closing. If you are the owner and have received an approach, read I received an offer to buy my business. If you are planning a sale in the next few years, see how to sell my business.

Before talking to a buyer

Gather three years of figures with revenue by insurer, the claim denial history, an equipment list with ages and the contracts of the medical staff. Fix what can be fixed: licenses, the lease, dependence on the founder. This takes time, and it is what separates the bottom of the range from the top.

Meu Equity provides business valuation for clinics, laboratories and healthcare companies, with the method and assumptions explained behind every number.