📖 Approx. 7 min read ／ Updated 2026.05.08
Overview and Characteristics of the Medical M&A Market in the Kansai Area
The Kansai area, as Japan’s second-largest medical M&A market after the Tokyo metropolitan area, has been increasing its presence in recent years. Particularly in urban centers like Osaka, Kyoto, and Hyogo prefectures, the need for business succession among medical institutions is significant, leading to an increase in M&A-based transfers. The aging of clinic directors, leading to succession issues, and the advancement of regional medical plans, driving healthcare system reorganization, are the primary factors boosting this market’s activity. Furthermore, the distinct regional characteristics, from urban centers to suburbs and mountainous areas, result in significant differences in healthcare delivery systems, patient demographics, and evaluation criteria for medical institutions, which are important perspectives when considering M&A in the Kansai area. Specifically, the reorganization of hospital bed functions under regional medical plans and participation in home healthcare and community-integrated care systems are directly linked to the future prospects of medical institutions, requiring detailed analysis during M&A due diligence.
Medical M&A Market in Osaka Prefecture: Diversity and Transfer Price Trends
Osaka Prefecture is an area where a diverse range of medical institutions coexist, from central districts like Umeda, Namba, and Tennoji, to residential areas and suburbs. In urban centers, M&A activity is brisk for clinics focusing on cosmetic medicine and private-pay services, with highly profitable institutions tending to have transfer prices set relatively high compared to their annual sales. For example, self-pay clinics with annual sales exceeding 100 million yen sometimes see transfer prices exceeding 150 million yen, supported by specific brand strength, unique technologies, and patient acquisition capabilities. On the other hand, clinics primarily offering insurance-based services located in residential areas are valued for their trust from local residents, long-standing track records, and stable patient base. For clinics with annual sales around 100 million yen, a transfer price of 30 to 100 million yen is considered standard. However, this is merely a guideline, and prices can fluctuate significantly based on a wide range of factors, including specialty, fulfillment of facility standards, response to medical fee revisions, the age of medical equipment, and the willingness of physicians and staff to transfer. In particular, the impact of future medical fee revisions and the institution’s positioning within regional medical plans are essential elements for long-term revenue projections.
Market Trends and Evaluation Points in Kyoto and Hyogo Prefectures
The medical M&A market in Kyoto Prefecture combines traditional regional healthcare unique to the ancient capital with the characteristics of a tourist city. Clinics rooted in the community tend to be valued for their long-term relationships with patients and stable management foundations. Additionally, from the perspective of an international tourist city, the potential for private-pay services and health check-up businesses targeting inbound demand can also be an evaluation point. Hyogo Prefecture, especially Kobe City and the Hanshin area (Nishinomiya, Ashiya, etc.), is an area where many affluent individuals reside, and there is stable demand for clinics that provide high-quality medical services and specialized treatments. Health check-up services and specific specialties (e.g., orthopedics, dermatology, ophthalmology) tend to be popular in the M&A market as stable revenue streams. In these regions, the status of collaboration with medical associations and the willingness to participate in community-integrated care systems can also influence the evaluation of a medical institution’s contribution to the community. Furthermore, the status of permits and licenses and whether specific facility standards are met are crucial for post-acquisition business development, requiring careful verification.
Medical Corporation Types and Shareholding: Key Issues in M&A
In the M&A of medical corporations, the type of corporation is an extremely important issue. Specifically, the distinction between “medical corporations with shareholding” and “medical corporations without shareholding” has a decisive impact on the transfer scheme, taxation, and determination of the transfer price. In the case of medical corporations with shareholding, the management rights of the medical institution are effectively transferred by transferring the shares held by the members (shareholders). At this time, the director, who is a member, will incur capital gains tax, which significantly affects the transfer price. Furthermore, the valuation of shares is generally calculated based on the net assets of the medical corporation, but in some cases, intangible assets such as medical rights and goodwill may also be considered. On the other hand, in the case of medical corporations without shareholding, since there is no concept of transferring shares, management rights are succeeded through the change of “members” such as directors and supervisors. In this case, a succession scheme involving the new director paying a “retirement allowance” to the former director, or a scheme involving the “return of funds” in the case of fund-based medical corporations, may be considered. In either type, the procedure for changing members involves specialized legal procedures such as amending the articles of incorporation of the medical corporation, reporting to the prefecture, and changing the registration. In particular, for the return of funds, securing the funds to be returned and confirming the conditions for return are essential.
Impact of Medical Fee Revisions and Facility Standards on M&A Evaluation
When considering M&A for medical institutions, medical fee revisions and facility standards are indispensable elements for evaluating the future profitability and business continuity of the target institution. Medical fees are revised every two years, and their content directly impacts the management of medical institutions. For example, reductions in the points for specific medical procedures or examinations, or the introduction of new additions, can significantly affect the revenue plan after M&A. Potential acquirers need to analyze the trends of past medical fee revisions to assess in detail how the target institution has been affected and what risks and opportunities exist in future revisions. Furthermore, the “facility standards” obtained by the medical institution are also important. These are standards set by the government regarding staffing and equipment required to perform certain medical procedures, and without meeting them, medical fees for those procedures cannot be claimed. Whether existing facility standards can be maintained after M&A, or whether new facility standards can be acquired for new treatment development, directly relates to the feasibility of the business plan. A thorough due diligence by experts, including the continuity of permits and licenses and future renewal requirements, is essential.
Tax and Legal Considerations in Medical Succession
M&A of medical institutions, or medical succession, requires a wide range of specialized considerations in both tax and legal aspects. On the tax side, the transferring party will incur capital gains tax on the transfer of shares or income tax and resident tax as retirement allowances. It is important to set an appropriate transfer price after considering these tax burdens. On the other hand, for the acquiring party, it is essential to evaluate the assets and liabilities of the acquired medical corporation or clinic, especially to confirm the absence of off-balance-sheet liabilities. The treatment of medical corporation business tax is also complex, and it is necessary to understand the method of calculating taxable income and the applicable tax rates depending on the business form. On the legal side, confirming compliance with related laws such as the Medical Care Act, the Medical Practitioners Act, and the Act on Comprehensive Promotion of Healthcare and Long-Term Care is paramount. In particular, legal due diligence to identify potential risks, such as the appropriateness of permits and licenses, history of medical accidents, patient information management system, employment contracts with employees, and real estate lease agreements, should be conducted thoroughly. It is also necessary to evaluate legal risks in future business development, considering medical bed reorganization based on regional medical plans and legal amendments to adapt to changes in the healthcare delivery system. To facilitate these complex processes smoothly, collaboration with tax accountants, lawyers, and certified public accountants who are well-versed in medical M&A is indispensable.
Successful Medical M&A Strategy in the Kansai Area
To achieve success in medical M&A in the Kansai area, it is crucial to deeply understand the region’s unique medical culture and market trends and to approach it strategically. First, directors and presidents of medical institutions considering a transfer should objectively analyze their institution’s strengths, weaknesses, and future prospects, and clarify to whom they wish to transfer their business. In particular, the institution’s role in regional medical plans and its participation in regional healthcare collaboration will significantly influence the acquirer’s evaluation. Acquirers should evaluate not only the financial status of the target institution but also comprehensively assess the characteristics of the service area, patient demographics, competitive landscape, and reputation within the local community. Furthermore, it is essential to thoroughly understand the differences in succession schemes based on medical corporation types, trends in medical fee revisions and facility standards, and tax and legal risks in advance, and to proceed with negotiations cautiously in collaboration with experts. The Kansai area has diverse M&A needs, ranging from community-based clinics struggling with a lack of successors to urban clinics aiming for business expansion. For each case, the dedicated support of an M&A intermediary company specializing in the healthcare industry will be indispensable to achieve optimal matching and smooth succession.
M&A Medical, leveraging its extensive support experience and specialized knowledge in the Kansai area, provides comprehensive support for the business succession of medical institutions. In the complex process of medical M&A, please utilize our free consultation service to guide you to the best choice for your institution. Our specialized consultants will carefully listen to your institution’s situation and propose the optimal M&A strategy.
For Medical Succession Consultations, Contact M&A Medical
M&A Medical is a specialized M&A and business succession support service for medical institutions. As an M&A support institution certified by the Small and Medium Enterprise Agency, we support the success of transfers for clinics and medical corporations struggling with a lack of successors, as well as strategic acquisitions, on a success fee basis.
- Initial consultation and preliminary assessment are free
- No upfront fees or monthly charges (success fee only)
- Strict confidentiality (proceeds under NDA)
- Support for all 47 prefectures and all medical specialties
Please consult with us early in your consideration phase, whether you just want to know the market value, have no successor, or are considering joining a group.