Healthcare is becoming critical infrastructure, rather than an alternative asset class.
Institutional capital is showing growing interest in healthcare, while perceptions of healthcare real estate are also evolving. The essential care provided by nursing homes, hospitals, clinics and mental health facilities, combined with the investment fundamentals they offer, is attracting investors seeking long-term stability.
This was highlighted by Gonzalo de Troya, CIO of Healthcare Activos, during the editorial roundtable “Opportunities in Alternative Assets”, organised by Observatorio Inmobiliario and sponsored by Urbanitae, Nhood and Grohe.
The pandemic marked a turning point in this perception. As De Troya explained, before COVID-19, healthcare was regarded as a “highly alternative” segment. Since then, it has increasingly come to be recognised as critical infrastructure for society, given its essential role in caring for vulnerable people.
From an investment perspective, De Troya identified three key characteristics that attract investors to the sector: long-term leases, stable cash flows and inflation-linked income.
Investment to modernise and expand healthcare infrastructure
“There is a significant need for investment to modernise existing facilities and, above all, to develop new ones,” he said in his assessment of the event, highlighting the growing interest of institutional investors in the healthcare sector.
This influx of capital is also taking place alongside the increasing professionalisation of operators, a trend which, in his view, is set to continue positively in the coming years.
Healthcare provision requires specialist expertise
De Troya distinguished between senior living and nursing homes, where healthcare and care services play a much more significant role than accommodation services. Between the two sits assisted living, a housing option for older people that is often linked to a residential care facility.
The importance of care provision makes the choice of operator a crucial consideration: “It is absolutely essential to work with an operator that specialises in providing this type of care because, ultimately, you are looking after vulnerable people who are on medication and often have multiple health conditions, whether in a hospital, clinic or nursing home.”
Institutional capital expands its presence in the sector
The interest described by De Troya is also reflected in the Spanish market, where investment in healthcare real estate reached €471 million in the first quarter of 2026, the highest volume ever recorded for that period and more than ten times the figure registered a year earlier, according to JLL. This growth follows Spain’s consolidation in 2025 as the fourth-largest European healthcare market by investment volume.
Against this backdrop, Healthcare Activos launched Healthcare Activos Hospitals in July, an investment vehicle backed by long-term institutional investors already associated with the asset manager, with an initial investment target of €800 million. Its strategy covers the acquisition, development, expansion and modernisation of private hospitals in the United Kingdom, Spain, Portugal, Ireland and Italy, through long-term triple-net leases with inflation-linked rents.
Its first transaction comprises three hospitals in Lisbon, Porto and Albufeira, representing an investment of €250 million, including planned works to expand and modernise the facilities. Acquired from a fund managed by Praemia REIM, the hospitals have a combined capacity of 350 beds, 21 operating theatres and 255 consultation rooms, with Lusíadas Saúde, part of Vivalto Santé, remaining as operator.
Adapting assets to meet healthcare needs has also been incorporated into financing arrangements. That same month, the asset manager linked the €122.5 million senior loan of Healthcare Activos Yield 2, its investment vehicle focused on nursing homes, mental health and rehabilitation, to ESG criteria. The transaction was backed by a banking syndicate comprising Crédit Agricole CIB, BNP Paribas, Abanca and Novobanco, and includes indicators relating to access to healthcare in underserved areas, sectorised care models and decarbonisation. With this agreement, all acquisition debt across its investment vehicles became linked to sustainability targets.
Following the acquisition of the Portuguese hospitals, Healthcare Activos reported in July a total investment volume of €1.6 billion across seven European countries, of which €1.2 billion related to nursing homes, mental health and rehabilitation, with the remaining €400 million invested in hospitals and clinics.
Its investment plan envisages annual investments of between €350 million and €400 million, with the objective of growing the portfolio to €3 billion by 2030.
