Over the past couple of decades a key theme for South African investors has been to see their blue-chip companies seek expansion opportunities outside the country to deal with the discount associated with political risk at home. Hospital groups have not been immune to these pressures, but about 12 years after venturing into the UK, Netcare's scorecard doesn't make for good reading. The question is just where the growth is, as the most recent results from Netcare, Mediclinic and Life Healthcare reflect the challenges they face outside SA, while battling a domestic market that is seemingly mature. After a period of high-volume growth from 2008 until 2015, the past three years had been difficult for hospital groups, said Samantha Hartard, a portfolio manager at Investec. In 2014, SA's population of insured lives was 8.8-million. Four years later, the figure is unchanged. Hartard said the stagnant growth in insured lives was exacerbated by the pressure on hospitals from medical aids try...

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