Access to products and services

Our impacts, risks, and opportunities [S4 SBM-3] Material impacts, risks, and opportunities and their interaction with strategy and business model

We assume responsibility for the well-being of millions of patients. Our portfolio includes vital products and therapies whose development takes into account various social and regulatory requirements. These also need to be adapted to different healthcare systems in order to meet differing regulatory requirements or social aspects, such as cultural differences. In this way, we contribute to meeting the growing global demand for innovative, high-quality, and affordable therapies. Our range of products and services includes the services of a broad network of clinics as well as high-quality pharmaceuticals and medical devices. We also use digitalization opportunities, such as those described in the company-specific standard Digital transformation, and develop new forms of therapy. In this way, we aim to reach as many people as possible with our healthcare services and products. In doing so, we strive for equitable access to medical care and the non-discriminatory treatment of people as part of our vision of health equity. We have committed to this ambition by signing the Zero Health Gaps Pledge, among other things. We want to overcome financial inequalities through affordability and fair pricing and are also committed to gender-equitable healthcare. This will not only have an actual positive impact on current and future patients in our healthcare facilities and in our downstream value chain, but also bring medium-term financial opportunities for us. By providing more and more information and high-quality services, we can build a broader customer base and strengthen customer loyalty, thus improving our financial performance. Access to affordable, innovative medical products also has a positive impact on the downstream value chain: we are obliged to provide comprehensive information about our products and services, conduct educational talks before treatments and provide technical services. Our activities described in topical standard G1 Business conduct are also intended to support the sensitization of relevant stakeholders. In order to avoid potential negative effects, we must offer a high quality and create the framework conditions for the safe handling of medicinal products.

At the same time, our ambition to provide as many people as possible with our products and services also presents us with challenges. These primarily relate to medium-term risks, such as systemic changes in reimbursement or government regulations that could affect our financial position or financial targets. These market developments can also have a potential negative impact on our patients and customers, who may have less access to affordable, high-quality products and services as a result.

Crises such as geopolitical conflicts or severe weather events also pose a risk to the maintenance of our business activities. These can lead to short- to medium-term interruptions in supply chains, production shutdowns, and restrictions in the supply of our facilities. To protect our patients and maintain access to our products and services, we need a robust crisis management system. Our approach to dealing with climate change and its impacts can be found in the topical standard E1 Climate change.

Our approach [S4-1] Policies related to consumers and end-users

Access to healthcare and medicine

Fresenius’ long-term goal is to further develop its position as one of the leading international providers of healthcare products and services. In recent years, we have expanded our company along our value chain – increasing the global availability of our products and services. We launched the #FutureFresenius transformation in February 2023 with the aim of positioning the company with a clear focus for future growth.

Our strategy to promote access to healthcare and medicine includes the following areas:

• Affordable medical products
• Integrated healthcare concepts
• Patient support in crisis and emergency situations

The strategy also covers the topics of innovation and digital transformation, which we disclose separately in the corresponding company-specific standards Innovation and Digital transformation.

Affordable medical products

With our comprehensive range of products, which also includes generics and biosimilars, we provide access to modern, high-quality, and affordable therapies for patients. Generics and biosimilars are cost-effective alternatives to originator drugs. They help to lower the price of treatments and thus reduce the burden on healthcare systems. To promote accessibility and affordability of healthcare products in a resilient way, we support various initiatives and work together with other companies in international, European and national associations. For further information, please refer to the standard ESRS 2 General disclosures, section SBM-2 Stakeholders and partnerships.

In addition, as many people as possible worldwide should have the chance to participate in this progress. We therefore want to help make access to critical medicines and health services more equitable worldwide and support the development of sustainable health systems. This means we want to make treatment and health education available to everyone who needs them, irrespective of age, income, race or ethnicity, or education. This ambition is particularly reflected in our commitment to society. In January 2024, Fresenius signed the Zero Health Gaps Pledge to promote equal opportunities in healthcare.

Ensuring the availability of our products and access to our services is an important concern for us: Avoiding bottlenecks in the supply of important medications is also a priority. This also includes our own facilities.

Integrated healthcare concepts

In recent years, healthcare providers, regulatory authorities, and insurance companies around the world have been working to improve treatment outcomes for patients while simultaneously reducing healthcare costs. This benefits- and results-oriented concept is known as value-based healthcare.

This scientific approach supports our long-standing strategy: systematic establishment of regional care clusters and interdisciplinary knowledge sharing among experts, from which all hospitals in our network can benefit. Patients should benefit from the focus on technological advances, innovative treatment options, and our investments in high-level healthcare infrastructure and technical equipment. With this approach, we want to help to tackle the increasing cost pressure for insurers and relieve the burden on healthcare systems.

We firmly believe that combining healthcare facilities, known as cluster formation, is beneficial both for the quality of healthcare and when it comes to the potential for reducing costs. In the hospital sector, one of the ways we are pursuing this approach is through our choice of acquisitions in recent years. The aim with these choices is to link together the special care offerings of the individual hospitals, and to jointly improve quality, e.g. in oncology care or stroke treatment, through cluster conferences. This type of networking makes it possible to offer expensive and labor-intensive treatments within a hospital cluster without having to provide them at every location.

Helios Germany, for example, supports certain projects that involve deploying multidisciplinary teams following surgical interventions in order to help speed up and improve patients’ recovery. One area of focus is on rapid mobilization after operations.

In order to counter the specific effects on healthcare, Helios Spain is pursuing the goal of significantly optimizing care processes. For example, the structured medical information already obtained with the help of digitalized processes is to be linked to a newly generated healthcare model. This should give doctors more capacity to provide valuable care to an increasing number of patients. Further details can be found in the company-specific standard Digital transformation.

Patient support in crisis and emergency situations

As a healthcare Group, we have to be crisis-proof in all areas and be able to respond flexibly to unforeseeable challenges: It is our task to provide patients with unrestricted access to our services and seamless care even under difficult conditions. To ensure this, we have established high-performance and resilient emergency systems and programs in our business segments.

Crisis situations refer to unforeseen events that may have negative consequences for the company or society, for example. The Fresenius crisis management organization aims to ensure a rapid and coordinated response to crisis situations, including a comprehensive flow of information to relevant stakeholders and a structured recovery of critical business operations to enable the fastest possible return to normal business activities. A crisis team is convened immediately after an event that could potentially lead to a crisis. This crisis team consists of a core team with fixed members, regardless of the scenario, as well as representatives from relevant functions of the company depending on the requirements of the situation. The crisis team also involves the units in affected markets and the members of the Management Board of the Fresenius Group. It coordinates the activities to maintain business operations and monitors the measures specifically defined and initiated to deal with a crisis. Members of the crisis team and representatives of the business units are also responsible for coordinating product donations if requested by affected countries, e.g. in the event of a natural disaster or war.

At Fresenius Helios, there are legal requirements for how care is to be organized in the event of an emergency. Accordingly, we have dedicated emergency plans to respond immediately to incidents that might be critical for patients. They encompass, among other aspects, evacuation plans, emergency systems in case of interruption of power or water supply, and plans to respond to impacts on local infrastructure, e.g. due to flooding. Emergency power generators ensure that operations or vital therapies, such as artificial respiration, can continue even in the event of a power failure. Pandemic plans that guide behavior in the event of a pandemic outbreak are also included.

Our approach to promoting access to healthcare and medicine is anchored in the Group-wide strategy. The approaches differ depending on the business segment.

Access to products and services is defined as a material topic of the overarching corporate strategy and is subject to the to the ongoing transformation process of #FutureFresenius. In the implementation, the business segments specify their respective strategies with the support of the Group functions, and from these, the healthcare service and product markets in which Fresenius will be active in the long-term are derived. Within the Management Board, the Chief Executive Officer is responsible for the Group’s overall strategy. Operational implementation takes place within the business segments and their units. It is anchored in the local organizations and managed by the respective management functions. Information on the Supervisory Board and related procedures for material sustainability aspects are explained in standard ESRS 2 General disclosures, section GOV-1 Our sustainability organization.

The highest management functions of the business segments decide on the implementation of the strategy, define management approaches, and regulate responsibility within the management, e.g. through a business allocation plan.

Our Group-wide Human Rights Program is aligned with internationally recognized instruments relevant to our consumers and end-users, including the United Nations Guiding Principles on Business and Human Rights. We report on this in topical standard S2 Workers in the value chain.

Engaging with patients [S4-2] Process for engaging with consumers, and end-users about impacts [S4-3] Process to remediate negative impacts and channels for consumers and end-users to raise concerns

Fresenius’ risk management is designed to identify material negative impacts on consumers and / or end-users. The aim is to evaluate these effects as part of our risk management and, if necessary, to develop corrective measures. We obtain new insights, for example, through whistleblower systems, patient surveys, or through interest groups, such as workplace representation bodies or industry organizations. The respective assessments can also be used to check whether and how the concepts are sufficient to support trust in our processes and procedures or to protect individuals from retaliation.

Fresenius is integrated into a diverse network of interest groups. Through the exchange with our stakeholders, we gain valuable insights that help us to continuously develop the management of material topics and to address the material impacts on patients. The same applies to our opportunity and risk management. We explain our most important stakeholders and further information on their integration in the standard ESRS 2 General disclosures, section SBM-2 Stakeholders and partnerships. Our exchange with political institutions and external organizations focuses on the areas of health and patient care. In the topical standard G1 Business conduct, we provide a detailed description of our policy in connection with this material topic.

We report on our patient engagement and reporting systems in the topical standard S4 Consumers and end-users in the Health and safety section. There are no special mechanisms in place regarding access to products and services.

Our actions [S4-4] Taking action on material impacts on consumers and end-users, and approaches to managing material risks, and pursuing material opportunities related to consumers and end-users, and effectiveness of those actions

In the 2024 reporting year, Fresenius began to define a supplementary strategy for the material topic of access to healthcare and products. We are currently examining whether this should be established and expanded as a supplementary policy to the existing corporate strategy. We plan to report the results of this analysis and the first measures taken in the 2025 report.

This includes both potential and actual impacts on consumers and end-users, as well as material risks, and opportunities for our Group relating to this topic.

Our goals and ambitions [S4-5] Targets related to managing material negative impacts, advancing positive impacts, and managing material risks, and opportunities

All people should be able to benefit from our healthcare services – and not experience any disadvantage due to a lack of financial resources or their geographical location. The goal of Fresenius is therefore to improve access to medical care, for example by expanding the medical infrastructure and collaborating with organizations and initiatives on Group and business segment level. Since this ambition cannot be tracked by targets, we evaluate the progress based on the expansion of our healthcare facilities and our patient numbers. In addition, we use patient satisfaction as an indicator to measure progress.

One initiative in Spain, for example, is the participation in a project of the Fundación IDIS (Institute for the Development and Integration of Healthcare). Helios in Spain is a member of the Fundación IDIS. The goal of the project is to centralize patient data more effectively and to improve the exchange of information between insurance companies, hospital operators, and medical personnel. The MiHC (Mi Historia Clínica) platform is already part of the Fresenius Helios Spain patient portal app. For this reason, we are actively involved in this project in order to work together to improve processes.

We want to simplify access to healthcare and medicine through, for example, digital processes and applications. Our targets in the area of digitalization can be found in the company-specific standard Digital transformation.

Metrics S4-Company-specific

Number of patients Fresenius Helios

The Number of patients is defined as the absolute number of patients treated in our Fresenius Helios facilities in Germany and Spain in the reporting year.

In 2024, we treated nearly 26 million patients at our hospitals, of which more than 24 million were outpatients and more than 2 million were inpatients. The number of patients in Germany was slightly above the previous year’s level. In Spain, the number increased by around 3% in the outpatient sector and by around 2% in the inpatient sector.