The regulatory side, we receive all our money from the government and they are squeezing it, but so is the UK, Australia and United States. All governments are trying to save money around the world. It will be an issue wherever we go." Mr Siddle added Ramsay was cautious about China, and had strict investment hurdles, admitting it had walked from late stage deals after looking for hospitals to buy in Germany, Spain and Scandinavia. Chief executive Craig McNally also defended the move, saying buying Generale de Sante was a good acquisition although the pricing pressure had been greater than anticipated. France remained a challenge but there were some positive signs, he said. "We are establishing good relationships with the new Macron government," he said. "We continue to maximise our cluster strategy to strengthen our portfolio in local geographies and we are progressing out-of-hospital business growth opportunities. We have acquired small patient transport business in Lyon in July." Mr McNally added the UK was also difficult for Ramsay; in this market a small tariff increase was being offset by the NHS restricting access amid a community backlash over waiting lists. "The public system is under strain, which means there is a significant increase in people wanting to pay for hospital access," he said. But the number of people with private health insurance had stayed the same for about 40 years, sitting at about 10 to 12 per cent in the UK.

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