Analysts said the group may eventually seek to list those operations separately offshore.

The growing importance of overseas operations echoes a trend among several top healthcare suppliers in the country, which are turning their focus away from South Africa.

The government has implemented limits on what pharmaceutical firms can charge for medicines and by how much they can increase prices .

Added to this is the uncertainty created in the sector by the proposed National Health Insurance scheme.

While private medical aids may take a knock from the ensuing downsizing and consolidation, there may be opportunities for private hospitals, which are likely to provide more public-private partnerships with the government.

Frost & Sullivan healthcare analyst Lizelle Wentzel says Netcare's acquisition strategy in the UK has created an opportunity to expand its presence there and into other European countries.

Medi-Clinic's "lucrative returns in Switzerland have demonstrated that there is potential for high revenues in developed markets".

Expansion of the 13 hospitals in that country has provided a good return on investment. Even though the group's hospital in Dubai recorded a loss for the six months to September, it will expand projects in Dubai to support growth.

Netcare has stated its interest in African markets with growth potential for private healthcare service providers.

Frost & Sullivan has found that there is well-established demand for private healthcare in East Africa, particularly in Kenya and Tanzania. "The establishment of hospitals in countries such as Angola, Mozambique and Mauritius is taking off," Wentzel added.

Aspen Pharmacare, South Africa's biggest generics manufacturer, continues to expand globally and it expects Latin America to contribute more to the group than South Africa within the next three years.

In the year to June 2009, 44% of group revenue was generated from offshore operations, up from 23% the previous year.

Moreover, global healthcare giant GlaxoSmithKline has bought 16% of Aspen, a key element of which is to market and sell prescription pharmaceuticals in sub-Saharan Africa.

Peter Breitenbach, Frost & Sullivan's healthcare programme manager, said this would give Aspen even greater exposure to other African countries.