Ville Iho, President and CEO: Continued strong demand, profit improvement program proceeding as planned
Demand for health services continued to be strong in the fourth quarter of 2022. Challenges related to the sales mix continued, and demand in our core business continued to focus on appointments and lower-margin care chains, reducing revenue and profitability compared to the reference period, which coincided with the peak in coronavirus testing due to the spread of the Omicron variant. The share of diagnostics visits excluding COVID testing is gradually increasing but remains below the level of 2019. Surgical operations and digital services, which were in strong demand throughout the year, continued to grow. In the last quarter of the year, revenue overall increased by 2.2% year-on-year to EUR 334.8 million. Our business in Sweden accounted for about half of this growth.
Inflationary pressures and the dilution of the sales mix continued in the last quarter of the year. However, the actions taken throughout 2022 to increase our supply are starting to yield results. Our supply clearly improved at the end of the year, not only in terms of digital appointments but also in terms of appointments at the clinics. However, the clear improvement was not enough to compensate for the negative profit drivers and profitability still fell short of the targets. Adjusted EBITA for the fourth quarter decreased by 29.1% to EUR 29.7 million, representing 8.9% of revenue. Earnings per share were EUR 0.06.
In connection with Q3, we communicated three sets of measures we are taking to react to the change in the operating environment: the profit improvement program, a change in the operating model, and the independent profitability improvement measures of the portfolio businesses. We have made progress in each of these areas. Our profit improvement program is progressing as planned and we are confident that we will achieve our goal of an annual run-rate EBITA improvement of EUR 50 million by 2024, most of which is estimated to be achieved already in 2023. The measures implemented by the end of 2022 are expected to generate an EBITA improvement of EUR 11 million in 2023. Our renewed management model, based on a clearer division of the core business, portfolio business, and Swedish business, has brought clarity to profit drivers and speed to decision-making; we will renew our reporting from 2023 in accordance with the new structure.
In Finnish healthcare services, the conditions for growth are good. Demand is strong, and the utilization rate of total capacity is high, despite the dip in consumer confidence and the uncertain market environment. Poor access to treatment in public healthcare increases the demand for privately provided services, especially through voluntary health insurance. The situation in the public market is predictably quiet after the reform and there are few new tenders. We expect the market to pick up in the second half of the year 2023 after the start-up phase of the well-being services counties.
In the portfolio businesses, each business now has an independent plan to strengthen profitability in a timely manner and these plans are being promoted at full speed.
Our Swedish business developed as expected in 2022. Revenue grew organically and through acquisitions, and profitability strengthened compared to the reference period. We see growth potential and opportunities for value creation in Sweden in the medium term.
Our financial targets and strategy remain unchanged; in our core business, we aim for industry-leading profitability, and we want to keep our spot as the preferred choice for customers and professionals. Portfolio businesses aim at independent value creation, and in Sweden, we aim for significant and profitable growth in the medium term. Due to the changed operating environment, our primary focus is on the core business and organic growth, and we are clearly more selective in M&A in both of our home markets, Finland, and Sweden.
Our financial position is strong, and we are confident about the future. Our goal is to significantly improve the total return for shareholders in the coming years. The board proposes to the Annual General Meeting that the dividend remains at the 2021 level of 0.28 euros.
Our customer satisfaction is very strong, and we have maintained our position as the preferred employer among industry professionals. The clinical quality of our services is excellent, and our work to develop the effectiveness of treatment is particularly strongly reflected in the results of our investment areas, such as mental well-being, and in the results of treatment paths for the musculoskeletal system. In the business built around the musculoskeletal system, the number of customers has grown strongly during the year, and the number of referrals from insurance companies has increased thanks to the fast access to care and excellent treatment results based on multi-professional treatment paths. In terms of mental well-being, Terveystalo has long been a pioneer in building low-threshold services for companies, and our extensive data shows that the services radically reduce sickness absences related to mental health. Our mission is to fight for a healthier life. We want to keep our client companies moving and we will continue to invest in the effectiveness and high-quality of care pathways.