Orders and revenue showed strong and similar development in fiscal 2019: clear growth; increases in all businesses led by the imaging business, and growth in all three reporting regions, notably including in China and in the U. S. which benefited from positive currency translation effects.
Adjusted EBITA was clearly up compared to fiscal 2018, with increases in the imaging and advance therapies businesses. The diagnostics business recorded lower Adjusted EBITA year-over-year due mainly to Combined Management Report 13 increases in costs related to its Atellica Solution platform. Severance charges were € 57 million in fiscal 2019 and € 96 million in fiscal 2018. The order backlog for Siemens Healthineers was € 18 billion at the end of the fiscal year, of which € 6 billion are
expected to be converted into revenue in fiscal 2020.
While demand in the markets served by Siemens Healthineers continued to grow in fiscal 2019, these markets also showed price pressure on new purchases and increased utilization rates for installed systems. All major served markets were in a healthy state, which contributed to a slightly higher market growth in Europe, C. I. S., Africa, Middle East and the Americas, most notably in the imaging and advanced therapies markets. The markets in Asia, Australia grew moderately. Markets in the U. S. showed slight growth in the imaging and clear growth in the advanced therapies
business, with continued moderate market growth in diagnostics.
Still, the U. S. market environment remained challenging
as pressure on reimbursement systems and the focus on more
extended utilization of equipment at customers’ sites persist.
Government initiatives and programs, together with a growing private market segment contributed to the re-stabilization and growth of markets in China. For the healthcare industry as a whole, the trend towards consolidation continued in fiscal 2019,
leading to higher utilization rates at customers’ sites, which are counterbalancing procedure volume growth in developed markets. Competition among the leading healthcare companies remained at a high level. For fiscal 2020, Siemens Healthineers expects the imaging and advanced therapies equipment markets to stay on a moderate growth path, while the diagnostics market is expected to grow clearly. Siemens Healthineers’ markets will continue to benefit from the long-term trends mentioned above, but are restricted by public spending constraints and by consolidation among healthcare providers.
On a geographic basis,
Siemens Healthineers expects markets in the region Asia, Australia to be the major growth driver. For China, Siemens Healthineers expects continuing strong growth due to rising government spending on healthcare, promotion of the private segment and wider access to healthcare services nationwide, pronounced effects of an aging population, and a growing incidence of chronic diseases. Growth in the U. S. is expected to be held back by continued pressure to increase utilization of existing equipment, reduced reimbursement rates and uncertainty about policies. For Europe, Siemens Healthineers expects slight growth, with a likely increased emphasis on equipment replacement and business with large customers such as hospital chains.
Table:
 |  | Fiscal year |  | % Change
(in millions of €) | 2019 | 2018 | Actual | Comp.
Orders | 15,853 | 14,506 | 9 % | 7 %
Revenue | 14,517 | 13,425 | 8 % | 6 %
Adjusted EBITA | 2,461 | 2,221 | 11 % | 
Adjusted EBITA margin | 17.0 % | 16.5 % |  | 


Question: How have the markets served by Siemens Healthineers responded in 2019?
Answer: While demand in the markets served by Siemens Healthineers continued to grow in fiscal 2019, these markets also showed price pressure on new purchases and increased utilization rates for installed systems.