The HealthcareSystem and theMedicalTechnology Industryin...

1

The Healthcare System

and the Medical Technology

Industry in Hungary

„Wirtschaftsforum Ungarn: Märkte und Innovationen“

4. Mai 2016, Handelskammer Hamburg

László Rásky, Geschäftsführer

2

– AMDM established in 1997.

– Member of Eucomed since 1998.

– With its 43 members AMDM is the most powerful and recognised trade

association representing manufacturers and distributors of medical

devices in Hungary.

– AMDM members represent approx. 60% of reimbursed commodity

market

– 43 members (42 companies + 1 association): 25% manufacturers; 50%

national – 50 % international; 55% inpatient care – 45% outpatient care

sector interest.

– Key role in lobby for medical devices, imaging diagnostics and healthcare

IT industry.

Association of Medical Devices Manufacturers, Hungary

(AMDM Hungary)




3

– 1854: the Austrian Mining Law Act ordered, that all mineowners are

required to establish co-treasuries.

– 1891. Act, Article 14.: ordered the organizing of the considered

individuals’ healthcare under the principle of compulsory insurance.

– 1928. Act, Article 40.: initiation of old-age and invalidity pension.

Foundation of National Social Insurance Institution (OTI) for supervising

insurance companies. (social security)

– 1950: nationalisation of insurance assets, OTI and hospitals. Reduction

of healthcare professionals’ wages. Emergence of gratuity payments.

– In 1975 healthcare became a citizenship right. (national health system)

Historical outlook (Hungary)




4

– 1990: regime change. Health financing is insurance-based again, but with

only one insurance company. ( National Health Insurance Fund – OEP).

Majority of healtcare institutes managed by municipalities.

– 1994: additional voluntary welfare funds.

– 1998: opening of first private hospital (Telki). Worked till 2013.

– 2008: „social” referendum on visit fee (outpatient services), on daily

hospital fee (inpatient services) and on multi-insured system.

– 2012: all inpatient institutes became state-funded. Majority of

outpatient institutes remain in municipality ownership.

– 2015: start constructing the second private hospital (Duna Medical

Center).

Historical outlook (Hungary)




5

Financing of healthcare in Eastern-Europe and Germany

Remark: Data less than 1% are not indicated.

35,9

69,7

44,9

55,861,0

66,7 67,6 67,8

78,2

36,9

6,6

31,3 8,8

9,6

11,0 6,7 3,2

6,019,4 13,517,4

28,123,6

21,823,3

12,6

14,76,3 9,3 5,0

2,74,0

15,2

1,6 1,5 4,5 1,8 2,5 1,2 1,0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

OECD34 Germany Austria Hungary Poland Estonia Slovak

Republic

Slovenia Czech

Republic

Expenditure on health by type of financing, 2013 (or nearest year)

Social security General government Private out-of-pocket Private insurance Other




6

Financing of healthcare in Eastern-Europe and Germany

3,2%

4,1%

4,5% 4,6%4,8%

5,6%

6,0%6,2%

6,5%

7,7%

8,4%

0 $

500 $

1.000 $

1.500 $

2.000 $

2.500 $

3.000 $

3.500 $

4.000 $

4.500 $

0,0%

1,0%

2,0%

3,0%

4,0%

5,0%

6,0%

7,0%

8,0%

9,0%

Latvia Lithuania Poland Estonia Hungary Slovak

Republic

Czech

Republic

Slovenia OECD Austria Germany

Public health expenditure as a share of GDP and per capita, 2013

Expenditure on public health as a share of GDP in 2013 (%)

Expenditure on public health per capita in 2013 (US$)




7

Health Status in Eastern-Europe

73,5 73,9

75,7

76,5

77,1 77,3

78,3

80,4 80,580,9

81,2

68

70

72

74

76

78

80

82

Lithuania Latvia Hungary Slovak

Republic

Poland Estonia Czech

Republic

Slovenia OECD (34) Germany Austria

Life expectancy at birth, 2013 (or nearest years)




8


217,5

213,5 209,9 210,5207,0 206,0 205,0

201,6

288,6291,9 293,0

294,7

295,5

292,2

291,1

293,3

200

220

240

260

280

300

320

2005 2006 2007 2008 2009 2010 2011 2012

Deaths from cancer: total population

Mortality per 100.000 population

Germany Austria Czech Republic Hungary Poland Slovak Republic Slovenia




9





10

Change of the age composition in Hungary

Population by sex and age-groups, 1 January 1956 and 2016




11

Conclusions of the provided data:

– Aging is the key challenge for the next decades. Increasing of aging

population raises the healthcare expenditures.

– Direct link between the amount spent on the healthcare and the health

status of the population.

– Most of the medical equipment users are low-earners or pensioners with

very low earnings.

– Private health insurance can be only partial financing element in the

Eastern-European healthcare systems. The main part of the financing /

subsidy must come from the Social (Public) Insurance.

– Governments must not save money on healthcare. On the contrary: their

increased involvement in financing will be necessary in the future.





12

– Medical devices and in vitro

diagnostic devices comply with EU

legislations.

– Medical equipment: special

terminology for prescribed

equipments in outpatient service.

Legislation of Medical Devices in Hungary

– Fundamental conceptual difference: for Medical Devices healthcare

professionals need to be present. Medical Equipments: can be used by

the patient alone, after training.

– Commercial practice: Medical Devices (and medicines) are under strict

advertising and compliance regulations.

– Central Implant Register since 01.01.2014. – obligatory.




Reimbursement (inpatient healthcare):

– New reimbursement regulation since 2010 with the professional help of

our Association.

– In the past 6 years 24 applications handed in: 6 terminated, 4 ongoing

and 14 completed.

– Reimbursed technologies have not received assigned financing.

Reimbursement (outpatient healthcare – Medical Equipments):

– In 50 large product groups quasi 3000 equipments.

– Reimbursement of new, innovative products, namely opening a new

group is extremely difficult.

– Reference product, reference price.

– For 13 years stagnating or falling prices (mass-production).

– Custom-made equipments (Orthopaedic & Prosthetic Devices) under

special regulation.

13

Legislation of Medical Devices in Hungary




14

– November 2015: amendment of the Public Procurement Law. Enables the

tendering party not to accept the cheapest offer. AMDM is to elaborate

new assessment criteria for medical devices to optimize the medical

devices procurement tenders.

– The Hungarian government hoped significant savings from the

centralized public procurements. Since 2012 only one tender has been

published in the circle of medical devices, for the surgical gloves. Later

even this was ceased.

– Since 2015 hospitals have been obliged to purchase certain medical

devices from detention facilities (prisons). Disposable non-woven fabrics

like surgical coats and caps, operating theatre gowns, blankets, protective

clothing and operating sets. AMDM considers this regulation to enable

one particular economic operator to monopolize the given product

market and during this procedure the concerned member companies

drop out of this market.

Public procurement of the Medical Devices in Hungary




15

– 2015: the Government provided 200 million Euros for the partial

regularisation of the then 300 million Euros debt.

– 31.03.2016.: the total amount of expired debts of healthcare institution

system 155 million Euros. 33% below 30 days, 22% is between 30 and 60

days, and 45% is over 60 days expired debts.

– The average late payment length currently is 110 days, the longest period

from payment deadlines is about 360 days.

– The nationalisation of the institutional system did not fulfil the

expectations, moreover in terms of financing the situation aggravated in

the past few years.

– According to some estimates 2 billion € percentage points of GDP is

missing from the public healthcare budgets, compared to the European

average.

Late payment in Hungary

(Inpatient healthcare)




16

– Approx. 11.000-12.000 employees

– Approx. 400 companies

– Total reimbursed market volume estimated 420 million Euros – 220

million in outpatient, 200 million in inpatient healthcare

– Multinational companies manufacturing in Hungary: Coloplast, B.Braun,

GE, Semperit.

– German companies (B.Braun, Biotronik, Hartmann, Siemens, etc.) are key

players in the Hungarian market.

– Dozens of Hungarian medical instrument or appliance manufacturers –

traditional and new, innovative companies .

– Nearly hundred of Hungarian orthopaedic SMEs

– R&D spending by MD industry +/- 4% of sales

Hungarian Medical Devices manufacturers




17

– Long tradition of scientific equipment manufacturing.

– More than 150 manufacturers.

– The annual export volume of more than 327 million USD was generated

by Hungarian manufacturing MEDTECH companies (year 2009, source:

ESPICOM, EUROSTAT).

– Major products: orthopedic appliances, x-ray generators, dental fittings,

artificial body parts, electrodiagnostic apparatus, needles, syringes.

– 56% of goods are exported: Germany is the main destination, Russia is

still a significant market.

– Significant presence of multinationals.

– Cutting edge research and development in university spin-offs.





18





19

– MediCluster was established in 2006.

– MediCluster is a network of for-profit and not-for-profit companies and

institutions engaged in the development, sales and services related to

medical devices as well as in import activities and associated businesses

and technical consulting.

– The cluster operates with a flat hierarchy and in a spirit of trust and

economic partnership among its members.

– The cluster member companies are Hungarian-owned and involved in the

development, production, distribution and promotion of medical

technology to provide high-quality medical solutions for sociat benefit.

– ln 2008 MediCluster earned the title "Accredited lnnovation Cluster". Of

the nine accredited clusters in Hungary, this is the only one specialising in

medical technology.

MediCluster of Hungarian Medical

Manufacturers and Service Providers




20

– Medicor Elektronika Co. Ltd.: clinical neonatal incubators, reanimation

and warming tables, phototherapy lamps, infusion pumps and accessories

for neonatal medical care. Furthermore home diagnosis and therapy

products: baby scales, apnea alarms, digital blood pressure monitors, TENS

devices, blood sugar monitors, digital thermometres and massage

products.

– lnnomed Medical Co. Ltd.: ECG equipment from basic to complex as well

as Holter monitors and stress test systems. Digital pulmonary function

testing cabins and mobile adaptations suitable for installation in vehicles.

– Dispomedicor Co. Ltd.: hypodermic needles for single use; hypodermic

needles for blood taking; special ophthalmic hypodermic tipless needles;

two-, three-, four-part syringes; scalp vein sets, infusion extension sets;

connecting sets; urine sets; transfusion sets; infusion sets; oxygen nasal

cannula; safety needles; safety syringes and safety scalp vein sets.






21

– Diagon Co. Ltd.: clynical diagnostic systems (instruments ad reagents).

– 77 Elektronika Ltd.: blood glucose monitoring systems and urine analyzers.

– Sanatmetal Ltd.: traumatology, orthopaedics, spie, dental veterinary

implants.

– 3DHISTECH Ltd.: high capacity digital slide scanner, high throughput tissue

microarray machine with 72 block capacity.






22

Summary

Hungary as an investment target country:

– EU legislation.

– Economic growth potential.

– Traditionally good and strong German links.

– Medium risks in terms of predictability.

Cooperation with Hungarian medical devices manufacturers:

– Centuries-long industrial traditions.

– Innovative approach.

– Tradable products.

– Flexibility.




23




Vielen Dank für Ihre Aufmerksamkeit!

The HealthcareSystem and theMedicalTechnology Industryin...

Documents

Transcript of The HealthcareSystem and theMedicalTechnology Industryin...