THE GERMAN HEALTHCARE MARKET - JULY 2018 - GTAI
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THE GERMAN HEALTHCARE MARKET JULY 2018 Dr. Marcus C. Schmidt Director Chemicals & Healthcare www.gtai.com
Healthcare Market Germany
One of Germany’s largest growth markets at a glance:
3.7% size of China
Hamburg Schwerin
Bremen
4% of Chinese population (82 million)
Berlin
Potsdam
Magdeburg € 374B (CNY 2.800B) healthcare market
Düsseldorf
Erfurt Dresden
Wiesbaden
3.8% CAGR past 11 years
Mainz
7 million+ employed in healthcare sector
Stuttgart
München
nearly 2000 hospitals with 500,000 beds
© Germany Trade & Invest www.gtai.com 2
Health Insurance
Germany achieves almost universal health insurance coverage
Types of health insurance in Germany
Voluntarily insured
Private Other 5.9 million • Health insurance coverage
health 2.7 million is mandatory in Germany.
3.2% Pensioners
insurance
16.7 million
8.8 million • Both publicly and privately
10.7%
insured can choose their
Family members of provider.
insured
15.6 million
82.2 million • Number of health
inhabitants insurance companies
(2017):
Mandatorily - 44 private
Public health
insured - 112 public
32.5 million
insurance
70.7 million
86.1%
Source: Verband der Ersatzkassen e. V. (vdek) 2017
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The German Hospital Sector
The share of privately owned hospitals continues to rise
Number of hospitals and ownership 2016 Share of hospital ownership 1996-2016
45%
41.8%
40%
40.6% 35.8%
35%
34.7%
public 30%
29.2% private 29.5%
25%
36.2%
1,951 20%
Hospitals 15% 17.6%
10%
5%
charity
0%
based 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
34.6%
private charity based public
Source: German Hospital Federation 2017 Source: German Hospital Federation 2017
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The German Hospital Sector
Germany largest private and public hospital groups
Top 5 largest private hospital groups Hospital ownership in Germany‘s 16 federal
in Germany 2016 states (share in percent 2016)
Hospital Sales in EUR
Hospitals Beds
Group million Schleswig-
Holstein Mecklenburg-
Helios Vorpommern
5,800.0 112 35,000
Kliniken
Hamburg
Asklepios 3,211.0 102 34,690 Bremen
Niedersachsen
Sana Kliniken 2,400.0 50 11,056 Saxony- Berlin
Anhalt Brandenburg
Rhön Kliniken 1,176.3 5 5,348
North-Rhine
Westphalia
Schön
796.8 17 4,200 Thuringia Saxony
Kliniken
Hessen
The largest municipal hospital group is Vivantes Network Rheinland-
for Health GmbH in Berlin, with more than 100 hospitals Pfalz
and a total of about 5,500 hospital beds in 2016. Saarland
Bavaria
Baden-
Württemberg Public
Private
Charity based
Source: helios-kliniken.de, asklepios.com, rhoen-klinikum-ag.com, sana.de,
schoen-kliniken.de, Vivantes – Netzwerk für Gesundheit GmbH 2017, Grunddaten der
Krankenhäuser 2017
© Germany Trade & Invest www.gtai.com 5
Market Drivers
Demographic change has a significant impact on healthcare demand
and solutions in Germany
Aging Society
• 2035: 24 million people aged 65 years or older
(31 percent of the population)
Care Dependency
• 2020: 2.5 to 3 million
• 2050: 3.25 to 4 million
Chronic Diseases
• Chronic and long-term diseases account for about 80 percent of German healthcare
spending (EUR 200 billion)
• Within 14 years the number of people with diabetes mellitus has risen from
5.8 to 7.2 million people
Source: DB Research 2010, Statista 2014, Statistische Bundesamt 2014
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Market Drivers
As many other industries, the healthcare sector is rapidly changing due
to new technology
New Materials
New Production Methods / Industrie 4.0
Digitalization & Interconnectivity
© Germany Trade & Invest www.gtai.com 7
Market Opportunities
Many healthcare segments in Germany continue to be very attractive
non-prescription
€ 67.4 billion
drugs € 6.8 billion
Self- Care € 39.5 billion
Medication
€ 11.2 billion (+4% vs. LYP)
Preventive
Healthcare Pharmaceuticals
Medical
E-Health
Devices
Medical and
€ 34 billion Technical Aids
(+3% vs. LYP) € 6.5 billion
€ 18.8 billion (+4% vs. LYP)
Source: Statistisches Bundesamt, BVMed, 2017, Statista, 2017
© Germany Trade & Invest www.gtai.com 8
Medical Technology Market
Medical devices “made in Germany” are in high demand both at home
and around the globe
Expenses and Production
40
34 billion
35
30 27.6 billion
25 Sold in
Germany
20
15
Exports
10
5
0
German Market Size German Production
© Germany Trade & Invest Source: BVMED – Branchenbericht 2017 www.gtai.com 9
Medical Technology Market
Despite a competitive domestic medical device industry, Germany is a
significant importer
German Medical Technology imports
account for over € 15 billion per annum Ranking of Products Made in Germany
4% X-Ray and other radio active apparatus 30%
1%
Devices and Materials for Dental 17%
Prostheses and artificial joint implants 10%
18,9%
32%
Endoscopes and surgical instruments 8%
Orthopaedic apparatus 6%
EEG and other electrical diagnostic apps 5%
Transfusion and Infusion 5%
29,5% Disposables 5%
14,2%
Medical needs furniture 4%
Artificial kidneys 4%
EU Rest of Europe Apparatus for anaesthetics/breathing 3%
North America Asia
Ophthalmic segment 2%
Middle- and South America Middle East
Rest of World Wheel chairs 1%
Source: Statista 2017 Source: SPECTARIS Jahrbuch Medizintechnik 2014/2015
© Germany Trade & Invest www.gtai.com 10Medical Technology Industry
Germany is home to more than 12,000 medical technology companies
with about 210,000 employees
~ 11,300 companies
< 20 employees
Total: ~ 81,000 employees > 500 employees
100 - 499 employees
< 100 employees
3% 11%
86%
~ 1,250 manufacturers
> 20 employees
Total: ~ 133,000 employees
Source: BVMed Annual Report 2016/17
© Germany Trade & Invest www.gtai.com 11Moving Forward
Pilot projects for Germany's healthcare system
Remote treatment
ePrescriptions
Electronic Doctors’ Notes
© suedhang_gettyimages.com
© Germany Trade & Invest www.gtai.com 12E-Health Act 2016
Secure Digital Communication and Applications in Healthcare
2016
2017
The E-Health Act became
effective January 1st. 2018
A reimbursement scheme will be
From October on, patients introduced for tele-consulted X-ray
are entitled to receive a diagnosis (from April on) and video
medication plan. consultation (from July on). The medication plan will be accessible electronically
through the Electronic Health Card.
Emergency data can be stored on Electronic Health
Card.
Patients can store their own data (e.g. fitness data) in a
patient file.
Gematik has to lay the foundation for the usage of the
patient file with the Electronic Health Card to ensure
that patient can access their data also outside of the
doctor’s office.
Source: Bundesverband Gesundheits-IT – bvitg e.V. 2016, gematik GmbH 2016
© Germany Trade & Invest www.gtai.com 13Smart Solutions for Diabetes Management
The German market for diabetes solutions will continue to grow
by 27% through 2022
Revenue forecast for digital diabetes solutions 2016 – 2022 (in EUR million)
110
Apps Telemedicine Solutions Connected Devices 98.3
100
10.3
90
82.8
80
9.6
70 65.9
40.2
8.5
60
30.5
50.8
50
7.5 20.3
39.2
40
6.3 12.4
30.4
30 23.3 7.7 47.8
5.1 42.7
4.0 5.3 37.2
20 30.9
4.3 25.2
20.0
15.0
10
2016 2017 2018 2019 2020 2021 2022
Source: Statista Digital Market Outlook 2017
© Germany Trade & Invest www.gtai.com 14Smart Solutions for Heart Failure Management
The German market for heart failure solutions will grow by 16%
through 2022
Revenue forecast for digital heart failure solutions 2016 – 2022 (in EUR million)
350
Apps Telemedicine Solutions Connected Devices 296.8
290.7
300 2.8
2.2
271.3
1.7
243.0
250 1.3
209.5 136.7
128.0
1.0
116.6
200
103.4
165.2
0.7
88.9
150 123.3
0.5 69.8
152.9 160.5 157.3
100 52.2 138.3
119.6
94.7
70.6
50
2016 2017 2018 2019 2020 2021 2022
Source: Statista Digital Market Outlook 2017
© Germany Trade & Invest www.gtai.com 15Telemedicine
The German market for telemedicine will grow by 41% through 2022
Revenue forecast for telemedicine used to manage high blood pressure 2016 – 2022 (in EUR million)
67
Apps Connected Devices Telemedicine Services 62.3
62
57 8.7
52 49.9
47 6.3
42 38.0 24.8
37
4.6
20.6
32
25.5
27
16.2
3.2
22
17.0
17 11.5 2.1 11.8 28.7
7.9 1.4 23.1
12
0.8 8.5 17.3
7 5.7 10.5
3.6
4.4 6.4
2 3.6
2016 2017 2018 2019 2020 2021 2022
Source: Statista Digital Market Outlook 2017
© Germany Trade & Invest www.gtai.com 16Ambient Assisted Living
The German market for AAL solutions will grow by 66% through 2021
Revenue forecast for AAL solutions 2016 – 2021 (in EUR million)
400
350
300
250
200
365.4
150
254.6
100
164.6
50 98.3
54.6
28.9
0
2016 2017 2018 2019 2020 2021
Source: Statista Digital Market Outlook 2016
© Germany Trade & Invest www.gtai.com 17Telemedicine Networks in Germany
Germany has a dense network of certified stroke units and tele-stroke
units
Certified stroke units
Telemedicine networks
• There are about 276 hospitals with certified
stroke unites.
• Telemedicine enables the connection of local
hospitals and bigger hospitals with strokes
units.
• Tele-stroke units complement high quality and
comprehensive medical care of stroke cases in
rural areas.
Source: DGTelemed 2015
© Germany Trade & Invest www.gtai.com 18Market Access
Germany offers a lucrative, but also demanding healthcare market
Keys to Success:
Quality Product Safety
Innovation Added Benefits
Cost Reimbursement
Reliability Customer Relationship
© Germany Trade & Invest www.gtai.com 19Regulatory and Reimbursement
Revision of the European Medical Device Regulation 2017 (MDR)
Revision Timeline and Involved Bodies: “MDR” to replace “MDD”
Start in 2012: 2014: 06/2015: Concluded 05/2016: 05/2017: 05/2020:
European
European EU Council Published, Conclusion:
Parliament
Commission First Trialogue 3-year Revision
First
Proposal Reading transition effective
Reading
2024:
Latest expiry
of CE-Marks
under present
regime (MDD)
© Germany Trade & Invest www.gtai.com 20Market Access
Buyers and Sales Channels
Multiple Buyer Options Direct Sales Preferred
• Hospitals • Digital Sales
• Purchasing Groups • „Distributors“:
• Tenders – License out to Manufacturers
• Medical practices – Fee-For-Service Sales Teams
• Care facilities and providers – Agents/Sales Reps
• Homecare medical supply stores – Wholesalers
– Consultants
• Private consumers / out of pocket
market • Direct Sales: Subsidiary
© Germany Trade & Invest www.gtai.com 21Market Access
Successful market penetration in many cases requires setting up a local
subsidiary in Germany
The need for a subsidiary depends on the product to be sold
F(x) = Need for own subsidiary in Germany
1
Risk class
Liability
Margin
Training
X=
Service
I IIa IIb III
Regulatory
© Germany Trade & Invest www.gtai.com 22Innovation
German companies maintain their competitive advantage by putting a
lot of emphasis on product development
1 in 3 products sold in Germany less than 3 years old
9% of revenue spent on R&D
15% of employees work in R&D
Public funding for R&D projects
R&D Regulatory Sourcing Production Marketing Sales Service
© Germany Trade & Invest www.gtai.com 23Innovation
Technology clusters provide benefits throughout the entire value chain
Education & Labs, Incubators &
Training Shared Facilities
Cooperation &
R&D Funding
Partnering
R&D Regulatory Sourcing Production Marketing Sales Service
© Germany Trade & Invest www.gtai.com 24Innovation
The German Medical Technology Clusters play a central role in
Germany´s med tech innovation landscape
German Medical Technology Clusters More than 30 specialized cluster networks
focusing on medical technology.
Goal:
• connecting companies, hospitals,
universities, and other research
institutions
• support continuous innovation in R&D
• help obtain funding for joint R&D projects
• provide shared facilities
• organize educational training programs
© Germany Trade & Invest www.gtai.com 25Medical Technology Clusters
Manufacturing and innovation clusters can be found in many parts of
Germany
• 11,000 medical technology companies
• 1,250 medical device manufacturers
• 30+ medical device clusters
• 426 institutions of higher education
• 33 university hospitals
• Cash grants for manufacturing and R&D
© Germany Trade & Invest www.gtai.com 26Our Services
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© Germany Trade & Invest www.gtai.com 27Contact Us
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Germany. The company helps create and secure extra employment opportunities,
strengthening Germany as a business location. With more than 50 offices in Germany and
abroad and its network of partners throughout the world, Germany Trade & Invest supports
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Contact Berlin Bonn
Dr. Marcus Schmidt Friedrichstraße 60 Villemombler Straße 76
T: +49 (0)30 200 099-600 10117 Berlin 53123 Bonn
Marcus.Schmidt@gtai.com www.gtai.com www.gtai.de
Supported by the Federal Ministry for Economic Affairs and Energy
on the basis of a decision by the German Bundestag.
© Germany Trade & Invest
All market data provided is based on the most current market information available at the time of publication.
Germany
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Invest accepts no liability for the actuality, accuracy, or completeness of the information provided. www.gtai.com 28You can also read
