The countries of Central and Eastern Europe represent a total market of 303 million people and a combined GDP of US$2.5 trillion in 2009.
Central & Eastern Europe is composed of a diverse range of markets, all at different stages of development. Many of the markets exhibit fast growth rates, and the region as a whole is expected to grow annually by 9.3%, to reach US$14.1 billion in 2015.
Russia, Poland, the Czech Republic, Hungary and Slovakia represent the five largest markets in the region. The Balkans are among the fastest-growing markets. Slovenia is the wealthiest country in Central & Eastern Europe, and is able to spend 8.4% of GDP on healthcare expenditure.
In 2009, the countries of Central and Eastern Europe will spend an estimated US$150.3 billion on healthcare, equal to an average of 6.9% of GDP. Healthcare expenditure is projected to rise to US$245.0 billion by 2015. Although the current economic slowdown will prevent levels of expenditure from rising as quickly as in the past, most economies are expected to see positive economic growth from 2010 onwards. In addition to health insurance contributions, projectbased investments for the improvement of healthcare facilities have injected capital into the region’s health systems. For instance, under Russia’s ‘National Health Project’, the government has spent over US$1 billion on diagnostic equipment and money has been allocated for the construction of 15 high-tech medical centres, which are due to be operational by 2010. Other countries in the region also receive project funding, mainly from the World Bank and the European Agency for Reconstruction.
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Highlights from the region
Czech healthcare funding is largely public, and mainly through health insurance, and private spending will only account for an estimated 12.1% of total health expenditure in 2009. Provision of care is also largely public; the Czech Republic has yet to develop a substantial private sector. In 2011, the Czech market for medical equipment and supplies is estimated at US$1,454 million, or US$139 per capita. The market has proved generally resilient to the economic downturn in 2009, and it is expected that the device market will continue to expand at a CAGR of 4.3% per annum, reaching US$1,798 million, or US$173 per capita, by 2016. Responsibility for hospitals was devolved to local governments in 2003. This has shifted the burden of hospital debt to local authorities. Some are planning privatisations, although this is politically controversial and likely to be stopped by the national government. The country has a small but skilled manufacturing sector operating mainly at the low to medium end of the technology scale, but of increasingly of good quality. Local producers tend to concentrate on export markets.
The Polish population is estimated at 38.1 million in 2009 with nearly 13% of residents aged 65 years or over. Funding for healthcare in Poland is principally through the health insurance system. The National Health Fund was established in 2003, replacing the 16 Regional Health Funds but financing remains a problem as Poland only spends around 6.2% of GDP on healthcare. This does not fully cover the cost of medical equipment and upgrades required in hospitals. The size of the private healthcare sector is slowly expanding and around a third of health expenditure is private, although out-of-pocket payments account for most of this. In 2009, the Polish market for medical equipment and supplies was estimated at US$1,758 million, or US$46 per capita and around 85% of the Polish medical device market is supplied by imports with Germany and the USA being the leading suppliers in 2007.
In 2007, the Hungarian government implemented reforms that were aimed at drawing money into the health system and improving the quality of services but these have run into trouble. The new fees for visits to doctors and hospital stays were abolished in March 2008, following a referendum which saw over 80% of voters oppose the fees. Similarly, in February 2008, a new bill on health insurance was signed into law, which enabled private companies to buy shares in 22 new health funds. However, the legislation was repealed in May 2008 and the health funds are to be phased out. Around 62% of the medical device market is supplied by imports. Germany, the Netherlands and Austria were the leading suppliers in 2007, accounting for around 50% of imports. Consumables and orthopaedic products were the largest import categories in 2007.
The Russian market is potentially huge, given its population and potential wealth of natural resources. Health expenditure remains low however, and patients are often forced to rely on out-of-pocket payments for treatment. A system of medical insurance is in place, but it is badly managed and the quality of treatment varies from region to region. However, the government’s national ‘health’ project aims to improve healthcare standards. Since the project’s implementation, numerous medical facilities have been upgraded and a substantial number of medical personnel have been awarded salary increases. In 2009, the Russian market for medical equipment and supplies was estimated at US$5,961.3 million. Per capita spending is very low at US$42 per capita. It is expected that the Russian medical device market will continue to expand at a rate of 5.4% per annum. Around 73% of the market is supplied by imports which haves generally increased over the last five years.
Focus on market opportunities:
Recent data shows that the value of medical equipment imported by the countries of Central & Eastern Europe has grown consistently year on year, particularly in the field of diagnostic imaging. In 2007, Ukraine’s imports of diagnostic imaging apparatus increased by 116.8% and Romania’s by 112.9%. Although there are exceptions, due to one-off purchases, the region is reliant on imports as domestic medical production tends to focus on the lower end of the technology scale.
Many countries are modernising their ageing facilities and equipment, providing opportunities for foreign suppliers. For example, Romania has virtually no domestic medical equipment industry, and therefore has to import 86% of its requirements. Almost 70% of Romania’s medical imports were sourced from the EU-15 in 2007.