UK - CQC Rates More NHS Trusts ‘Excellent’, but Concerns Remain

The Care Quality Commission (CQC) released a report on the performance of NHS trusts on 15th October 2009.

The report, carried out annually, revealed that the NHS is achieving higher standards overall, but that a significant number of trusts are failing to reach key targets.

More than half of Primary Care Trusts (PCTs) achieved scores of ‘excellent’ or ‘good’ for the first time, but fewer acute trusts were given a top rating, with more receiving a ‘fair’ judgement.

In total, 20 trusts were rated ‘weak’ and a further 27 have not reached a score above ‘fair’ on both quality and financial management indicators for the past four years. However, only one trust was judged to be ‘double-weak’ for its quality of care and financial management, compared to six in 2008. This was Barking, Havering and Redbridge Hospitals NHS Trust.

The CQC expressed concern that 63,000 operations were cancelled for non-clinical reasons, but a higher proportion of procedures are now being rearranged within 28 days of the original appointment.

A total of 48 acute trusts failed to meet at least one of the three standards for infection control according to the report, compared to 44 in 2008. However, progress has been made in rates of hospital-acquired infections, such as Clostridium difficile and MRSA, which have both fallen by around a third.

The report also found that 98% of the 19 million patients who visited A&E were seen within four hours of arrival, and more patients are receiving hospital treatment within 18 weeks of referral.

The CQC will soon gain new powers which will allow it to close down any under-achieving trusts. All trusts must be registered with the CQC from 1st April 2010, and must adhere to core standards or risk being refused a licence to operate. Currently, only half of trusts fully comply.

Further reading - An in-depth analysis of the UK medical device market, including more information on the NHS and the CQC, is available from Espicom: The Medical Device Market: United Kingdom (published September 2009)

UK - Seven Million at Risk from Diabetes

Seven million people in the UK are at risk of developing diabetes, according to a report from Diabetes UK in October 2009.

Diabetes UK warned that seven million people have prediabetes, also known as impaired glucose regulation. These people are 15 times more likely to develop diabetes, but prediabetes alone can cause long-term damage to the heart and circulatory system, among others.

However, prediabetes can be reversed and the risk can be reduced by 60% simply by adopting a healthier lifestyle.

In September, Diabetes UK revealed that there were 145,000 new cases of diabetes in 2008 alone (see UK - Diabetes Now Affects 5% of the Population).

Further reading - A detailed review of the UK medical device market is available from Espicom: The Medical Device Market: United Kingdom (published September 2009)

USA - Senate Approves Health Reform Bill

The US Senate Finance Committee approved the health reform bill with a 14-9 majority on 13th October 2009.

The bill, drawn up by chairman Senator Max Baucus, proposes a ten-year US$829 billion plan to reduce health costs and provide affordable health insurance, but does not include a government-run, universal health insurance scheme.

The bill will now go through a compromise process with the bill approved by the Senate Health, Education, Labour and Pensions (HELP) Committee in July 2009, before receiving a full vote on the Senate floor.

The Finance panel is the last of five Congressional committees to put forward health reform proposals.

Further reading - An in-depth analysis of the US medical device market, including some background information on the healthcare system and reform plans, is available from Espicom: The Medical Device Market: USA (published September 2009)

UK - NHS in Wales Scrap 22 Local Health Boards

On 1st October 2009, the 22 local health boards in Wales were scrapped, and integrated with NHS trusts to form seven new local health boards. These will control all hospital and community services, in addition to GP and dentist funding. The new boards will also be responsible for meeting hospital targets on waiting times.

The new local health boards are:

• Betsi Cadwallader;
• Hywel Dda;
• Abertawe Bro Morganwg University;
• Powys Teaching;
• Cwm Taf;
• Cardiff and Vale; and
• Aneurin Bevan.

The only NHS trusts to remain are the Welsh Ambulance Service and Velindre Hospital in Cardiff, which specialises in cancer treatment.

Further reading - An in-depth analysis of the UK medical device market, including some background information on the NHS, is available from Espicom: The Medical Device Market: United Kingdom (published September 2009)

UK - Diabetes Now Affects 5% of the Population

Around one in twenty people in the UK has diabetes, with around 145,000 new cases diagnosed in the past year, according to figures published by Diabetes UK in October 2009.

The data was compiled from GP practices and reveals that 2.6 million people now suffer from the condition, and around 90% of these have diabetes type II, which is linked to obesity on many occasions.

Diabetes UK warned that the increasing number of cases is putting a strain on the NHS, as diabetes already costs the health service £1 million an hour to treat. Also, diabetes can lead to more serious conditions such as heart disease, stroke, kidney failure and blindness.

Furthermore, it is estimated that around half a million people in the UK have the condition but have not been diagnosed, as the condition can remain undetected for around 10 years. Therefore, many of these may already have complications by the time they are diagnosed.

The rise in cases of diabetes is known to be linked to rising levels of obesity, which is a factor in around 80% of cases of type II diabetes, according to the International Diabetes Federation.

Further reading - A detailed analysis of the UK medical device market is available from: The Medical Device Market: United Kingdom (published September 2009)

India - Doctors Working in Rural Areas to be Given More Money

Doctors who work in rural areas will be compensated with extra money and assistance when they apply for higher study, Health Minister Ghulam Nabi Azad announced on 17th September 2009.

The Indian government is also planning to set up more medical colleges, as there is expected to be a lack of medical personnel in the coming years. According to a Planning Commission report, India is facing a shortage of around 600,000 doctors, one million nurses and 200,000 dental surgeons.

Further reading - An in-depth review of the Indian medical device market, including some background information on healthcare personnel, is available from Espicom: The Medical Device Market: India (published June 2009)

UK - NHS Workforce Proposals Rejected

Proposals to cut the NHS workforce in England by up to 10% in the next five years have been rejected by the government, who claim the NHS need more staff, not less.

Consultancy firm McKinsey and Company advised the Department of Health in September 2009 that the loss of 137,000 clinical and administration posts would save around £20 billion by 2014. The report also recommended a recruitment freeze to begin within two years, with the possibility of medical school places being reduced, and also suggested an early retirement programme should be established.

However, Health Minister Mike O’Brien said, “Ministers have rejected the suggested proposals in the McKinsey report and there are no plans to adopt these proposals in the future”, claiming that certain services, particularly maternity, nursing and primary care, need more staff rather than fewer.

McKinsey also claimed that up to £3 billion a year could be saved by improving staff productivity, while nearly £2 billion could be saved on external contracts for areas such as food and waste.

Further reading - An in-depth analysis of the UK medical device market, including some background information on healthcare personnel, is available from Espicom: The Medical Device Market: United Kingdom (published June 2009)

UK - GP Consultations Rising

The number of GP consultations has risen from 217.3 million in 1995 to 300.4 million in 2008, according to data published by the NHS Information Centre in September 2009.

The study, conducted using the QResearch general practice database, revealed that an average patient had 5.5 consultations in 2008, compared with 3.9 in 1995. Meanwhile, the average GP surgery carried out 34,200 appointments in 2008, up from 21,100 in 1995.

The study also highlighted an increase in the number of patients seen by a nurse in primary care. In 1995, 76% of consultations were undertaken by GPs, 21% by nurses and 3% by other clinicians, whereas in 2008, 62% were carried out by GPs, 34% by nurses and 4% by other clinicians. However, this increase in proportion could be explained by an increase in patients seeing nurses in general, rather than fewer patients seeing a GP.

However, the study did not take into account the length of consultations, or the number of tasks undertaken within a consultation, which could impact on the reliability of the findings.

Further reading - A detailed analysis of the UK medical device market, including further statistics on ambulatory care, is available from Espicom: The Medical Device Market: United Kingdom (published June 2009)

UK - Axis Shield Posts Positive Sales Performance

Scottish company Axis Shield posted positive financial performance in August 2009, following strong demands for its diabetes testing machine.

By the end of June 2009, Axis Shield had sold a total of 5,000 Afinion machines, compared to 4,000 machines sold during the whole of 2008. The company expects to sell a further 2,500 machines by the end of the year, with 50% of sales in the US.

The Afinion machine can screen blood or urine samples for diabetes indicators. The company now plans to market an Afinion test for high sensitivity C-Reactive Protein (hs-CRP), an indicator of cardiovascular disease, and has also secured rights to a new test for sepsis diagnosis.

For the six months up to 30th June 2009, pre-tax profit more than quadrupled, rising from £1.6 million to £7.5 million. Axis Shield ‘s sales amounted to £50.6 million in the same period, rising by 18.5%. The Point-of Care division’s sales amounted to £22.1 million, a rise of 27.3%, while sales from the Laboratory division rose by 23.0% to total £12.8 million.

Further reading - A detailed review of the UK medical device market is available from Espicom: The Medical Device Market: United Kingdom (published June 2009)

UK - Proton Beam Therapy to be Made Available to Cancer Patients

NHS cancer patients may soon have access to proton beam therapy, after the Health Minister Ann Keen announced on 18th August 2009 that hospitals are being invited to bid to provide such services.

Proton beam therapy is a form of radiotherapy, which attacks the tumour with ionising protons damaging cell DNA, without damaging vital organs. The Department of Health has claimed that proton therapy treatment can be more effective than radiotherapy on cancers in specific areas, such as the neck, retina, base of the skull and near the spine. It is also said to be more beneficial in children, as it precisely targets the tumour, allowing for better distribution of the dose and thus providing less risk of damage to the surrounding cells.

The Department of Health has asked the National Specialised Commissioning Team (NSCT) to identify possible providers of proton beam services in England.

Further reading - A detailed review of the UK medical device market, including some background information on cancer treatments, is available from Espicom: The Medical Device Market: United Kingdom (published June 2009)

UK - Foundation Trusts’ Spending Plans are Over-Optimistic

Foundation trusts were warned that their spending plans up to 2012 are overly optimistic, by Monitor, the regulator of foundation trusts, in August 2009. The trusts have been asked to also submit a downside forecast, which will give a more realistic projection of future spending growth.

Overall, 115 trusts have forecast a growth in their income of 4.2% in 2009/10, 2.1% in 2010/11 and 1.6% in 2011/12. It is known that NHS funding will increase in the next two years but funding post-2011 has not yet been finalised.

Further reading - An in-depth analysis of the UK medical device market, including some background information on NHS funding, is available from Espicom: The Medical Device Market: United Kingdom (published June 2009)

UK - Dentists’ Earnings Published

The NHS Information Centre has published the earnings of dentists in England and Wales. The 2007/08 Dental Earnings and Expenses Report, England and Wales, details the earnings and expenses of self-employed primary care dentists. The report looked at Providing-Performer dentists, who had a contract with a local health body and performed other dental services, and Performer Only dentists, who performed dental services but did not have a contract.

The report revealed that a total of 382 dentists out of 20,000 had a gross income of over £300,000 between 2007 and 2008, and 1,172 had gross earnings of more than £200,000 over the course of the year. It also highlighted a pay difference between dentists in England and Wales, with the average pay in England being £88,870 and the average in Wales being £93,924.

The key findings of the report are:

• The average taxable income for Providing-Performer dentists was £126,807, compared to £65,697 for Performer Only dentists. The overall average was £89,062;
• The average expenses for Providing-Performer dentists were £218,843, compared to just £33,512 for Performer Only dentists; and
• The average gross earnings for Providing Performer dentists were £345,651, compared to £99,208 for Performer Only dentists.

Further reading - A detailed review of the UK medical device market, including some background information on dentistry, is available from Espicom: The Medical Device Market: United Kingdom (published June 2009)

UK - NHS Faces Bill of £400 million for Private Contracts

The NHS is facing a bill of £400 million in the next two years, when independent sector treatment centre (ISTC) contracts with private sector operators expire.

Around £200 million will be paid for operation capacity bought by Primary Care Trusts (PCTs) but not used, as it is estimated that the health service only delivered around 85% of the agreed number of operations. A further £200 million will be paid to buy the premises built by the private sector operators.

Since ISTCs opened in 2005, they have cut waiting lists and introduced competition. So far, they have provided more than 1.7 million operations and other procedures, helping to cut the maximum NHS waiting time to 18 weeks.

ISTCs were originally commissioned by the Department of Health. They offered a five-year deal guaranteeing volumes of patients, with a buy-back clause on the buildings, and prices around 11% higher than NHS prices.

It will now be up to PCTs to decide if they want to renew the contracts, under different terms, most likely with no guarantees of volume and standard NHS prices.

Health Minister Mike O’Brien insisted that the initiative had been value for money, claiming it had cleared a backlog of 250,000 NHS patients who had to be treated to reduce waiting times. He told the Financial Times, “We wanted to ensure we had sufficient capacity. And if you hit your target, as we have, you have value for money.”

Further reading - A detailed review of the UK medical device market, including some background information on healthcare infrastructure, is available from Espicom: The Medical Device Market: United Kingdom (published June 2009)

UK - Report Forecasts Future for NHS Funding

A report into the possible future of NHS funding was published in July 2009. The report, How cold will it be? Prospects for NHS Funding: 2011-17, by The King’s Fund and Institute for Fiscal Studies, analyses how much of an impact the economic recession could have on NHS funding. Public spending will be inevitably hit by the financial crisis, and the report analyses the different outcomes this could have on the NHS in England between 2011/12 to 2016/17.

There are three possible funding outcomes over the next two spending review periods:

• ‘Tepid’ – annual real increases of 2% for the first three years, increasing to 3% for the final three years;
• ‘Cold’ – zero real change; and
• ‘Arctic’ – annual real reductions of 2% for the first three years, falling to 1% for the final three years.

The financial future of the NHS remains uncertain, and depends on the extent of tax increases and productivity levels. The report notes that over the next spending review period (2011/12-2013/14) the budget could reduce for all government areas, including the NHS, by an average of 2.3% per year. If the NHS were to be protected by a greater or lesser degree, this could result in greater cuts for other departments, although this could be lessened by an increase in taxes.

The changes to the budget could have implications on taxation. Even the ‘tepid’ scenario would require an increase in taxation (or reduction in spending on social security benefits and tax credits) of £6.9 billion, which would be equivalent to £220 extra per family, or raised through a 1.6% increase in the level of VAT.

The report notes that demographic pressures, including a rising and ageing population, are likely to cost the NHS around £1.0-1.4 billion extra each year at 2010/11 prices, and would require funding increases of around 1.1% to maintain quality. Only the ‘tepid’ scenario would provide enough money to cover this. These pressures are also adding to the demands placed on the healthcare system, and the report argues that productivity gains are essential, regardless of the future funding of the NHS.

The report notes that the NHS could fill this gap in funding with increased productivity levels. However, these would need to be significant if they were to make an impact. The report states that over the period between 2011 and 2017, the NHS would need to make gains of between £21.6 billion and £47.0 billion, equivalent to improvements of 3.4% to 7.4% per year, or £3.6 billion to £7.8 billion per year.

The report argues that the NHS in England is in some ways better prepared than ever to deal with the downturn. Current funding levels mean that it has employed more professionals, there have been huge improvements in the infrastructure and waiting times have been dramatically reduced.

Further reading - An in-depth analysis of the UK medical device market, including some background information on NHS funding, is available from Espicom: The Medical Device Market: United Kingdom (published June 2009)

USA - Obesity Costs the US Healthcare System US$147 billion

A study has found that obesity-related diseases account for 9.1% of health spending in the USA, equivalent to around US$147 billion. Researchers also found that obese people spend 40% more in healthcare costs, equal to around US$1,429 more per year, than people of a normal weight.

RTI international, the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality analysed medical cost data for the years between 1998 and 2006. The findings showed that rates of obesity rose by 37% between 1998 and 2006, driving an 89% increase in spending for obesity-related disease treatments such as diabetes, heart disease and arthritis. It also found that an obese Medicare patient spends US$600 more each year in drug costs than a Medicare patient of a healthy weight.

The CDC issued 24 recommendations in July 2009, on how communities can tackle the problem of obesity, mostly by encouraging healthy eating and exercise.

Obesity accounts for 9.1% of health spending, up from 6.5% in 1998. In total, more than 26% of Americans are obese.

Further reading - An in-depth analysis of the US medical device market, including some background information on health expenditure, is available from Espicom: The Medical Device Market: USA (published June 2009)

UK - Think-Tank Proposes £20 Fee for GP Appointments

Patients should be charged £20 for an appointment with a GP to encourage people to visit a doctor only when necessary, according to a report by independent think-tank the Social Market Foundation (SMF).

In the report, From feast to famine: reforming the NHS for an age of austerity, published in July 2009, the SMF states that the NHS will need to change dramatically to survive the impact of the economic downturn. The think-tank says the NHS will have to become more efficient due to the reduction in funding, and change its approach to what is fair. The report outlines three possible approaches that the NHS can take: raise more money, use existing resources better, or slow the growth in healthcare demand.

The report says the NHS must recognise that fair does not necessarily mean free. Charges could not be used to raise revenue, as they would need to be set at a very high level to do so, but charging for access to healthcare could force patients to consider whether they need to use healthcare resources.

The report recommends:

• The NHS charging system should be reformed to reflect income not categories such as pregnancy or retirement;
• Anyone receiving tax credits should be exempt from NHS prescription charges - a good deal for the poorest 30% of society;
• A charge of £20 for GP appointments should be introduced to encourage healthier, wealthier people to avoid using the NHS except when absolutely necessary (those receiving tax credits will be exempt);
• NHS charges for GP appointments and prescriptions should be capped at around £100 per year.

The report also outlines that the only way to achieve efficiency is to move from national targets to a model of local provision based around high quality commissioners. Recommendations to improve efficiency include:

• A reduction in national targets to become a minimum service guarantee;
• The establishment of a single body to regulate commissioners;
• Local contracts for GPs and consultants;
• Public petitions that can trigger a review of commissioner performance;
• A new ‘Royal College of Commissioners’ to give commissioning higher status;
• New powers and responsibilities for commissioners to improve the quality of healthcare providers.

However, Dr Chaand Nagpaul, on the GP committee of the British Medical Association, expressed concern that some patients may be put off visiting a doctor because of the fees. He commented, “All patients have the right to free healthcare that is based on their clinical needs, not the size of their bank balance.”

The Department of Health said ministers are also opposed to charges, with a spokeswoman commenting that it would be against “the founding principles of the NHS”.

Further reading - An in-depth analysis of the UK medical device market, including some background information on the healthcare system, is available from Espicom: The Medical Device Market: United Kingdom (published June 2009)

Germany - Hospital Chain Plans to Make Acquisitions

The largest hospital chain in Germany, Rhön Klinikum, is expecting the recession to trigger a number of hospital privatisations and plans to raise 460 million euros (US$644 million) in fresh capital and boost its equity base by one third so it is ready for buying opportunities.

The chain expects the recession to mirror the events of 2002 and 2003, when private operators lifted their share of the market to 13.5%, compared to 7.4% in 2000, as public assets were sold.

According to the chief executive, Wolfgang Pföhler, Rhön spent 960 million euros (US$1,345 million) on 20 hospitals between 2002 and 2006, and it now runs 48 clinics and has control of 3.0% of all hospital beds in Germany.

Mr Pföhler said that he expected the non-profit sector to maintain its market share but suggested the market share of publicly owned institutions could shrink notably. He believes Rhön can more than double its share of beds to 8.0% in the coming years and the chain aims to offer a nationwide service eventually.

In 2005, Rhön became the first private operator in Europe to take over a university hospital and its research department. It has since pledged to invest almost 400 million euros (US$560 million) in the facility in Giessen and Marburg, central Germany.

However, Mr Pföhler conceded that Rhön faces stiff competition from its two main German rivals, Helios Kliniken, owned by Fresenius, and Asklepios Kliniken, which each control around 3.0% of beds.

Further reading - An in-depth analysis of the German medical device market, including some background information on the hospital sector, is available from Espicom: The Medical Device Market: Germany (published June 2009)

South Africa - National Health Insurance, Can Zuma Deliver?

The long term growth prospects of the South African medical device market will be strongly influenced by the ANC government’s policies in regards to the new National Health Insurance (NHI) scheme, the promotion of public-private partnerships to develop and upgrade hospitals, the serious shortage of healthcare personnel and an urgent need to effectively address the AIDS crisis in the country.

The AIDS situation is dire in South Africa. According to projections from the EIU, the population of South Africa will start to decline from 2011, not normal for a country which has a relatively low elderly demographic (estimated 5.7% of the total population in 2011) and one of the highest birth rates in the world (25 live births per thousand population).

In 2008, there were a total 34,687 doctors or medical practitioners registered with the Health Professions Council of South Africa (HPCSA), equal to less than one doctor (0.7) per thousand population. This rate is very low by world standards. The majority of these doctors worked in the private sector, with only 30.7% or 10,653 working in the public sector in 2008. This means the provision rate for doctors in the public sector is just 0.2 per thousand population.

Private hospitals and doctors were unhappy with the government’s proposed National Health Amendment Bill in June 2008, which would have resulted in private hospitals and medical scheme providers having to “negotiate” private healthcare fees. At time of writing, nothing had been finalised.

A key driver of growth is expected to be the public-private partnerships to develop hospitals in South Africa but this could be tempered slightly, by a depreciating rand against the US dollar and the general state of the South African economy.

Further reading - An in-depth analysis of the South African medical device market, including some background information on the healthcare system, is available from Espicom: The Medical Device Market: South Africa (published June 2009)

USA - Hospitals to Contribute US$155 billion to Healthcare Reform

Three major hospital associations have agreed to contribute US$155 billion over ten years to the healthcare reform, it was announced on 8th July 2009.

Vice President Joe Biden did not provide specific details, but said the savings would come from delivery system reforms and trimming the annual inflationary adjustments to hospital reimbursement payments from two government health programmes.

It is expected that around US$100 billion will come from lower Medicare and Medicaid payments to hospitals, while a further US$40 billion will be saved by reducing the subsidies paid to hospitals to care for the uninsured.

The three hospital associations participating in the deal are the American Hospital Association, the Hospital Corporation of America and the Catholic Health Association of the United States.

The deal is similar to the agreement made with the pharmaceutical industry in June 2009, under which drug companies agreed to contribute US$80 billion over ten years towards the costs of the healthcare reform. However, both deals are contingent on the healthcare reform legislation being passed.

Further reading - An in-depth review of the US medical device market, including some background information on the healthcare system, is available from Espicom: The Medical Device Market: USA (published March 2009)

UK - Brown Promises New Rights for NHS Patients

Prime Minister Gordon Brown promised new rights for NHS patients in June 2009, under the draft legislative programme, Building Britain’s Future, which includes many other public reforms.

In a statement to the Commons, Mr Brown pledged that NHS patients would have “enforceable rights to high standards of care” including hospital treatment within 18 weeks, access to a cancer specialist within two weeks, and free health checks on the NHS for people aged 40-74. Mr Brown also said they would look into the possibility of new rights regarding NHS dentistry, extended access to GPs, individual health budgets for patients with long-term illnesses and the right to choose to die at home.

Mr Brown also pledged that Health Secretary Andy Burnham would bring forward proposals to strengthen the NHS’ focus on disease prevention and early intervention, to extend patient choice, and to reform early years and maternity services.

In addition, Mr Brown said ministers would consult on “far-reaching proposals for how we need to modernise our health and social care systems so that our country can meet the challenge of an ageing society”.

However, the British Medical Association claims the changes will have little impact, with the “vast majority” of patients referred to a cancer specialist already seeing one within two weeks and claiming that “further improvements will depend on an expansion in numbers of consultants”.

Further reading - An in-depth analysis of the UK medical device market, including some background information on the healthcare system and health policies, is available from Espicom: The Medical Device Market: United Kingdom (published March 2009)

UK - Cervical Cancer Screening Age Will Not Be Lowered

The Department of Health will not lower the age for cervical cancer screening, following a review by the independent Advisory Committee on Cervical Screening (ACCS) in June 2009. The ACCS cited evidence that shows earlier screening can lead to more harm than good, with too many false positives and an increase in the risk of premature births in some women.

However, at the British Medical Association’s annual conference on 2nd July 2009, doctors voted three to one that women should be screened from the age of 20.

Cervical cancer screening takes place from the age of 20 in Scotland, Wales and Northern Ireland, but was raised to 25 in England in 2003.

It was also noted that the number of women attending smear tests has fallen by 10 per cent over the past 10 years, and the poorest attendees - around 72 per cent - are those in the younger age group.

However, part of the review by the ACCS also recommended expanding work to increase screening uptake in women aged 25 to 34.

Further reading - An in-depth analysis of the UK Medical Device Market, including some background information on health policies and cancer statistics, is available from Espicom: The Medical Device Market: United Kingdom (published March 2009)

UK - Elderly Cancer Deaths on the Rise

Around 15,000 cancer patients aged 75 years and over may be dying unnecessarily every year in the UK, according to research from the North West Cancer Intelligence Unit. The findings show that the number of under-75 year olds dying from cancer has fallen, but that little progress has been made in the over 75 years category. Every year 75,000 people aged over 75 years die of cancer.

The researchers blamed the findings on delays in diagnosis and poor treatment. According to the lead researcher, Dr Tony Moran, elderly cancer patients are not benefiting from cancer care improvements made in the past 10 years. He stated that if the UK was performing as well as Western Europe in the 75-84 year olds age group, and as well as the US in the over 85 year old group, there would be 15,000 fewer cancer deaths in the elderly each year.

The study also showed that UK cancer deaths in people aged over 85 years increased by two per cent in eight years, while in Europe they fell by 16 per cent.

Further reading - An in-depth analysis of the UK Medical Device Market, including some background information on UK cancer statistics, is available from Espicom: The Medical Device Market: United Kingdom (published March 2009)

UK - NHS Dentists to Be Paid According to Number of Patients

There will be a shift in NHS dentistry to focus on preventative care, following an independent review into NHS dental services in England, published in June 2009. The review, led by Professor Jimmy Steele, made recommendations that dentists be paid according to the number of patients on their books and the quality of care they provide, rather than the amount of treatment carried out.

The review recommends that a “significant chunk” of dentists’ income should be linked to the number of patients registered with them, and this could amount to as much as 50%. The report also recommends that dentists have greater accountability, and should be penalised for faulty work and required to carry out necessary procedures to correct it at no extra cost to the NHS. Dentists should also focus on ensuring patients understand the importance of oral health and diet, as dentistry has become too preoccupied with treatment rather than prevention, according to the review.

The proposed changes see a return to patient registration, which was scrapped in the widely-criticised dental reforms of 2006. It is estimated that a million fewer patients have access to an NHS dentist in England than before the reform came into force three years ago.

The review also proposes a new system of patient charges, replacing the current three-band system with one of between five and 12 bands. This will relate payments more closely to the amount of work being done, as currently it costs the same amount to have one filling, as it does to have ten.

Health Secretary Andy Burnham has accepted all of the recommendations “in principle” and pilot trials of the new system will begin in the autumn.

Further reading - An in-depth review of the UK medical device market, including some background information on dentistry, is available from Espicom: The Medical Device Market: United Kingdom (published March 2009)

USA - Public Health Insurance Bill Unveiled, June 2009

President Obama has indicated that he views major reform of the US healthcare system as a priority, arguing in February 2009 that it ‘…cannot wait, it must not wait, and it will not wait another year’. Details are slow in emerging, although a number of basic principles have been laid down:

• Reduce long-term growth of health care costs for businesses and government
• Protect families from bankruptcy or debt because of health care costs
• Guarantee choice of doctors and health plans
• Invest in prevention and wellness
• Improve patient safety and quality of care
• Assure affordable, quality health coverage for all Americans
• Maintain coverage when you change or lose your job
• End barriers to coverage for people with pre-existing medical conditions

Reducing the number of uninsured Americans is a key, and contentious, component of this. One element became a little clearer in June 2009, with the introduction into the House of Bill H.R. 2668, the Choice in Health Options Insures Care for Everyone (CHOICE) Act. This is being sponsored by Chris Murphy (D-Conn.), and co-sponsored by Peter Welch (D-Vermont) and Bruce Braley (D-Iowa).

The bill would create a Federal public health insurance plan for the first time in the USA. It would not be compulsory, but would compete with private health plans for members. It was introduced in the House on June 2nd 2009 and referred to the House Committee on Energy and Commerce, which has jurisdiction over healthcare legislation, and also the House Ways and Means Committee. It will probably form part of a wider health reform plan currently being prepared in Congress by the Democrats.

The proposed public plan (the American Trust Health Plan) would be operated by the DHHS and would be self-financing. Anyone eligible to purchase private health insurance would be able to enroll. All healthcare providers providing services under Medicare would be required to participate. Premiums would be set by the DHHS. Regional variations in premiums will be allowed, as will other variations in accordance with existing norms.

The bill’s sponsors hope that the public plan will give private providers an incentive to reduce costs and make health insurance more affordable. Critics see it as a first step on the road to a compulsory public system, similar to that proposed by President Clinton in 1993. That effort failed as a result of a concerted lobbying effort by the healthcare industry. The current bill may face a more benign Congress, but pressure from the private insurance industry and its allies is sure to be strong, and will test the resolve of Democrats to present a united front.

Further reading - An in-depth review of the US medical device market, including some background information on the healthcare system, is available from Espicom: The Medical Device Market: USA (published March 2009)

UK - The NHS Faces £15 billion Budget Shortfall

The UK’s National Health Service (NHS) is facing a cut in funding of up to £15 billion from 2011, as a result of the economic recession and rising healthcare costs. According to the report from the NHS Confederation, released in June 2009, funding could fall by 2.5 to 3.0 per cent per annum from 2011/12, which is equivalent to a cut of between £8 to 10 billion over three years and up to £15 billion over five years.

The report, Dealing with the downturn: the greatest ever leadership challenge for the NHS?, outlines that demand is expected to continue to increase “from long-term trends in ageing, increasing disease burden from improved survival and rising fertility”, in addition to “the negative health effects of recession in areas such as mental health and alcohol use”.

There was a period of huge growth in health spending under the Labour government, which saw the NHS budget almost triple. In 2009, the NHS budget is £98.2 billion, and will rise to £102.3 billion in 2010. However, despite the surplus of around £1.35 billion in the financial year 2008/09, NHS finances will deteriorate considerably after the comprehensive spending review in 2011.

The Health Secretary, Andy Burnham, asserted that concerns over closures and job cuts were “completely premature” and claimed that focusing on prevention through promoting healthier lifestyle choices would lessen the pressure on the NHS. He also claimed that core targets, such as waiting time guarantees, would remain in place as minimum standards.

Unions, such as Unison and the British Medical Association (BMA), are concerned the cuts could lead to increased use of private healthcare providers to meet the growing demands placed on healthcare services.

Further reading - An in-depth review of the UK medical device market, which includes some background information on the healthcare system and the NHS, is available from Espicom: The Medical Device Market: United Kingdom (published March 2009)

The Outlook for Medical Devices in Brazil, Russia, India and China 2009

Many are concerned that the global economic downturn is blunting the rapid growth in the BRIC countries. Is this a time of exciting opportunity or commercial danger for medical manufacturers and how is the economic turmoil affecting each market?

These leading emerging economies represent a total medical market of US$10.8 billion. But how might the impact of the economic downturn affect them? Where do commercial opportunities exist for medical device companies now, and what are the future prospects?

Putting things in perspective
With a combined population of 2.7 billion people and with significant unmet medical need the challenges and opportunities of BRIC markets are considerable. The economic downturn has affected these markets varyingly; for example, the Brazilian import market may be affected by disadvantageous US$ exchange rates, but China is affected more by a weak economy in the USA, its major market. Significant growth rates, up to 9.1% in China for example, are impressive, but the low starting point – along with a range of other operational issues – means companies must be targeted in the opportunities they pursue.

Opportunities do exist
There are, of course, wide regional differences in expenditure levels within the BRIC countries, far more so than in developed countries where health systems have evolved to provide a more uniform level of coverage. All four countries have a relatively wealthy urban population with a far greater spending power than their respective national average. These urban populations have grown rapidly, and number hundreds of millions. The challenge for these countries is to extend this level of wealth to the rest of the population, in order that better levels of healthcare become affordable.

A long haul
The prevailing economic woes have to be seen over the long term. This is evolution not revolution, and change will be incremental. Short-term opportunities exist in meeting the health demands of the burgeoning middle classes, and future prospects are bright, where steady growth in BRIC markets will erode commercial differences with the established markets in North America, Japan and Europe.

Further reading
Espicom has issued a collection of quarterly-updated reports covering each of the BRIC medical device markets in detail: The Outlook for Medical Devices in Brazil, Russia, India & China 2009. For each country there is a comprehensive examination of the market for medical devices and equipment which covers all aspects of the operating environment from the regulatory situation through health provision/expenditure to domestic production. Each market evaluation includes 5 year growth forecasts and SWOT analysis.

A separate report is also available for each market.
The Medical Device Market: Brazil
The Medical Device Market: China
The Medical Device Market: India
The Medical Device Market: Russia