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