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)
Tuesday 25 August 2009
Friday 14 August 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)
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)
Thursday 6 August 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 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)
Wednesday 5 August 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)
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:
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)
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)
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:
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)
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)
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)
Monday 3 August 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)
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)
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