The Healthcare System and Delivery Network in Emerging Economies (China, India and Brazil) - Growth Opportunities Driven by Awareness, Affordability and Access by GBIResearch

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									       The Healthcare System and Delivery Network in Emerging
              Economies (China, India and Brazil) - Growth
                  Opportunities Driven by Awareness,
                        Affordability and Access
     Reference Code: GBIME0010MR                                                                                                      Publication Date: JUL 2010

                                      China, India and Brazil are the fastest growing emerging markets in the world. The unprecedented
China, India and Brazil are           growth seen in these emerging economies despite the world economic slowdown consolidates their
the     fastest    growing            role as the key players to influence the world economy in the future. India, China and Brazil
emerging markets in the               together account for about one-third of the total world population. However, the huge population
world. The unprecedented              base in these countries continues to face serious healthcare issues, such as the rise in diseases
growth seen in these                  and inadequate infrastructure facilities, in spite of the economic development. This presents
economies despite the                 enormous growth potential for healthcare delivery in these countries.
world economic slowdown               High Economic and Population Growth Driving the Healthcare Delivery Market
consolidates their role as
key players to influence                Demographics and GDP, Opportunities and Trends, by Country, 2009
the world economy in the
future.                                                                        CHINA
                                                                               Population: 1.3 billion
                                                                               Health Expenditure: 4.7% of GDP
                                                                               Key Investment Opportunities:
                                                                               Hospital Construction, Medical Equipments
                                                                               Emerging Trends: Out and In-hospital Advertising




                                               BRAZIL
                                               Population: 0.19 billion
                                               Health Expenditure: 8% of GDP
                                               Key Investment Opportunities:
                                               Home Healthcare Delivery, Hospitals,
                                               Medical Equipments, Generics
                                               Emerging Trends: Cosmetic Travel
                                                                                                              INDIA
                                                                                                              Population: 1.1 billion
                                                                                                              Health Expenditure: 5% of GDP
                                                                                                              Key Investment Opportunities:
                                                                                                              Hospitals and Health Cities, Medical
                                                                                                              Equipments, Medical Tourism
                                                                                                              Emerging Trends: Hospotels
                                              Note: Costmetic Travel – Medical toursim for cosmetic surgery
                                                    Hospotels – Hospitals offering hotel like services


                                        Source: GBI Research



                                      According to the 2010 world development indicators by the World Bank, China, India and Brazil are
                                      respectively ranked the 2nd, 4th and 9th largest economies in the world in terms of GDP based on
                                      Purchasing Power Parity (PPP). Each of the three countries spends 4.7% (China), 5% (India) and
                                      8% (Brazil) of its GDP on healthcare. Although healthcare expenditure as a percentage of GDP has
                                      been increasing consistently, there has not been a significant rise in the per capita health
                                      expenditure because of the high population growth in these countries. The population of China is
                                      1.3 billion while that of India is 1.1 billion. China implemented the ‘one child policy’ in 1979 which
                                      reduced the birth rate in the country while the Indian population continues to grow. In fact, India is
                                      poised to become the most populous country in the world, surpassing China by 2030. In respect to
                                      Brazil, this continues to be the largest and the most populous country in South America with a
                                      population base of 190 million.

The Healthcare System and Delivery Network in Emerging                                                                         GBIME0010MR /Published JUL 2010
Economies (China, India and Brazil) - Growth Opportunities
Driven by Awareness, Affordability and Access                                                                                                             Page 1
                                                                                  © GBI Research. This is a licensed product and is not to be photocopied
                                      The healthcare services and infrastructure facilities in these countries are inadequate to take care
                                      of the growing needs of this huge population. This makes the healthcare delivery market in these
                                      emerging economies an attractive opportunity for investors.
                                      Socio-Demographic Trends Conducive to Growth in Healthcare Delivery Market in Emerging
                                      Economies
                                      Emergence of the Huge Middle Class Population
                                      The demographics of China, India and Brazil have undergone some fundamental changes such as
India’s    middle   class             the emergence of the ’middle class’. This middle class population has a high personal disposable
population was estimated              income presenting it with greater purchasing power. For example, India’s middle class population
at 300 million in 2009,               was estimated at 300 million in 2009, representing 30% of the population and spreading across
representing 30% of the               5,000 towns and cities. Further, India has 10 of the 30 fastest-growing urban areas in the world
population.                           and, based on current trends, a massive 700 million people will move to the cities by 2050. This will
                                      create significant demands for healthcare infrastructure and quality health services in India. In
                                      China, with the increase in disposable income, an increasing proportion of the middle class
                                      population is opting for private healthcare services offering better quality services. With about 190
                                      million people, Brazil too has a fast emerging middle class population with over 30 million Brazilians
                                      joining the country’s middle class population between 2003 and 2009. The emergence of this new
                                      middle class population with greater income and access to credit offers abundant potential for the
                                      healthcare system and delivery network in the country.
                                      Rise in Lifestyle Related Diseases
                                      In the emerging economies, with the availability of greater disposable income, more and more
                                      people are enjoying a high standard of living, are more stressed out and are also leading a
                                      sedentary lifestyle. These factors have given rise to lifestyle related diseases such as hypertension,
                                      cardiovascular diseases and diabetes. In fact, cardiovascular disease is one of the leading causes
                                      of death in both urban and rural areas of China. It is estimated that there will be 21.3 million more
                                      cardiovascular events leading to 7.7 million more deaths between 2010 and 2030 alone.
                                      Chronic diseases such as diabetes, cardiovascular diseases and cancer account for about 50% of
                                      all deaths in India. It is already the diabetic capital of the world and will have nearly 30 million
                                      diabetics by 2020. In Brazil, the situation is very similar with an increasing prevalence of lifestyle
                                      related diseases. Circulatory diseases happen to be of the top three causes of death in Brazil and
                                      these diseases account for nearly 50% of the deaths in the population age group of above 60
                                      years.
                                      This disease burden demands the expansion of the healthcare delivery system in these economies.
                                      The governments` in these economies are already taking steps in that direction and are also
                                      encouraging the private sector to invest.
                                      China’s Plan to Invest $124 billion in Healthcare by 2011 to Drive Growth in the Hospital
                                      Construction and Medical Equipment Market
                                      China plans to invest $124 billion in the healthcare sector by 2011 according to the healthcare
China’s plan to invest
                                      reform plan passed in 2009. The money will be spent on building hospitals, improving rural
$124     billion    in    the
                                      infrastructure facilities and providing basic medical insurance to all the people. This has given rise
healthcare sector by 2011
                                      to a thriving hospital construction market within China. The fact that 80% of the hospitals in China
has given rise to a thriving
                                      need to be rebuilt also strengthens the potential of this market. The government is also
hospital         construction
                                      encouraging Sino (China) - foreign joint ventures, privatization of public hospitals and the
market, further fueled by
                                      outsourcing of hospital management and logistic services to encourage growth in the hospital
the fact that 80% of the
                                      sector. Although the investment of foreign companies in Chinese hospitals is limited to 70%, there
hospitals in China need to
                                      have been an increasing number of foreign investments seen in the hospital sector. For example,
be rebuilt.
                                      the United Family Hospitals group, a division of Chindex International Inc, has set up world class
                                      hospitals in the country. Shanghai’s Tongji University, a national key university directly under the
                                      State Education Ministry, Siemens, and Germany-based hospital operator Asklepios Kliniken; have
                                      established a joint-venture Sino-German Friendship Hospital which will be launched in 2010 World
                                      Exposition. The hospital has a bed capacity of 500 with the overall investment for the hospital at
                                      more than $120m. An emerging trend seen in China is the investment in hospitals by Taiwanese
                                      entrepreneurs and corporations.




The Healthcare System and Delivery Network in Emerging                                                     GBIME0010MR /Published JUL 2010
Economies (China, India and Brazil) - Growth Opportunities
Driven by Awareness, Affordability and Access                                                                                           Page 2
                                                                         © GBI Research. This is a licensed product and is not to be photocopied
                                        Medical Equipment Market Size ($bn), China (2009 – 2016)
    With the construction of
    new      hospitals     and                                 25
    upgrading     of   existing
    hospitals, China’s medical
    equipment market will
    receive a boost and will                                   20
    grow from $11.8 billion in
    2009 to $19.1 billion by



                                           Market Size ($bn)
    2016.                                                      15




                                                               10




                                                                5




                                                                0
                                                                    2009     2010          2011       2012          2013      2014          2015     2016

                                        Source: GBI Research



                                        Medical Equipment Market size ($bn), China (2009 – 2016)
                                                                                                                                               CAGR (Compound
                                                                           2009     2010    2011    2012     2013    2014    2015    2016        Annual Growth
                                                                                                                                                      Rate) (%)
                                        Market size ($bn)                  11.8     12.6     13.5    14.4    15.5     16.6   17.8    19.1                   7.1%
                                        Source: GBI Research



                                      With the construction of new hospitals and the upgrading of the existing hospitals, there will be a
Around 60-65% of the                  huge demand for medical equipment. China’s already growing medical equipment market will
hospitals in India are                receive a further boost growing from $11.8 billion in 2009 to reach $19.1 billion by 2016. Currently,
private with some of the              China’s medical equipment market is the third largest in the world, only behind the US & Japan. GE
most developed world-                 is the largest foreign owned manufacturer of medical equipment in China while Mindray is the
class hospital chains such            largest domestic manufacturer.
as Apollo, Fortis, Max and            Hospital Sector Experiencing Exponential Growth in India
Columbia Asia having a
presence.                             A striking feature of India’s healthcare system is the significant and growing role of the private
                                      sector in healthcare delivery. The hospital sector is growing exponentially with India allowing 100%
                                      foreign ownership of hospitals under the Special Economic Zones Act (SEZ). About 60% of all the
                                      hospitals in India are private with some of the most developed world-class hospital chains such as
                                      Apollo, Fortis, Max and Columbia Asia having a presence.




The Healthcare System and Delivery Network in Emerging                                                                       GBIME0010MR /Published JUL 2010
Economies (China, India and Brazil) - Growth Opportunities
Driven by Awareness, Affordability and Access                                                                                                               Page 3
                                                                                           © GBI Research. This is a licensed product and is not to be photocopied
                                        Evolution of Private Healthcare Sector, India
  The concept of ‘Hospotels’
  and ‘Medicities’ is gaining
  increasing popularity in                                                           More Privates
  India.                                       Charitable Trust                    Wockhardt, Lilavati,
                                                  Hospitals                           Fortis, Max




                                                                                                                                      Recently:
                                                   1950-1980          1990-2000           1990-2000       2000 onward                Aditya Birla,
                                                                                                                                    Reliance ADAG




                                                                          Apollo                          Artemis, Columbia Asia,
                                                                  First Corporate Group                           Global,
                                                                                                                Hrudalaya

                                        Source: GBI Research



                                      Corporate groups in India such as Reliance and the Aditya Birla Group are increasingly investing in
                                      the hospital sector. These hospitals provide general and specialized services at competitive prices
                                      enabling domestic as well as foreign patients to receive treatment. This has also led to the growth
                                      of medical tourism in India. The hospital sector is also attracting private equity and major venture
                                      capital funding. For example, ICICI, the largest equity firm in India has created a $225m equity fund
                                      to invest in the development of hospitals chains whilst a company called Global Healthcare
                                      investments and solutions has planned to invest part of its $500m equity fund in Indian tertiary care
                                      hospitals.
                                      With the high economic growth and emergence of the famed Indian middle class, the hospital
                                      sector in India is continuously evolving to meet the growing need for quality care and services. This
                                      has given rise to the concept of ‘Hospotels’ and ‘Medicities’ which are also known as ‘Health cities’
                                      to provide quality healthcare to a large group of people while offering other facilities such as hotels,
                                      residential facilities, spas, gyms and sometimes even a golf course. With people being able to
                                      afford better quality healthcare, the concept of a health city seems to have moved up in the patient
                                      value proposition chain. This concept seems to be gaining strength in the country with prominent
                                      health cities being established including the Dr. Naresh Trehan’s medicity at Gurgoan and the
                                      Fortis medicity at Lucknow. This growth in the hospital sector has given a boost to the Indian
                                      medical equipment industry as well.
                                      Home Healthcare Delivery and Private Hospitals Represent Key Opportunities in Brazil
The Brazilian healthcare
delivery market presents              As Brazil prepares to host soccer’s 2014 World Cup and the 2016 Olympic Games, its economy is
growth opportunities in the           experiencing a new surge. The events have driven new deals and contracts to attain international
hospital, home healthcare             standards even in the healthcare sector. Although Brazil has a Unified Health System (UHS) which
delivery,          medical            is supposed to provide healthcare to all its citizens, the private sector still accounts for about 58%
equipment and hospital                of the overall health expenditure in the country. Also, about 75-80% of the hospitals providing
information       systems             services in Brazil are private. Rede O D’Or and Sao Luiz are two of the most prominent hospital
sector.                               chains in Brazil, while Sociedade Beneficente Israelita Brasileira Albert Einstein (SBIBAE) and
                                      Samaritan are other important hospitals.
                                      With the rise in the aging population in Brazil, people are looking for alternative healthcare services
                                      and this has given rise to a thriving home healthcare delivery market. Brazil is a fast growing home
                                      healthcare delivery market which is focused on serving about 30% of the entire population that
                                      primarily suffers from chronic illnesses such as diabetes, hypertension, rheumatism and respiratory
                                      diseases. The homecare segment in Brazil currently accounts for an estimated 250 companies and
                                      the programs treat about 30,000 patients per month. Brazil is also the largest medical equipment
                                      market in Latin America with the majority of imports coming from the US (20%), Germany and
                                      Switzerland (13% each). Overall, the Brazilian healthcare delivery market looks positive with
                                      greater opportunities in the hospital, home healthcare delivery, medical equipment and hospital
                                      information systems sector.




The Healthcare System and Delivery Network in Emerging                                                               GBIME0010MR /Published JUL 2010
Economies (China, India and Brazil) - Growth Opportunities
Driven by Awareness, Affordability and Access                                                                                                   Page 4
                                                                               © GBI Research. This is a licensed product and is not to be photocopied
                                      Medical Tourism - An Emerging Trend in India and Brazil
                                      Due to the high cost of treatment and surgeries in the developed countries such as the US and the
                                      UK, patients are looking for cost effective alternatives for their treatment. With surgeries performed
                                      in India, patients are expected to save 60 to 90% of the total treatment cost. Medical tourism is
                                      expected to represent 3 to 5% of the total healthcare delivery market in India. To promote medical
                                      tourism, the Indian government has started issuing medical visas (M visas) to patients. The
                                      government also announced in 2008 that an investment of $6.5 billion was in the pipeline to set up
                                      affordable budget hospitals and treatment care for medical tourists. In India, some of the leading
                                      players in the medical tourism sector are Narayana Hrudalaya, Apollo Hospitals and Fortis
                                      Healthcare.
                                      The US has the highest number of cosmetic surgeries in the world. Being geographically close to
                                      the US, cosmetic travel i.e. plastic surgery medical tourism is popular in Brazil. In fact, Brazil is
                                      considered a haven for cosmetic surgery travel with surgeries being performed at 40 to 60% of the
                                      costs incurred in developed countries such as the US. Some of the leading players in cosmetic
                                      travel in Brazil are the Albert Einstein Jewish Hospital - Sao Paolo, Sociedade Hospital Samaritano
                                      - Sao Paolo and Hospital do Coracao - Sao Paolo.




The Healthcare System and Delivery Network in Emerging                                                     GBIME0010MR /Published JUL 2010
Economies (China, India and Brazil) - Growth Opportunities
Driven by Awareness, Affordability and Access                                                                                           Page 5
                                                                         © GBI Research. This is a licensed product and is not to be photocopied
                                      1 Table of Contents
                                      1 Table of Contents ........................................................................................................................ 6
                                        1.1    List of Tables..................................................................................................................... 9
                                        1.2    List of Figures ................................................................................................................. 10
                                      2 Introduction................................................................................................................................ 11
                                        2.1    GBI Research Guidance ................................................................................................. 11
                                      3 Healthcare Delivery System in India.......................................................................................... 13
                                        3.1    Introduction ..................................................................................................................... 13
                                        3.2    Healthcare Expenditure .................................................................................................. 13
                                        3.3    Healthcare Infrastructure ................................................................................................ 14
                                           3.3.1    Public Healthcare Infrastructure .............................................................................. 16
                                           3.3.2    Private Healthcare infrastructure ............................................................................. 17
                                        3.4    Healthcare Regulation .................................................................................................... 19
                                           3.4.1    The Union Ministry of Health and Family Welfare (MoHFW) ................................... 19
                                           3.4.2    National Programs and Schemes ............................................................................ 20
                                           3.4.3    Highlights of BUDGET 2010-2011........................................................................... 22
                                           3.4.4    Health Insurance Regulation ................................................................................... 22
                                        3.5    Key Players in the Healthcare Industry ........................................................................... 23
                                           3.5.1    Apollo Hospitals Enterprise Ltd................................................................................ 23
                                           3.5.2    Fortis Healthcare ..................................................................................................... 24
                                           3.5.3    Manipal Health Systems.......................................................................................... 24
                                           3.5.4    Max Healthcare ....................................................................................................... 24
                                           3.5.5    Narayana Hrudayalaya............................................................................................ 25
                                           3.5.6    Columbia Asia ......................................................................................................... 25
                                           3.5.7    Profiles of New Entrants .......................................................................................... 25
                                        3.6    Sources of Funding......................................................................................................... 26
                                           3.6.1    Foreign Direct Investment (FDI) & other Foreign Investments ................................ 26
                                           3.6.2    Private Equity and Venture Capital.......................................................................... 27
                                        3.7    Evolving Trends in the Healthcare System in India......................................................... 28
                                           3.7.1    Health Cities ............................................................................................................ 28
                                           3.7.2    Hospotels ................................................................................................................ 29
                                           3.7.3    Health and Wellness................................................................................................ 29
                                        3.8    Socio-Economic and Demographic Trends Affecting Healthcare Sector ........................ 30
                                           3.8.1    High Population and Economic Growth ................................................................... 30
                                           3.8.2    Emergence of the Middle Class............................................................................... 31
                                           3.8.3    Shift in Disease profile............................................................................................. 31
                                        3.9    Reimbursement Scenario................................................................................................ 32
                                           3.9.1    Private Health Insurance ......................................................................................... 32
                                        3.10 India Healthcare Delivery Opportunities.......................................................................... 35
                                           3.10.1 Medical Tourism ...................................................................................................... 35
                                           3.10.2 Investments in Healthcare Infrastructure ................................................................. 36
                                           3.10.3 Increase in Foreign Direct Investment (FDI) ............................................................ 36
                                           3.10.4 Telemedicine ........................................................................................................... 36
                                           3.10.5 Opportunities in the Medical Equipment Industry .................................................... 37
                                           3.10.6 Health Insurance ..................................................................................................... 38
                                        3.11 India Healthcare Delivery Challenges ............................................................................. 38
                                           3.11.1 Financial Disparity ................................................................................................... 38
                                           3.11.2 Weak Infrastructure ................................................................................................. 38
                                           3.11.3 Intellectual Property (IP) Concerns.......................................................................... 38
                                      4 Healthcare Delivery System in China ........................................................................................ 39
                                        4.1    Introduction ..................................................................................................................... 39
                                        4.2    Healthcare Expenditure .................................................................................................. 39
                                        4.3    Healthcare Infrastructure ................................................................................................ 39
                                           4.3.1    Public and Private Sector Scenario ......................................................................... 42


The Healthcare System and Delivery Network in Emerging                                                                                GBIME0010MR /Published JUL 2010
Economies (China, India and Brazil) - Growth Opportunities
Driven by Awareness, Affordability and Access                                                                                                                                Page 6
                                                                                        © GBI Research. This is a licensed product and is not to be photocopied
                                           4.3.2    Impact of Healthcare Reforms, 2009 ....................................................................... 44
                                        4.4    Healthcare Regulation .................................................................................................... 45
                                           4.4.1    Ministry of Health..................................................................................................... 47
                                           4.4.2    The National Development and Reform Commission (NDRC) ................................ 48
                                           4.4.3    Chinese Center for Disease Control and Prevention (China CDC).......................... 48
                                           4.4.4    The Ministry of Finance (MoF)................................................................................. 48
                                           4.4.5    Ministry of Labor and Social Security (MoLSS) ....................................................... 48
                                        4.5    Profiles of Key Players .................................................................................................... 48
                                           4.5.1    United Family Hospitals Group (UFH) ..................................................................... 48
                                           4.5.2    Parkway Health, China ............................................................................................ 49
                                           4.5.3    Sunnylife Global, Inc................................................................................................ 49
                                           4.5.4    Sino-German Friendship Hospital............................................................................ 49
                                           4.5.5    SK Group................................................................................................................. 50
                                           4.5.6    Shanghai East International Medical Center ........................................................... 50
                                           4.5.7    Global Doctor........................................................................................................... 50
                                        4.6    Sources of Funding......................................................................................................... 50
                                           4.6.1    Private, Share holdings and Sino-foreign Joint Venture Hospitals........................... 50
                                        4.7    Evolving Trends in the Healthcare System in China ....................................................... 51
                                           4.7.1    Increase in Taiwanese Investment in hospitals in China ......................................... 51
                                           4.7.2    Hospital Advertising................................................................................................. 51
                                        4.8    Socio-Economic and Demographic Trends Affecting the Healthcare Sector .................. 53
                                           4.8.1    Shift in Demographics ............................................................................................. 53
                                           4.8.2    Rise in Personal Disposable Income ....................................................................... 54
                                           4.8.3    Rise in Lifestyle Diseases........................................................................................ 54
                                        4.9    Reimbursement Scenario................................................................................................ 55
                                           4.9.1    Urban Health Insurance........................................................................................... 55
                                           4.9.2    Rural Health Insurance............................................................................................ 55
                                           4.9.3    Private Insurance..................................................................................................... 56
                                        4.10 China Healthcare Delivery Opportunities ........................................................................ 57
                                           4.10.1 High growth in Medical Equipment Market .............................................................. 57
                                           4.10.2 Growth in Pharmaceutical Industry Sector .............................................................. 57
                                           4.10.3 Booming Healthcare Construction Market ............................................................... 58
                                           4.10.4 Opportunity in Hospital Information Systems Sector ............................................... 58
                                        4.11 China Healthcare Delivery Challenges ........................................................................... 58
                                           4.11.1 Regulatory and Bureaucratic issues ........................................................................ 58
                                           4.11.2 Weak Intellectual Property Protection...................................................................... 58
                                           4.11.3 High Cost of Prescription Drugs .............................................................................. 58
                                           4.11.4 Financial Disparity and Coverage Problems............................................................ 59
                                           4.11.5 Inadequate Infrastructure and Qualified Workforce ................................................. 59
                                           4.11.6 Language Barrier..................................................................................................... 59
                                      5 Healthcare Delivery System in Brazil......................................................................................... 60
                                        5.1    Introduction ..................................................................................................................... 60
                                        5.2    Healthcare Expenditure .................................................................................................. 60
                                        5.3    Healthcare Infrastructure ................................................................................................ 61
                                           5.3.1    Public and Private Sector Scenario ......................................................................... 63
                                        5.4    Healthcare Regulation .................................................................................................... 64
                                           5.4.1    Unified Health System (UHS also called as SUS in Brazil) ..................................... 64
                                           5.4.2    National Agency of Sanitary Surveillance (ANVISA) ............................................... 64
                                           5.4.3    National Private Healthcare Insurance Agency (ANS)............................................. 64
                                        5.5    Profiles of Key Players .................................................................................................... 65
                                           5.5.1    Rede D’Or (D’Or’ or ‘The Company’)....................................................................... 65
                                           5.5.2    Sao Luiz .................................................................................................................. 66
                                           5.5.3    HCor – Hospital do Coracao.................................................................................... 67
                                           5.5.4    Samaritan Hospital of Sao Paulo............................................................................. 67
                                           5.5.5    Sociedade Beneficente Israelita Brasileira Albert Einstein (SBIBAE) ...................... 68

The Healthcare System and Delivery Network in Emerging                                                                              GBIME0010MR /Published JUL 2010
Economies (China, India and Brazil) - Growth Opportunities
Driven by Awareness, Affordability and Access                                                                                                                             Page 7
                                                                                       © GBI Research. This is a licensed product and is not to be photocopied
                                        5.6    Sources of Funding......................................................................................................... 68
                                           5.6.1    Joint, Foreign Direct Investment (FDI) and Private Ventures.................................. 68
                                           5.6.2    Impact of Soccer World Cup 2014 and Olympic Games 2016 in Brazil................... 69
                                        5.7    Evolving Trends in the Healthcare System in Brazil........................................................ 69
                                           5.7.1    Hospotels ................................................................................................................ 69
                                           5.7.2    Cosmetic Travel....................................................................................................... 69
                                        5.8    Socio-Economic and Demographic Trends Affecting Healthcare Sector ........................ 70
                                           5.8.1    Changing Population Trends ................................................................................... 70
                                           5.8.2    Impact of Financial Disparity on Disease Profile...................................................... 71
                                           5.8.3    AIDS Pandemic ....................................................................................................... 72
                                        5.9    Reimbursement Scenario................................................................................................ 72
                                           5.9.1    Private Insurance..................................................................................................... 72
                                        5.10 Brazil Healthcare Delivery Opportunities ........................................................................ 75
                                           5.10.1 Huge Generic Drugs Market .................................................................................... 76
                                           5.10.2 Soaring Imports of Medical Equipment.................................................................... 76
                                           5.10.3 Growth in Pharmaceutical Sector ............................................................................ 76
                                           5.10.4 Home Healthcare Delivery market........................................................................... 77
                                           5.10.5 Government - The Largest Buyer of Pharmaceutical Products and Services .......... 77
                                           5.10.6 Investment Opportunities in Hospital Information Systems Sector .......................... 78
                                           5.10.7 Telemedicine ........................................................................................................... 78
                                        5.11 Brazil Healthcare Delivery Challenges ............................................................................ 78
                                           5.11.1 High Taxes .............................................................................................................. 78
                                           5.11.2 Weak Intellectual Property Protection...................................................................... 78
                                           5.11.3 Weak Infrastructure ................................................................................................. 78
                                      6 Appendix ................................................................................................................................... 79
                                        6.1    Acronyms ........................................................................................................................ 79
                                        6.2    References...................................................................................................................... 81
                                        6.3    Methodology ................................................................................................................... 82
                                           6.3.1    Secondary Research ............................................................................................... 82
                                           6.3.2    Primary Research.................................................................................................... 82
                                           6.3.3    Models ..................................................................................................................... 83
                                           6.3.4    Forecasts................................................................................................................. 83
                                           6.3.5    Expert Panels .......................................................................................................... 83
                                        6.4    Contact Us ...................................................................................................................... 84
                                        6.5    Disclaimer ....................................................................................................................... 84




The Healthcare System and Delivery Network in Emerging                                                                                GBIME0010MR /Published JUL 2010
Economies (China, India and Brazil) - Growth Opportunities
Driven by Awareness, Affordability and Access                                                                                                                                Page 8
                                                                                        © GBI Research. This is a licensed product and is not to be photocopied
                                      1.1       List of Tables
                                      Table 1:   Healthcare Professionals, India, 2009............................................................................ 14
                                      Table 2:   Healthcare Infrastructure, Public and Private Distribution, India, 2009 .......................... 15
                                      Table 3:   Snapshot of International Finance Corporation (IFC), Investments ($m), India, (1997 –
                                                 2009).............................................................................................................................. 28
                                      Table 4: Prominent Health City Projects, India, 2010...............................
								
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