Opportunities in the China Healthcare Sector. December 2008

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1 Opportunities in the China Healthcare Sector December 28

2 Opportunities in the China Healthcare Sector Executive Summary China s healthcare sector is rapidly developing Total Health expenditure in China grew at a CAGR of 15.1% from 22 to 26, and reached USD 123 Bn in 26 Government spending on healthcare is increasing, and may increase to as much as 73Bn by 21, from 38 Bn in 28 The Public Health Insurance System is expected to cover ~ 9% of the population by 21, from 8% in 22 China has been identified as an attractive market for the pharmaceutical sector Chinese pharmaceutical sales are expected to reach USD 28 Bn in 21 China is expected to become the world s 5th largest pharmaceutical market in 211, from #7 in 27 Consumer spending by urban residents is expected to grow at a CAGR of 9.6% from 25 to 225 Source: Ministry of Health, China; Ministry of Labor and Social Security, China; IMS Health; The McKinsey Quarterly; Press Release December 28 Copyright 28 Grail Research, a division of Integreon 2

3 Major Changes are Underway in the Chinese Market, Including Healthcare Expenditure China has witnessed increased economic growth but healthcare spending has only kept pace with the rest of the world over the last few years GDP and Growth Rate, China, GDP 15 Total Health Expenditure, China, ,2 4, USD Bn 2, 9.1% 1,452 1.% 1, % 1, % 2, % 2, % 3,276 Growth Rate 12 6 % USD Bn Ranking & Contribution to World GDP Growth Rate World Ranking 4 6 Contribution (23-27) 26.% Note: 1 Average exchange rate for each year is provided by Oanda; 2 It includes government expenditure, employer expenditure and out-of-pocket expenditure; 3 The health expenditure for other countries is calculated by GDP and health expenditure as a percentage of GDP, and the total number of the countries is 176 Source: National Bureau of Statistics, China; Ministry of Health, China; World Bank; IMF; Oanda; Press Release; Grail Analysis December 28 Copyright 28 Grail Research, a division of Integreon 3 Ranking & Contribution to World Health Expenditure World Ranking 8 8 Contribution (22-26) 3.6%

4 However, China s Healthcare Expenditure is Still Far Lower than its Counterparts Compared with developed nations and other BRIC countries, China s healthcare expenditure per capita and as a percent of GDP ranks low Per Capita Total Expenditure on Healthcare in Select Countries, 26 Total Healthcare Expenditure as a % of GDP, Select Countries, 26 in 7, 6, ,5 12 USD 3,5 3,361 % , 2, China US UK Japan Brazil Russia 39 India China US UK Japan Brazil Russia India Source: WHO Statistics December 28 Copyright 28 Grail Research, a division of Integreon 4

5 China is Undertaking Initiatives to Catch Up The government is restructuring the health insurance system and increasing spending on healthcare Healthcare Reform in Rural Areas Initiated Coverage Expanded to The Unemployed in Urban Area Healthcare Reform in Urban Areas Initiated Fiscal Budget on Healthcare Reform Specialized Health Insurance Companies were Authorized Reform Deepened, Regulations are Undergoing Revision Stimulus Package USD 38Bn 1 USD Bn 1 China announced a USD 573 Bn 1 stimulus package from now until the end of 21 USD 14 Bn 1 will be spent in Q4, 28 13% of Q4 spending (USD 1.9 Bn) was designated for healthcare, education, and culture sectors Note: 1 Average exchange rate of Oct. 31st, 28 is provided by Oanda, 1 USD=6.85 CNY Source: Ministry of Labor and Social Security, China; State Council, China; Oanda; Press Release December 28 Copyright 28 Grail Research, a division of Integreon 5

6 Public Insurance has Expanded Significantly Since 1998 Reform of the Public Insurance System has resulted in a steep increase in both the covered population and insurance claims paid Population Covered by Public Insurance, China, E Claims Paid 2 by Public Insurance, China, % 2, % of the Insured 9% 1% Insured Population MM 65% 1,198 1,36 5% USD Bn , 1% % E 22E Note: 1 In 22, New Cooperative Medical System for rural area was introduced; 2 Average exchange rate for each year is provided by Oanda Source: Ministry of Labour and Social Security, China; State Council, China; National Bureau of Statistics, China; Nanjing Institute of Meteorology & Nanjing University of Economics; Oanda; Press Release; Grail Analysis December 28 Copyright 28 Grail Research, a division of Integreon 6

7 The Spending Power of China s Middle Class is on the Rise China s per capita GDP is expected to grow and the purchasing power of the Chinese people is also increasing USD MM Households 4 2 6, 3, GDP Per Capita, China, 27 22E GDP forecast including GDP per capita Like 翻 几 番, 相 当 于 中 等 发 达 国 家 水 平 等 2,461 3, 6, 27 21E 22E Number of Urban Households by Annual Income Segment, China, E E E 12 Global Affluent Affluent Upper Middle Class Lower Middle Class Poor USD Bn 3, 2,5 2, 1,5 1, 5 Urban Household Spending by Annual Income Segment, China, E 1, , E E 1, E 1,793 1, , E Global Affluent (>29.2K USD) Master Affluent ( K USD) Upper Middle Class ( K USD) Lower Middle Class ( K USD) Poor (<3.6K USD) Note: 1 Average exchange rate of Oct. 31st, 28 is provided by Oanda, 1 USD=6.85 CNY; 2 When accounting for purchasing-power parity, a household income of USD14.6K, buys a lifestyle in China similar to that of a household earning USD 4, in the United States; Source: Chinese Government s Official Web Portal; The Value of China's Emerging Middle Class, June 26, The McKinsey Quarterly; The Rise of China s Urban Middle Class, November 26, McKinsey Global Institute; Chinese Academy of Social Sciences; Oanda; Grail Analysis December 28 Copyright 28 Grail Research, a division of Integreon 7

8 The Private Insurance Sector is Thriving and Playing a More Important Role As a supplement to the Public Health Insurance System, private health insurance has rapidly grown, especially in metropolitan areas Number of Health Insurance Companies 13 (27) Population 1 Covered by Private Insurance 15MM (25) 25 USD Bn Claims Paid 2 by Private Insurance, China, PICC has expanded its customer base from employer units, seniors and children to rural residents; [rural residents ] purchasing power should not be underestimated - A Sales Manager from PICC Health Insurance Company - A Sales Manager from PICC Health Insurance Company Note: 1 The figure is sales based; 2 Average exchange rate for each year is provided by Oanda; 3 The survey was conducted by China s Development Research Center of the State Council and the Insurance Institute of China in 5 cities in China Source: Ministry of Labour and Social Security, China; State Council, China; National Bureau of Statistics, China; Oanda; Press Release; Grail Analysis December 28 Copyright 28 Grail Research, a division of Integreon 8 Shanghai and Beijing are our largest markets with steady and rapid growth. Not only is the population in these two cities huge, but also the Public Health Insurance Systems in these two cities are more complete, which has helped improve people s awareness of the importance of health insurance

9 Global Pharmaceutical Companies have Taken Notice of China s Healthcare Market Opportunity Global pharmaceutical manufacturers have experienced significant sales growth and have a positive outlook on the Chinese market Sales in China increased 25% in 26 launched five new products in China in 27 and plans to introduce an additional 15 new products and line extensions through the year 212 (Sanofi-Aventis experienced) Highest growth of more than 36% in 27 in China... - Sanofi-Aventis Annual Review 27 - Jorg Ostertag, President, Eli Lilly China, 27 China, accounted for around 5% of the region s sales growth in 27 China is currently Novo Nordisk s fifth-largest market and is expected to be its second- or thirdlargest within the next five years - Novo Nordisk Annual Report 27 We are going to launch over 2 new products in the next five years, and we aim to bring all our blockbusters to China in the next two to three years - Liam Condon, Managing Director Bayer HealthCare China, 27 Source: Company Websites; Company Annual Reports; Company Conference Call Presentations December 28 Copyright 28 Grail Research, a division of Integreon 9

10 IMS Indentifies China as the Emerging Market with the Greatest Growth Potential for the Pharmaceutical Sector (1/2) China is expected to rise to the 5 th largest pharmaceutical market in Pharmaceutical Sales Volume, China, 24 21E 28. Pharmaceutical Market Rankings, E E 3 211E 4 USD Bn US US US US US 2 Japan Japan Japan Japan Japan E 3 Germany Germany France Germany France 4 France France Germany France Germany 5 Italy Italy Italy U.K. China Growth Rate of Pharmaceutical Sales Volume in Selected Countries, 25 29E Year China US Japan UK India Brazil Russia 29E 12-16% 1-2% 4-5 % 1-2% 12-16% 12-16% 12-16% % 4.1% 3.6% 5.2% 4 13% 9.7% 2.2% 6 U.K. U.K. U.K. Italy U.K. 7 Spain Spain Spain China Italy 8 Canada Canada Canada Spain Brazil 9 Brazil China China Canada Canada 1 China Turkey Brazil Turkey Spain % 5.1% 6.8% -2.2% 8.6% 9.5% 17.3% Note: 1 It is calculated, based on the sales volume in 26 and growth rate in 27; 2 It is estimated in Global Pharma Perspective, 24; 3 It is estimated in Global Pharma Perspective, 25; 4 It is estimated in Global Pharma Perspective, 27 Source: IMS Health; Grail Analysis December 28 Copyright 28 Grail Research, a division of Integreon 1

11 To Take Advantage of the Opportunity, Global Pharmaceutical Companies will Need to Navigate Chinese Market Complexities Big Government and the economic imbalance between urban & rural, and coastal & western areas of China have resulted in strict regulation of the Public and Private Health Insurance Systems For Example Numerous Rules The central government sets guidelines for the Public Health System Local governments formulate their own regulations, which may differ from central government guidelines Medicine Restriction Only drugs listed on the Basic Medical Catalogue are covered by the Public Health Insurance System Private Health Insurance companies may deviate from the Basic Medical Catalogue Disease Restriction The government sets non-reimbursable and partly-reimbursable diseases for the Public Insurance System Private Insurance policies must cover a mandated set of illnesses Source: Ministry of Labor and Social Security, China; National Development and Reform Commission, China; Insurance Regulatory Commission, China December 28 Copyright 28 Grail Research, a division of Integreon 11

12 For More Information Contact: Grail Research Copyright 28 by Grail Research, a division of Integreon No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without the permission of Grail Research, a division of Integreon December 28 Copyright 28 Grail Research, a division of Integreon 12

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