citi China Healthcare Handbook Dec 2011

Section 1 - Analysis of Chinese Pharmaceutical Market 7
China’s Hospital Drug Market 8
Analysis of Market for Essential Drug List (EDL) 9
Traditional Chinese Medicine (TCM) Market 10
Drug Market Sales Trend in 2011 11
What’s Driving China’s Pharmaceutical Market? 12
Expecting a De-acceleration of Chinese Pharmaceutical Market 14
Detailed Analysis of Therapeutic Drugs 15
Looking for Winners and Category Leaders 15
Key Findings from Our Analysis 15
Top 20 Drug Companies Based on Analysis of Prescription Data
from 418 hospitals in 22 Major Cities 18
Top 20 Hospital Drugs Based on Analysis of Prescription Data
from 418 hospitals in 22 Major Cities 19
Top Therapeutic Categories and Regional Markets Based on
Prescription Data from 418 Hospitals in 22 Major Cities 20
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Distribution Survey Sample by Hospital Class 166
Expecting Double Digit Growth in Medical Equipment Purchasing
in 2012 167
Self-funding Remain as the Major Funding Source in Chinese
Hospitals 168
Hospitals Prefer Direct Sales in Medical Equipment Purchasing 169
Government Tender and Hospital Brand Awareness 170
Analysis of Medical Equipment Markets 171
Hospital Penetration of Medical Equipments 171
Multinationals Dominate China Medical Equipments Market 172
Multinationals: All-Around Winners vs. Niche Players 173
Domestic Market: Mindray as the Most Significant Domestic
Players in the Market 175
Hospital Purchasing Preference 2012 for Patient Monitors, Color
Ultrasound and Biochemistry Analyzers 176
Analysis of Patient Monitor Market 177
Analysis of Black and White Ultrasound Market 179
Analysis of Color Ultrasound Market 181
Analysis of Automatic Biochemistry Analyzer Market 184
Analysis of Anesthesia Market 186
Analysis of Computed Tomography (CT) Market 188
Analysis of Computed Radiography (CR) Market 190
Analysis of Digital Radiography (DR) Market 192
Analysis of Digital Subtraction Angiography (DSA) Market 194
Analysis of Magnetic Resonance Imaging (MRI) Market 196
Analysis of Linear Accelerator (LA) Market 198
Analysis of Medical Consumables Markets Based on Citi 2011
Hospital Survey 201
Hospital Penetration of Major Medical Consumable Products 201
Domestic Players Is More Competitive in the Market 202
Hospitals Prefer Distributor for Procurement of Consumables
Products 203
Analysis of Conventional Medical Consumables Market 204
Analysis of Drug Eluted Stent (DES) Market 205
Domestic Growth Rate for PCI Procedures 206
More Hospitals/Doctors Will Be Able to Perform PCI surgery 207
Distribution of Hospitals with Annual PCI Capacity of More Than
100 208
Stent Cost Accounts for Over 60% of PCI Cost 209
Stent Price Cuts 210
Reimbursement Policies Favor Domestic Brands 211
Sales and Marketing Strategies 212
Citi Estimates of Stent Market Shares by Key Players 213
Hospital Penetration of Major Players Based on Citi Hospital
Survey 214
Overview of Major DES Products in China Market 215
Analysis of Orthopedic Market 216
Growth in China Orthopedics Market 216
Analysis of Global Orthopedics Market 217
Orthopedics Market Breakdown by Segment 218
Competitive Landscape of China Orthopedics Market 219
Summary of Key Domestic Players and Market Segments 220
Section 3- Analysis of Drug Distribution Industry 221
With Multiple Layers, China’s Drug Distribution System Lacks
Efficiency 221
Drug Distribution Value Chain 222
Industry Is Gravitating Towards Large Players 223
The Pharmaceutical Markets in the US, EU and Japan Have
Been Increasingly Consolidated 224
Drugstore Overview 227
Financial Highlights of Drug Distribution Industry – Gross Margin 228
Financial Highlights of Drug Distribution Industry – Operating and
Net Margin 229
Financial Highlights of Drug Distribution Industry – Inventory
Turnover and AR Turnover 230
Financial Highlights of Drug Distribution Industry – Accounts
Payable and Cash Conversion Cycle 231
Section 4 - Analysis of Contract Research Organization (CRO) 232
Key Players and Value Chain in China’s Contract Research
Organization (CRO) Market 232
China vs. India – Split Opinion 233
China and India CRO: Dragon vs. Elephant? 234
Comparison of Outsourcing Environment for China vs. India 235
Deep Dive into China’s CRO Market 236
Citi Estimate of Outsourcing Market in China (US$ millions) 237
Toxicology Outsourcing Facing Numerous Hurdles 238
Global R&D Spending Outlook 239
Global R&D Spending 240
Citi R&D Outsourcing Survey 241
Survey Suggests That 10-20% of the Total R&D Work Is
Outsourced 242
Section 5 - Analysis of Rural Market (Citi Rural Hospital Survey) 248
Professional Shortage 248
Change in Hospital Visits: After Healthcare Reform and Over
Next 3~5 Years 249
Cardiovascular and Diabetes Become More Prevalence in Rural
Areas 250
Analysis of Essential Drug List (EDL) Policies – EDL 251
Analysis of Rural Medical Device Markets 259
~62% of the Rural Hospitals Have Construction Plan 262
Section 6- Healthcare Infrastructure 263
Overview of Chinese Hospitals 263
Overview of Rural Hospitals and Community Healthcare Centers 264
Distribution of Class I, II, III and Township Hospitals 265
Growth in Hospital Beds 267
Number of Beds Per Thousand Population Still Below Global
Average 268
Growth of Hospital Beds in Urban and Rural Areas 269
Strong Growth in Private Hospitals 270
Strong Growth in Private Hospitals 271
Health Workforce and Patient Visits 272
Physicians and Nurses: China vs. Global 273
Number of Physicians: Urban vs. Rural 274
Hospital Patient Visits 275
Patient Visits in Different Level of Medical Institutions 276
Physician Daily Burden 277
Analysis of Inpatient Visits 278
Analysis of Inpatient Visits 279
Analysis of Outpatient Visits 280
Analysis of Surgery Cases 281
Analysis of Surgery Cases at Different Hospitals 282
Section 7- Healthcare Expenditure 283
Dynamics of China Healthcare Expenditure 283
Healthcare Expenditure Accounted for 5% of GDP in China 284
Correlation Analysis of GDP Per Capita and Healthcare
Expenditure Per Capita 285
Analysis of Healthcare Spending as % GDP vs Global
Benchmark 286
Healthcare Expenditure Per Capita vs Global Benchmark 287
Government Spending Driving Growth in National Health
Expenses 288
Detail Analysis of Out of Pocket Expenditure 289
Analysis of Out of Pocket Expenditure 290
Detail Analysis of Government Healthcare Expenditure 291
Detail Analysis of Government Healthcare Expenditure 292
Healthcare Expenditures: Urban vs. Rural 293
Healthcare Expenditures Per Capita: Urban vs. Rural 294
Healthcare Expenditures: Urban vs. Rural 295
Section 8 - Overview of Medical Insurance System 296
Flow of the Medical Insurance Fund 298
Medical Insurance Expenditure vs. Inflow 299
Medical Insurance Expenditure vs. Inflow 300
Increasing Medical Insurance Coverage 301
Case Study on Province-Level Reimbursement 302
Urban Resident Basic Medical Insurance – Overview 303
Urban Resident Basic Medical Insurance – Inflow and Outflow 305
Urban Resident Basic Medical Insurance – Breakdown 306
Urban Employee Basic Medical Insurance – Overview 308
Urban Employee Basic Medical Insurance – In-flow 309
Urban Employee Basic Medical Insurance – Inflow and Outflow 310
Urban Employee Basic Medical Insurance – Income vs. Inflow 311
Urban Employee Basic Medical Insurance – Breakdown 312
Urban Employee Basic Medical Insurance – Net Balance 313
New Rural Cooperative Medical Insurance – Overview 314
New Rural Cooperative Medical Insurance – Fund Inflow 315
New Rural Cooperative Medical Insurance – Inflow and Outflow 316
Medical Insurance System: China vs. Developed Markets 317
Section 9 - Overview of EDL, NRDL and Drug Tender 318
Summary of ‘Zero-Markup’ Implementation 319
Summary of NRDL Drugs 320
Provincial NRDL 321
National Drug Reimbursement List Number 2005 vs 2009 322
Provincial EDL 323
Section 10 - Health Indicators 324
Population Pyramid 324
Birth Rate and Death Rate 325
Labor Force Population in China 326
Rural Population vs. Urban Population 327
Aged Dependency Ratio 328
Aged Population: Asia vs. China 329
Major Diseases in China - Diabetes’ Prevalence 330
Section 11- Overview of Hospital Financials 331
Growth of Hospital Income and Expenditure 332
Breakdown of Hospital Income and Expenditure 333
Growth in Hospital Income and Expenditure in Different Medical
Institutions 334
General Hospital Income and Expenditure 335
Community Center Income and Expenditure 336
Township Hospitals Income and Expenditure 337
Assets in Medical Service Institutions 338
Debts in Medical Service Institutions 339
Hospital Debts and Gearing Ratio 340
Appendix A-1 344

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