Private Healthcare Market Research Articles

Problems of licensing of private healthcare facilities in Ukraine

The article examines the problems faced by the private sector in obtaining licences to conduct medical practice. The author focuses on both private healthcare facilities and individual entrepreneurs engaged in medical practice.
 The author notes that the public healthcare sector alone is not capable to fully satisfy the population’s demand for affordable and high-quality medical services, and therefore the growth of the number of private healthcare facilities is inevitable. Analysing the data of the Licensing Register of the Ministry of Health of Ukraine for medical practice, the author notes that more than 60 per cent of all licences were issued to the private sector, but the lion’s share of them (85 per cent) were issued to individual entrepreneurs.
 The author shares the opinion that only private healthcare facilities are subject to real state regulation in the form of licensing and control with the possibility of administrative and economic sanctions, including cancellation of licences.
 The author, in particular, draws attention to the contradictory requirements of the Licensing Conditions regarding staffing of license applicants, who, on the one hand, must submit information on the available staff to obtain a licence, and, on the other hand, must conclude contracts with these employees within a month after obtaining a licence.
 The author has studied the circumstances of some court cases where the plaintiffs challenged the decisions of the Ministry of Health of Ukraine to revoke the licence. In the analysed cases, the court satisfied the plaintiffs’ claims and found the cancellation of licences to be groundless.
 The author also draws attention to the need to regulate the activities of so-called hospital funds, which are correlated with the activities of healthcare facilities but are not subject to licensing.
 The author comes to the conclusion that licensing plays a very important role in the establishment and operation of a private healthcare facility, but the current system has numerous inaccuracies and inconsistencies with the practical state of affairs and creates significant pressure on private facilities, which may lead to negative trends in the development of the private healthcare market.

Entrepreneurial orientation and performance analysis at the private healthcare sector

The unavailability of resources has often been stated as one of the main limitations for SMEs’ growth in developing countries. The aim of this study is to address how the position of limited resources impacts the relationship between the entrepreneurial orientation of SMEs in developing countries and their business performances. For this purpose, a conceptual framework has been created, delivering six theoretical propositions aiming to test the impact of limited resources on SMEs’ courage for exploring new opportunities and taking risks, promoting innovation, act proactively on the market, and set autonomy and competitive aggressiveness as standards in their operations. Derived propositions have been elaborated by applying a multiple-case research strategy. Six companies from the private healthcare sector in North Macedonia have participated in the research and contributed to the same with a valuable set of data. Study results have indicated relatively low threats from the limited resources to the entrepreneurial orientation dimensions and the business's success correspondingly. Businesses have mainly been financed through their own resources and bank loans, and in some cases through grants as a result of collaboration with innovative and other SMEs supporting funds. Nevertheless, despite the unenthusiastic level of available resources, entrepreneurs have shown courage to take risks, initiate innovation and act proactively in the private healthcare market.

The demand for competence and qualification of medical personnel in the light of the results of empirical studies

The demand for competence and qualification of medical personnel in the light of the results of empirical studies

The emergence of coopetition in highly regulated industries: A study on the Brazilian private healthcare market

Coopetition between firms starts from one of two general development patterns: the deliberate strategy or the emergent strategy. These two patterns of coopetition have been largely studied in developed countries where institutions are efficient and provide a favorable environment for business strategies. However, the institutional environments in developing economies are neither efficient nor business friendly. Government intervention is not uncommon in developing economies, particularly in highly regulated industries. The purpose of this paper is to advance knowledge about the emergence of coopetition in highly regulated industries in developing economies. To achieve this, we carried out an exploratory case study with 22 representatives from the Brazilian private healthcare industry. The study extends coopetition theory on the emergence of cooperation between competitors in a highly regulated industry; advances the institutional approach to coopetition; shows the role of governmental pressures in the interplay of competition and cooperation in developing economies; and contributes to the coopetition strategy literature by identifying institutional dysmorphia, a distortion of a formal institutional agent's primary role, and its effects on the strategic decisions of competitors. We conclude that legitimate institutional pressures foster the emergence of transactional coopetition while dysmorphic institutional pressures foster the emergence of confrontational coopetition.

Russia’s Private HealthCare Market: A Marketing Specialist’s Point of View

ABSTRACT This article analyzes the marketing innovations of private medical clinics as a significant internal driver of the transformation and development of Russia’s private health care market. The latter is manifested in the rapid spread of professional practices, new formats, business models, and value propositions. This directly affects the structure and volume of the nongovernmental health care services sector. Product innovations, which are the basis for the value propositions and positioning of medical clinics, form new segments in the private health care market. The author highlights market trends in innovative product categories: multiple products, highly specialized medical services and medical social care, the accessible-clinic format, anti-aging medicine, and painless dentistry with elements of gamification.

Moving from a bad to a good pricing regime: The South African private health care market

AbstractThe South African private health care market combines a highly concentrated demand side with expensive medical services. This combination suggests that medical insurance schemes are not using their full market power. To explain this puzzle, we construct a delegated bargaining model in which agency costs give rise to two different pricing regimes. In the ‘good’ pricing regime, the scheme incentivises its administrator towards aggressive bargaining behaviour with health care providers. The ‘bad’ pricing regime results when the scheme decides against such incentivation. Policy measures that push the number of providers above some critical threshold can force a change from the ‘bad’ to the ‘good’ pricing regime.

Differential diffusion of pharmaceutical innovations in a mixed market middle - income economy

BackgroundPolicymakers are faced with the challenge of balancing patient’s access for effective and affordable medicines to sustain the rising healthcare costs. In a mixed healthcare market such as Malaysia, coverage decisions of new medicines are different: public funded health system has a formulary listing process whereas for private sector, which is a market-based economy, depends on patient’s willingness to pay and insurance coverage. There is little overlap between public and private healthcare service delivery with access to new innovative medicines, as differentiated by sources of funding. The objectives of this study were to examine the diffusion of New Chemical Entities (NCEs) into the public and private healthcare market between 2010 and 2014, and determine the factors explaining the diffusion.MethodsWe matched medicines from the product registration database by medicine formulation to medicines in IQVIA National Pharmaceutical Audit database for each year. The price per Defined Daily Dose (DDD), market concentration and generic utilization share variables were calculated. A panel fixed effect model was performed to measure diffusion of NCEs for each year and test possible determinants of diffusion of NCEs for overall market and sector specifics.ResultsThe utilization of NCEs was larger in the private sector compared to the public sector but the speed of diffusion over time was higher in the public sector. Price per DDD was negatively associated with diffusion of NCEs, while generic utilization share was significantly regressive in the public sector. Market concentration was negatively associated with utilization of NCEs, however result tends to be mixed according to sector and Anatomical Therapeutic Chemical (ATC) category.ConclusionsUnderstanding key aspects of sectoral variation in diffusion of NCEs are crucial to reduce the differences of access to new medicines within a country and ensure resources are used on cost effective treatments.

Evaluating the impact of single exit pricing (SEP) on medicine product withdrawal from the private healthcare market in South Africa.

The introduction of medicine pricing policies in South Africa (SA) in the form of single exit pricing (SEP) provided a mechanism to improve medicine price transparency and reduce the medicine price and inflation. However, regulation of medicine prices may have further unforeseen effects on the availability of medicine. This research presents the impact of SEP on discontinuation of medicine products on the private healthcare market in SA. To evaluate the impact of SEP legislation on the availability of medicines in the SA private health sector in terms of withdrawal of medicines from the market. A descriptive, quantitative analysis of all registered medicines on the SA market by stock-keeping units (SKUs) was done to establish medicine products that were withdrawn from the market by SKUs during a 14-year period (2001 - 2014). A total of 152 manufacturers discontinued 3 691 SKUs between 2001 and 2014. The mean number of discontinuations per generic manufacturer was 22.34 (standard deviation (SD) 58.11), while innovator manufacturers discontinued a mean of 27.61 (41.89). The largest number of SKUs were commercially withdrawn in 2002 (n=603), followed by discontinuations in 2003 (n=463) and 2004 (n=407). There was a negative correlation between number of discontinued SKUs per year and SEP increase (Pearson's correlation coefficient r ‒0.414; p=0.14). The results showed that SEP and a transparent pricing policy may have had an impact on SKU withdrawal from the market prior to SEP implementation. The result of reduced product availability on the market and its impact on the cost and quality of healthcare to the patient need to be regularly monitored and evaluated to ascertain if direct price regulations achieve the intended outcomes. Other intended or unintended effects on pharmaceutical market dynamics should also be evaluated.

English

Nurses have every capacity to dominate the private healthcare market in Nigeria. However, ignorance, the tradition of seeking for already established jobs in the hospitals mainly, and self-limiting legal impediments of the law establishing nursing and midwifery in Nigeria have not allowed them to recognize this fact. Given the situation of the present-day saturated labor market, getting the nurses to realize their abilities has become necessary. Exposing the areas of the Nigerian nursing and midwifery law that are germane to this effort and such other areas that may not allow for a smooth transition to this needed liberation is equally pertinent. It is for the above background that this paper discussed the concepts of entrepreneurship and SWOT analysis; explained why nurses' entrepreneurial potentials are said to be masked in Nigeria; highlighted possible approaches toward undoing the mask; analyzed the SWOT of Nigerian Nursing and Midwifery Act concerning undoing the mask; and offered useful recommendations toward unmasking of the entrepreneurial potentials of nurses in Nigeria. Nurses' entrepreneurial potentials are said to be masked because most nurses in Nigeria do not know they possess what can make them leaders of the Nigerian healthcare industry. Nigerian Nursing and Midwifery Act had enormously empowered nurses to do a lot about their entrepreneurial growth, but few areas of the Act need some amendments to liberalize entrepreneurial pursuits of nurses at all levels. With the increasing scarcity of already established jobs, nurses with innate resilience and passion for success should embrace entrepreneurship without further delay. Key words: Entrepreneurship, nurses, strengths, weaknesses, opportunities, and threats (SWOT) analysis, unmasking.

Private health care market shaping and changes in inequities in childhood diarrhoea treatment coverage: evidence from the analysis of baseline and endline surveys of an ORS and zinc scale-up program in Nigeria

BackgroundNearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. In this study, we examine changes in the inequities of coverage of ORS and zinc over the intervention period.MethodsBaseline and endline household surveys were used to measure ORS and zinc coverage and household assets. Principal component analysis was used to construct wealth quintiles. We used multi-level logistic regression models to estimate predictive coverage of ORS and zinc by wealth and urbanicity at each survey period. Simple measures of disparity and concentration indices and curves were used to evaluate changes in ORS and zinc coverage inequities.ResultsAt baseline, 28% (95% CI: 22–35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52–58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P < 0.001) for the poorest and 17%-points (P < 0.001) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration indices declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35–41%) compared to 29% (95%CI, 25–33%) in the urban.ConclusionThe results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

Healthcare seeking for chronic illness among adult slum dwellers in Bangladesh: A descriptive cross-sectional study in two urban settings.

IntroductionAccompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country’s goal of Universal Health Coverage by 2030.MethodsThis descriptive cross-sectional study compares survey data from slum settlements located in two urban sites in Bangladesh, Tongi and Sylhet. Reported chronic illness symptoms and associated healthcare-seeking strategies are compared, and the catastrophic impact of household healthcare expenditures are assessed.ResultsSignificant differences in healthcare-seeking for chronic illness were apparent both within and between slum settlements related to sex, wealth score (PPI), and location. Women were more likely to use private clinics than men. Compared to poorer residents, those from wealthier households sought care to a greater extent in private clinics, while poorer households relied more on drug shops and public hospitals. Chronic symptoms also differed. A greater prevalence of musculoskeletal, respiratory, digestive and neurological symptoms was reported among those with lower PPIs. In both slum sites, reliance on the private healthcare market was widespread, but greater in industrialized Tongi. Tongi also experienced a higher probability of catastrophic expenditure than Sylhet.ConclusionsStudy results point to the value of understanding context-specific health-seeking patterns for chronic illness when designing delivery strategies to address the growing burden of NCDs in slum environments. Slums are complex social and geographic entities and cannot be generalized. Priority attention should be focused on developing chronic care services that meet the needs of the working poor in terms of proximity, opening hours, quality, and cost.

Health insurance ownership and its impact on healthcare utilization

PurposeThe purpose of this paper is to explore the determinants of health insurance ownership of individuals in the Sri Lankan labor force and to examine how insurance ownership impacts healthcare utilization.Design/methodology/approachThe authors first used logit model to explore determinants of health insurance ownership. The authors then employed propensity score matching method to estimate impact of insurance ownership on healthcare utilization. Data were obtained from national survey of self-reported health in Sri Lanka – 2014 (n=59,276). National survey of self-reported health in Sri Lanka – 2014 was conducted by the Department of Census and Statistics from January to December 2014.FindingsResults showed that individuals with higher educational attainments, headed by literate-heads, based in urban sector, employed in formal sector, and with health adversities and higher degree of risk propensity are more inclined to have a health cover. Health insurance ownership reduces the likelihood of utilizing public facilities while increasing the likelihood of utilizing private facilities for non-communicable diseases (NCDs) and acute illnesses. Welfare consequences of expanding insurance ownership are doubtful due to oligopolistic private healthcare market and adverse selection issue faced by insurers in Sri Lanka.Originality/valueThis is the first study examining health insurance–healthcare utilization nexus based on Sri Lanka-wide microdata. Also, the study applies bias-corrected matching methods to establish causal links between two constructs. Without being so generalized, healthcare utilization is examined in terms of NCD care and Acute illnesses care, which improves robustness of results and leads to evidence-based healthcare policies.Peer reviewThe peer review history for this paper is available at: https//publons.com/publon/10.1108/IJSE-05-2019-0333.

Рынок частной медицины в России: взгляд маркетолога

&lt;span&gt;В статье анализируются маркетинговые инновации частных медицинских клиник как значимый внутренний драйвер трансформации и развития рынка частной медицины в России. Последняя проявляется в высокой скорости распространения профессиональных практик и новых форматов деятельности, бизнес-моделей и ценностных предложений, что напрямую влияет на структуру и объем сектора негосударственных медицинских услуг. Продуктовые инновации, являющиеся основой для ценностного предложения и позиционирования медицинских клиник, формируют новые сегменты рынка частной медицины. Авторы выделили следующие направления формирования инновационных продуктовых категорий на исследуемом рынке: мультипродукты, высокоспециализированные медицинские услуги и медико-социальный уход, формат «доступная клиника», антивозрастная медицина, стоматология без боли с элементами геймификации.&lt;/span&gt;

Between ‘going private’ and ‘NHS privatisation’: patient choice, competition reforms and the relationship between the NHS and private healthcare in England

AbstractPatient choice in the context of National Health Service (NHS) reforms in England can refer to the law and policy underpinning patient movement between the NHS and private healthcare sector (in existence since the introduction of the NHS in 1948), as well as recent competition reforms of the Health and Social Care Act 2012, the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 and the 2014 Private Healthcare Market Investigation by the Competition and Markets Authority (CMA). This paper highlights the existence of two discrete, yet related frameworks: the ‘NHS patient – private patient’ framework based on Department of Health, NHS England and latterly Clinical Commissioning Group policy, and the ‘NHS patient choice’ framework, derived from New Labour choice and competition policies and subsequently enshrined by the 2012 Act reforms. The juxtaposition of these frameworks underscores the symbiotic relationship between the NHS and private healthcare, which raises questions about the fitness for purpose of current policy. It also helps explain why the competition reforms are difficult to implement, and suggests that the knitting together of patient choice and competition may unravel following the 2012 Act reforms and CMA private healthcare market development.

PBI16 COST MINIMIZATION ANALYSIS OF BIOSIMILAR INFLIXIMAB IN BRAZILIAN SUPLEMENTARY HEALTHCARE SYSTEM

Autoimmune inflammatory diseases constitute a complex and heterogeneous group of diseases, representing an important cause of morbidity and mortality, especially on inflammatory bowel, rheumatoid and dermatological diseases. After failure or intolerance to treatment with synthetic DMARDs, diagnosed patients are candidates for treatment with biological DMARDs, generating considerable expenditures. This analysis proposes to estimate the potential cost minimization of using infliximab biosimilar for all indications in a 5 years time horizon in Brazilian Private Healthcare System. The evaluation of annual consumption was based on IMS Health data on infliximab sales in Brazilian Private Healthcare market from October 2017 to September 2018. Additionally, were considered the percentage of annual increase in the number of beneficiaries. The inclusion of infliximab biosimilar in the total infliximab market was considering an assumption: initiating from 10% in the first year, with annual growth of 5 percentage points, reaching 30% participation in year 5. Regarding the prices of the comparators, were used the reference factory price with 18% tax aliquot. The resultant impact was BRL 407.9 million and BRL 393.8 million in the first year, to BRL 624 million and BRL 559.6 million in the fifth year, for reference infliximab and its biosimilar respectively. The results presented indicate a potential of approximately BRL 185 million in savings for five years. The inclusion of biosimilar infliximab as an alternative for the reference medicine may contribute to expand access to treatment for patients with high clinical and economical impact while representing important savings for private healthcare system in Brazil.

Utilization of Interactive Clinical Video Telemedicine by Rural and Urban Veterans in the Veterans Health Administration Health Care System.

Interactive clinical video telemedicine (CVT) has the potential to benefit health care systems and patients by improving access, lowering costs, and more efficiently distributing providers. However, there is a gap in current knowledge around the demand for and potential uses of CVT in large integrated health care systems. We conducted an observational study using Veterans Health Administration (VHA) administrative databases to analyze trends in CVT utilization, and types of care received, among 7.65 million veterans during fiscal years (FY) 2009-2015 (October 1, 2008-September 30, 2015). Trends were stratified by veteran rurality and analyzed using linear regression. Among 4.95 million veterans in FY2015, we used logistic regression to identify characteristics associated with CVT utilization for any care, mental health care, and major specialties. Over 6 years, the annual CVT utilization grew from 30 to 124 encounters per 1,000 veterans (>300% increase), with faster growth among rural veterans than urban veterans. Over the study period, ≥50% of all CVT-delivered care was mental health care. In FY2015, 3.2% of urban and 7.2% of rural veterans utilized CVT for nearly 725,000 clinical encounters. Rural residence, younger age, longer driving distance to VHA facilities, one or more comorbidities, and higher rates of traditional, non-video utilization were independently associated with higher odds of CVT use. CVT utilization in VHA has increased quickly and exceeds published rates in the private health care market. The availability of CVT has likely increased access to VHA care for rural veterans, especially for mental health care.

The private healthcare market and the sustainability of an innovative community nurses programme based on social entrepreneurship - CoNSENSo project

BackgroundCoNSENSo is a project funded by the European Union, which is aimed at developing an innovative care model based on community nurses to support active ageing in mountain areas. The planned sustainability of this innovative approach relies on social entrepreneurship on the healthcare market, and this work highlights the necessary conditions for the successful implementation of these entrepreneurial initiatives.MethodsConsidering municipalities in the Piedmont Region and those aged 65 or older as target population, the authors propose several negative binomial regression models to estimate the effectiveness of current private healthcare services in supporting the active aging process. Such effectiveness may represent the ex-ante (positive) reputation of these new social entrepreneurial initiatives on the market.ResultsAccording to our results, the private supply of healthcare services can effectively support the aging process. Indeed, given that the other predictor variables in the model are held constant, there are statistically significant negative relations between the number of hip fractures and the private supply of healthcare services by dental practitioners and psychologists (p-value < 0.05), as well as the private supply of opportunities for social interaction by coffee bars (p-value < 0.05).ConclusionsThe authors expect a favourable environment for the entrepreneurial initiatives of community nurses in mountain areas. Accordingly, policy makers cannot reject the hypothesis that the goals reached by the CoNSENSo project may be maintained for the sake of the future generations, avoiding its collapse as soon as public funding shifts to new programmes.

Issues and Challenges: The Development of Fair and Equitable Health Policy

Public health policy/law is a discipline that seeks to identify opportunities and implement mechanisms to achieve justice in the public health sector. Several public health policies and programs have been implemented by virtue of the Affordable Care Act (ACA), and these policies and programs seek to decrease America’s “paradox of excess and deprivation” and address socioeconomic barriers that exist in the U.S. healthcare system. Private healthcare market interests have accused the ACA of intruding heavily into the professional autonomy of the medical profession, eroding healthcare market competition, and driving up national healthcare spending. Counter-arguments defending the ACA state that the law exposes the limitations to such professional autonomy of the medical profession, primarily because the U.S. healthcare system is currently ridden with excess, waste, and social injustice. This review article outlines the types of policies and laws governing healthcare, unique healthcare issues faced by particularly vulnerable populations, and future challenges and opportunities under the ACA. Lastly, the article provides recommendations to address future challenges and opportunities under the ACA, so as to balance the scales between private market interests and public health equity.

Patterns of Care with Biological Drugs for Ankylosing Spondylitis: Real-World Data from the Private Healthcare Market in Brazil

Patterns of Care with Biological Drugs for Ankylosing Spondylitis: Real-World Data from the Private Healthcare Market in Brazil

Public Retreat, Private Expenses, and Penury

Health care can be expensive for the un-insured, often constituting a potential poverty trap. Urban India is particularly vulnerable to this possibility given the greater demand for health, absence of a structured health care system, overburdened public institutions, ubiquitous, and unregulated private health care market and the generic paucity of public funds. Using nationally representative household level data for two points of time and a suitable alteration of an existing methodology, this article computes the degree and depth of impoverishment from out of pocket medical expenses, and its variation across states and select socioeconomic characteristics. Roughly 6 percent of the urban population or about 18 million people face impoverishment entirely due to out of pocket medical expenses in India. There are substantial inter-state and inter-group variations in the incidence of this burden. The findings are potentially crucial as India prepares to embark on its journey toward universal health coverage.