Healthcare Global - August 2014

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A u g u s t 2 0 14

medical tourism

Top hospital destinations

mHealth Six steps to success

finance

Controlling company-provided insurance costs Countries spending the most on healthcare

Blackberry versus Google in the Smartphones for Doctors race

top 10

e d i t o r ’ s c o mm e nt

Tech expertise for a people-driven industry I n t h i s i ss u e o f

Healthcare Global, we feature two giants

in their respective fields and their jarring views on entering the healthcare industry. Blackberry is diverging from the broader consumer market and launching services with NantHealth – a company whose operating platform is already being used in over 250 hospitals. Google, on the other hand, would rather continue working on individual projects, finding the industry far too regulated.

We then travel over to Asia and discover why Prince Court Medical Center is ranked as the world’s leading hospital for medical tourists and share the best medical destinations from around the world.

Also in this issue, we report on the top priorities for financial executives given the improving economy and stable financial markets. We found that controlling the cost for healthcare benefits still remains at the forefront of their minds. Just as well, integrating technology into the healthcare field is at an all-time high. Tony Kane Consulting Ltd. shares with us his newly developed methodology on how to drive the most successful mobile health project.

Finally, we compile the Top 10 countries that are spending the most on healthcare based on their health expenditure numbers and discuss the current state of healthcare within their region.

We hope you enjoy this issue and wish you the best of health!

Stephanie C. Ocano Editor stephanie.ocano@wdmgroup.com 3

Contents

Features

32

Technology 6 Steps to mHealth Success

8

Top 10

Countries Spending the Most on Healthcare

Hospitals Asia Leading the Best in Medical Destinations

16 Finance Healthcare Costs Remain Key Priority for Financial Executives

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Supply Chain Blackberry In Google Out

40 5

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h o s p i ta l s

Asia Leading the Best in Medical Destinations Prince Court Medical Center has been ranked as the world’s best hospital for medical tourists thanks to its advanced medical equipment, patient-centered principles, and world class care management W r i t t e n b y: S t e p h a n i e C . O c a n o

For the first time ever, a Malaysian medical center was named as the top hospital for medical tourists by the Medical Travel Quality Alliance (MTQA).

In the annual ranking by MTQA, Prince Court Medical Center in Kuala Lumpur was selected as the hospital that best provides medical tourists with outstanding care beyond 8

August 2014

standard clinical protocols as well as excellent medical treatment.

“Prince Court is already known as an outstanding medical facility,” said Julie Munro, MTQUA president in an issued release. “This award recognizes that it also pays the utmost attention to key non-clinical aspects of care that influence good outcomes and a successful medical travel

journey for medical tourists.�

According to MTQA, Prince Court Medical Center provides excellent surgery options for medical travelers and pays exceptional attention not only to the medical care its doctors and nurses provide but to the details of patient comfort, as well.

Special services include a sophisticated burn unit, an In Vitro

Fertility department and a senior manager that coordinates all international patient and medical tourist services, assuring travelers that coordination of care that meets the needs of the medical traveler is a top priority. “It’s almost impossible for medical tourists to know how to find a good hospital that will truly provide the 9

h o s p i ta l s treatment and care they are traveling to get. We hope consumers and doctors will pay more attention to nonclinical factors that can significantly impact clinical outcomes and not just ask about hotels and airport pickups,” said Munro.

Prince Court Medical Center continues to be a major participant in the Malaysian Health Travel Council’s activities in road shows and exhibitions including Bangladesh, Hong Kong, China, Indonesia, and Myanmar, according to MTQA. The hospital’s website has also been redesigned to offer specific clinical information, educational articles and comprehensive write-ups.

Continuing to serve as the only private hospital with a full-fledged eMR coupled with RIS/PACS, Prince Court Medical Center’s improvements in medical equipment and procedures within the past year include obstetrics monitoring upgrades to allow for multiple fetal monitoring, installation of the Swisslog Pillpick system for inpatient medication dispensing, evaluation of a card-based USB for uploading imaging data for medical travelers, and the investment in dialysis equipment.

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‘Prince Court Medical Center provides excellent surgery options for medical travelers and pays exceptional attention not only to the medical care its doctors and nurses provide but to the details of patient comfort, as well’ “Prince Court Medical Center is now under direct management of experienced Malaysian managers chosen for their experience and expertise within the local private hospital sector, with key position holders having a minimum of 10 years prior private hospital experience,” said Dr. Chong Su-lin, managing director of Prince Court Medical Center. “There has been no change of ownership. The owner is still Petronas Hartabina.”

Also for the first time, seven of the top 10 hospitals reviewed are in Asia, serving hundreds of thousands of

A s i a L e a d i ng th e B e s t i n M e d i cal D e s t i nat i o n s

Prince Court Medical Center medical tourists from the region and beyond for inpatient and outpatient medical treatment. Asian medical centers continue to offer better medical procedures and care than most other medical destinations.

All 10 hospitals on the list provide

medical treatment and care for medical travelers that are of the highest quality, according to MTQA. The additional hospitals that made it on MTQA’s 2013 World’s Best Hospitals for Medical Tourists™ list include: 11

h o s p i ta l s

Clemenceau Medical Center Asklepios Klinik Barmbek – Hamburg, Germany Asklepios is of particular value for medical tourists who need treatment beyond the scope of their top facilities at home. It partners with innovative medical technology companies from Germany to test the most modern medical equipment before it is released worldwide. Asklepios Group is the largest private hospital operator in Europe.

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Clemenceau Medical Center – Beirut, Lebanon Clemenceau has ties with Johns Hopkins Hospital in Baltimore, Maryland, and stands out as perhaps the leading hospital in the Middle East. This past year, CMC adopted “Six International Patient Safety Goals,” increased the use of encryption protected passwords to access patient electronic records, and introduced multidisciplinary rounds to better coordinate medical treatment for patients.

Sh o r t h e a d l i n e

Fortis Hospital Fortis Hospital – Bangalore, India Fortis Hospital, formerly Wockhardt Hospital, provides excellent surgery options for medical travelers seeking orthopedic procedures including hip resurfacing and replacement. It works closely with some U.S.-based medical travel agents for follow up care and services of American patients once they return home.

Wooridul Spine Hospital – Seoul, Korea Wooridul is a world leader in medical treatment of the spine. Wooridul’s

influence and prestige has spread worldwide through its doctors and its joint ventures with hospitals in Asia and Europe.

Bumrungrad International – Bangkok, Thailand The most well-known hospital for medical tourists, Bumrungrad has been taking foreign patients for 20 years. It has invested heavily in integration of medical records, pharmacy, labs and other hospital departments into a state-of-the-art electronic environment.

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August 2014

h o s p i ta l s

Sh o r t h e a d l i n e

Gleneagles Hospital Anadolu Medical Center – Istanbul, Turkey Anadolu offers a very high standard of treatment and care, and seems to understand the needs of the medical traveler. It has an international focus, with multilingual doctors and nurses, and a keen awareness of the services and support systems a medical traveler should have.

Gleneagles Hospital – Singapore The Parkway Hospital Group may well be the standard bearer for private hospital care in Singapore, and Gleneagles Hospital is its flagship. The Parkway group owns and operates hospitals throughout Asia.

Asian Heart Institute – Mumbai, India Asian Heart Institute is one of the few centers in the world performing nearly 100 percent bypass surgeries on a beating heart and with a very significant percentage using total arterial grafting. The hospital boasts the lowest surgical mortality rates in the world with 0.26 percent in isolated bypass surgeries and an overall mortality rate of 0.8 percent.

According to MTQA, some of the most challenging and rare cases are performed regularly at Asian Heart Institute.

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finance

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Healthcare Costs Remain Key Priority for Financial Executives Largely in part to an improving economy and stable financial markets, finance executives feel that their companies are in a better financial position to consider a range of options for managing pension risk W r i t t e n b y: S t e p h a n i e C . O c a n o

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finance Controlling the cost for company-provided healthcare benefits remains the top priority for financial executives, according to research released by Prudential Financial, Inc. and CFO Research Services.

The report, “Managing Financial Risk in Retirement and Benefits Programs,� found that finance executives believe improvements in funding benefit plans will make it easier to reduce and eventually eliminate risks associated with such plans.

The study found that most employers don’t plan to drop health coverage and switch employees to the public health insurance exchanges established under the Affordable Care

The percentage rates of how likely companies will transfer liabilities to third-party insurers

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Employers are looking at private health insurance exchanges to control costs

CREDIT: CFO Publishing LLC

C o s t s R e ma i n K e y P r i o r i t y

Act. Instead, employers are looking at private health insurance exchanges where the employer continues to fund benefits but employees have the option to choose from any health plan they like.

“Everyone is looking at how to better control benefit costs and healthcare is still the No. 1 issue,” said Jim Gemus, senior vice president of Product for Prudential Group Insurance. “But they are acutely aware of the need to retain

employees and attract new ones. The improving economy and recovery of the financial markets is making it a bit easier to do this.”

Companies are still shifting healthcare costs to employees, with 80 percent either transitioning more costs to employees or likely to do so, the study found. Only 38 percent are willing to end employer-paid healthcare and direct employees to public health insurance exchanges. Fifty-seven percent say they wouldn’t consider the idea, but 41 percent would be willing to provide subsidies to employees for use on private health insurance exchanges.

The report found that an improving economy and stable financial markets have given financial executives the confidence to explore a range of options to help their companies better manage the costs and risks of their healthcare, pension and benefits programs.

“Overall, finance executives feel that their companies are in a better financial position to consider a range of options for managing pension risk; many companies have experienced an improvement in funded status as a result of equity market improvements combined with increasing discount 19

finance rates,” the study noted. “Executives are now able to weigh the relative advantages and disadvantages of plan restructuring alternatives that can lead to the ultimate disposition of their pension liabilities.”

The survey targeted senior financial executives at companies with defined benefit retirement plans holding $250 million or more in assets – plans that pay out a specified benefit to retirees.

Most of the 182 companies included in the survey had revenue of more than $500 million and more than half had revenue of more than $5 billion.

“Many finance executives in this year’s survey perceive a trend toward employees extending their careers beyond historical retirement ages. In the face of this, companies are also considering expanding offerings in defined contribution plans to enhance security and reduce volatility in their employees’ retirement investment strategies. Automatic enrollments, stable value funds, and guaranteed income products are receiving more attention, and executives continue to consider ways to enhance targetdate funds to reduce risk and provide retirement income,” the survey stated.

Thirty-five percent of responding 20

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C o s t s R e ma i n K e y P r i o r i t y

companies have already closed their pension plans to new entrants and another 25 have frozen them, the survey found. Executives cited concerns about the impact of defined benefits plans on earnings, balance sheets and their companies’ ability to invest in growth opportunities. The survey found that companies continue to prefer defined contribution plans such as 401(k) where employees contribute their own money to their retirement plan, usually with matching dollars from the company.

“The rebound in financial markets has not only restored the value of 401(k) plans but helped improve the funding levels of defined benefit plans as well, though market volatility and other risk factors remain a concern,” said Phil Waldeck, senior vice president, Pensions and Structured Solutions, Prudential Retirement. “Now the focus can be placed on further reducing the risk of defined benefit plans and improving the offering and investment security of defined contribution plans like 401(k)s.”

Additional key findings included that more than half of the executives surveyed said they are likely to offer lump sum distributions to defined 21

finance

Which of the following are your company’s top priorities for its employee benefits programs over the next year?

54% Controlling the employer cost for company-provided healthcare benefits

39% Increasing employee satisfaction with the company’s benefits plans

29% Minimising the impact on employees of the increasing cost of healthcare benefits

27% Maximising employees’ productivity by preventing absences or returning employees to work more quickly following absences

27% Managing employee benefits on a global scale

27% Reducing the cost of employee benefits other than healthcare benefits

24% Reducing the volatility in the funded status of the DB plan

20% Reducing employee risk of large out-of-pocket healthcare costs by offering voluntary benefits

19% Ensuring employees have sufficient funds for a secure retirement

18% Reducing or closing the funding gap in the DB plan(s)

12% Expanding the range of voluntary benefits being offered Note: Respondents were asked to select up to three responses. CREDIT: CFO Publishing LLC

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Controlling employer costs is the top priority for most companies over the next year

C o s t s R e ma i n K e y P r i o r i t y

benefits pension plan participants over the next two years, and more than half of the respondents believe a significant portion of the workforce will have to delay retirement because of inadequate savings.

Nearly 50 percent of financial executives said they are likely to outsource some or all of their benefits administration on top of the 27 percent that already do so. Additionally, some 70 percent of the respondents believe offering voluntary benefits is a way to increase employee satisfaction and 58 percent are likely to expand voluntary benefit offerings.

In summary, the survey found that finance executives are examining a variety of solutions that can help them enhance benefit offerings while still allowing them to manage the financial risk of the programs.

“For their definitive benefits plans, more finance executives, as well as the boards they report to, are examining the feasibility and benefits of liability transfer – that is, purchasing annuities at some point in the future to transfer some

or all of their companies’ definitive benefits plan liabilities to a third party insurer,” noted the survey. “Many see the adoption or expansion of liabilitydriven investment strategies as a means of dampening the volatility of definitive benefits investments, either as an initial step toward the ultimate transfer of liabilities, or as a sound riskmanagement strategy in itself.”

With the advent of both private and public health insurance exchanges, finance executives are given another resource to evaluate in their efforts to optimally balance corporate expense and employee benefits.

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S UPPLY C H AIN

Blackberry In Google Out While Blackberry’s latest move is entering the healthcare space with a new smartphone designed for medical professionals, Google finds it far too regulated to warrant serious investment W r i t t e n b y: S t e p h a n i e C . O c a n o

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July 2014

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S UPPLY C H AIN After losing ground in the smartphone race, Canadian phone maker Blackberry Limited has decided to venture into a new field by launching a healthcare service platform that will integrate thousands of medical devices to enable early detection of illnesses in India.

A report by the Economic Times declared that the Waterloo, Ontariobased company will be launching services with NantHealth – a company whose current platform is installed in more than 250 hospitals worldwide.

NantHealth connects more than 16,000 medical devices and collects vital information for over 3 billion patients annually.

“Work has started on it but we haven’t finalized an official launch date,” Sunil Lalvani, managing director

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of BlackBerry India, told the Economic Times. “We are running trials with multiple hospitals in India. It includes integration with different hospital information systems as well as various medical equipment.”

With Blackerry’s QNX embedded technology and NantHealth’s Clinical Operating System (cOS), the new platform will combine secure cloudbased services to provide data integration, decision support and analytics. Medical equipment such as scanners, dopplers, and ECG machines are among thousands of medical devices that can be integrated using cOS and QNX. Healthcare providers in India are expected to spend $1.08 billion on technology products and services this year, a four percent increase from last year, according to Equentis Capital.

The two companies are working to manufacture a smartphone that caters to the needs of the healthcare sector. The smartphone is expected to be launched by the end of this year or early 2015. The device will help doctors access immediate information regarding patients’ health while having the option to share such information with other medical professionals and

B lackb e r r y In , G o o gl e Out

The QNX SDK for Apps and Media enables developers to build media-rich embedded products that can integrate seamlessly with various smartphones and tablets

‘Healthcare providers in India are expected to spend $1.08 billion on technology products and services this year, a four percent increase from last year’

consult diagnostic and treatment resources from top global institutions.

“We need to create an integrated system that follows a human being through the continuum of life,” NantHealth founder Patrick SoonShion, MD, told mHealth News in an interview prior to the announcement.

He added that NantHealth is “trying to create a true operating system” that would encompass clinical decision 27

S UPPLY C H AIN

‘The device will help doctors access immediate information regarding patients’ health while having the option to share such information with other medical professionals’

An example of applications utilising NantHealth’s Clinical Operating System (cOS)

support, machine learning and “adaptive amplified intelligence” that “integrates pieces of the puzzle” and “gives you inputs … so that you can manage outputs.”

Earlier in April, Blackberry bought a minority stake in the privately held NantHealth to enter the connected healthcare space. The company has seen great turnaround under the leadership of John Chen who has been steering the company towards profits via proper cash management since his inception in November 2013.

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B lackb e r r y In , G o o gl e Out

Other smartphone makers such as Apple Inc. and Samsung Electronics Ltd., have also ventured into the healthcare sector by introducing smartphone add-ons such as heart rate monitors and a plethora of health apps to gather data. There is one technology giant, however, who refuses to enter the healthcare space: Google.

At a yearly CEO summit, Google co-founders Sergey Brin and Larry Page discussed many of their projects such as driverless cars and flying wind turbines. Towards the end of the

discussion however, host VC Vinod Khosla began to ask about health.

When questioned whether Google could imagine itself becoming a health company, Brin and Page’s response was a collective “no.”

“Generally, health is just so heavily regulated. It’s just a painful business to be in. It’s just not necessarily how I want to spend my time. Even though we do have some health projects, and we’ll be doing that to a certain extent.

But I think the regulatory burden in the U.S. is so high that it would dissuade a 29

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“Medicine needs to come out of the Dark Ages now” says Google lot of entrepreneurs,” said Brin.

“We have Calico, obviously, we did that with Art Levinson, which is pretty independent effort. Focuses on health and longevity. I’m really excited about that. I am really excited about the possibility of data also, to improve health. But that’s – I think what Sergey’s saying, it’s so heavily regulated. It’s a difficult area. I can give you an example. Imagine you had the ability to search people’s medical records in the U.S. Any medical researcher can do it. Maybe 30

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they have the names removed.

Maybe when the medical researcher searches your data, you get to see which researcher searched it and why.

I imagine that would save 10,000 lives in the first year. Just that. That’s almost impossible to do because of HIPAA. I do worry that we regulate ourselves out of some really great possibilities that are certainly on the data-mining end,” added Page.

Brin and Page’s final view on healthcare is that while it is fun to work on a few “cool” projects, the regulatory

M c K e s s o n ’ s e ff e ct i v e s uppl y cha i n manag e m e nt

challenges are too great to warrant serious investment.

Google Ventures’ Managing Partner Bill Maris shares a similar view in that “medicine needs to come out of the Dark Ages now.”

“I think the laws need to catch up with science and reality, and the law is never good at that. It’s always slow,” Maris told Re/code. “At the end of the day, what always happens is, the right products for society and the people get out there.”

While giants such as Google are

treading carefully due to regulatory roadblocks, Blackberry, amongst others, are taking on the challenge.

“The future of the healthcare industry requires the ability to share information securely and quickly, whether device-to-device or doctorto-doctor anywhere and at any time,” Soon-Shiong said. “Providing actionable information at the time of need will significantly improve the efficiency of healthcare and, more importantly, the efficacy of care for the patient.”

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T e ch n o l o gy

6 Steps to

mHealth Success Tony Kane Consulting Ltd shares new methodology on driving a successful mobile health project

W r i t t e n b y: Ste phan i e C. Ocano 33

T e ch n o l o gy Technology integration within the healthcare sector has the great potential to advance public health services by facilitating professional practice and communication while reducing health disparities. The road to success, however, has been a grey area as mHealth is a relatively new project that must be adapted for global practices. mHealth, the practice of medicine and public health supported by mobile devices, has great application for industrialized nations. However, due to the rapid rise of mobile phone penetration in low-income nations (Samsung recently partnered with GSMA to provide mobile technology to 15.5 million mothers in Africa), certain strategies must be amended.

Tony Kane Consulting Limited has recently released the world’s first structured methodology to enable robust planning of mHealth programs.

The new method revolves around six key stages that are aimed towards saving money and avoiding costly mistakes, identifying the most suitable targets, and getting access to the right answers quicker.

According to Tony Kane, mHealth has been held back by “a lack of 34

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“The dominant form of mHealth today is characterized by small scale pilot projects that address single issues in information sharing and access” – World Health Organization

insight into the necessary factors to ensure a successful program.”

Therefore, the structure is supported by real life case studies and practical tool kits to help project sponsors incorporate the critical elements for success into their plans.

The “6 Steps to mHealth Success” is delivered in the form of personal coaching and training events to deliver the necessary confidence and skills to all mHealth stakeholders, whether they be healthcare payers, insurers, providers, or pharmacy and medical device companies.

Healthcare Global shares the six stages of a successful mHealth project, courtesy of Tony Kane Consulting Limited.

6 St e p s t o m H e alth Succ e s s

mHealth success chart

Step 1: Identify a viable opportunity Is there a real problem or compelling event to address? How much would an mHealth solution support a patient or HCP in the “job they are trying to do?” For example, there is no point in measuring someone’s weight if their real problem is simply getting their medicines delivered.

Step 2: Identify all stakeholders and benefits for each of them This is probably the most important step of the process. Can we identify all stakeholders and users – not just the obvious ones like HCP or patient?

What about pharmacists, carers, and payers? More importantly, do they all win with our solution? If any one of them loses they will certainly discontinue use and your project will fail.

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T e ch n o l o gy

Step 3: Build a sustainable business model Too many mHealth projects have kicked off as pilots with a limited amount of funding in the naïve hope that the pilot will inevitably bring in further funding. Sustainability and funding needs to be planned from day one, and if you can’t identify someone who would fund the service in the long term, then it probably isn’t worth building.

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Step 4: Design for success There are so many options for the functionality that you could insert into an mHealth service such as monitoring, adherence, patient support, education, behavioral change, gamification, and connected devices. Which are the right ones to support your users in their objectives, though? Equally, if you can’t make the user experience really simple, then your good work will be in vain.

6 St e p s t o m H e alth Succ e s s

Step 5: Acquire, build and deliver Only when you know the answers to the previous steps should you start to consider technology solutions to support your project, and most importantly whether to build in-house (advantages of control) versus acquire an external solution (advantages of speed).

The most common mistake we see in mHealth is that sponsors dive in at this stage, prompted by seeing some hot, new technology without having gone through the rigor of the pre-requisite stages.

Step 6: Measure and improve Assuming you are serious about building a sustainable service with a long lifespan, you need to futureproof your project. What measures do I need to gather ongoing evidence that is working and how will I use that evidence to refine my service over time? Too often we see sponsors

“Sustainability and funding needs to be planned from day one, and if you can’t identify someone who would fund the service in the long term, then it probably isn’t worth building” deliver a project and then scramble later to gather some evidence. Build those hooks in from the outset and you make life a lot easier.

There are multiple characteristics on both the supply and the demand ends of mHealth that currently reveal the market to be inefficient and immature.

On the supply end, thousands of technology companies are vying to establish themselves with sustainable revenues, and while so far there has been no shortage of backers, investors are beginning to question when the real return will materialize.

On the demand side, the large number of potential mHealth users, providers, and pharmacy companies are unclear, and therefore uncomfortable, with the 37

T e ch n o l o gy benefits of mHealth.

According to a survey done by the World Health Organization (WHO), “the dominant form of mHealth today is characterized by small scale pilot projects that address single issues in information sharing and access.”

While large-scale and complex programs will become more common as mHealth matures, WHO advises strategies and policies to integrate

eHealth and mHealth interoperability into health services.

“Moving towards a more strategic approach to planning, development, and evaluation of mHealth activities will greatly enhance the impact of mHealth,” the survey states.

“Increased guidance and information are needed to help align mHealth with broader health priorities in countries and integrate mHealth into overall

Malaria Clinic in Tanzania helped by SMS for Life program, an Extreme Blue project

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6 St e p s t o m H e alth Succ e s s

efforts to strengthen health systems.”

With Tony Kane Consulting Ltd’s new methodology, a successful and result-driven mHealth future might be closer to reality than we think.

To learn more about Tony Kane Consulting Limited’s new methodology for mHealth success, visit: www.tonykaneconsulting.com

extreme Blue mhealth in action Extreme Blue uses IBM engineers, interns, and business managers to develop technology and business plans for new products and services such as rapid prototyping of high-profile software and hardware projects.

Publicly released projects include the following: • AmalgamR amalgamates social information from multiple sources, including Twitter, and displays relevant and timely group-based information • BreadCrumbs is an iPhone application that scans grocery food barcodes and gives consumers information such as ingredients, manufacturing history, and product recall alerts with the use of food traceability servers • SMS for Life fights malaria in Africa by utilizing cell phones, texting and web mapping technology to track and manage antimalarial drugs • exSEL is an end-to-end marketing tool which provides a virtual tour and allows virtual interactions with the exhibits in the IBM Solutions Experience Lab

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Countries Spending the Most on Healthcare Healthcare Global discusses the countries with the highest health expenditure per capita based on data compiled by the Organization for Economic Co-operation and Development (OECD) W r i t t e n b y: S t e p h a n i e C . O c a n o

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top 10

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Belgium

Health expenditure per capita: $4,419 Expenditure as a pct. of GDP: 10.9% (9th highest) Pct. obese: 13.8% (10th lowest) Life expectancy: 80.5 years (12th lowest)

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Belgium spent $3,560 on health per capita in 2012, versus the OECD average of $2,867. On pharmaceuticals, Belgium spent $593 per capita in 2012, trailing just behind Canada and the United States among OECD countries. But despite the higher health expenditure, health outcomes weren’t the greatest. Life expectancy was 80.5 years, just slightly above the OECD average of 80.2 years.

C o unt r i e s Sp e n d i ng th e M o s t o n H e althca r e

09

Luxembourg

Health expenditure per capita:Â $4,578 Expenditure as a pct. of GDP:Â 7.1% (5th lowest)

Luxembourg only spent 7.1 percent of its GDP on healthcare, less than almost all other OECD countries.

Its residents were quite wealthy, earning an average of $52,000 annually as of 2011, second only to United States residents.

Life expectancy: 81.5 years (10th lowest) 43

top 10

08

Canada

Health expenditure per capita: $4,602 Expenditure as a pct. of GDP: 10.9% (8th highest) Pct. obese: 17.7% (8th highest) Life expectancy: 81.5 years (10th highest)

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Health spending accounted for 10.9 percent of GDP in Canada, only one and a half percentage point higher than the OECD average of 9.3 percent. Canada experienced a substantial expansion of its medical workforce since 2000, driven by the increase of graduates from Canadian universities. While a growing number of doctors will improve access to healthcare, it may put pressure on future healthcare budgets as more graduates enter the workforce.

C o unt r i e s Sp e n d i ng th e M o s t o n H e althca r e

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Denmark

Health expenditure per capita: $4,698 Expenditure as a pct. of GDP: 11.0% (7th highest) Pct. obese: 13.4% (9th lowest) Life expectancy: 80.1 years (10th lowest)

In Denmark, 86 percent of all health spending was funded by public sources in 2012, the highest share among all OECD countries. The life expectancy in Denmark, however, still remains significantly lower than most Western European countries and other Nordic countries at 80.1 years. Obesity rates among adults have also increased which foreshadows increases in the occurrence of health problems and higher health care costs in the future.

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06

Germany

Health expenditure per capita: $4,811 Expenditure as a pct. of GDP: 11.3% (5th highest) Pct. obese: 14.7% (12th lowest) Life expectancy: 81.0 years (16th highest)

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In 2011, Germany introduced a new law that raised compulsory rebates for manufacturers and froze prices until 2013. This has led to a decrease in pharmaceutical spending in the country. Their current expenditure lies at 0.7 percent of GDP, significantly lower than the OECD average of 1.4 percent. Along with other countries, Germany’s smoking rates among adults have decreased to 22 percent, closer to the OECD average of 20.7 percent.

C o unt r i e s Sp e n d i ng th e M o s t o n H e althca r e

05

Austria

Health expenditure per capita: $4,896 Expenditure as a pct. of GDP: 11.1% (6th highest) Pct. obese: 12.4% (8th lowest) Life expectancy: 81.0 years (16th highest)

The growth rate in health spending in Austria slowed down after following their economic crisis but it has since begun to increase. In 2012, their health spending average grew by three percent in real terms. Alcohol consumption is still higher than that in nearly all other OECD countries with a consumption rate of 12.2 liters per adult, compared to the average of 9.0 liters. Obesity rates have also gone up from 9.1 percent in 1999 to 12.4 percent in 2006 (latest year of information available).

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top 10

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Netherlands

Health expenditure per capita: $5,099 Expenditure as a pct. of GDP: 11.8% (2nd highest) Pct. obese: 12.0% (6th lowest) Life expectancy: 81.2 years (15th highest)

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Health spending in the Netherlands has continued to grow despite the economic crisis, averaging an annual real term growth rate of over three percent between 2006 and 2012, according to reports from the OECD. In 2012, life expectancy at birth stood at 81.2 years, one year higher than the OECD average of 80.2.

C o unt r i e s Sp e n d i ng th e M o s t o n H e althca r e

03

Switzerland

Health expenditure per capita: $6,080 Expenditure as a pct. of GDP: 11.4% (4th highest) Pct. obese: 10.3% (3rd lowest) Life expectancy: 82.8 years (3rd highest)

Switzerland introduced a series of measures to contain pharmaceutical spending growth in 2010 and 2011, which put downward pressure on prices. In 2012, however, it rose by over three percent. Switzerland also had the third highest life expectancy among OECD countries at 82.8 years. Only Japan and Iceland enjoyed a higher life expectancy at 83.2 and 83.0 years, respectively.

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Don’t let your customers down

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C o unt r i e s Sp e n d i ng th e M o s t o n H e althca r e

02

Norway

Health expenditure per capita: $6,140 Expenditure as a pct. of GDP: 9.3% (16th highest) Pct. obese: 10.0% (2nd lowest) Life expectancy: 81.5 years (10th highest)

Total health spending accounted for 9.3 percent of GDP in Norway in 2012, equal to the average across all OECD countries. While health spending growth slowed down following the economic crisis, it picked up again in 2011 and Norway recorded annual increases of three to five percent since. Life expectancy stood at 81.5 years, more than a year higher than the OECD average and the obesity rate remains among the lowest.

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top 10

01

United States

Health expenditure per capita: $8,745 Expenditure as a pct. of GDP: 16.9% (highest of all) Pct. obese: 35.3% (highest of all) Life expectancy: 78.7 years (8th lowest)

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According to the Organization for Economic Co-operation and Development (OECD), the U.S. currently spends more on healthcare than any other developed country. Its health outcomes, however, are among the worst. The U.S. spent $8,745 per person on healthcare in 2012 and dedicated roughly 17 percent of its GDP to the industry. The U.S. has also made significant progress in

C o unt r i e s Sp e n d i ng th e M o s t o n H e althca r e

reducing the proportion of adults who smoke tobacco, coming down from 19 percent in 2000 to 14 percent in 2012 – the lowest rate after Mexico, Sweden and Iceland. Obesity rates however have been on the rise to reach 35.3 percent in 2012, the highest rate among OECD countries.

While most OECD countries were funded disproportionately by public sources, healthcare spending in the

U.S. was divided evenly between public and private sources. Despite spending the most, however, the U.S. had one of the lowest life expectancies, resting at 78.7 years. The slower progress in life expectancy is due to gaps in health insurance coverage and proper primary care, poorer health-related behaviors and poor living conditions for a significant proportion of the U.S. population.

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BridgeCrest

Medical, Inc. Better Health and Safety in Construction

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BridgeCrest Medical, Inc. Employee health and safety are crucial concerns for any construction company. Employers can often be surprised by potential dangers to employee health such as heart failure, hearing loss, and lung damage.

In the 21st century, we now have to power to proactively monitor and address employee health concerns before they become more serious.

BridgeCrest is a digital platform that closely monitors and runs diagnostics from two water bottle sized moÂŹbile health devices which connect to a smartphone or tablet via Bluetooth. Simple to set up and use, this application stores crucial information in the cloud, where safety professionals

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and doctors can carefully analyze and give immediate medical reports. Additionally, the system automatically provides employers with alerts and suggestions to improve their employee productivity.

This easy turnkey solution provides state of the art surveillance that can significantly reduce accidents and liability costs.

What are the credentials of this company?

BridgeCrest partners with the industry’s leading medical doctors. In developing its product, BridgeCrest works with Dr. Steven Steinhubl, Director of Digital Medicine at the Scripps Translational Science Institute.

Together, Dr. Steinhubl works with the BridgeCrest Medical team to identify devices that can positively impact your employee surveillance program and bottom line.

Their system is currently in operation in the USA, Africa and South America. Besides typical use cases such as cardiac health, lung health and hearing loss the system provides rapid diagnostics to closely

au s t r al i a

track the spread of drug use and infectious diseases such as malaria or dengue fever. With a global distribution network and the ability to work without cell connection, the BridgeCrest platform can operate anywhere.

Co-Founders of BridgeCrest Medical, believe that the system has broad applications for the industry as a whole. “Our low cost occupational health technology platform benefits both employers and employees – it’s a win-win”.

How effective is this program?

Innovation at Hand

Some clients have been able to save thousands of dollars in work related costs. “BridgeCrest has helped me to identify pending health problems to save on insurance costs, protecting my bottom line.” Alex Dolginov, Dolan Realty San Diego, CA. Nathan Klarer and AJ Cawood,

The BridgeCrest service differentiates itself from other devices by incorporating realtime telemedicine assistance.

Suppose that an employee fractures an arm or requires immediate CPR instructions in the field. Using BridgeCrest you can receive immediate video and

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cr oim nsatmM e edical, Inc. B d pa g en Cyr e audio medical attention through a partnered telemedicine system that operates through the same tablet or phone used to collect diagnostic data. The company believes that as a custodian of your data they

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have the utmost responsibility for its integrity. The system ensures the highest standard of security and HIPAA compliant integrity.

The technology revolution for medical devices can be extended

au s t r al i a

to many fields: transportation, natural resource production, and humanitarian efforts; the possibilities are endless. BridgeCrest is a true bridge for health data and actionable results to reduce work related accidents and insurer liability.

This system can and should be rapidly utilized.

Company Information Industry

Construction headquarters

12255 EL Camino Real, San Diego CA, 92130 founded

2013 employees

Nathan Klarer, AJ Cawood, Dr. Steven Steinhubl, Michael Holland

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A century-old operation backs the industry leaders in pharmaceutics:

Perrigo Mexico’s accelerated growth in Latin America and its projections within the generics’ market

Written by: Rebecca Castrejon Produced by: Carmenza David Interviewee: Ricardo Ganem, CEO for Perrigo Mexico Translated by: Rafael Tablado

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Perrigo MExico Quality and savings in pharmaceutics

P Perrigo Headquarters

errigo Mexico, a branch of one of the largest corporations in the global pharmaceutical industry, is led by the parent company’s more than 125-year experience with manufacturing generic drugs, along with value, leadership and product quality, traits shared by the Mexican operation since opening in 1999.

Perrigo Mexico has established itself as a competitive supplier to the Latin American market within a decade, more or less. The company’s catalogue includes prescription drugs, formula, solutions, ointments, transdermal patches, tablets, beta-lactam antibiotics, hormone-related medication, dietary supplements and generics.

They supply brands known worldwide, which are sold at outlets with global presences such as Walmart, as well as domestic retail chains and specialized outlets, including Farmacias del Ahorro, Farmacias de Guadalajara, Comercial Mexicana, Soriana and others.

“I can assure that our plants in Mexico are top of the line” – Ricardo Ganem, CEO, Perrigo México

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H e althca r e G l o bal

Perrigo Mexico’s business model consists of three main units: 1. Production and supply of patented drugs (store brands) to the largest retailers in Mexico and United States.

2. Subcontractors for drug brands and laboratories; an example of this is the company’s involvement in manufacturing Big Pharma’s line of products.

3. Production of Perrigo brand pharmaceutics, a business unit with high projected growth in the coming years through the company’s distribution network.

Plant or oral-solid products

The company’s laboratories and facilities are certified by Secretaria de Salud (Mexico’s federal health board), USFDA (Food and

Production of generic medicine

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Perrigo MExico

Christmas event for the community

Laboratories DIBA, an

Drug Administration), COFEPRIS (Federal Commission for the Protection against Sanitary Risk), Australia’s TGA (Therapeutic Goods Administration), and PROFEPA (federal environmental protection agency), which also certified the company with the Clean Industry approval.

acquisition by Perrigo

Entrepreneurial front office

in 2008

Perrigo Mexico’s leadership is derived from a team effort, and is achieved in every single area in the company from human resources, competitive procedures, equipment and machinery, to the front office and management team.

Atop this operation is Ricardo Ganem, current CEO for Perrigo Mexico. First hired in August, 64

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2009, Ganem started as chief commercial officer, delivering an outstanding performance in sales and marketing. Two years later, thanks to his strategic entrepreneurship, he was appointed CEO --his position during the last three years-- leading the company to its vision of commercial prosperity.

“A trait which most defines us is our commitment to quality. We manufacture a product with high standards to be sold at affordable prices, which sums up our company’s philosophy by becoming our own decisionmaking policy, which we experience day in and day out,” said the executive.

Perrigo headquarters

Competitive differentiation Perrigo Mexico goes beyond the plain subcontractor role to strengthen their clients’ brands, providing them with commercial consultancy and research as well as marketing strategies.

“We treat and approach clients as if they were our own brands, and we involve ourselves by creating and implementing business strategies to increase their competitiveness,” he said.

The company’s competitiveness displayed abroad is a magnet for multinational companies, as shown by their ability to live up to the “quality and affordable healthcare” motto, introduce quality products into the market at affordable prices, earn new customers everyday and build w w w. p e r r i g o . c o m . m x

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Perrigo MExico their trust and loyalty towards the brand.

Industrial expansion and internationalization • Mexico: The company seeks domestic consolidation for the store brands market by remaining at the top of that category through custom production for retail chains’ private brands. The company’s consolidation also encompasses the pharmaceutics manufacturing operation by supplying the public health sector with high quality products and engaging in subcontractor commitments with the area’s top laboratories by late 2014.

• Latin America: Since 2011, the company developed an international distribution network focused in Central America. These efforts’ results started paying off earlier this year with projections to grow farther south towards Colombia, Venezuela, Chile and Peru.

• Perrigo worldwide: The company’s strategy to achieve exponential growth and global expansion includes mergers, acquisitions and consolidation of existing markets, such as India, Israel, Europe, Australia and China, among others.

Human resource The human team at Perrigo Mexico is considered the company’s top value; keeping the staff’s well-being in optimal conditions is 66

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Key People

Ricardo Ganem Executive Director of Perrigo Mexico

Equipment for cream manufacturing

always a priority. These efforts translate into talented, properly-trained, motivated, pro-active employees. Health professionals in the company are constantly driven to improve via special training and rewards since their hiring through programs established with educational institutions.

Due to its presence in different countries, w w w. p e r r i g o . c o m . m x

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Perrigo MExico

“ A trait which most defines us is our commitment to quality. We manufacture a product with high standards to be sold at affordable prices, which sums up our company’s philosophy by becoming our own decision-making policy, which we experience day in and day out” – Ricardo Ganem, CEO, Perrigo México

Perrigo develops constant talent exchange programs within its branches worldwide.

“We are committed to providing our employees with the knowledge made possible only by this kind of experiences; and not only with our staff in Mexico, in every country we are present we have this competition programs, intensive surveillance for each position and thoroughly-developed training plans,” says Ganem.

Automation up to global standards As part of continual development, Perrigo Mexico’s plant introduced automation and network systems to improve every procedure, which are based on corporate standards and under regulation from health authorities.

Regular updating programs are run by Perrigo Mexico to increase productivity, reduce risks and for quality assurance in every operation. Cuttingedge technology and equipment has been introduced in every plant and laboratory, bringing innovation in control quality and staff training.

“I can assure that our plants in Mexico are top of the line,” Ganem says.

Logistics The company’s supply chain is designed depending on clients’ demands, subcontracting agreements and distribution plans (including for public health institutions). Also, new suppliers

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Plant QUIFA in Ramos Arizpe, Mexico, Perrigo acquisition in 1997

must comply not only with official regulations and standards but also with those set by Perrigo Mexico.

Clients’ orders are manufactured a month in advance, so a substantial reserve of two months is at hand. Subcontracting orders vary depending on buyers’ demand, including raw materials to be processed. Distributors and public health entities are dealt with in the same way as private brands are, with the same logistics procedures depending on the client’s required inventory.

The only difference is that the brands belong to Perrigo.

Perrigo Mexico’s business model has a distinction in logistics due to the wide variety of products and portfolios for retail clients.

“We supply from small business to large w w w. p e r r i g o . c o m . m x

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Perrigo MExico corporations. This wouldn’t be possible without our suppliers’ network support; we work very closely with them to ensure provision of required goods, price, quality and flexibility,” Ganem says.

Distribution projects for Mexico in the short term are quite aggressive, along with strong investments in capital, capability, staff and, as a consequence, expansion and/or strengthening the suppliers’ core and their capabilities.

Projections for the next five years Machinery for the creation of liquids

www.siepsa.com

There has been a very positive behavior in the pharmaceutical industry not only in manufacturing, but in every aspect: retail

H e althca r e G l o bal

competitors, doctors and the end consumer. With this current trend, Perrigo Mexico predicts growth both in clientele and as manufacturers. Also, public health institutions have increased their consumption of generic drugs.

“We are expecting volume and value growth, even though there is more competition within the trade, there are more retailers and laboratories seeking introduction into this sector. Growth will be capitalized only by laboratories able to guarantee quality, delivering product value and with the capacity to supply all the market segments,” Ganem says.

Company Information C o m pa n y

Perrigo Mexico industry

Pharmaceutics (health) headquarters

Ramos Arizpe, Coahuila, México founded

1887 globally, 1999 in Mexico employees

1,500 revenue

USD +$150 million email

atencion_clientes@perrigo.mx website

www.perrigo.com.mx

w w w. f a c e b o o k . c o m / Pe r r i g o C o m p a n y h t t p s : / / t w i t t e r. c o m / p e r r i g o c o m p a n y h t t p : / / w w w. l i n k e d i n . c o m / c o m p a n y / p e r r i g o w w w. p e r r i g o . c o m . m x

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