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Market Studies Opportunities for the Dutch Health Sector in Colombia

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Market Studies Opportunities for the Dutch Health Sector in Colombia Market Studies: Opportunities for the Dutch Health Sector in Mexico Commissioned by the Netherlands Enterprise Agency MEXICO Market Studies Opportunities for the Dutch Health Sector in Mexico EXECUTIVE SUMMARY October 2019 Mexico is Latin America’s 2nd largest economy and boasts the 15th largest GDP in the world. Nonetheless, economic prosperity is unequally divided over the population, with about half of all citizens living in poverty. Health policy has recently been aimed towards strengthening the public healthcare system and guaranteeing access to all Mexicans. Investment in public and private healthcare facilities, including telehealth solutions, are expected to increase in the near future. Mexico is facing a double burden of disease, with health problems stemming from both communicable and noncommunicable diseases. Obesity is considered the highest risk factor in Mexico, with 73% of the population being overweight or obese. Furthermore, Mexico is facing a rapidly ageing society, which will pose great challenges to the health system, especially with regards to the increasing prevalence of NCDs. Inequality and uneven distribution characterize Mexico’s healthcare system. Private healthcare facilities represent the majority of all facilities, with 69% of hospitals being run privately. However, the majority of treatment is being carried out in public facilities. While Mexico’s private sector provides high quality treatment, these services are restricted to those who can afford the high premiums. Inequality is emphasized further due to the uneven distribution of these services, with most healthcare facilities being located in the three largest cities. Mexico represents the largest importer of medical devices in Latin America, with 94% of all medical devices being imported. The reputation of European products in Mexico is excellent. Therefore, healthcare stakeholders are often interested in the propositions of Dutch companies. However, due to bureaucratic and political obstacles, there are not many foreign SMEs active in Mexico. In this report, developments and opportunities for Dutch companies and organisations in the field of Medical Devices & Supplies, Mobility & Vitality, eHealth, and Hospital Design & Build are further discussed. This report was commissioned by the Netherlands Enterprise Agency (RVO.nl) and is produced by the Task Force Health Care (TFHC) in cooperation with the Netherlands Embassy in Mexico City and Transfer LBC. It aims to align the respective health sectors of the Netherlands and Mexico. In an effort to increase mutual understanding and inspire collaboration between these countries, this report provides useful insights into the Mexican health system and sector and identifies potential areas of opportunity. 2 OUR APPROACH TASK FORCE HEALTH CARE IMPROVING HEALTHCARE TOGETHER Established in 1996, Task Force Health Care (TFHC) Our core mission is to improve healthcare and well- is a public-private not-for-profit platform that being internationally and in a sustainable and represents and supports the Dutch Life Sciences & demand-driven manner, with the use of Dutch Health (LSH) sector. Our platform has a reach of 1 expertise. We are currently actively engaged with 200 LSH organisations in the Netherlands, with 130 over 20 countries to stimulate and facilitate dedicated and diverse partners. Our partners relationships on government, knowledge and include government, industry, knowledge business levels. Our partners are active around the institutes, NGOs, and healthcare providers. world and provide innovative and sustainable solutions relevant to both global and local healthcare challenges. A PROGRAMMATIC APPROACH OUR FOCUS Bridging Knowledge, Aligning Interests Mutual Interests and Benefits and Identifying Opportunities Fostering and Strengthening Developing Sustainable and Long-Term Networks Approaches Demand-Driven and Context Specific Facilitating Dialogues on Health Themes and Opportunities to Collaborate 3 CONTENT OUR APPROACH 3 CONTENT 4 TOP REASONS – WHY MEXICO IS INTERESTING FOR THE DUTCH HEALTH SECTOR 6 HOW DOES MEXICO COMPARE TO LATAM? 7 LIST OF FIGURES AND TABLES 8 1 ABOUT THIS REPORT 9 1.1 BACKGROUND & PURPOSE 9 1.2 METHODOLOGY 9 2 MAPPING DUTCH INTEREST IN MEXICO 10 3 INTRODUCING MEXICO 14 3.1 HISTORY & GEOGRAPHY 14 3.2 PEOPLE & DEMOGRAPHY 15 15 3.3 ECONOMY 16 4 THE MEXICAN HEALTH SYSTEM 17 4.1 THE HEALTH SYSTEM 17 4.2 HEALTH FUNDING & EXPENDITURE 20 4.3 HEALTH STATUS & BURDEN OF DISEASE 21 22 4.4 HEALTH INFRASTRUCTURE 22 4.5 CURRENT POLICY PLANNING 25 4.6 FURTHER READING 27 5 MARKET ACCESS 28 4 5.1 DOING BUSINESS IN MEXICO 28 5.2 MARKET ACCESS 30 6 ALIGNING DUTCH STRENGTHS WITH MEXICAN OPPORTUNITIES 33 6.1 MEDICAL DEVICES & SUPPLIES 33 6.2 MOBILITY & VITALITY 34 6.4 EHEALTH 35 6.5 HOSPITAL DESIGN & BUILD 37 7 CONCLUSIONS 38 8 REFERENCES 40 ANNEXES 43 ANNEX 1 – LIST OF INTERVIEWEES 43 ANNEX 2 – LIST OF RELEVANT EVENTS AND TRADE FAIRS 45 ANNEX 3 –MAIN MEDICAL ASSOCIATIONS IN MEXICO 46 ANNEX 4 – LIST OF IMPORTERS AND DISTRIBUTORS OF MEDICAL DEVICES & SUPPLIES 47 5 TOP REASONS – WHY MEXICO IS INTERESTING FOR THE DUTCH HEALTH SECTOR INCREASE IN HEALTHCARE FIRST MOVER ADVANTAGE INFRASTRUCTURE Mexico has a large deficit and uneven distribution of health Many Mexican organisations are looking abroad for solutions infrastructure, with high concentrations of healthcare to combat the current and future health challenges. Due to infrastructure in the three largest Mexican cities. However, bureaucratic and political hurdles there are not many foreign continuous investment in public and private hospital construction SMEs active in Mexico, especially in the fields of apps, AI, and primary care facilities - including telehealth solutions, is drones, blockchain, telemedicine, robotics, genomics, and expected in the near-future. See Section 4.4 for more virtual and augmented reality. Thus, if one is up for the information. challenge and willing to invest time and money, the Mexican market has its advantages for those who get there first. Read more about opportunities in Section 6. THE BIGGEST IMPORTER REPUTATION OF EU IN LATIN AMERICA PRODUCTS 94% of all medical devices in Mexico are imported. Mexico European products have an excellent reputation in Mexico is the leading importer of medical devices in Latin America, and high-level healthcare stakeholders, such as hospital followed by Brazil, Chile, and Colombia. directors, are often interested in the propositions of Dutch See Section 6.1 for more on medical devices. companies. There is currently a relatively small presence of European companies active in Mexico, making stakeholders eager to meet with those offering EU-products and solutions. A RAPIDLY AGEING SOCIETY It is estimated that the proportion of people aged 60 and older living in Mexico will increase from 8.9% to 27% of the total population in 2050. This rapidly changing demographic will pose great challenges to its health system. Mexico will be looking to countries with experience in dealing with an ageing 6 population for solutions. See Section 3.2 for more information on demographics in Mexico. HOW DOES MEXICO COMPARE TO LATAM? Table 1: Geographic, Demographic, Economic, Business, and Health Context in Mexico compared to other Countries. Accumulated data from: World Bank Group Data (2019), World Health Organisation (2018), Healthdata.org (2019), BMI Medical Devices reports, IMS Market Prognosis (2016), International Trade Administration (2016) Brazil Chile Colombia Mexico Netherlands Land Size (km²) 8 515 767 049 756 950 1 109 500 1 972 550 33 690 Population (2019) 212 000 000 18 000 000 49 853 630 132 343 600 17 109 189 expected annual growth rate (%) 0.8 1.4 1.5 1.1 0.6 65 years and older (%) 9.6 12.2 9.1 7.6 19 expected in 2050 (%) 22.7 24.9 21 20.2 25 Maternal Mortality Rate (100 000 births) 58 17 71 38 7 Life Expectancy at Birth 76 80 75 75 82 Life Expectancy Global Rank (2017) 125 51 95 92 25 Economic Context GDP (current million USD) 2018 1 868 626 298 231 330 227 1 223 808 913 658 expected growth (2020) 1.1 4 2.7 2 2 GDP per capita (USD) 8 920 8 15 923 4 6 651 3 9 698 1 52 978 4 annual growth rate (%) 0.3 2.6 1.1 0.9 2.54 (Health) Business Context Ease of Doing Business Rank 109 56 65 54 32 Logistics Index 56 34 58 51 6 Pharmaceutical Market (bln USD-2016) 20 547 3 520 3 140 16 190 6 000 Expected growth 2016-2021 (%) 8.6 8.6 6.0 5.1 0-0.5 Medical Device Market (mln USD – 2016) 5 500 0 800 1 1 197 1 4 655 3 3 486 1 Expected growth 2016-2021 (%) 5.2 9.0 8.5 8.1 5.0 Medical Device Import from the Netherlands 000s USD 24 329 13 670 9 787 n/a - Ranking 17th 12th 16th n/a - Medical Device Export to the Netherlands 000s USD (%) n/a 737 n/a 69 879 - Ranking n/a 5th n/a 4 - Health Context Health Expenditure (bln USD) 155.3 2.8 21.1 64.2 81.7 Health Expenditure as % of GDP 11.77 8.53 7.4 6.1 10.69 Health Expenditure per Capita (USD) 1 015 93 1 190 55 358 461 79 4 746 01 Public Health Share of HE 46% 51.5% 75.5 52.1 86.7 Type of Health System Social Health Social health Social health Social health Social Health Insurance Insurance and insurance and insurance and insurance and supplementary supplementary supplementary supplementary private private insurance private insurance private insurance insurance Top three causes of death 1. Ischemic heart Ischemic heart Ischemic heart Ischemic heart Ischemic heart disease disease disease disease disease 2. Stroke Stroke Stroke Chronic kidney Alzheimer’s Disease disease 3. Lower Alzheimer's Interpersonal Diabetes Lung cancer respiratory infect disease violence 7 LIST OF FIGURES AND TABLES Figure 1: Dutch Activity in Mexico According to Interest Surveys ..................................................................................................
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