BIOMEDICAL CLUSTERS WORLDWIDE: SUCCESS FACTORS International Medical Cluster Foundation and BEST PRACTICES

BIOMEDICAL CLUSTERS WORLDWIDE: SUCCESS FACTORS International Medical Cluster Foundation AND BEST PRACTICES

Address: 5 Nikitskiy Pereulok, 6 bld., Moscow, 125009, Russia Phone: +7 (495) 139-24-44 https://mimc.global/ E-mail: [email protected] BIOMEDICAL CLUSTERS WORLDWIDE: CLUSTERS FACTORSBIOMEDICAL SUCCESS PRACTICES BEST AND

Institute for Statistical Studies and Economics of Knowledge, National Research University Higher School of Economics

Address: 20 Myasnitskaya Ulitsa, Moscow, 101000, Russia Phone: +7 (495) 621-28-73 https://issek.hse.ru/en/ E-mail: [email protected]

HSE ISSEK Russian Cluster Observatory http://cluster.hse.ru E-mail: [email protected]

BIOMEDICAL CLUSTERS WORLDWIDE: SUCCESS FACTORS AND BEST PRACTICES

Mosсow 2019

Medical_Clusters_english_version.indd 1 20.03.2019 19:00:32 УДК [60:61]:332.12 ББК 65.495 B60

Editorial Board: Leonid Gokhberg, Mikhail Yugay

Authors: Ekaterina Islankina, Evgeniy Kutsenko, Faina Filina, Victoria Pankevich, Elena Popova, and Valeriia Moiseieva

Biomedical Clusters Worldwide: Success Factors and Best Practices / E. Islankina, E. Kutsenko, F. Filina, В60 V. Pankevich et al.; International Medical Cluster Foundation; National Research University Higher School of Economics. – Moscow: HSE, 2019. – 156 p. – 100 copies. – ISBN 978-5-7598-1958-5 (pbk).

The report presents the results of a global study of biomedical clusters. Its goal is to identify and analyse the most successful international practices of promoting biomedical clusters, in which the cooperation of universities, firms and clinics, combined with a developed infrastructure and public support measures led to a significant improvement in the quality of healthcare.

The edition summarises the positive effects of biomedical clusters, describes their global landscape and reveals the key success factors, which are then compared with the features of the Moscow International Medical Cluster activities.

The publication is of practical interest to government officials, entrepreneurs, researchers, clinicians, and other professionals involved in the development of biomedical clusters, and to anyone else interested in healthcare and cluster policies.

УДК [60:61]:332.12 ББК 65.495

This publication was prepared under contract № MK/18 dated April 25, 2018 “On conducting the research into the success factors of biomedical clusters worldwide”.

ISBN 978-5-7598-1958-5 © International Medical Cluster Foundation, 2019 © National Research University Higher School of Economics, 2019 Reference is mandatory in case of reproduction

Medical_Clusters_english_version.indd 2 22-Mar-19 17:46:38 CONTENTS

Foreword ...... 6

Abbreviations. 12

1. Positive Effects of Biomedical Clusters 16

2. Global Landscape of Biomedical Clusters 42

3. Success Factors of Biomedical Clusters ...... 62

4. The Moscow International Medical Cluster: Its Value for the Capital City and for the National Healthcare System ...... 126

In Lieu of Conclusion 148

Bibliography ...... 149

Medical_Clusters_english_version.indd 3 22-Mar-19 18:47:35 ACKNOWLEDGMENTS

The authors sincerely acknowledge significant contributions to the report provided by the following representatives of biomedical cluster organisations who participated in interviews: Dr Kai Uwe Bindseil, Cluster Manager of HealthCapital Berlin-Brandenburg (Germany); Chris Doomernik, MMO, Managing Director of Health Valley Netherlands (the Netherlands); Dr Patrick Dümmler, Cluster Manager of Health Tech Cluster Switzerland (Switzerland); Dr Hinrich Habeck, Managing Director of Life Science Nord Management GmbH (Germany); Petter Hartman, CEO of Medicon Valley Alliance (Den- mark – Sweden); Piret Hirv, Cluster Manager of Connected Health (Estonia); Gražvydas Morkus, Managing Director of Lithuanian Medical Tourism Cluster (Lithuania); Seda Şenol, Cluster Manager of Istanbul Health Industry Cluster (Turkey), and Caroline Simoes-Auberger, Communication and Strategy Ma- nager of GIE Eurasanté (France).

We are especially grateful to Russian healthcare practitioners for their expertise in preparing the fourth chapter: Yaroslav Ashikhmin, MD, PhD, Cardiolo- gist, Advisor to CEO of the IMC Foundation; Ildar Khairullin, MD, PhD, DBA, First Deputy Director of the IMC Foundation; Alexei Khripun, Dr Med. Sci., Professor, Moscow City Government Minister, Head of Moscow City Healthcare Department; Yury Krestinsky, Director of Healthcare Development Centre (Mos-

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cow School of Management SKOLKOVO), Chairman of the Board at Bionica Group of Companies; Sergey Morozov, MPH, Dr Med. Sci., Professor, CEO of Research and Prac- tice Centre of Medical Radiology, Chief External Expert on Radiologic Diagnostics of Moscow City; Sergey Petrikov, Dr Med. Sci., Professor of RAS, Director of N.V.Sklifos- ovsky Emergency Medicine Research Institute; Vlada Sayfetdinova, MD, PhD, Medical Director of the IMC Foundation; Alexei Sysoev, Project Manager of the IMC Founda- tion; Konstantin Tsaranov, MD, PhD, MPA, Director of Healthcare Development Cen- tre at the Moscow City Government University of Management, and Professor Zeev Rothstein, MD, PhD, Director General of Hadassah Medical Organization (Israel).

This work would have been impossible without the active participation of the staff and partners of the Institute for Statistical Studies and Economics of Knowledge, National Research University Higher School of Economics: Sergey Artemov, Ekate- rina Buderkina, Olga Divitkina, Oleg Egin, Yulia Gavrilova, Pavel Girin, Anna Golovki- na, Saule Ismagulova, Tatyana Koltsova, Olga Leshchenko, Daniil Maksimenko, Iwao Ohashi (Japan), Galina Podzolkova, Vladimir Puchkov, Maria Radzikhovskaya, Maria Sokolova, Polina Sukhova, Boris Syomin, Oleg Vasilyev.

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Money cannot buy it, it is above wealth, and it is the greatest gift. Health. The world over, human well-being and life expectancy are the major indicators of a country’s socioeconomic development, and their increase is seen as a public policy priority.

Today, medicine and healthcare are facing a number of global challenges such as a growing and ageing population, the proliferation of stress-induced pathologies (“big city diseases”), illnesses caused by inadequate hygiene, metabolic disorders, and brain maladies. Meanwhile, major trends in the aforementioned areas include the transition to personalised and preventive medicine as well as steadily growing demand for a new quality of life, including the ability to com- pensate for lost body functions [Gokhberg (Ed.), 2016].

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Parrying global challenges and meet- diseases, a technology park, various ing emerging needs is not an easy R&D infrastructural facilities, an inter- task. Accomplishing this requires national university, and producers of joining the efforts of various actors pharmaceuticals and medical equip- operating at the junction of research, ment. A special legal regime already production, clinical practice, and applies in the cluster, which allows healthcare policymaking, and also by foreign clinics from OECD member involving patients in improving treat- states use protocols and medical ments. Numerous countries focus on techniques, equipment and drug clusters as a way to step up coope- preparations officially approved in ration to foster the development of their countries without extra licencing medicine [Alberti et al., 2014; Bathelt, in Russia, and to employ professionals Zhao, 2016; Braunerhjelm et al., 2000; from abroad without obtaining quotas Cooke, 2002; Fornahl, Tran, 2010; Koo, and work permits. This will help Rus- Choi, 2013; Mishra et al., 2004; Pre- sian and foreign doctors improve the vezer, 2008; Vasmant, 2009; Wolff, healthcare sector together. 2003]. The Russian Federation is one of them [HSE, 2018a]. The MIMC has been conceived as a global project from the very start. According to the Cluster Map of Rus- Therefore the goal of this study is to sia, there are more than 20 clusters identify and analyse the most suc- throughout the country, which bring cessful international practices of pro- together members specialising in moting biomedical clusters and exam- medicine, pharmaceuticals, biotech- ine the Moscow International Medical nology, and related industries [HSE, Cluster through the prism of the accu- 2018b]. One of the recent and most mulated experience. large-scale cluster initiatives in Rus- sia is the Moscow International Medi- Despite the wide variety of definitions cal Cluster (MIMC) currently being set for such terms as “cluster” and “bio- up in the Skolkovo innovation centre. medicine”, we still decided to suggest Its mission is to support the transfer our own – synthetic – interpretation and application of best global med- of a “biomedical cluster”, based upon ical practices in the national health- the study’s focus and the attributes care system. of its subjects (which could hardly be challenged). Therefore we propose The MIMC will comprise clinics spe- viewing a biomedical cluster as a geo- cialising in treating socially significant graphic concentration of clinics,

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relevant R&D and educational innovations in clinical practice. Final- organisations, and biotechnolo- ly, biomedical clusters contribute to gy and pharmaceutical companies the development of the patient care linked by a functional dependency system by bringing in new medical and implementing joint projects competences and creating advanced in order to develop medical medical solutions. technologies and improve the quality of healthcare. From the positive effects we moved on to their sources: the global bio- The global study of biomedical medical cluster landscape was ana- clusters included several stages, lysed at the next stage of the study. each described in a specific chapter To this end, we selected 40 clusters in this report. from 22 countries, which were the leaders in medical tourism or in We began with the review of aca- terms of the overall level of health- demic literature to identify and care. The cluster selection criteria structure the positive effects that were international visibility, involve- clusters have upon patients, re- ment in developing national medical search, businesses, and the overall treatment systems, and the pres- healthcare system. For example, ence of clinics among their mem- biomedical clusters promote the bers. Having assessed the whole emergence of new services at the sample using binary indicators to junction of the medical, hospitality, measure the cluster home countries’ and insurance industries and help positions on the global medical ser- maintain the continuity of treatment vices market, their members’ activi- due to the territorial proximity of ties, and management systems, we clinics and specialised infrastructure. conducted a cluster analysis which Cluster members conduct intensive produced the following grouping: biomedical research by recruiting R&D personnel worldwide, having global high-technology medicine shared access to advanced facilities clusters, which bring together and equipment, and attracting in- a large number of members rep- vestments for projects jointly imple- resenting various industries and mented by companies, clinics, and technology areas, and whose prod- universities. Such alliances lead to ucts and services are widely in the emergence of medical start-ups demand abroad; and the accelerated application of

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world-class biomedical research studies with quotes from the inter- clusters, which are primarily focused views. In summary, it can be argued on implementing scientific discoveries that biomedical clusters’ success in in treatment practice on the basis various countries depends upon the of advanced university clinics and following factors: knowledge centres; a full communication agenda, international medical tourism clus- implemented via active net- ters, which blend the healthcare and working (online and offline), joint hospitality industries to provide inno- projects, formal and informal con- vative integrated services to patients tacts, the dissemination of informa- by merging treatment and recreation. tion about the cluster and its members; Target models were also identified for each group, describing the key points interdisciplinary cooperation, of members’ cooperation and the pre- which implies bringing together requisites of clusters’ creation. the research, technological, and social competences of various cluster mem- The resulting diverse global biomedi- bers to develop and apply relevant cal cluster landscape was then stud- medical solutions at the junction of ied in detail, namely by identifying different activities (such as patient success factors. Representatives treatment services, the production of of each cluster group were inter- medical equipment, pharmaceuticals viewed about the clusters’ emer- and nutrition, construction, etc.) and gence, members, and their contribu- technologies (nano-, bio-, information, tion to the development of medicine etc.); and healthcare, the government support they received, and the role of the partnership-based manage- cluster management team. That is, ment, to balance the interests we asked them about all the factors of key members representing different that had made those particular clus- areas (healthcare, medical and phar- ters sources of best practices. Each maceutical industries, research, edu- cluster prospered in its own unique cation, public administration) and way, yet many of the activities turned professionally administer cluster out to be similar. We grouped them development; into seven success factors subsequently described in detail in 30 case

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support from the regional involving patients and doc- authorities, which implies tors in the development and clusters can receive both public testing of healthcare innovations, funding and non-monetary bene- which is an area where end users’ fits (such as assistance in dealing needs frequently inspire producers with the national government, to create new goods and services involvement in the drafting and or improve them; adjustment of industry-specific regulations and programmes, a comprehensive approach preferential access to infrastruc- to supporting innovation, ture, and so on); which implies building up basic and specialised infrastructures, nurtur- national-level recognition ing start-ups, and using the intel- of clusters, which means that lectual base of universities and the government requires their other knowledge centres. expertise in healthcare-related issues and participation in state projects and programmes;

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At the final stage of the study, a com- The special legal regime granted parative analysis of the identified to the MIMC at the national level, success factors and key aspects of the the managerial and investment con- Moscow International Medical Cluster tribution of the regional authorities activities was conducted. Is the MIMC to the cluster development, diverse going its own unique way or does it international membership, and fit into the mainstream of biomedical advanced infrastructure create unique clusters in other countries? To answer career and educational opportunities this question, we polled experts from for Russian doctors and biomedical the Russian medical community: what researchers, while patients get access role, in their opinions, could the MIMC to the world-class healthcare in their play in the development of Moscow’s own country. and the larger Russian healthcare system. We discovered that the Moscow We hope the members of existing International Medical Cluster did fol- biomedical clusters will find the low the major global trends but also results of this study useful and that it could offer certain unique solutions to will inspire those just launching its peers from abroad. a cluster initiative.

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ABBREVIATIONS

AG Aktien Gesellschaft (Joint Stock Company)

AIDS Acquired Immune Deficiency Syndrome

BB Brandenburg

BE Berlin

BMA Business Support Centre for Biomedical Research Activities

CEO Chief Executive Officer

CfPIE Centre for Professional Innovation and Education

CHU Collège Сentres Hospitaliers Universitaires (University Clinics College)

CIC-IT Lille Clinical Investigation Centre for Innovative Technology

COBIS Copenhagen Bio Science Park

CRO Contract Research Organisation

DBA Doctor of Business Administration

DGMIF Daegu Gyeongbuk Medical Innovation Foundation

EFS L’Etablissement Français du Sang (The French Institute of Blood)

eHIS electronic Hospital Information System

ERDF EU Regional Development Fund

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ESCA European Secretariat for Cluster Analysis

ESS European Spallation Source

EU European Union

EvB Klinikum Klinikum Ernst von Bergmann

FUI Fonds Unique Interministériel (French Unified Interagency Investment Fund)

GDPR General Data Protection Regulation

GIE Groupement d’Intérêt Économique (Group of Economic Interests)

GmbH Gesellschaft mit beschränkter Haftung (Limited Liability Company)

GMP Good Manufacturing Practice

HAN Hogeschool van Arnhem en Nijmegen (HAN University of Applied Sciences)

HIV Human Immunodeficiency Virus

HSE Higher School of Economics

HZB Helmholtz-Zentrum Berlin für Materialien und Energie (Berlin Helmholtz Centre for Materials and Energy)

ICT Information and Communication Technology

IFC Inter-firm Cooperation

IHRC International Human Rights Commission

IRBs Institutional Review Boards

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ISMED Institute for SMEs Development

ISO International Organisation for Standardisation

IT Information Technology

LSN Life Science Nord

MBA Master of Business Administration

MD Doctor of Medicine

MDC Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaf (Max Delbrück Centre for Molecular Medicine in Helmholtz Association)

MIMC Moscow International Medical Cluster

MMO Master of Management and Organisation

MPA Master of Public Administration

MSc Master of Science

NBIC Nanotechnology, Biotechnology, Information Technology and Cognitive Science

NL Netherlands

OECD Organisation for Economic Co-operation and Development

PPP Public-private partnership

PwC PricewaterhouseCoopers

R&D Research and Development

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RAS Russian Academy of Science

S&T Science and Technology

Scion DTU Technical University of Denmark Science Park

SMEs Small and medium-sized enterprises

STEMO STroke Emergency MObile

TAT Tourism Authority of Thailand

TCI Network The Competitiveness Institute-Asociación Competitividad

TFHC Task Force Health Сare cluster

UK United Kingdom

US United States

WHO The World Health Organisation

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POSITIVE EFFECTS OF BIOMEDICAL CLUSTERS

OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS

Why do we need clusters?

Any initiative to join the efforts of government agencies, businesses, research and educational organisations to step up the development of a particular field starts with this simple, logical question. In our case the field is healthcare. Will treatments become more effective and affordable if hospitals are members of a cluster? Could the establishment of a cluster lead to breakthroughs in biomedical science? Will the quality of the medical personnel’s training improve? Will research results be applied more rapidly by manufacturers and doctors? These questions have inspired our study. To answer them, we have reviewed academic literature and scrutinised best practices of biomedical clusters around the world. The analysis revealed that clusters affect several areas of economic and social activities. We grouped the identified positive effects into four categories. This chapter suggests a closer look at each of them.

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BIOMEDICAL CLUSTERS: POSITIVE EFFECTS

FOR PATIENTS FOR SCIENCE FOR HEALTHCARE

/ Emergence of new / Development of biomedical research SYSTEM integrated services, and commercialisation of its results / Optimisation of medical due to cooperation by recruiting R&D personnel worldwide processes between the healthcare / Improved training of medical sector, hospitality, and / Extension of R&D potential personnel insurance businesses by concentrating advanced equipment and facilities in clusters, and providing / Ensuring treatment collective access to them continuity due to joint medical infrastructure / Increased investments in cluster FOR BUSINESSES members’ joint R&D projects / Increased number of healthcare start-ups

/ Accelerated application of innovations in medical practice

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POSITIVE EFFECTS FOR PATIENTS

Emergence of New Integrated Services, due to Cooperation between the Healthcare Sector, Hospitality, and Insurance Businesses OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS

Many biomedical clusters select medical tourism as their main activity profile. In recent years, treatment, rehabilitation, and wellness have become the fastest-growing segments in the tourism industry [Alberti et al., 2014; De Vera et al., 2008; Horowitz, Rosensweig, 2007]. Certain Asian countries such as Thailand, Singapore, and the Republic of Korea receive more than a million foreign patients a year [Kandasamy, Rassiah, 2010], while global medical tourism turnover amounts to several billion US dollars.

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BRINGING THE HEALTHCARE appointments with doctors, booking tickets, translation, babysitting, and SECTOR AND HOSPITALITY so on. In addition to medical assis- INDUSTRY TOGETHER INTO tance, patients are offered various A CLUSTER ALLOWS ONE recreational opportunities: in the city TO OFFER PATIENTS NEW or in the countryside, there are entertainment, museums, sports, amuse- INTEGRATED SERVICES, ments for children, excursions, and NOT SOLELY MEDICAL much more (fig. 1.2). ASSISTANCE, BUT ALSO One of the barriers hindering biomed- VARIOUS RELATED ical clusters’ development is insur- FACILITIES. ance companies’ reluctance to cover healthcare treatment costs incurred abroad. Any medical insurance is a high-risk activity, but if the patient decides to receive curing in another country, the uncertainty becomes Further, this industry’s share in deve- much greater [Harryono et al., 2006]. loping economies is steadily growing Therefore, setting up insurance pro- [Castillo and Conchada, 2010]. For grammes specifically oriented towards example, Thailand Medical Tourism medical tourism is a necessary con- Cluster offers its clients translation, dition for the industry’s successful banking, insurance, and legal advice development in a particular region. [Harryono et al., 2006] (fig. 1.1).

The integration of healthcare and hospitality service providers into Lithuanian Medical Tourism Cluster (LitCare) allowed the members to create a unique system where everything was specifically planned to meet all possible needs of patients in the best way. Among other things, the cluster offers a full spectrum of information and arrangement services such as visa support, accommodation, making

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STRENGTHENING The effect from such cooperation may increase further if an insurance THE LINKS BETWEEN organisation already has experience A MEDICAL TOURISM with the relevant international pro- CLUSTER AND INSURANCE grammes. Today a number of firms COMPANIES (THROUGH in different countries offer medical tourism services as part of their basic TO INTEGRATING THEM AS coverage package. For example, FULL-FLEDGED MEMBERS) Ingosstrakh Insurance Company COULD CREATE MULTIPLE (Russia) has the international insurance programme, which covers POSITIVE EFFECTS FOR medical treatment costs the world VARIOUS PARTIES. over, with a wider range of services than the standard voluntary medical 1 OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS insurance policy provides . AlfaStra- khovanie Group (Russia) offers pro- Clinics within the cluster get an op- tection against oncology-related risks portunity to attract more customers: within the AlfaSynopsis programme people who are not ready to pay for that covers treatment costs in Israeli, medical tourism out of their own Spanish, and South Korean clinics, pocket, but whose insurance compa- airfare, and accommodation (at ho- nies cover treatment costs incurred tels of up to 4-star rating), in other countries can be potential for the insured and one companion2. clients. For patients, acquiring health- Blue Cross Blue Shield of South care services abroad becomes much Carolina already offers access more affordable. Insurance compa- to overseas procedures through nies as members of the cluster can a subsidiary, Companion Global cooperate with hospitals more closely Healthcare, Inc., which has medical and better assess the quality and tourism contracts with hospitals costs of medical services. in Singapore, Thailand, Ireland, Tur- key, and Costa Rica3 .

1 Ingosstrakh Insurance Company [official website]. URL: https://www.ingos.ru/health_life/intl_dms/ (last accessed on September 21, 2018).

2 AlfaStrakhovanie Group [official website]. URL: https://www.alfastrah.ru/individuals/life/antionko/calc/ (last accessed on September 21, 2018).

3 Medical Tourism Magazine [official website]. URL: https://www.medicaltourismmag.com/news/2014/07/health-insurers-look- medical-tourism-transparent-strategy-face-obamacare/ (last accessed on December 10, 2018).

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CORE ACTIVITIES

TOURISM ACTIVITIES RELATED AND SUPPORTING INDUSTRIES / Transportation Services Food Suppliers / Restaurants Translators / Hotels and Hospitalities Retailers / Travel Agencies Insurance Services Professional / International Airlines Legal Services Associations

Banking Services

Ministry of Tourism and Sport

Ministry of Health MEDICAL ACTIVITIES RELATED AND SUPPORTING INDUSTRIES Tourism Authority / Thai Medicine Medical Device Suppliers of Thailand (TAT) / General Medicine Spa Operators

/ Hospitals and Clinics Universities and Medical Schools / Dental Treatments Institute for SMEs Development / Medical Transporters (ISMED) / Cosmetic Surgery

Fig. 1.1. Members and Partners of Thailand Medical Tourism Cluster Source: compiled by the authors based on [Harryono et al., 2006].

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LITHUANIAN MEDICAL TOURISM CLUSTER SERVICES

WAY OF А MEDICAL TOURIST

1 7 10

Salon treatments Information support DENTISTRY 11 Trip planning Implantation

Prosthetics TOURISM AND RECREATIONAL SERVICES 2 Surgery Rest in the city or in nature Orthodontics Preliminary medical Organisation of business meetings consultations Periodontics Entertainment events Endodontics 3 Visiting museums and galleries Laser dentistry Sea tour Visa support Aesthetic dentistry Sport Ticket reservation Sedation dentistry Excursions Organisation of transfers Pediatric dentistry Shopping OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS 4 8 Driver services

Babysitting service Accommodation REHABILITATION The services of a personal guide Rest Neurology 5 Traumatology 12

Orthopedics Medical consultations Ticket reservation Arthrology Preparation for procedures Organisation of transfers Cardiology (for adults) 13 6 Pulmonology (for children) Ophthalmology (for children) Patient-doctor relationship MEDICAL SERVICES Gastroenterology Diagnostics and treatment (for children) Complex examination CLUSTER Gastroenterology Ophthalmology Observation MEMBERS Gynecology Consultations Logistics Tour operators Urology Recommendations Organisers of treatment Reproductive medicine 9 Treatment Traumatology Medical organisations Orthopedics SPA PROCEDURES Dental clinics Cardiology Rehabilitation centres Spa treatment Vascular surgery Wellness Mud bath Spas Plastic and aesthetic surgery Vertical baths Hotels Classical massage Underwater massage

Fig. 1.2. The Chain of Services Offered by LitCare Source: compiled by the authors based on the Lithuanian Medical Tourism Cluster data.

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Ensuring Treatment Continuity due to Joint Medical Infrastructure

One of the healthcare problems that Clinics that are members of a cluster patients frequently encounter is a lack have much better opportunities of treatment continuity, or in broader to set up integrated medical assistance terms, fragmented medical assistance systems due to several factors. These [Sheiman, Shevski, 2014]. It arises when include territorial proximity, healthcare there is no coordination between clinics, organisations’ ability to concentrate which leads to the duplication of ser- on treatment (while other cluster mem- vices and failing to meet patients’ real bers step in to provide supplementary needs [Montenegro et al., 2011]. services the patient might need) and the centralisation and coordination Integrated medical assistance models of support and logistics activities such designed to address the fragmentation as purchases, laundry, the supply issue are based upon novel approaches of medicines, etc. [Schmidt et al., 2007]. to organising the work of hospital staff (e.g. setting up multifunctional teams) and the application of integrated electronic systems to improve interactions between various healthcare service providers [Burns, Pauly, 2002; Fulop et al., 2005; Goodwin, 2016; Lê G. et al., 2016; Lewis et al., 2010].

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HealthCapital Berlin-Bran- of information between them help denburg (Germany) is a good to ensure treatment continuity example of setting up an inte- [Goodwin, 2016]. grated medical assistance system. The cluster comprises the EvB Biomedical clusters frequently Klinikum health park (29 special- implement initiatives to improve ised hospitals with the total capac- the coordination of medical activi-

ity in excess of 1,000 beds); ties by setting up unified clinical the Vivantes concern (10 clinics, information databases. For exam- 5,000 beds); a pension; nursing ple, Health Valley Netherlands homes; rehabilitation centres; the participates in developing and test- Carl-Theim Klinikum (24 depart- ing the digital MeXtra system4 de- ments); and one of the largest in signed to allow doctors, patients, Europe, the Charité University Hos- and nursing personnel to share in- OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS pital. The clear, well-defined proce- formation, draft and subsequently dures for the interaction of medical adjust treatment plans, and so on. staff and the efficient exchange

Clusters ensure patient care continuity, due to sustainable interactions among various medical organisations and the creation of a unified information infrastructure that facilitates the exchange of clinical data among all participants in the treatment process. In addition, the coordinated activities by all biomedical cluster members lead to the emergence of new integrated services for patients with their provision at all stages being arranged and supervised by a single supplier.

4 ZorgInnovatie [official website]. URL: https://www.zorginnovatie.nl/innovaties/mextra (last accessed on September 23, 2018).

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POSITIVE EFFECTS FOR SCIENCE

Development of Biomedical Research and Commercialisation of Its Results by Recruiting R&D Personnel Worldwide

A “high-skill ecosystem,” this is how international partnerships an association of gifted researchers [Owen-Smith, Powell, 2004]. capable of achieving breakthrough results in life sciences can be de- The establishment of biomedical scribed [Finegold et al., 2004]. clusters in Singapore and China was It is not a simple task, which re- followed by the implementation of quires the involvement of profes- programmes aimed at attracting sionals specialising in various S&T scientists from abroad. This, in turn, areas (medicine, biology, engineer- led not only to the improved qual- ing, ICT, etc.). A cluster accumulates ity of studies but increased entre- a critical mass of participants with preneurial activity [Finegold et al., mutually complementary skills. 2004; Prevezer, 2008]. In 2002–2005, The research community emerging the Singapore National University therein looks attractive to scientists Hospital together with the Biopolis in other countries, who can contrib- Technology Park launched integrated ute to its activities [Rauch, Wappler, housing programmes for the invited 2011]. For example, a case study researchers [Wong, 2007]. To smooth of Boston biotechnology cluster their integration into clusters, the revealed that higher-quality infor- government adjusted national bioeth- mation (i.e. novel and critically im- ics practices to match international portant) is more often created and requirements. For example, in 2001 disseminated not within local com- the Bioethics Advisory Committee munities but as part of strategic was established, and “Research

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Involving Human Subjects: Guide- Less than 25% returned to China lines for IRBs” was published upon completing their studies. in 2004. Incubators designed The Encourage Overseas Scholars to help foreign scientists launch to Serve their Country in Differ- start-ups for commercialising R&D ent Ways programme was aimed results were set up in the Singa- at creating favourable conditions porean clusters likewise, e.g. and providing initial funding for

BioEnterprise Asia. scientists returning from abroad to start their own companies. A major programme to repatriate Examples of successful biotech researchers from abroad was firms established by repatriated implemented in China in 1996– researchers in Shenzhen, Beijing, 2003. About 700,000 young peo- and Shanghai clusters are Proex- ple left for other countries to do act Biotech, Beijing Huada OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS academic work in 1978–1996, 30% Genomics Institute, and United of them specialising in biomedi- Gene [Prevezer, 2008]. cine and technology [Qi, 2003].

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Extension of R&D Potential by Concentrating Advanced Equipment and Facilities in Clusters, and Providing Collective Access to Them

Medical innovation would not be pos- of Korea, only 8.7% of medical equip- sible without high-technology equipment producers have their own ment [Collins, 2008]. At the same research facilities [Sohn et al., 2015]. time, many companies in the industry are small or medium and have limited opportunities for procuring expensive devices. For example, in the Republic

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IN BIOMEDICAL CLUSTERS, MEMBER COMPANIES’ R&D DEPARTMENTS FREQUENTLY SHARE EQUIPMENT AND PREMISES WITH HOSPITALS; THIS COOPERATION IS

MUTUALLY BENEFICIAL FOR Also, the BMA provides them CLINICAL TRIALS. with the opportunity to share the costs of animal testing conducted by specialised firms Certain features specific to the [Collins, 2008]. Similarly, mem- biomedical industry create a bers of the French biomedical OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS number of additional barriers cluster Lyonbiopôle can use the related to the high level of re- cluster’s resources for their own gulation and strict requirements research. The Lyonbiopôle labo- for in vivo testing [Brennen- ratories are equipped in line with raedts et al., 2006]. To help the ISO and GMP standards; small and medium producers of all facilities are operated and medical equipment and develop- serviced by private companies5. ers of drugs enter the relevant markets, many clusters provide shared access to advanced research infrastructure [Collins, 2008; Sohn et al., 2015].

The Business Support Centre for Biomedical Research Activities – BMA, a facility at KOBE Biomed- ical Innovation Cluster (Japan), allows members use its laboratories to study radioactive isotopes.

5 Lyonbiopôle Auvergne-Rhône-Alpes [official website]. URL: https://lyonbiopole.com/en/facilities/our-labs-offer (last accessed on September 9, 2018).

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Increased Investments in Cluster Members’ Joint R&D Projects

Clusters’ contribution to encouraging ical clusters’ R&D directly depends investments in biomedical research upon the coordinated activities of their was noted in many countries [Gui- members. A cooperation agreement mon, 2013]. For example, in Singapore, based on a shared vision of the future measures to support the biomedi- cluster development is a necessary cal cluster were aimed, among other condition to receive support. Also, things, at improving the intellectual cluster members must present a de- property protection system, which re- tailed description of a joint project sulted in increased R&D expenditures including technical, R&D, and finan- by member companies [Finegold et cial specifications. For example, in al., 2004; Graham, Woo, 2009]. 2008—2011 the French Eurobiomed cluster received 423 million euros in A study of Scottish, Swedish, and public funding for 121 R&D projects Danish experiences [Rosiello, 2005] implemented by research organisations revealed that the amount of private and companies together, in the scope and public funding in clusters largely of the Poles of Competitiveness (Les depends upon how the R&D and pro- Pôles de Compétitivité) programme6. duction system is organised and how members cooperate. Accordingly, in many countries cluster policy is focused on improving communication as an investment attraction factor.

For example, in France, the amount of public financing provided for biomed-

6 Pôle de compétitivité: Eurobiomed [official website] URL: http://competitivite.gouv.fr/documents/commun/Les_Poles_en_ mouvement/fiches_synthetiques/Fiche-Eurobiomed-fr.pdf (last accessed on September 9, 2018).

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OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS

Some biomedical clusters take events five times a year, where specific steps to encourage mem- companies and research organi- bers to step up their R&D expen- sations are given ten minutes to ditures and simplify their dealings present their projects to an inves- with investors. The French Medicen tors’ committee7. Paris Region cluster hosts special

Clusters positively affect the dynamics of interdisciplinary R&D at the junction of medicine, biology, computer science, chemistry, and physics, involving the leading local and foreign researchers. Joint cluster projects implemented by universities and enterprises largely become subject to private and public investments, while the collective access of cluster members to advanced infrastructure, equipment, and facilities ensures the flow of such projects.

7 Medicen Paris Region. Innovation for Health [official website]. URL: http://www.medicen.org/services/financement/ (last accessed on September 2, 2018).

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POSITIVE EFFECTS FOR THE HEALTHCARE SYSTEM Optimisation of Medical Processes

The members of biomedical clusters lance calls are registered in a unified such as R&D organisations, firms, information system. This makes the universities, and hospitals frequently provision of medical services signifi- become the first to find innovative cantly more efficient [Amarasingham medical assistance solutions. These et al., 2009]. may include not only improved therapy and diagnostic techniques but In many cases, such practices emerge also new ways to optimise treatment, and are replicated due to the activities procurement, regulation, and data of clusters comprising networks management processes [Rosiello, of clinics and developers of relevant Orsenigo, 2008]. The latter is still a IT products. For example, the mem- problem for many medical organisa- bers of Health Valley Netherlands tions. According to the WHO report, actively participate in designing some national databases do not track healthcare information systems. patients in and out of hospitals, be- The cluster has a partnership with tween hospitals or even within the the Zorginnovatie platform where same hospital, because they do not companies can present new solutions use unique patient identifiers [World for optimising medical processes and Health Organisation, 2013]. Devel- receive financial support. For example, oped countries and leading clinics are Cortex is a toolset for healthcare insti- constantly improving their databases tutions and pharmaceutical manufac- and electronic appointments facilities, turers to build mobile ecosystems while hospital admissions or ambu- for certain patient groups. So-called

Medical_Clusters_english_version.indd 31 20.03.2019 19:00:46 3232 POSITIVE EFFECTS POSITIVE EFFECTS BIOMEDICALOF CLUSTERS

Clinicards make it possible to cre- gether to come up with a solu- ate a personalised app to capture tion for seamlessly integrating specifi c data for the diagnostic remote treatment into process- plan (among others with sensors) es and including them in the and to support digital interven- fund’s pricelist9. tions for evidence-based be- havioural infl uencing8. In line with Such systems and applications the national e-health strategy, the allow one to more actively involve Connected Health cluster mem- patients in the medical assistance bers together with the Estonian process, reduce the time they need Health Insurance Fund and the to spend with doctors (planned Ministry of Social Aff airs are devel- visits) and quickly react to changes oping telemedicine services. in their state of health. In particular, they are working to-

8 ZorgInnovatie [offi cial website]. URL: https://www.zorginnovatie.nl/innovaties/cortex (last accessed on September 23, 2018).

9 Connected Health [offi cial website]. URL: http://connectedhealth.ee/success-stories/connected-health-cluster-promotes- entrepreneurship-helps-make-world-better-place/ (last accessed on September 22, 2018).

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Improved Training of Medical Personnel

Apart from usual professional duties, sional Innovation and Education – the medical staff of cluster member CfPIE. Cluster member companies organisations have other responsi- that pay for training their profession- bilities: they participate in the devel- als specialising in pharmaceuticals or opment and implementation of joint medical technologies at the CfPIE get projects, organise events, consult a 10% discount10. businesses on involving patients in the assessment of innovative products Another American cluster, BIOCOM, and services, etc. All this creates the offers medical education programmes need for the ongoing upgrading of together with San Diego University, their communication skills, and abili- Miramar College, and the non-profit ties to work with diverse groups organisation San Diego Workforce [Kósa et al., 2013]. Partnership. While the University of San Diego and Miramar College are Many biomedical cluster organisations implementing a master programme, arrange coaching sessions for their the BIOCOM cluster runs courses in members’ clinicians in order to help biotechnology (both intramural and them acquire the relevant supplemen- online). For example, the Life Science tary competencies (e.g. in project Immersion programme helps students management, advanced ICT, com- gain insights into the work of biomed- munication, and research). Most clus- ical companies and the overall busi- ters comprise medical universities or ness environment of California. Fur- organisations that specialise in staff ther, it also provides tips for running training and retraining. For example, projects and building communication the US BioOhio cluster offers various networks with industry experts. Thus, programmes at the Center for Profes- the cluster, on the one hand, organises

10 BioOhio [officialebsite]. w URL: https://www.bioohio.com/membership/talent/ (last accessed on September 22, 2018).

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personnel upgrading in the areas of Medicine, the Mayo School for demanded by the member compa- Graduate Medical Education, nies, while on the other, it spreads the Mayo Graduate School, job offers among potential workers, the Mayo School for Health Scienc- helping reduce unemployment in es, the Mayo Medical School, the region [Global Connect, 2010]. the Mayo School for Continuous Professional Development, and

Some clusters provide educational the Mayo Clinic School of Medicine11. services not just to their members’ Such impressive educational base employees but to other organisa- allows the Mayo Clinic to make tions’ staff as well. The Mayo Clinic a sizeable contribution to upgrading (member of the US Medical Alley medical personnel in the cluster’s cluster) established several train- home region. ing centres: the Mayo Clinic College OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS

11 Mayo Clinic [official website]. URL: https://www.mayo.edu/mayo-clinic-school-of-medicine (last accessed on September 22, 2018).

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Clusters stimulate positive changes in the healthcare system by bringing together the most active representatives of the professional community, knowledge centres, and innovative companies from the medical and related industries. They jointly develop and test information systems, software products, and applications that allow patients to be more actively involved in the treatment process, and enable doctors to respond faster to changes in their health, reduce the administrative burden on hospital staff, and ensure the efficient use of medical record systems. In addition, the interaction between different cluster members contributes to the development of a whole training chain (university studies – internships at clinics and companies – professional qualification upgrade during a career – the transition of clinicians into R&D and academic work) as well as to an increase the professional standards in healthcare.

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POSITIVE EFFECTS FOR BUSINESSES

Increased Number of Healthcare Start-Ups

Many biomedical clusters support existing OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS start-ups and promote the creation of new ones. This is an effective way to attract funding, promote growth in the industry, strengthen clinics, and increase their market competitiveness [Bagchi-Sen, 2007]. For example, many US biomedical clusters became leaders in emerging therapy and diagnostics due to strong, well-established cooperation between academia and business, which be- gins already at the university research stage. Alliances of biotech companies and R&D centres within clusters frequently lead to the creation of start-ups.

The situation in Europe is similar [Serwatka, 2018]. For example, according to a Dutch law passed in 2015, young entrepreneurs from non-EU countries can get temporary resi- dence permits for up to one year to launch an innovative business. A condition to obtain this privilege is to have a mentor at a state-approved organisation.

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Health Valley Netherlands is start-ups who develop innovative one of such mentors. The clus- solutions in areas such as self-help, ter signs an agreement with the smart premises, and doctor-patient prospective entrepreneur, according communication platforms. The pro- to which the support in areas such as gramme provides funding for the organisation, management, market best start-ups (up to 20,000 euros), research, securing funding sources, mentor services, organises meetings and assessing the business idea has with venture capitalists, grants pref- to be provided. Apart from acting as erential access to infrastructure, a foreign start-up facilitator, Health helps with team building and man- Valley Netherlands also helps its own agement, and with international members, who are early-stage inno- promotion via partnership networks. vation entrepreneurs. For example, Ten cluster members have been sup- the cluster is a partner of the Rock- ported in the scope of the pro- start Digital Health Accelerator programme so far12. gramme which provides assistance to

MORE THAN 100 START-UPS SPECIALISING IN BIOMEDICINE AND LIFE SCIENCES HAVE BEEN ESTABLISHED IN THE CAPITAL REGION BERLIN-BRANDENBURG IN THE LAST FIVE YEARS.

12 Health Valley Netherlands [official website]. URL: https://www.healthvalley.nl/services/start-up-ondersteuning (last accessed on September 22, 2018).

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OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS Such an impressive number of A SPECIAL KIND OF new companies having emerged SUPPORT TO GAIN ENTRY in quite a short amount of time is ONTO FOREIGN MARKETS due to favourable conditions for supporting young innovative IS PROVIDED IN THE SCOPE entrepreneurs, which were created OF THE START ALLIANCE by HealthCapital Berlin-Branden- PROGRAMME. burg. The cluster organisation’s professionals hand-pick the most appropriate funding tools ing their business models to meet for start-up projects, refer international needs and speed up the beginner businessmen and the innovation process. The clus- businesswomen to targeted inves- ter members’ interests in the pro- tors, and help them integrate into gramme are represented by the the regional innovation ecosystem. cluster organisation’s co-head in Berlin – Berlin Partner for Busi- Berlin is a part of Start Alliance – ness and Technology13. an association of ten cities that are global start-up industry hubs, which help new companies adapt-

13 HealthCapital Berlin-Brandenburg [official website]. URL: https://www.healthcapital.de/en/services/startups/ (last accessed on September 22, 2018).

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Accelerated Application of Innovations in Medical Practice

Regular exchanges of information the construction of a new Clinical Re- and ideas within clusters not only search Centre. It is partially funded by promote research and development the Wyeth pharmaceutical company. but also extend businesses’ oppor- The rapid practical application tunities to transfer their scientific of R&D results is not just a positive results into production [De la Lama, effect of cooperation between univer- 2006]. The role of biomedical clus- sities and hospitals; it is actively pro- ters is speeding up the application moted by various initiatives of cluster of innovations by hospitals. organisations. Depending on regional and other features, such initiatives The Translational Medicine Re- may be focused on technology trans- search Collaboration initiative fer mechanisms or on fostering entre- of the Scottish BioDundee cluster preneurial skills among researchers aims at fostering the transition [Europe Innova, 2008]. of new drugs, treatment, and diagnostic techniques from the laboratory The Value Chain Coaching programme to the clinic. In particular, the initia- implemented by the Swedish Biotech- tive is intended to use the existing valley cluster is dedicated to sup- infrastructure of cluster members (e.g. porting member SMEs in the practical the University of Dundee), as well as application of their products.

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The cluster acts as an agent and The French cluster Lyonbiopôle consultant for companies. It pro- has been implementing the Clinical vides expert evaluation and “sec- Innovation programme since 201314. ond opinion” services, access to Its objective is to help to introduce laboratories, and helps with or- innovative products designed by ganising clinical trials. cluster member SMEs into medical practice in the Auvergne-Rhône-

Alpes region.

The main directions of Clinical Innovation Programme OF BIOMEDICALOF CLUSTERS POSITIVE EFFECTS POSITIVE EFFECTS

Identify hospitals’ Conduct clinical Present innovative Interact with public needs and potential trials products to doctors agencies and help barriers to minimise and patients SMEs receive the the risks of ethical committee’s projects’ failure approval

14 Lyonbiopôle Auvergne-Rhône-Alpes [official website]. URL: https://lyonbiopole.com/en/research-and-innovation/clinical- innovation (last accessed on September 22, 2018).

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The primary role of clusters in entrepreneurship development is to create conditions for growing new businesses and introduce the R&D results of their members into the healthcare system. Management teams of biomedical clusters facilitate the access of research organisations and companies to the spe- сialised infrastructure, support programmes, investors and partners, as well as interactions with the regulatory authorities, doctors, and patients who are the fi nal consumers of innovative products and services.

Medical_Clusters_english_version.indd 41 20.03.2019 19:00:56 GLOBAL LANDSCAPE OF BIOMEDICAL CLUSTERS GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS

What is a modern biomedical cluster?

Healthcare development has always involved the transfer of S&T advances in the medical, pharmaceutical, and related industries, as well as clinical practices. ICT now plays a major role in all these areas, transforming not just treatment techniques and the production of medicines and equipment, but also management models applied by hospitals and national systems of patient care more generally. Clusters as a format for bringing actors from medicine, science, business, and public administration together and coordinating their efforts often become drivers of positive changes in the whole healthcare sector.

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OUR WORK AIMS AT PERFORMING A COMPREHENSIVE STUDY OF THE CORE ACTIVITIES, BEST PRACTICES, AND SUCCESS FACTORS OF BIOMEDICAL CLUSTERS IN WHICH THE COLLABORATION OF UNIVERSITIES, COMPANIES, AND CLINICS COMBINED WITH ADVANCED INFRASTRUCTURE AND PUBLIC SUPPORT RESULTED IN APPRECIABLY IMPROVED QUALITY OF PATIENT CARE.

This chapter describes the sampling for analysis, the employed assessment system, and the resulting groups and target models of biomedical clusters, which, in our opinion, make up their global landscape.

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RESEARCH SAMPLE

At the first stage of the study, we drafted a longlist of biomedical clusters, which served as our sample. The main information sources comprised specialised databases such as European Cluster Collaboration Platform1, TCI Network2, and European Cluster Observatory3. GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS

Clusters included in the sample had to meet at least one of the following criteria:

Presence Involvement Membership Location Leading of medical in the in countrywide in a country positions organisations development and international with a high- of the cluster’s or university of the national medical quality home country clinics among healthcare associations healthcare in rankings their members system or partnerships system maintained by medical tourism websites

Forty clusters from twenty-two countries were included on the longlist based upon the analysis of the databases (fig. 2.1). Biopharmaceutical and biotechnology clusters with no clinics among their members were not considered.

1 https://www.clustercollaboration.eu/

2 http://www.tci-network.org/

3 http://ec.europa.eu/growth/industry/policy/cluster/observatory_en

Medical_Clusters_english_version.indd 44 20.03.2019 19:00:58 Medical_Clusters_english_version.indd 45 RESEARCH SAMPLE RESEARCH

5 4 21 10 12 7 13

19 6 3 15 8 16 17 20 14 9

1 COLOMBIA 6 FRANCE 8 ITALY 13 POLAND 18 SWEDEN Medellin Health City Eurasanté Advanced Life Science Polish Innovative Medical Medicon Valley in Italy – I talian Technological Cluster PIKMED Medical Travel International Eurobiomed Cluster (ALISEI) 19 SWITZERLAND Genopole Cluster of Health, Innovation 14 REPUBLIC OF KOREA Health Tech Cluster Switzerland 2 COSTA RICA i-Care Cluster and Community (C.H.I.CO.) Daegu Medical Cluster PROMED Lyonbiopôle 20 TURKEY 9 JAPAN 3 CROATIA Medicen Paris Region 15 ROMANIA Istanbul Health Industry KOBE Biomedical Innovation Cluster (ISEK) Kvarner Health Tourism Cluster Nutrition Health Health Romania Cluster Longevity Cluster 21 UNITED KINGDOM 4 DENMARK (NHL Cluster) 16 SERBIA 10 LITHUANIA Cambridge Medical Campus Wellness Serbia Copenhagen Healthtech Cluster Lithuanian Medical Tourism 7 GERMANY eHealth Cluster Medicon Valley Cluster (LitCare) BioCon Valley 17 SPAIN 22 UNITED STATES 11 BIOTECYL – Health Cluster 5 EST ONIA BioPark Regensburg MEXICO of Castilla y León Monterrey Healthcare City BioOhio Connected Health Gesundheitswirtschaft Hamburg Cluster Mental Health Cluster MassBio HealthCapital Berlin- of Catalonia Medical Alley Brandenburg 12 NETHERLANDS Life Science Nord Health Valley Netherlands 22.03.2019 14:09:25 Task Force Health Care 45 Medical Valley EMN

Fig. 2.1. Biomedical Clusters Included in the Sample Source: compiled by the authors. 46

CLUSTER ASSESSMENT SYSTEM

At the next stage of the research, biomedical clusters on the longlist were assessed for their subsequent classification, description of patterns, and identification of success factors. A system of 15 indicators grouped into three categories was developed (fig. 2.2).

HOME COUNTRY MEMBERS MANAGEMENT CLUSTER’S HOME COUNTRY ON THE GL OBAL HEALTHCARE MARKET CLUSTER SIZE PPP-BASED MANAGEMENT Annual revenue from medical Number of organisations that have tourism Having public authorities Number of foreign patients per in a cluster represented within a cluster’s year governance structure GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS Position in the Bloomberg DIVERSITY OF CLUSTER MEMBERS GOALS

Medical Tourism Index value Having members that belong to one Indicating one or more of the or more of the following groups: Inclusion on the PwC list following goals in the cluster’s of leading medical tourism • Clinics strategy: destinations (top 10) • Production companies • Promoting members Ranking by medical tourism aggregators • R&D organisations and universities • Contributing to socioeconomic development • Public authorities of its home region • Support organisations • Contributing to S&T SPECIALISATION development of its home region One or more of the following activities: ESCA LABEL • Medical services (diagnostics, treatment, rehabilitation, wellness) Having ESCA cluster management quality label • Biomedical R&D (bronze, silver, or gold) • Production (pharmaceuticals, INTERNATIONAL medical equipment) VISIBILITY

INNOVATION ACTIVITY Availability of information in English on the cluster’s Two or more innovation infrastructure website (home page and facilities structure only, or full version) Two or more start-ups

Fig. 2.2. The System of Biomedical Cluster Assessment Indicators Source: compiled by the authors.

Medical_Clusters_english_version.indd 46 20.03.2019 19:01:00 CLUSTER ASSESSMENT SYSTEM 47

The first category comprises Indicators in the second cate- indicators measuring the posi- gory assess cluster members tion of a cluster’s home country on and their core activities. We took the global healthcare market. We into account cluster size measured assumed that the level of the nation- as the total number of participating al medical system and related indus- organisations (the threshold value for tries determined the strengths of classifying a cluster as large was set particular clusters to some extent. at 100). Another criterion was diver- The assessment was based on the sity, i.e., having various types amount of annual revenues from of members such as universities, medical tourism and the number manufacturers, clinics, and public of foreign patients. Relevant figures agencies. Cluster specialisations were were calculated by HSE experts (500 considered as well, measured million US dollars, and 200,000 as the mix of members’ activities people, respectively, were set as the (treatment and rehabilitation ser- threshold values for ranking a cluster vices; the production of medical home country as a major exporter equipment and pharmaceuticals; of medical services) [Syomin, Petrova, biomedical R&D). The more organisa- 2018]. A country’s position in the tions a cluster had and the wider Bloomberg Healthcare Efficiency the range of their activities were Index was also taken into account the higher was the cluster’s overall (the top 20). Furthermore, its Medical score for those criteria. Plus, clusters Tourism Index value (at least 65), were assessed by the level of innova- inclusion on the PwC list of leading tive infrastructure4, which the mem- medical tourism destinations, and bers had access to, and by the pres- ranking by aggregators such as ence of start-ups among their Healthtourism.com, Booking Health: participating firms. Treatment Abroad, and similar websites were considered [Bloomberg, 2014; IHRC, 2017; PwC, 2018].

4 For the purposes of this study, the following facilities are classified as innovative infrastructure: business incubators, industrial and technology parks, engineering centres, prototyping centres, certification, standardisation, and testing centres, technology transfer centres, business accelerators, and laboratories.

Medical_Clusters_english_version.indd 47 20.03.2019 19:01:00 48

The third category comprises and projects available in English on management-related indica- the official cluster portals was used tors. These include having public as an indicator. We distinguished agencies represented in a cluster’s between either the translated home governance structure and a cluster’s page and structure, or the full strategy reflecting its home region’s English version of the website. socioeconomic and S&T development goals. We also checked The assessment, based on all whether or not a cluster organisa- three indicator categories, was tion5 had an ESCA6 label (bronze, conducted by using a binary sys- silver, or gold), and the level tem: one point was assigned if of cluster international visibility. a cluster matched the criterion, The amount of information about and zero if it did not. the key members, their activities GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS

5 Here and below, by a cluster organisation (or a cluster management company) we mean an entity chosen or established by cluster members (or founders) to provide methodological, organisational, expert, analytical, and information support.

6 The European Secretariat for Cluster Analysis established a system for assessing cluster management and issues relevant certificates. The system was developed within the scope of the European Cluster Excellence Initiative (ECEI) of the EU Competitiveness and Innovation Framework Programme.

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GROUPS OF BIOMEDICAL CLUSTERS

The following stage of our research of certain characteristics) categories. was a cluster analysis of the assess- After several iterations, the whole ment results for breaking up the sam- biomedical cluster sample was divided ple into uniform or similar (in terms into three groups (table 2.1).

GROUPS / Global High-Technology World-Class Biomedical International CHARACTERISTICS Medicine Clusters Research Clusters Medical Tourism Clusters

Germany, the United States, European and Asian European and Latin HOME COUNTRY and the Republic of Korea countries American countries

Medical services: treatment and Biomedical R&D (100% of clusters), medical services: SPECIALISATION rehabilitation (90%), treatment and rehabilitation (over 55%) biomedical R&D (30%)

COMPETITIVE High external demand Strong university clinics Medical treatment ADVANTAGE for medical services and knowledge centres at relatively low prices

Interdisciplinary cooperation: Application of R&D results Full range of medical FOCUS OF ACTIVITY medicine and ICT; treatment in clinical practice tourism services and tourism

Less than SIZE Over 100 organisations 100 organisations

High-level tourism INNOVATION High-level innovation infrastructure (over 60%), supporting infrastructure, ACTIVITY start-ups (over 45%) supporting start-ups in some clusters

ESTABLISHMENT Predominantly public Predominantly private INITIATIVE

PUBLIC AGENCIES’ Public agencies usually INVOLVEMENT involved in cluster Management usually independent from the state IN MANAGEMENT management (70%)

ESCA MANAGEMENT QUALITY

Table 2.1. Groups of Biomedical Clusters and Their Characteristics Source: compiled by the authors.

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GROUP 1.

Global High-Technology Medicine Clusters

The first group comprises ten clusters from Germany, the United States, and the Republic of Korea (fig. 2.3). PwC (2018) ranks these countries among the top 10 with the largest shares of the medical tourism market. Clusters in the first group typically have a large

GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS number of various members (up to Daegu Medical Cluster was set up 650), i.e., clinics, pharmaceutical within the scope of the Daegu– and ICT companies, producers Gyeongbuk Regional Development of medical equipment, and biotech- Plan [DGMIF, 2016]. nology firms. The state plays a significant role in their development: Global high-technology medicine 70% of clusters in the first group clusters become gravity centres were established either by the attracting professionals and pa- public authorities or through PPP tients from abroad; their home mechanisms. For example, Bio- countries’ annual revenues from Con Valley (Germany) emerged as medical tourism exceed 1 billion US a result of the joint efforts by the dollars, and the number of for- Mecklenburg-Vorpommern Govern- eign patients served is more than ment and BioCon Valley® GmbH7. 200,000 people.

7 BioConValley [official website]. URL: http://www.bioconvalley.org/en/ueber-uns/ (last accessed on October 5, 2018).

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UNITED STATES GERMANY REPUBLIC

BioOhio BioCon Valley OF KOREA

MassBio BioPark Regensburg Daegu Medical Cluster

Medical Alley Gesundheitswirtschaft Hamburg

HealthCapital Berlin-Brandenburg

Life Science Nord

Medicine Valley EMN 20.03.2019 19:01:02 Fig. 2.3. Global High-Technology Medicine Clusters Source: compiled by the authors. 51 52

GROUP 2.

World-Class Biomedical Research Clusters

The second group in our typology A common feature of clusters is made by 20 clusters in European in the first and second groups and Asian countries (fig. 2.4). is that they see medical R&D as Notably, more than two-thirds a major area that also receives con- of them are based in the states siderable amounts of public sup- with advanced high-ranking health- port. For example, over 80% of R&D care systems [Bloomberg, 2014], in the French Nutrition Health Lon- but with small shares of the global gevity Cluster (group 2) was funded medical tourism market (in annual by the French Unified Interagency

GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS revenue terms). The development Investment Fund (Fonds Unique of biomedical science is a priority Interministériel – FUI)8. A group 1 for clusters included in the second cluster, MassBio (the United States), group. Academia played a major participates in the international role in setting up most of them. CARB-X programme, which sup- For example, Medicon Valley was ports R&D in creating next-genera- established at the initiative of the tion antibiotics to combat drug- Lund (Sweden) and Copenhagen resistant bacteria that cause serious (Denmark) universities. The Univer- infectious and chronic diseases9. sity of Lille was one of the founding organisations of the Eurasanté cluster. The Radboud University of Nijmegen, the University of Twente, and the HAN University of Applied Sciences are represented on the Board of Directors of Health Valley Netherlands.

8 NHL Cluster [official website]. URL: https://www.nhl-cluster.com/nhl-cluster-2/key-figures/ (last accessed on October 5, 2018).

9 CARB-X [official website]. URL: https://carb-x.org/about/overview/ (last accessed on October 5, 2018).

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8 2

11 6

3 9

4 7 10 5

1 DENMARK 4 ITALY 7 SPAIN Copenhagen Healthtech Cluster Advanced Life Science in Italy – BIOTECYL – Health Cluster Medicon Valley Italian Technological of Castilla y León Cluster (ALISEI) 2 ESTONIA 8 SWEDEN Connected Health Cluster of Health, Innovation Medicon Valley and Community (C.H.I.CO.) 3 FRANCE 9 SWITZERLAND Eurasanté 5 JAPAN Health Tech Cluster Switzerland Eurobiomed KOBE Biomedical Innovation Cluster Genopole 10 TURKEY i-Care Cluster 6 NETHERLANDS Istanbul Health Industry Cluster (ISEK) Lyonbiopôle Health Valley Netherlands Medicen Paris Region 11 UNITED KINGDOM Task Force Health Care Cambridge Biomedical Campus Nutrition Health eHealth Cluster Longevity Cluster (NHL Cluster) 27.03.2019 15:32:46 53

Fig. 2.4. World-Class Biomedical Research Clusters Source: compiled by the authors. 54

GROUP 3.

International Medical Tourism Clusters

Finally, the third group formed A developed infrastructure of medi- on the basis of our analysis com- cal organisations and tourist service prises 11 clusters located in Europe centres for patients from abroad as and Latin America (fig. 2.5). Their well as the active promotion of the key characteristics include predom- Medellin City brand as a personalised inantly private initiatives for cluster treatment provider allowed Medel- establishment; management struc- lin Health City (Colombia) to attract tures independent from the state; more than 12,000 people from other and the provision of medical treat- countries and increase the revenues

GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS ment at relatively low prices. from healthcare services by 75% In particular, countries like Mexico during the first three years of opera- and Costa Rica export healthcare tions. In 2010-2013, the inflow services at a level comparable with of foreign patients grew by 66%11. that of the United States, while the number of foreign patients they an- Unlike the clusters in the first and nually receive is twice as many [Sy- second groups, most of which omin, Petrova, 2018]. These clusters are large networks of organisations concentrate on providing a full range specialising in various areas ranging of services to patients and actively from biomedical R&D to pharmaceu- applying ICT for medical purposes. tical manufacturing and healthcare services, the third group comprises Clinics like the members of Monter- clusters, which promote cooperation rey Healthcare City Cluster (Mexico) between clinics, travel agencies, and offer rehabilitation programmes de- the hospitality industry in order to signed specifically for foreign clients, create an integrated chain of services in the scope of which the cluster for patients. bears the board and lodging costs10.

10 Salud Mexico [official website]. URL: http://mexicosalud.com/medical-tourism-clusters-as-a-means-to-promoting- the-industry/ (last accessed on October 5, 2018).

11 Medellin Health City [official website]. URL: http://www.medellinhealthcity.com/en/About-us (last accessed on October 5, 2018).

Medical_Clusters_english_version.indd 54 20.03.2019 19:01:04 GROUPS OF BIOMEDICAL CLUSTERS 55 alon ia of Ca t luster C ealth oma nia s S er bi a R H th ne s AI N en ta l el l SP M ROMANIA Hea l SE RBI A W

7 9 8 Ca re) ME D r (Li t PI K luster Cluste C cal Cl uster ou ri sm e C ity ca r cal T e M edi 4 7 at iv 8 Hea lth 6 ian Med i 3 Innov UA NIA sh

th uan EXI CO OLA ND ol i P P M Mo nterrey LIT H Li 5 4 6 Source: compiled by the authors. compiled Source: Cl uster iona l m na t 1 it y ou ris el I nter 2 RIC A n Hea lth C r Hea lth T TI A 5 ME D OMBI A el li ic al Trav CROA Kvarne COSTA PRO COL Med Med 1 3 2 Fig. 2.5. International Medical Clusters Tourism

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TARGET MODELS OF BIOMEDICAL CLUSTERS

In addition to the groups of biomedical clusters, we have identified their target models, which are supposed to be an important element of the global landscape as well. By “target models” we mean the basis of cooperation between clinics, enterprises, knowledge centres, and public administration agencies that reflects the prerequisites for cluster emergence. The target models were distinguished by expertise, using the analogy method, i.e. grouping objects based on the similarity of their features. The analysis was grounded on open data sources (such as cluster strategies, information from their websites and publications in the media). Table 2.2 illustrates the combination of target models and groups of biomedical clusters12. GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS

Global High- World-Class International GROUPS / TARGET Technology Biomedical Medical MODELS Medicine Clusters Research Clusters Tourism Clusters

BioCon Valley BIOTECYL — Health Cluster of Castilla y León Kvarner Health Gesundheitswirtschaft Tourism Cluster COORDINATING THE ACTIVITIES Hamburg Connected Health OF REGIONAL HEALTHCARE Medellin Health City PLAYERS HealthCapital i-Care Cluster Berlin-Brandenburg Monterrey Healthcare KOBE Biomedical City Cluster Life Science Nord Innovation Cluster

SETTING UP A FRAMEWORK Eurasanté FOR THE COOPERATION OF R&D ORGANISATIONS AND BUSINESSES Health Valley Netherlands WITHIN THE TECHNOLOGY Medicon Valley TRANSFER

BioOhio Health Tech Cluster HealthCapital ESTABLISHING A GLOBAL NETWORK Switzerland Berlin-Brandenburg OF MEDICAL AND PHARMACEUTICAL Lyonbiopôle COMPANIES, R&D ORGANISATIONS, Life Science Nord Medicen Paris Region AND UNIVERSITIES Massbio Task Force Health Care Medical Alley

PROMOTING COOPERATION BETWEEN MEDICAL Kvarner Health Tourism Cluster ORGANISATIONS, TRAVEL AGENCIES, AND INSURANCE FIRMS Lithuanian Medical Tourism TO PROVIDE A BROADER RANGE Cluster (LitCare) OF SERVICES FOR PATIENTS

Table 2.2. Combination of Target Models and Groups of Biomedical Source: compiled by the authors. Clusters

12 The table contains examples of the clusters we have addressed to in the text.

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TARGET MODEL 1.

Coordinating the Activities of Regional Healthcare Players Within the first target model a cluster organisation is typically established on the basis of a regional development institute with the following responsibilities:

Providing an Selecting regional Helping attract Assisting cluster integrated platforms to carry funding for cluster members make communication out R&D members’ projects the best use of platform for R&D that bring together available public organisations, R&D organisations support initiatives medicine centres, and businesses private companies, particularly universities, and important for the regional authorities region to facilitate the creation of a joined regional production network

Typically, in the scope of the first tar- For example, the goal of es- get model biomedical clusters are tablishing the German cluster focused on strengthening their home Gesundheitswirtshaft Hamburg region’s competitiveness and increas- (Free and Hanseatic Town of Ham- ing its investment appeal by concen- burg) (group 1) was to promote the trating public and private resources federal state’s sustainable image as in the healthcare sector. This model an advanced healthcare centre on the may be applied by clusters from all global market. The objectives included three groups: global high-technology improving the regional medical service medicine clusters, world-class biomed- system, ensuring continuity through- ical research clusters, and international out all stages of treatment, and opti- medical tourism clusters. mising patient assistance procedures13.

13 Gesundheitswirtshaft Hamburg [official website]. URL: https://www.gwhh.de/gesundheitswirtschaft-hamburg/ziele-und- leitbild/ (last accessed on October 5, 2018).

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Note that like many other German The Croatian Kvarner Health clusters, Gesundheitswirtshaft Tourism Cluster Hamburg was established at (the Primorje-Gorski Kotar county) the initiative of the state authori- (group 3) brings together key play- ties and its management company ers in the medicine and hospitality is a subsidiary of a regional areas, the University of Rijeka, development agency. Typically, the regional administration, such a structure does not feature and the Croatian Ministry of formal membership, all players Health in order to improve the in the regional healthcare sector quality of treatment and promote can use the basic services provided the Kvarner coast as a world-re- by the cluster organisation. nowned health resort. Cluster members receive marketing and A key area of the French consulting services, and assis-

GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS i-Care Cluster (the Auvergne- tance with attracting public and Rhône-Alpes region) (group 2) private funding15. is helping members find partners to implement joint innovation projects in medicine. The management team focuses primarily on organising communication events and exhibitions with the participation of clinics, R&D organisations and SMEs and on designing regional programmes to support healthcare start-ups14.

14 Cluster I-Care [official website]. URL: http://i-carecluster.org/historique/presentation/ (last accessed on October 5, 2018).

15 Kvarner Health [official website]. URL: http://www.kvarnerhealth.com/about-us (last accessed on October 5, 2018).

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TARGET MODEL 2.

Setting up a Framework for the Cooperation of R&D Organisations and Businesses within the Technology Transfer

If clusters based on the first model and educational organisations, more focus on helping their home regions than 30 medical institutions, and 350 accomplish the strategic socioeco- companies, a significant proportion nomic and S&T development goals, of which are university start-ups. clusters based on the second model usually concentrate on promoting The French cluster Eurasanté was the application of R&D results in cli- set up in 1994 at the influence of Lille nical practices or by pharmaceutical University, which even then had a lot and biotechnology companies. of impressive R&D results in need of commercialisation. The cluster or- In our “system of coordinates”, ganisation from the very start helped the world-class biomedical research members with evaluating ideas, pre- clusters (group 2) mostly fit this paring business plans, attracting model. For example, Health Valley funding, and hiring or training staff. Netherlands was established in 2004 As one of our experts noted, to improve direct communications a typical problem frequently faced between universities, private compa- by the healthcare sector was that nies, and medical organisations talented doctors or researchers were in the Nijmegen region. unable to implement their commercial projects due to the lack of business The Danish-Swedish cluster skills and managerial competencies. Medicon Valley was created at the initiative of two collaborating universities and has now grown into a large network comprising 11 R&D

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TARGET MODEL 3.

Establishing a Global Network of Medical and Pharmaceutical Companies, R&D Organisations, and Universities

In the scope of this model, clusters The MassBio’s MassCONNECT pro- operate as international associations gramme dives deep into the life comprising domestic companies and sciences: it involves a two-month overseas members alike. The goal mentorship where industry experts is to facilitate knowledge exchanges guide entrepreneurs as they seek to between them. The cluster acts as develop business plans, launch com- a communication platform provid- panies, and raise capital16. ing access to information about the

GLOBAL LANDSCAPE LANDSCAPE GLOBAL BIOMEDICALOF CLUSTERS participants’ R&D results and cut- Another example is the Dutch bio- ting-edge S&T advances. medical cluster Task Force Health Сare (group 2), which actively pro- We discovered that this target model motes partnerships with healthcare was predominantly applied by global organisations all over the world. The high-technology medicine clusters cluster has established six commu- and world-class biomedical research nication platforms: TFHC Asia, TFHC clusters (the first and second groups Europe, TFHC Africa, TFHC Latin in our sample, respectively). A good America, TFHC Middle East, and example is the US life science network TFHC North America. Their objec- MassBio (group 1). MassBio annually tives are helping members to find hosts more than a hundred events partners and share their experience such as international conferences and with leading life sciences companies subject-specific meetings with inves- in relevant regions. This structure tors and sponsors. The goal is to help allows one to take into account dif- members find interested partners for ferent approaches toward organising implementing joint projects, both to a healthcare system in various coun- conduct R&D and commercialise their tries and regions17. results.

16 Massachusetts Biotechnology Council [official website]. URL: https://www.massbio.org/discover/massconnect (last accessed on October 5, 2018).

17 Task Force Health Care [official website]. URL: https://www.tfhc.nl/ (last accessed on October 5, 2018).

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TARGET MODEL 4.

Promoting Cooperation between Medical Organisations, Travel Agencies, and Insurance Firms to Provide a Broader Range of Services for Patients

Clusters of the fourth target model aim at facilitating the collaboration of primarily private companies into a single chain in order to minimise the costs of services integrated. Universities rarely become members of such clusters and usually act EVEN IN CLUSTERS as their external partners. The fourth target model was adopted by interna- BELONGING TO A SINGLE tional medical tourism clusters. GROUP, THE TARGET A very good example is LitCare MODELS ARE FEATURED (Lithuania). The cluster comprises DIFFERENTLY, WHICH exclusively private clinics, spas, DEMONSTRATES THE sanatoriums, and hotels. Its competitive advantage is based upon a wide MULTITUDE OF THEIR range of high-technology medical PRACTICES. IN THE NEXT services offered at lower prices than CHAPTER, WE WILL SHIFT in Western Europe and the United THE FOCUS OF ANALYSIS States18. FROM THE GLOBAL LANDSCAPE TO SPECIFIC CASE STUDIES AND TRY TO IDENTIFY THE SUCCESS FACTORS OF BIOMEDICAL CLUSTERS.

18 LitCare [officialebsite]. w URL: https://www.litcare.com/homeru (last accessed on October 5, 2018).

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What is the secret of a cluster’s success?

SUCCESS FACTORS SUCCESS FACTORS BIOMEDICALOF CLUSTERS To answer this question, we must clearly define the successful- ness criteria. According to our initial hypothesis, each of the three identified cluster groups could have different measures of achievements. For example, the performance of global high-technology medicine clusters could be evaluated in terms of their revenues from exporting healthcare services. The growth of R&D expenditures could serve as an indication of world-class biomedical research clusters’ effectiveness. Further, high positions in medical tourism rankings could give one grounds to conclude that the relevant international medical tourism clusters were successful.

The testing of this hypothesis began with open-source data analysis such as websites, programmes, and presentation materials prepared by the clusters from our sample. The preliminary results were subsequently adjusted following the interviews with representatives of cluster management companies from each group. On the basis of those interviews, we came to the conclusion that totally different clusters became prosperous due to the adoption of similar practices, the exact mix of which in each case varied. We tried to interpret the resulting case studies in terms of success factors.

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SUCCESS FACTOR 1.

COMMUNICATION AS THE ULTIMATE VALUE

Personal meetings with members, designing a single cluster brand and promoting it globally, organising events, producing information materials, developing common databases and online platforms, interacting with clinics and patients – these are just a few of the answers we received from our experts to the question “What is the value of a cluster?” A full communication agenda is a common feature of all biomedical clusters and a key responsibility of their management companies. Without such ties, it would be impossible to arrange a flow of joint projects carried out by R&D organisations and enterprises, systematically promote research results, apply innovations in clinical practice, and develop international collaboration. Cluster managers we have interviewed used different approaches to establishing cooperation: some believed in “digital” and offered members all sorts of platform solutions to promote networking, while others were convinced nothing was more important than personal contacts. However, all of them agreed that communication was the most important aspect of clusters’ operations.

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DENMARK – SWEDEN «In Cluster Networks» Case of Medicon Valley SUCCESS FACTORS SUCCESS FACTORS BIOMEDICALOF CLUSTERS PETTER HARTMAN MSc in Political Science, CEO Medicon Valley Alliance

The key value that Medicon Valley Alliance brings to cluster members is developing a network of communications on both sides – Swedish and Danish. We construct the collaboration platform for regional authorities, hospitals, academia and industry players; provide facilitating services to develop and run their projects. So we use networks. You constantly need them (especially when working across national borders) to build an identity among various organisations and institutions – being a part of one single cluster from two different countries. And this is the foundation of our cluster management. We arrange about 25-30 events every year. When our members begin to network and find out how to collaborate, we then help them to develop these collaborations: getting an investor or a partner from business or research community.

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Medicon Valley Alliance helps clus- Medicon Valley Medtech Net- ter companies step up cooperation work: an association of com- and implement joint projects by panies and innovation infrastruc- involving them in various networks: ture organisations engaged in the production of advanced medical Medicon Valley Alliance equipment (e.g. Alteco Medical Executive Club: an exclusive and SAXOCON, Ideon Science network for top managers of the Park, etc.). Members meet quarter- cluster member companies; they ly, in Denmark and Sweden in turn. meet twice a year at gala dinner; Establishing such networks in the Medicon Valley Alliance cluster is an ongoing process prompt- Oncology Network: an asso- ed by the members’ current needs. ciation of the cluster firms and For example, in 2018 the cluster universities specialising in the organisation together with the treatment of oncological diseases. Technical University of Denmark, The alliance’s objective is to main- Lund University, and Novo Nordisk tain an expert discussion between company launched a new network – business and academic communi- Medicon Valley Alliance Microbiome ty, transfer research results into Network. This initiative emerged production, inform R&D organisa- in response to the growing interest tions about industrial problems, in microbiome research, which became and jointly look for solutions. evident during Microbiome Summit Members meet several times 2017, recenty hosted by the cluster. a year, taking turns to arrange The new network brings together the meetings; Danish and Swedish researchers and entrepreneurs focused on designing drugs, food additives, and probiotics.

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THE NETHERLANDS «Communication Ecosystem» Case of Health Valley Netherlands SUCCESS FACTORS SUCCESS FACTORS BIOMEDICALOF CLUSTERS

CHRIS DOOMERNIK MSc MMO, Managing Director Health Valley Netherlands

Businesses want to join our cluster because they see that we have created a very dynamic environment. The key benefit is that we would build an ecosystem of different parties that cooperate in innovations in healthcare. The number of our members grew from 110 to 270 over the last five years. A lot of parties joined us from other areas of the Netherlands. We provide connecting and communication services; we can guide our members to the right partners (investors or other parties of knowledge), to bring their products to the market. We also spread information in our newsletter and via social media.

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Most of the services provided At the moment, the cluster members by Health Valley Netherlands are participate in five EU-funded projects designed to help with professional (table 3.1). communication management, networking, and project team building. The cluster management company The cluster members include law firms, hosts about 30 members’ meetings consulting companies, living labs1, annually; regular appointments with marketing and estate agencies, representatives of healthcare organ- employment offices, innovation infra- isations to learn about the problems structure organisations, and venture and requests they might have for foundations. In response to their developers and researchers; it organ- requests, the cluster organisation finds ises “contact exchanges” for SMEs; the most suitable providers of services innovative ideas competitions for to conduct research, give legal advice, start-ups; workshops for doctors and prepare business plans or applications patients, etc. Several staff members for funding, recruit staff, find premises, of the cluster organisation are respon- facilities, and equipment. Health sible for the production and dissemi- Valley Netherlands helps set up con- nation of information materials about sortia comprising entrepreneurs, the cluster’s and its members’ activi- researchers, and medical organisations ties and for maintaining their visibility to implement joint projects, pick the in media and social networks. Health right subsidy programme or a private Valley Netherlands launched a special investor, test innovative products platform – Stay-connected! – to sup- in a real-life environment, etc. port communication among members.

PROJECT TITLE Total budget (million euros) Subsidy volume (million euros)

CIALE 0.43 0.32

VR4REHAB 4.01 2.41

Smart Systems 2.76 1.39

Zorg Verbindt 4.64 2.79

MIND 5.74 3.54

Table 3.1. EU-Funded Projects with Cluster Members’ Participation Source: compiled by the authors based on the Health Valley Netherlands data.

1 Living lab is a project or infrastructural facility which implies the systemic involvement of users in real-life innovation processes [Kokareva A., Kutsenko E., Islankina E., 2018].

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GERMANY «From Words to Projects» Case of HealthCapital Berlin-Brandenburg

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS DR KAI UWE BINDSEIL Cluster Manager HealthCapital Berlin-Brandenburg

The main goal of every cluster is to bring all the relevant parts of the industry and science together to share ideas and make them work. The majority of my team are engaged in project management. Projects are typically based on medical needs or technical problems and possible technological solutions. Communication is the key: it is very important that people can talk to each other, share their own experiences, and discuss possibilities. If you are connected with projects as a cluster organisation, you must host events, bring people together. We are typically becoming active if there is more than a single individual interested, but if we see that three, four, or five companies are collaborating in a new area. We are facilitators trying to find financing for different projects, to combine them with a systemic solution. Concrete projects are discussed by the cluster board. We are not making the decisions about whether a project is funded or not. We only decide if it is worth spending time on it and supporting financial engineering. Right now in my database, I have about 400 projects and initiatives.

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The Berlin-Brandenburg region hosts Supporting the transfer of R&D results a large number of research organisa- into production is a key success factor tions and predominantly small and for their joint innovation projects medium-sized enterprises operating development. in the biomedical sector.

The key areas to start joint cluster projects are: biotechnology and pharmaceutics, medical technologies, patient care and rehabilitation, and medical tourism and preventive medicine. Activities in each area are planned taking into account five cross-cutting topics: skilled professionals, ageing society, inward investment, internationalisation, and e-health (table 3.2).

HealthCapital Berlin-Brandenburg promotes cooperation between cluster members using various tools, including the following:

identifying and promoting the helping with the practical application development of scientific ideas with high of research results; market potential;

facilitating interdisciplinary networking providing support and securing funding in key research areas; for innovation projects in the scope initiating and coordinating joint R&D of regional and national programmes and projects; from the EU foundations (table 3.2).

Project Indicators 2017 2011 - 2017

Number of projects 50 118

Project volume (million euros) 95.32 220.53 Involved parties in Berlin (BE)-Brandenburg (BB) (million euros) 58.60 162.97

of which funding for participants in BE and BB is provided by (million euros): federal states authorities 8.12 35.74

national authority 37.52 111.03

European (EU) authority 1.25 1.81

other authorities 2.54 2.64

Table 3.2. Projects Implemented with the Participation of HealthCapital Berlin-Brandenburg Source: compiled by the authors based on the HealthCapital Berlin-Brandenburg data.

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GERMANY «Welcome to the Group!» Case of Life Science Nord

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS DR HINRICH HABECK Managing Director Life Science Nord Management GmbH

Communication is the cluster’s core. We have to get in contact with one another quite often. Last year we started a digital collaboration platform (called LSN XCHANGE), which operates as a social network: cluster members have their own profiles, talk to each other, join working groups, exchange experience and documents, etc. Their topics and inputs determine the platform content. We have established working groups that offer a place for members and external experts to engage with important issues. These are not just bringing people together, but helping them find investors for projects, jointly solve emerging problems. Besides, we do a lot of advising; one of the groups on LSN XCHANGE is dedicated to regulatory issues. At the moment, the most urgent concern is to adapt for changes in European regulation of medical devices manufacturers. Cluster companies have many questions about this, therefore we help them to correctly understand and implement the new rules. We discuss issues remotely, but we can also arrange to meet offline.

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Some of the services the cluster group encourages interested mem- organisation offers its members are bers to share their ideas, experience, integrated into the LSN XCHANGE competencies, and abilities in specific communication platform. The web- areas, which can lead to the emer- site is structured by thematic areas gence of joint projects. One of the (e.g. healthcare regulation, staff active projects currently being imple- development, project implementa- mented via the platform is Northo- tion, organising events, etc.), so the pedics. It focuses on designing solu- cluster members choose which they tions for bone fracture associated would like to join. Registered users problems. Members of the staff apply for membership, and when development working group share it is approved, they get involved in best human resources management the collective activities. The website practices. They also have access also features a database of cluster to a database of jobseekers in the members’ representatives one can biomedicine and pharmaceuticals contact regarding specific issues, companies. or invite to team up. For example, the project implementation working

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SWITZERLAND «Individual Approach» Case of Health Tech Cluster Switzerland

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS DR PATRICK DÜMMLER Cluster Manager Health Tech Cluster Switzerland

The main focus of the cluster is to provide a neutral networking platform for different parts of the value chain. This means that when they come together, it is not a very formal thing. After the presentation, we usually offer small things to eat and something to drink, so cluster members get into the discussion after the refreshments and start to develop a relationship with each other. Sometimes this results in new ideas, new ways of collaborating, sometimes it is just a promising contact for the future – who knows what it may bring. And the second thing is – apart from the worth of the networking platform – the content that we provide. For example, we have a regular event, which focuses on data security in healthcare, and this comes with speakers from abroad. They provide insight into how hospitals deal with the issue. This is really for our members to learn and compare it with their own approach. After the presentation they can exchange views on the topic – this is networking.

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Health Tech Cluster Switzerland’s Another kind of service off ered by services are built around networking – the cluster organisation is informa- events and bilateral meetings. One of tion (monthly news digests, sent the top managers of the cluster organ- to cluster members strictly upon isation regularly and personally meets request), thematic discussions and representatives of the 250 member workshops, participation in exhibi- companies to discuss their objectives, tions and fairs. Importantly, some needs, and problems. Companies of the events hosted by Health Tech often want to fi nd partners with re- Cluster Switzerland are free for levant competencies, capital, or even non-members as well. According require information on access to infra- to the managers, it helps to attract structure or equipment for a specifi c new companies and institutions. project. The manager’s objective is to fi nd such partners and bring them together with the cluster members, so their cooperation, in the end, leads to new products or technologies.

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LITHUANIA «One Cluster, One Brand» Case of Lithuanian Medical Tourism Cluster

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS GRAŽVYDAS MORKUS Managing Director Lithuanian Medical Tourism Cluster

In medical tourism, reputation builds up for a long time, you need to work for at least five years to start getting feedback. In our case, it is the country’s reputation. We try to participate everywhere, to present both the cluster and Lithuania as a world-class healthcare resort.

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A European Union grant played Marketing accounts for a major share an important role in establishing of services the cluster organisation LitCare and provided funding for provides. LitCare is represented various communication and market- on international and national clus- ing activities such as domestic and ter platforms (such as TCI Network, international market research, brand European Cluster Collaboration Plat- development, the production and dis- form, KlasterLT, Lithuanian Clusters semination of presentation materials, Association). The cluster actively pro- website design, a publicity campaign, motes its members on medical tour- participation in numerous fairs and ism aggregators and social networks; exhibitions, and so on. This allowed presents its activities at specialised it to organise the work professionally international fora in Moscow, St. Pe- from the very start, both inside the tersburg, Oslo, Dubai, Baku, and other cluster (the differentiation between locations; and arranges publicity tours and segmentation of the members’ for partner travel agencies. services), and outside it (clearly de- fining the niche and target audience An important factor affecting the and properly positioning itself on the development of the cluster’s brand market). Like any other cluster, LitCare was (and remains) mutual trust be- comprises companies that not only tween its members and medical tour- complement one another, but also ists. Regular communication (board compete with each other. According- meetings, working group sessions and ly, a common marketing strategy was joint workshops, participation in fairs developed for the cluster, taking into and exhibitions, personal contacts, account each member’s unique advan- etc.) allowed Lithuanian Medical Tour- tages. They were structured into ism Cluster to build a reputation as a chain reflecting the typical path a reliable partner and service provider. of medical tourists.

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SUCCESS FACTOR 2.

INTERDISCIPLINARY COOPERATION

Healthcare is an area around which the structural transformation of the economy is taking place. The success of many biomedical clusters is due to the fact that they bring together different members – patients, doctors, researchers, and manufacturers – to develop marketable interdisciplinary high-technology solutions. At the junction of healthcare, pharmaceuticals, the production OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS of medical equipment, construction, ICT, and other areas, new, rapidly growing and research-intensive activities are emerging that integrate cluster members’ various industrial and technological competencies in a novel way (e.g., healthy longevity). Biomedical clusters are also able to foster NBIC-convergence through intensive interdisciplinary research in areas such as nanotechnology, biotechnology, information technology, and cognitive science.

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GERMANY «Healthcare under the Cluster’s Umbrella» Case of HealthCapital Berlin-Brandenburg

DR KAI UWE BINDSEIL Cluster Manager HealthCapital Berlin-Brandenburg

New products in the healthcare sector should bring additional benefits to patients, doctors, academia, and business. At their interface in HealthCapital Berlin- Brandenburg, we drive networking and the technology transfer. We are coming from small fields to big projects. Healthcare is at the heart of a comprehensive structural transformation. Our cluster brings together hundreds of companies in pharma, bio- and medtech, major research facilities, and universities. Together, they are working on regenerative and telemedicine; digital health and hospital IT; big data for drug development, ambient assisted living, and smart sensor technology. Everybody who is active in these fields is automatically a part of the cluster. We are not a membership organisation and the cluster is free for everybody to participate. I think the picture of an umbrella is the right illustration of our structure.

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The Berlin-Brandenburg cluster post-stroke medications. The labo- comprises more than 20,000 par- ratory is located on the clinic’s ticipants (including more than 500 campus next to the Berlin Centre major biomedical, pharmaceutical, for Stroke Research; and medical equipment firms; 25 universities; 18 R&D organisations; the Charité (a leading German

and eight specialised industrial medical organisation special- parks). Among other members, ising in cardiovascular diseases) there are 130 hospitals (including together with the Brandenburg one of the oldest and biggest cluster members MEYTEC, Thermo university hospitals in Europe, Fisher Scientific, and the Berlin Fire the Charité). The diversity of Department, established the Berlin HealthСapital Berlin-Brandenburg Mobile Stroke Unit – STEMO. member organisations, combined It is an emergency assistance OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS with an active communications service for patients in particularly agenda and advanced conditions bad condition, supplied with for interdisciplinary research and a portable tomographic scanner, development at the junction of biomarkers, equipment for electron- science, production, and medical ically documenting the treatment practices helped the cluster to and directly communicating with become a leader in the healthcare the hospital; sector and related industries. in 2011, the Charité and the Here are just a few examples of Vivantes concern joined their strategic partnerships and joint experience and knowledge in the initiatives the HealthСapital Ber- scope of Labor Berlin – one of the lin-Brandenburg members are leading laboratories in Europe. engaged in: Labor Berlin conducts research in nine areas: laboratory medicine, the Charité and the Sanofi microbiology and hygiene, virology, pharmaceutical company human genetics, allergy diagnostics, have been cooperating since 2010. autoimmune diagnostics, endocri- One of their common projects is nology and metabolism, haematol- the joint laboratory for testing ogy and oncology, and immunology;

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 in 2013, based on the combined for ophthalmologic diseases and research competencies of the tumours based on proton therapy Max Delbrück Centre for Molecular techniques, under the BerlinProtonen Medicine in Helmholtz Association brand. Combined eff orts by medical (Max-Delbrück-Centrum für Moleku- physicists, ophthalmologists, and on- lare Medizin in der Helmholtz-Gemein- cologists resulted in the development schaft – MDC) and the Charité’s practi- of a high-precision treatment tech- cal experience, the Berlin Institute nique. One of its components, eye of Health – BIH was established; applicators, are also made by a cluster member, Eckert & Ziegler.  jointly with the Berlin Helmholtz Centre for Materials and Energy (Helmholtz-Zentrum Berlin für Materi- alien und Energie – HZB), the Charité is working on designing treatments

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LITHUANIA «One Window» Case of Lithuanian Medical Tourism Cluster

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS GRAŽVYDAS MORKUS Managing Director In 2013, leading Lithuanian private Lithuanian Medical Tourism Cluster healthcare organisations, dental clinics, spas, hotels, sanatoriums, The principle of our cluster and hospitality industry companies is one window. This means joined forces to create a cluster that the medical tourist, in of medical tourism – LitCare. Their contact with any point of the cluster objective was to provide a full range (no matter which clinic or sanatorium he of high-quality treatment and make or she has arrived in), from everywhere the best possible offers to patients. should receive a full package of Medical tourists can receive services. Such an approach creates numerous basic and additional additional value for the customer. services along the way. This ap- Packaged services became our unique proach allows the cluster to take competitive advantage and turned out care of the clients’ varied needs and to be of interest to patients. Today, we control the quality and costs. Specif- receive medical tourists from Russia ically for these purposes, a company and many countries in Europe. We do was established to handle admin- not say that we are the best istrative aspects such as meeting or the cheapest, but we patients, managing their logistics, offer the smart ratio board and lodging, planning treat- of price and quality. ment, rehabilitation, etc.

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SWITZERLAND «Tied into a Chain» Case of Health Tech Cluster Switzerland

Currently, the cluster brings together more than 250 organisations. They comprise clinics, sanatoriums, diagnostic centres and laboratories, manufacturers of medical equipment and pharmaceutics, insurance and consulting firms, engineering and IT companies DR PATRICK DÜMMLER Cluster Manager Furthermore, 13 cluster members Health Tech Cluster Switzerland (mainly medical equipment manufacturers) operate abroad: in Germany (seven organisations), Italy (two), Austria (two), Poland and Belgium (each one). Every What is quite special about month three to four new mem- our cluster is that we really bers join the cluster. hit a market niche. We are not only focusing on medical Health Tech Cluster Switzerland technology or pharmaceutics alone, has partnerships with other clus- but we are embracing the whole ters, universities, and professional health tech value chain, bringing associations – 50 organisations together companies from different in total. They are based not only parts of it. This makes them better in Switzerland but in other coun- understand the needs of each tries as well. The partnership other, jointly discuss ideas for agreements Health Tech Cluster new solutions to finally Switzerland signs with them imply improve the overall no financial obligations – simply quality of healthcare information exchanges, participa- services. tion in joint events, etc.

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ESTONIA «Everyone Will Be Heard» Case of Connected Health

The Connected Health cluster comprises more than 80 members; some of them are start-up companies, IT firms, biomedical technology developers, and pharmaceuticals producers. The cluster actively cooperates OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS with universities (including PIRET HIRV Tallinn University, Tartu Univer- sity and the Tallinn University of Cluster Manager Connected Health Technology), and infrastructural organisations (e.g. Tallinn Sci- One of the cluster’s success ence Park Tehnopol acts as factors is its diverse the cluster organisation). Two membership and a high level of national ministries (the Ministry communication among all parties. We really of Economy and the Ministry have to have personal contacts with all of Social Affairs) are the main stakeholders of the ecosystem. Cooperation public partners of Connect- among firms is important, but not enough ed Health. A major part of the to improve the quality of healthcare. cluster is medical organisations Here, one party is not always the buyer and (hospitals, polyclinics, rehabil- the other the supplier; often combinations itation centres, and retirement of multiple players emerge. Establishing homes), doctors, and patients’ and maintaining relations with the public organisations. Cooperation with sector and providers of medical services has them allows one to receive a vital role in this sphere. They participate a sufficiently clear understand- in our cluster to be in the centre ing of medical services users’ of activities, get the new current needs and involve them information, and we are the in finding the best solutions primary source of it. for the industry’s problems.

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SUCCESS FACTOR 3.

PARTNERSHIP-BASED MANAGEMENT

A feature of many biomedical clusters is that they bring together companies and organisations whose activities go beyond a single industry or research area. This requires setting up a management system, which would allow one to balance the interests of key members from various socioeconomic spheres. Most of the clusters we have surveyed establish a multilevel management system.

Strategic management functions are a responsibility of the cluster board comprising representatives of clinics, production enterprises, universities, public authorities, and development institutes. The board makes major decisions regarding cluster development. It frequently has an expert committee, which is comprised of highly qualified professionals. The committee conducts an integrated evaluation of S&T and innovation projects suggested by cluster members seeking additional funding.

A cluster organisation is set up to handle the day-to-day management issues. It is responsible for methodological, organisational, expert, analytical, and information support of cluster companies. Many cluster organisations are focused on project management. Their teams typically comprise project groups formed with consideration of the cluster members’ research and industry specialisations and opportunities to implement interdisciplinary joint projects.

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THE NETHERLANDS «Collaborate Like Never Before» Case of Health Valley Netherlands

Health Valley Netherlands is the largest innovative healthcare and life sciences

cluster in the country. The cluster board is responsible for strategic management. It comprises members representing leading universities (Radboud University of Nijmegen, University of Twente, HAN University of Applied Sciences, University of Applied Sciences Saxion), healthcare organisations (Radboud University Med- OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS ical Centre, the Jeroen Bosch Hospital, CHRIS DOOMERNIK the Siza Care for people with disabilities, MSc MMO, Managing Director the Ikone patients’ organisation), three Health Valley Netherlands private companies, and the Regional Development Agency East Netherlands The cluster was Oost NL. established in 2004 at the initiative of The ongoing management (organising universities, the events, producing and disseminating municipal authorities of the city information materials, helping clus- where we are located, regional ter members to find partners, attract governments and a few big funding, etc.) is the responsibility of the companies. The main goal was Team Bureau Health Valley with the organisational: to bring know- staff of eight employees. Four of them ledge to the society, they had to are innovation managers with profes- cooperate more than they had sional knowledge in areas such as digital done before. Today, we have a healthcare, pharmaceuticals, and medical board with representatives from equipment. The other half of the team R&D and education, the industry, is responsible for communication and healthcare sector, management. and a team bureau with eight employees.

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GERMANY «Balanced Interests» Case of HealthCapital Berlin-Brandenburg

DR KAI UWE BINDSEIL Cluster Manager HealthCapital Berlin-Brandenburg

The cluster initiative HealthCapital Berlin-Brandenburg is was a political decision an interregional cluster: it comprises shared with the big members from two German states, industry players. One of Berlin and Brandenburg. Two top the key success factors in cluster managers, who are representatives management is a balance between of the regional organisations: Berlin full-time professionals Partner for Business and Technology and honorary experts (Berlin Partner für Wirtschaft und both from academia Technologie) and Economic and business. Development Brandenburg (Wirtschaftsförderung Brandenburg) co-manage the cluster on a parity basis, in line with the partnership agreement2.

2 HealthCapital Berlin-Brandenburg is one of five cluster initiatives implemented in the scope of Berlin and Brandenburg’s joint innovation strategy InnoBB (2007). Along with medicine, the document sets four other priority development areas: energy, ICT and new media, optics, and transport systems. Relevant clusters have been established in these areas too. Berlin Partner for Business and Technology and Economic Development Brandenburg coordinate the implementation of the joint strategy together. Both organisations appointed managers to supervise each priority development area, and, accordingly, the relevant cluster.

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At the top of the cluster’s man- of projects for which the cluster agement structure is the board team should provide prime sup- comprising 25 members and the port. Typically, these are the initia- chairman. The members include tives having the highest share representatives of Berlin and of funding from businesses Brandenburg authorities, senior or R&D organisations. Such

company and medical organisa- a requirement minimises the risks tion executives (proposed by the of projects’ remaining uncomplet- chairman), and experts from both ed and strengthens the cluster regions’ academic and business members’ responsibility for communities who head the com- results due to their investments. mittees supervising key areas At the same time, the cluster bud- of the cluster’s activities. get does not include any membership fees; 70–75% of it comes from OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS One of the board’s responsibilities regional authorities, plus there is setting priorities for the cluster is a contribution made by the EU. in line with the Master Plan This ensures a balance of cluster for Healthcare Development in members’ interests and their equal the Berlin-Brandenburg region. access to the cluster managers’ It is implemented via the selection services.

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GERMANY «PPP-Based Management» Case of Life Science Nord

Life Science Nord is based on a public-private partnership model. The combined share of the German states Schleswig-Holstein and the Free and Hanseatic City of Hamburg (the cluster’s home locations) in the authorised capital of the cluster organisation (Life Science Nord Management GmbH) is 80%, and the remaining 20% is provided by Associ- ation Life Science Nord e.V. (a voluntary consortium of cluster members).

Life Science Nord Management GmbH serves as the gravity centre of the medical community – repre- DR HINRICH HABECK sentatives of related R&D organisa- Managing Director tions, businesses, and public authori- Life Science Nord Management GmbH ties. The team comprises 15 people; there are three departments: (1) A cluster is a political Innovation and Transformation, (2) instrument that can Marketing, Public Relations and regulate the economy International Cooperation, and (3) and science. In Life Sci- Human Resources. The cluster man- ence Nord, companies, universities, agement company is responsible for research institutes and government organising events, maintaining in- bodies have combined forces ternal and external communications, to strengthen the development providing information and consulting and economic power of biomedicine support to members of the two re- and related industries gions’ healthcare innovation ecosys- in Hamburg and tem, which comprises more than 500 Schleswig-Holstein. companies and several large universities (including those of Lübeck and Hamburg).

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FRANCE «Three in One» Case of Eurasanté

CAROLINE SIMOES-AUBERGER OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS Communication and Strategy Manager GIE Eurasanté

Eurasanté is simultaneously a tech transfer, an incubator, and a cluster manager in the life sciences sector located in the North of France. For more than 20 years, we have been working to promote the growth of nutrition and healthcare industries in our region by helping researchers, start-ups and companies develop their projects.

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Eurasanté is organised as a “group Eurasanté animates the Bio-busi- of economic interests” (Groupement ness Park, located at the heart of the d’Intérêt Economique – GIE), which leading hospital-university campus in implies various members’ joining Europe (a 300-hectare site of excel- forces to accomplish common objec- lence, dedicated to state-of-the-art tives while remaining legally indepen- activities in the health and nutrition dent. The Eurasanté Administrative sectors), plus two specialised clusters: Council comprises five colleges, bringing together 12 key representatives of  Nutrition Health Longevity the regional healthcare sector. Cluster — national competitiveness cluster with more than 200 mem- Each college supervises a specific bers, the only cluster in France spe- area of activities. For example, Collège cialising in research and commercial Association Eurasanté comprises five development at the junction of health- representatives of local universities; care, biotechnology, and food industry; University Clinics College (Collège Сentres Hospitaliers Universitaires –  Clubster Santé — regional cluster CHU); colleges of the Nutrition Health operating in close contact with Longevity Cluster and Clubster Santé; hospitals to help companies develop and the Distinguished Experts Col- solutions adapted to meet doctors’ lege. There is also another manage- and patients’ specific requirements. ment body – Eurasanté Directorate headed by president and director general (the latter is also the director of Nutrition Health Longevity Cluster).

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ESTONIA «The Management of Support» Connected Health

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS PIRET HIRV Cluster Manager Connected Health

I am the manager of the cluster and also of the health technology division in Tallinn Science Park Tehnopol. At the beginning, the park drafted applications for EU funding, which helped not only complete the cluster establishment, but also launch the first joint projects of our members.

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The Connected Health cluster organ- Diagnostic Match — a software isation reports to the national busi- application for therapists, ness development agency Enterprise allowing them to identify people Estonia, which administered the EU in the HIV risk group; grant allocated to fund the cluster’s creation. The money was used to pay  DocuMental — a digital plat- for marketing services and support form comprising internationally joint projects (on the 50/50 co-fund- recognised tools for diagnosing, and ing basis). Nine projects were imple- making treatment recommendations mented altogether, each comprising for patients with mental diseases. at least three cluster members. The total amount of funding was The three-strong Tallinn Science 395,000 euros. The objective was Park Tehnopol team is responsible to teach companies within a cluster for organising all events, promoting jointly create ICT solutions for the cluster members on domestic and healthcare sector. In particular, the international markets, issuing infor- following products were developed: mation materials, and supporting joint projects.  TempID — a smart thermo- meter integrated with a smart- phone;

Wizelife — a healthy lifestyle digital platform, which designs personal recommendations for participants based on the results of various tests;

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SUCCESS FACTOR 4.

SUPPORT FROM THE REGIONAL AUTHORITIES

Most of the biomedical clusters bring together the whole regional community of companies and organisations active in the healthcare sector and related industries (such as the production of medical equipment and pharmaceuticals, ICT, the food industry, etc.). The region serves as a cluster’s insti- OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS tutional basis; it provides specialised infrastructure, access to which is vitally important for cluster members. Regional budget is frequently the main source of initial funding for the cluster organisation. Even if no public financing is provided, information and organisational support of regional authorities is politically important (e.g. while dealing with the national government and development institutes, engagement in the drafting and adjustment of healthcare regulations and programmes).

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DENMARK – SWEDEN «ReproUnion Project: Two Regions’ Common Success» Case of Medicon Valley

we want to create a strong lifestyle cluster because we have so many universities, so many companies in our regions. There is a special EU fund, which supports Swedish-Danish collaboration. We managed to break down the national barrier PETTER HARTMAN and make a patient mobility MSc in Political Science, CEO agreement between Sweden and Medicon Valley Alliance Denmark, which gives people in both countries the opportunity Medicon Valley is to receive the best possible a regional cluster. From infertility treatment. In addition the public side, we have to the benefits of many couples only regional bodies involved who could become parents, the from both countries that support agreement is also an example us. Our mission is not simply to of how we can win by linking talk so much about two different competences on both sides regions of Denmark and Sweden, of the Öresund. Fertility is the but about Öresund – one region, first medical area in which patient the things we have in common, mobility was introduced. and how we can utilise them. I think ReproUnion could act Historically there has always been as a model for cross- a strong bond between the two border projects in nations. This value stands up in other therapeutic the intercalation competition: areas as well.

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The objective of ReproUnion responsible for all administrative is to establish the multidisci- aspects (such as the development plinary Reproductive Medicine of common standards and proce- Centre in the Öresund region, dures, coordination of activities, the cluster’s home location. etc.). In addition to helping hundreds of men and women striving

One of the project’s important to become parents, the project results was signing a mobility opens wide opportunities for the agreement for infertility patients cluster members’ international between the southern parts of cooperation in clinical research, Sweden and the capital area the provision of medical services, of Denmark. Now residents of both and next-generation staff training countries have mutual access which builds up competencies and to high-technology medical ser- strengthens the competitiveness OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS vices in the reproductive health of the whole transboundary region. and fertility fields. This means that couples from Sweden and Denmark ReproUnion was one of the will be able to receive specialised finalists of the RegioStars Awards treatment in the areas where Dan- competition for best regional ish and Swedish clinics have unique development practices. competencies and experience (e.g., ovarian transplantation at the Fifty per cent of the project fund- Copenhagen Rigshospitalet; a spe- ing is provided by the EU Regional cial analysis of biological material Development Fund – ERDF, in the at the Skåne University Hospital scope of a targeted programme laboratories in Malmö). to support research-intensive innovative projects in the Öresund ReproUnion comprises 13 clinics area (Interreg V-A - Sweden-Den- and research centres on both sides mark-Norway, Öresund-Katte- of the Öresund strait. gat-Skagerrak). The companies’ share in ReproUnion funding is 10%, The project was initiated by the the rest is provided by the regional cluster’s management company – authorities and universities. Medicon Valley Alliance, which is

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Other Medicon Valley’s projects have forms will be set up to speed up the been funded in line with this scheme transfer of R&D results to production; too, such as: members planning joint projects will receive help with finding investors;  KADABRA — a project on synchronising the databases Medicon Valley Ambassa- of medical organisations, insurance dor Programme — a project to companies, and biobanks in the two strengthen cluster members’ inter- countries, to reduce administrative national cooperation. The cluster has barriers and help patients; appointed “ambassadors” in three key geographical areas: Eastern and West- Medicon Valley Beacons — ern coasts of the United States and a project to support develop- South-East Asia. The ambassadors are ment in priority biomedicine and life authorised to represent Medicon Valley sciences areas, where the cluster is members in dealings with international among the leaders (including immu- partners, establish new contacts, find nology, drug delivery systems, sys- investors, prepare analytical materials, tems biology, and structural biology). arrange meetings, organise business In particular, communication plat- deals, and other activities.

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THE NETHERLANDS «Peaks in the Delta» Case of Health Valley Netherlands

centres, and regional institutes around the core made by the universities of Wageningen, Nijmegen and Twente. The concept was supported by the Ministry of Econom- ic Affairs. The next step towards establishing the cluster was the Health Valley initiative by the OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS Regional Development Agency East Netherlands Oost NL (now an advisor of the cluster board). It aimed at CHRIS DOOMERNIK identifying and supporting innova- MSc MMO, Managing Director tive joint projects in the healthcare Health Valley Netherlands sector implemented by members of the regional ecosystem (the Health Our main partner is the Valley Netherlands Foundation regional government. was established specifically for this At the beginning, their purpose). The cluster emerged in funding was 90% of the its present form when the Gelder- whole cluster budget. land authorities, Radboud Univer- They still give us a sity of Nijmegen, and a number subsidy to pay our of key companies from Eastern personnel. Netherlands decided they needed a reliable intermediary to facilitate The cluster was established after cooperation in transferring R&D the provinces of Gelderland and results to product development, Overijssel adopted a development and then into clinical practice, which concept as a part of the national would be capable to professionally Peaks in the Delta (Pieken in de Del- organise and maintain collaboration ta) initiative. The idea was to bring between relevant parties. together businesses, knowledge

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FRANCE «Our Mission is to Help All Members of the Regional Ecosystem» Eurasanté

CAROLINE SIMOES-AUBERGER At the initial stage of the cluster’s Communication and Strategy Manager creation, in 1994, all Eurasanté’s costs GIE Eurasanté were met from public sources. Today the balance of public and pri- The regional funding vate funding is approximately 60% is to help create jobs and 40%, respectively. Services avail- on our territory and able to all members of the regional develop businesses ecosystem include the facilitation of and research in the healthcare communications between industrial sector. Today there are more companies and R&D organisations, than 1,000 companies in the potentially leading to the emergence Hauts-de-France region, with of new joint projects, international more than 30,800 employees promotion of local companies, ac- (with the growth of 9% last cess to innovation infrastructure and year), and 4,000 researchers commercial real estate; there are also from both the personalised services such as legal public and private consulting or help with finding inves- sectors. tors. Eurasanté participates in various European programmes, which cover up to 50—60% of the projects’ costs using EU sources.

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SWITZERLAND «Medical Confederation» Health Tech Cluster Switzerland

In the beginning, our cluster was

an initiative from the canton of Schwyz, i.e., it was not coming from the business side. The canton thought it would make sense to have a regular exchange with companies focusing on health technology. So they were looking for relevant OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS enterprises, brought them together, which finally emerged into a cluster. Very soon they realised it must be something encompassing the whole of Switzerland instead of just one DR PATRICK DÜMMLER region. They actually said Cluster Manager ’’We want to expand our network Health Tech Cluster Switzerland from the central part of the country and make it nationwide’’.

The cluster was established four years ago by the Schwyz canton’s council. Today all cluster members including the canton councils pay membership fees. Regional authorities’ contribution amounts to 10% of the cluster’s budget; the state provides no other financial support. The remaining 90% comes from private companies’ membership fees and earnings from events and trade shows.

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SUCCESS FACTOR 5.

NATIONAL-LEVEL RECOGNITION OF THE CLUSTER

Biomedical clusters’ impressive results are largely due to the fact that their management companies and members are involved in the national healthcare policy. They take part in expert com- missions’ meetings; actively interact with the public authorities and the medical community as participants of, or consultants for, various high-level projects and programmes. Healthcare is quite a conservative (as many people believe) socioeconomic sphere regulated usually at the countrywide level of governance. National recognition is critical for biomedical clusters and may open far-reaching opportunities to apply innovations.

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DENMARK – SWEDEN «Rivalry is Losing, Cooperation is Winning» Case of Medicon Valley

it interferes with our national

agenda”. Both governments have chosen to focus on the life sciences sector. More often the cluster loses from their competition and benefits from their collaboration. For instance, in the EU countries’ campaigns to host the European OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS Medicines Agency (which had had to leave London as a result PETTER HARTMAN of Brexit), Sweden chose to MSc in Political Science, CEO compete rather than collaborate Medicon Valley Alliance with Denmark. And what happened obviously was that both countries Many things we discuss lost and the agency would be in our cluster are cross- placed in Amsterdam instead. border and depend on the An alternative solution based decisions of two national on working together was chosen governments. One of the largest at the establishment of the problems we have is that the central European Spallation Source. authorities of Sweden or Denmark In this case, Stockholm and do not always support the idea Copenhagen joined forces of Medicon Valley as an integrated nationally. It was a mutual decision cross-border cluster. Sometimes that the facilities should be placed at the regional level, policymakers on the Swedish side and the joint agree with us that we need to Danish-Swedish bid actually won. support Danish-Swedish Öresund So, if I look five years ahead, region, while the politicians up in I would like to see more Copenhagen or Stockholm may involvement of say “We should not necessarily national authorities have this close connection because in the cluster support.

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DENMARK – SWEDEN In 2016-2017, projects to build two construction is scheduled to be com- «Rivalry is Losing, Cooperation is Winning» world-class research infrastructure pleted in 2025. Case of Medicon Valley facilities were launched in the Öresund region and specifically in the Medicon The MАХ IV Synchrotron Radia- Valley cluster: the MАХ IV Synchrotron tion Laboratory was opened Radiation Laboratory and the in Lund in 2016. It is the largest Swe- European Spallation Source – ESS. dish research infrastructure investment The multimillion investments, inter- project, which will open opportunities national recognition of the cluster as to study molecular structures and sur- a unique biomedical and life sciences faces with the highest possible level research centre, new opportunities for of detail, using top-quality X-ray cluster members to implement joint beams, to university and corporate projects and attract international part- scientists from various countries. ners – all of this became possible due The MAX IV will allow them to create to collaboration between the Danish advanced precision-action drugs with and Swedish national authorities. minimum side effects. Investments in the first 14 beam installations amount- The ESS is a multi-disciplinary ed to 384 million euros; the total num- research facility based on the ber of beams is expected to reach 28, world’s most powerful neutron source. while the total project budget by 2026 Its construction will open new op- will exceed 570 million euros. portunities for scientists specialising in a broad range of areas such as life In 2017, the ESS and MAX IV signed sciences, biomedicine, and biotech- a cooperation agreement in the life nology. It includes a powerful proton sciences area, based on the mutual use accelerator, various laboratories, su- of beams and neutron. percomputer data centres, and software development centres. All ESS research infrastructure is currently being constructed on the Lund Uni- versity campus, while the data centres are already operating in the COBIS science park in Copenhagen. The project budget is 1.7 billion euros. The Swedish contribution is 35% and the Danish one is 12.5%. Neutron testing is expected to begin in 2019 and

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THE NETHERLANDS «Moving towards E-Health Together» Case of Health Valley Netherlands

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS

CHRIS DOOMERNIK MSc MMO, Managing Director Health Valley Netherlands

We have good relations with the Dutch government (though we are not a syndicate or lobby). We meet a few times a year to discuss new initiatives and how we can make each other stronger. Two main national ministries we cooperate with are the Ministry of Economic Affairs and the Ministry of Health, Welfare and Sport. Their representatives visit the events organised by Health Valley Netherlands and thus raise their status and visibility. Last year Ministry of Health, Welfare and Sport wanted to increase e-health initiatives in our country by introducing special electronic applications at hospitals. But not all of them could automatically implement it. So the ministry asked us to make it easier for healthcare organisations to adapt these innovations. It was not a subsidy, but a commercial project for us.

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In 2017, the Dutch Ministry of Health, doctors, and the medical staff would be Welfare and Sport proposed an initiative able to integrate certain nursing proce- to establish a national e-health system. dures into their patients’ daily schedule. The goal was to improve the quality and Cluster organisation of Health Valley accessibility of medical services, involve Netherlands became the ministry’s part- the patients in preventive medicine, ner in implementing one of the major treatment, and care practices, and re- projects within the national initiative – duce hospital staff’s workload through Pilot Acceleration Brokers (Pilot Vers- active application of ICT. For example, nellingsmakelaars). Three brokers, one that included the wide adoption of re- of whom was Health Valley Netherlands, mote monitoring and consultation tech- worked for five months in the regions se- nologies (telemedicine) by creating an lected for testing, namely in the Utrecht online environment where people would province, in the metropolitan Amsterdam be able to have round-the-clock ac- agglomeration, and in the Eastern region cess to providers of healthcare services, (the provinces of Gelderland and Overi- conduct certain measurements by them- jssel) (fig. 3.1). selves under the online supervision by

1 Economic Board Utrecht

2 Amsterdam Economic Board

3 Ministry of Health, Welfare and Sport

4 Health Valley Netherlands

Fig. 3.1. Pilot Acceleration Brokers

Source: compiled by the authors based on [Boon, Sloots, 2018].

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Their objective was to identify bar- obtain feedback from medical care riers hindering the application of recipients to improve their new

SUCCESS FACTORS SUCCESS FACTORS BIOMEDICALOF CLUSTERS ICT in medical practices and sug- developments is one of the special gest the best ways to accelerate services provided by the cluster in the transition to an e-health sys- partnership with living labs. They tem. The project budget was test innovations in areas such as 50,000 euros per region. As a bro- fi rst aid, care for the elderly and ker, Health Valley Netherlands people with mental or physical organised the networking of regi- disabilities. That experience turned onal doctors’ and patients’ commu- out to be quite valuable for the nities with companies developing national initiative too: the technol- digital solutions for the healthcare ogy for interacting with living labs sector. Three kinds of networks to speed up the application of ICT were identifi ed: to develop a busi- innovations approved by patients ness model for implementing inno- and doctors into medical practices vations, to deal with related legal was recognised as successful and issues, and to test new products recommended for implementation in living labs. Helping businesses in other Dutch regions.

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ESTONIA «National Partnership for Digital Medicine» Case of Connected Health

PIRET HIRV Cluster Manager Connected Health We help them interact with public Connected Health authorities. For example, now, has partners from all EU member states are facing different counties legal changes regarding private of Estonia; we really try to data protection – General Data create a special ecosystem for Protection Regulation – GDPR. developing medical services Many organisations become nationwide in cooperation with confused because they have the public institutions. The to amend some procedures, Ministry of Economic Affairs, their documentation, which is the Ministry of Social Affairs, complicated and expensive, and the Health Insurance Fund actually. We provide training are a part of the cluster. The sessions and invite officials government is very important. to speak to our members It is the only organisation, which so that they can find creates conditions for the cluster out what to do as part companies to do business. of their routines.

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The Connected Health companies on its own was for user devices operating at the junction of ICT and communicating with the national medicine develop software prod- medical records system. Now Nor- ucts for the National e-Health Sys- tal advises the government and tem created in Estonia in 2008. All cluster member companies on the providers of medical services who application of GDPR. Its services

use the centralised patient data- would help developers to take into base are connected to the system. account the new requirements for It comprises more than 20 million products from the very beginning records (test results, check-up and of the design process. vaccination records, clinical histo- ries, etc.). Everybody who has ever Helmes developed an electronic applied for healthcare assistance system that allows doctors and gets a personal account that can be pharmacists to have joint access to OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS accessed via the integrated portal. the prescriptions database, while By now, 95% of medical organisa- patients only need to hand over tions’ data is digitalised and 99% their electronic card at a drugstore of prescriptions are issued in elec- to buy the medicines they require. tronic format. The government has The second product the company put in place the infrastructure for designed in the scope of the na- the application of new products and tional e-health project was the eHIS services developed by private busi- information system for hospitals. nesses. Cluster companies – Nortal It is a modular platform for clinics, and Helmes – act as the govern- comprising various subsystems ment’s key partners in this major such as patient administration, national project. electronic medical records, and X-ray examination data. For example, Nortal was one of the developers of clinical information exchange systems, electronic medical records, and patient portals. As early as in 2003, the company created an integrated information system for the Tartu University hospital. Nortal is an expert in adapting to digital standards. One of such standards the company developed

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TURKEY «Cluster as a National Initiative» Case of Istanbul Health Industry Cluster

The cluster emerged on the basis of Inovita – Istanbul Cooperation Platform for Life Sciences and Technologies, which is an online communication network designed to facilitate collaboration between participants of the healthcare sector and foster the application SEDA ŞENOL of R&D results. The project was funded for a year by the Istan- Cluster Manager Istanbul Health Industry Cluster bul Development Agency. Sub- sequently, the agency financed another year-long project of the As a cluster, we have been Incubation Centre to promote funded by the Turkish high-technology biomedical start- Ministry of Industry and ups. Both these projects contrib- Technology since 2017. We also received uted to launching the institutional support from our founding members basis for the future cluster: a com- (Teknopark Istanbul, Bosphorus munication network, and a tool to Unıversity, Acıbadem University, Sabancı nurse start-ups. The cluster was University, and the Istanbul Chamber eventually established thanks to of Industry). Cluster membership is the funding provided by the Turk- now free; besides, private investors are ish Ministry of Industry and Tech- more interested in mature projects or in nology. Between 2017 and 2022, single companies. So public financing public support for Istanbul Health is very important. Close relations with Industry Cluster should amount to policymakers are a must in our cluster about 2.5 million euros. projects. For example, the government is the main purchaser of medicines and medical devices in Turkey.

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SUCCESS FACTOR 6.

INVOLVING PATIENTS AND DOCTORS

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS

Innovations that could improve the quality of medical treatment frequently have to go a long and arduous road before they are applied in clinical practice. This is due not only to the high level of regulation in the healthcare sector but also to its inherent conservatism (of doctors and patients alike). Medical discoveries can be transformed into commercial products or services, but they become really successful on the market only if there is sufficient demand for them. Involving patients and doctors in the development and testing of innovations has become a common practice in many biomedical clusters.

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FRANCE «Where Does It Hurt?» Case of Eurasanté

CAROLINE SIMOES-AUBERGER Communication and Strategy Manager GIE Eurasanté

We make the link We also do a lot of work with between hospitals patient associations. For and companies by four years we have organised organising a French national challenges to come up with initiative called “Challenge new developments for healthy Numérique” every year. The idea ageing. The competition, named is that one medical organisation “Silver Surfer”, involves old is invited to indicate a need in people living at home or in e-health, and then there is a geriatric facilities and their competition among regional caregivers; together they decide IT companies to bring the best what an innovation should solution that would meet the be. To organise the challenge, hospital’s requirements. Finally, we formed partnerships with one firm wins the challenge, hospitals, associations and we then accompany it to of disabled seniors, implement the innovation at the and retirement medical organisation. homes.

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The Eurasanté members are con- components, following sharp fluc- vinced that many innovative ideas tuations of such demand noted in medicine emerge from hospi- by the French Institute of Blood tal staff’s daily practices. Doctors (L’Etablissement Francais du are the ones who create demand Sang – EFS). The winner was for new medical technologies, by the OpenHealth Company, which

highlighting problems, the solving suggested a technological solu- of which may sometimes require tion allowing one to aggregate a unconventional approaches. Doc- large volume of data from the EFS tors may also be able to suggest and other sources (including the innovative ways to provide patient National Healthcare Institute, re- treatment or organise the health- gional statistical offices, etc.), and care system. The cluster’s objective analyse it in real time. The com- is to connect ideas generated and pany’ project PREVI-PSL received OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS problems identified by medical 70,000 euros from Bpifrance (a personnel with companies that state investment bank) and the could develop practical solutions. opportunity to complete the work Eurasanté has been holding tech- together with OVH, a European nological competitions and those leader in cloud computing. rewarding innovations pioneered by healthcare professionals to The technological competition for- further their development on mat helps the cluster to promote the market. members on international markets and attract foreign partners. For Competitions of the first example, in September 2018 in the type are organised for scope of the EU Interreg France high-technology companies in the (Channel) England programme to scope of the Challenge Numérique support joint French-British initia- national initiative. The objective is tives, Eurasanté together with its to select the best solution for UK partner – South East Health a specific problem identified by Technologies Alliance launched a clinic or another medical organ- the SMARTHEALTH project (the isation for subsequent imple- budget is 494,500 euros). The mentation. For example, in 2017 objective is to help e-health SMEs contestants had to propose a operating on both sides of the methodology for predicting the English Channel design innovative national demand for labile blood solutions requested by clinics and

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assist them in other areas such as create a firm, and some choose to procurement and entry onto foreign remain in medicine and sell the rights markets. In the scope of the project, to their know-how. French clinics are setting objectives for firms in the United Kingdom, and One of such competitions helps the vice versa. cluster develop services and products for the silver economy sector. The second type of compe- They are held in several stages: sub- titions, for new ideas, is held mitting applications, selecting the for nursing personnel. These are the five best projects to receive 50,000 people who take care of patients on euros (to share) for creating a proof- a daily basis, so they know the lat- of-concept, and then selecting the ter’s needs and specific requirements final winner(s) by a jury of elderly like nobody else, which is something people and caregivers. that could trigger the innovative process. The Eurasanté team helps such professionals to transform their ideas into practical results. The six years of holding such competitions show that some of the winners may

The Silver Surfer-2017 champions were:

Unaide – a device for HEROIC – a platform for interactions round-the-clock monitoring between the elderly and their care- of elderly people’s health; givers, which allows one to jointly improve the care;

Connect’Age – a series of computer games to train E-wear Solutions – an experimental memory; series of clothing for the elderly, with sensors to monitor their health (the People’s Choice Award). Officina Santé– an app to combat the insomnia;

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ESTONIA «We Want to Design Solutions with You, Not for You!» Case of Connected Health

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS

PIRET HIRV Cluster Manager Connected Health we had was part of the HIVdigital competition in 2017. We talked to people with the HIV-positive status We have patient and their doctors trying to identify organisations the largest issues in treatment. as partners of our Then we organised hackathons cluster, which are really important to find what can be solved for us. They are the recipients with digital tools. Some of our of the healthcare services. So we hospitals are functioning as living definitely need to have them labs. They co-create innovative as part of our ecosystem, products together with because how else can we know companies and then the problems to be solved. One test them. of the concrete forms to work with patients is hackathons. For example, one such activity

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Connected Health holds a competi- er the patient needs to be tested for tion for digital solutions to improve HIV. The second one was the mobile HIV treatment and prevention. It aims hINF application for people with the at promoting breakthrough e-health HIV-positive status, allowing them to innovations, supporting the transfer conduct planned check-ups remotely, of the best ideas into products, and halving the number of required visits involving the public in dealing with to the doctor. the AIDS proliferation problem. HIV- digital is organised in three stages. Connected Health continues The first stage includes the collection to work with patients in the of novel ideas and team building. scope of the international Pro- At the second, prototypes of future VaHealth project. Its main objec- innovative products are developed tive is testing new products and on the basis of the best concepts. technologies in real-life condi- At the final stage, the solutions are tions. Another objective is ex- tested and prepared for dissemina- changing best practices of pro- tion. The project participants are en- moting living labs and encour- gineers, programmers, entrepreneurs, aging their application by SMEs project managers, doctors, social in the Baltic Sea region. The workers, and most importantly, pa- ProVaHealth project partners tients and their relatives. Everybody are ScanBalt (international can suggest an idea to help HIV-pos- bio-economy and healthcare itive people fight the disease and project accelerator), and the Eu- limit its proliferation. ropean Network of Living Labs.

The winners of HIVdigital-2017 were two solutions designed to meet real- life problems encountered by patients and doctors, with the direct participation of both of these groups. The first invention was the Diagnos- tic Match application, which allows general medical practitioners in a few seconds’ time determine wheth-

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THE NETHERLANDS «FieldLabs: Patients- and Technologies- Based Healthcare» Case of Health Valley Netherlands

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS

CHRIS DOOMERNIK MSc MMO, Managing Director Health Valley Netherlands

Our cluster’s focus is very broad, but the main topic is healthcare innovation (e.g. in pharmaceuticals, medical devices, or patient treatment). In Health Valley Netherlands, we have hospitals, and also organisations for the disabled, people with mental diseases, and home care associations. Thus, other cluster companies have the unique opportunity to test and evaluate their innovations through the various FieldLabs3. Such collaboration allows businesses to bring improved products and services on the market, and consumers get solutions tailored to their needs.

3 The “FieldLab” term is more commonly used in the Netherlands; its meaning is similar to that of a living lab.

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The Health Valley Netherlands and services that could help cluster helps members launch such patients had a chance to new projects or join existing test their solutions and improve initiatives on testing innovations them based on direct feedback with the participation of pa- from users. Successful innova- tients in a living lab format. tions created in the cluster due For example, the FieldLab to cooperation with patients in Disabled Care project was the scope of FieldLab Disabled launched by the cluster mem- Care include the GoOV cell ber Siza (provider of care for phone application, which people with physical or mental allows people with limited mo- disorders, autism, or acquired bility to freely and safely use brain injuries). Cluster members public transport. developing innovative products

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SUCCESS FACTOR 7.

COMPREHENSIVE APPROACH TO SUPPORTING INNOVATION: INFRASTRUCTURE, START-UPS, AND UNIVERSITIES

Clusters are complex phenomena affected by various factors. One of them is the quality of the environment in which members operate, measured via the level of basic and specialised infrastructure development. The biomedical clusters we have OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS analysed are located in the areas with high concentration of world-class research and production facilities. Cluster management companies often have partnership agreements with science parks or business incubators, which, among other things, imply special conditions for start-ups (e.g. no membership fees, or free access to various services). Newly-established innovative businesses are important to biomedical clusters as a source of breakthrough unconventional solutions emerging at the junction of healthcare, high technologies, and patients’ needs. In the majority of cases, research-intensive initiatives are based upon the intellectual potential of universities and other knowledge centres. Typically, they are members of clusters, and in some cases have even initiated their establishment.

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DENMARK – SWEDEN «The Öresund Bridge: Two Countries, One Cluster» Case of Medicon Valley

PETTER HARTMAN MSc in Political Science, CEO Medicon Valley Alliance

Back in the days of 1990s, when the cluster initiative was just emerging, there was a decision to build a bridge connecting the southern parts of Sweden and the capital area of Denmark. Everyone was very optimistic because the construction would mean so much for the whole Öresund region. Sweden and Denmark both had really strong life sciences sectors; building the bridge was a good way to start cross-border integration and reinforce the Danish-Swedish Medicon Valley as Scandinavia’s leading life sciences cluster. I think, in terms of infrastructure, the most important thing at the beginning was the bridge. There would be no cluster without it.

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The Öresund Bridge created This practice allows people to basic conditions for much easier combine high Danish salaries contact between participants with low living costs in Sweden. of the cross-border macro- In turn, Sweden attracts Danish region’s innovation ecosystem. companies with broader access Thanks to the effort of the joint to venture capital and highly

Danish-Swedish team, the clus- profitable investment opportuni- ter initiative emerged along ties at the stock exchange. with implementing the newly built infrastructural potential Six large science parks located and filling it with tangible con- in the Öresund region make a tent. The competencies of major major contribution to the cre- companies Novo Nordisk, Lund- ation of new biomedical com- beck, Ferring Pharmaceuticals, panies in the cluster. On the OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS and LEO Pharma located on the Swedish side, it is Ideon in Lund Danish side of the Öresund strait (the oldest park in the cluster, were reinforced with the unique built in 1983) and Medeon in innovation infrastructure facilities Malmö, while on the Danish side in the Swedish part of the cluster. these companies are Symbion Almost 800 people go across the and Scion DTU. In 2012, two new bridge every day from Sweden to facilities were launched: COBIS Denmark and vice versa to work near Copenhagen and Medicon at cluster member companies. Village in Lund. The largest Danish firms with Swedish staff are Novo Nordisk (212 employees), Ferring Phar- maceuticals (121), and Lundbeck (73). Similarly, the Swedish Medi- con Village science park employs 40 Danish workers.

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GERMANY «Innovation Infrastructure Hub» Case of HealthCapital Berlin-Brandenburg

focused on the healthcare sector. For example, Bayer Grants4Apps Accelerator, Pfizer Healthcare Hub Berlin, Flying Health Incubator, he- lios.hub, Startupbootcamp Digital Health, Heartbeat Labs, and B. Braun Accelerator.

DR KAI UWE BINDSEIL Cluster members have access to the Cluster Manager services provided by eight leading HealthCapital Berlin-Brandenburg parks in the country, such as:

Berlin is a city of start-ups.  Berlin Adlershof — the largest The lively mix of economic S&T park in Germany, one players and scientific of the leading R&D support centres institutions, the diverse in the biomedicine and pharma- selection of initiatives, the beneficial ceuticals sphere. Companies have location factors and the growing access to laboratories, office space, number of IT companies make the and production facilities. One of the German capital region park’s residents, Eckert & Ziegler a unique hub for start- AG, is a member of the cluster; ups and digital health solutions. Berlinbiotechpark — this technology park was built on One of the cluster’s success factors the former premises of the Schering is the location at the core of Berlin Pharmaceuticals; accordingly, all and Brandenburg’s innovation infra- infrastructure is designed to meet structure, which comprises more than the requirements of biotechnology 60 facility units. Many of them are and medical companies. Members

Medical_Clusters_english_version.indd 119 20.03.2019 19:02:12 120 SUCCESS FACTORS SUCCESS FACTORS BIOMEDICALOF CLUSTERS of HealthCapital Berlin-Branden- The cluster member companies who burg who are residents in this tech- are residents in the biopark include nology park include Bayer AG and B. Braun Melsungen AG, Bayer AG Carl Zeiss Meditec AG. (owns 20% of the park’s shares), Glycotope GmbH, and Sanofi -  BiotechPark Berlin-Buch is Aventis Deutschland GmbH. located very close to Berlin’s key medical research and service centres. The main partners include the Charité University Hospital, the Max Delbrück Centre for Molecular Medicine in Helmholtz Association, and the Leibniz Institute for Molec- ular Pharmacology (Leibniz-For- schungsinstitut für Molekulare Pharmakologie). They have established the Experimental and Clini- cal Research Centre to implement interdisciplinary projects, which allows them to quickly test various innovative designs.

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FRANCE «Eurasanté Bio Incubator: From Start-Ups to Major Companies» Case of Eurasanté

CAROLINE SIMOES-AUBERGER Communication and Strategy Manager GIE Eurasanté

The Eurasanté Bio Incubator helps facilitate projects emerging from the regional healthcare sector to encourage the creation of innovative companies. The incubator was set up in 2000 and is approved by the French Ministry of Higher Education and Research. It supports various innovative biology, health, or nutrition projects resulting from public and private R&D. Since its foundation, the incubator facilitated more than 140 such projects and contributed to the establishment of more than 75 companies and 500 jobs. In 2017, it was ranked among the top 15 best biotech incubators in Europe for the emergence of innovative start-ups (Labiotech.eu) and has the “French Tech Ticket” label, which means that it is able to welcome young foreign entrepreneurs willing to set up a new branch in France.

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Located in the Eurasanté Bio- Acting as a real driver of innova- business Park, the Eurasanté Bio tion, the Bio Incubator team works Incubator provides companies together with project initiators with a 2,000-square-meter state- and entrepreneurs to help them of-the-art building, which houses at every stage of their projects. labs, offices, and shared facilities.

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS

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Global companies grown in the Mdoloris Medical Systems — Eurasanté Bio Incubator include: a producer of equipment for ongoing non-invasive pain monitoring,  ImaBiotech — a Contract including for unconscious patients. Research Organisation – CRO, The company was established on the specialising in assessing new drugs. basis of 23 years’ worth of R&D con- Established in 2010, in four years’ time ducted. the company grew by 320%. Currently, it has more than 200 clients, Europe- an, US, and Japanese pharmaceutical firms, and has conducted 300 trials for them. In 2017 ImaBiotech opened its second US office;

 Genfit — a biopharmaceutical company operating at the cutting edge of developing therapeutic and diagnostic solutions for patients suffering from metabolic and inflam- matory gastrointestinal diseases. It was established in 1999. Fifteen years later, its capitalisation exceed- ed 150 million euros. Genfit is a world leader in designing non-alcoholic ste- atohepatitis treatments;

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DENMARK – SWEDEN «The Founding Fathers of the Cluster» Case of Medicon Valley

OF BIOMEDICALOF CLUSTERS SUCCESS FACTORS SUCCESS FACTORS Nine universities (five in Denmark PETTER HARTMAN and four in Sweden) define the MSc in Political Science, CEO cluster’s R&D profile in the life sci- Medicon Valley Alliance ences area. For example, Copen- hagen University and Lund Univer- sity conduct world-class studies The cluster was actually in neurophysiology and diabetes initiated by two treatment. The Technical University universities; they were of Denmark and Malmö University Lund University on the are leading bioengineering cen- Swedish side and Copenhagen tres. Medicon Valley’s key research University on the Danish side at concerns metabolic problems, the the very beginning. When they use of stem cells, and cancer treat- applied for EU funding to create ment. The universities’ scientific a network organisation, Medicon advances are in demand by the Valley Alliance was called Medicon cluster companies. For instance, Valley Academy, which illustrates Novo Nordisk and Lundbeck fund that it was more about university- diabetes and neurology research. driven collaboration at that time. The Regenerative Medicine Centre The universities were is being built on the Lund Universi- a sort of the clusters’ ty campus and is sponsored by the founding fathers. Wallenberg Foundation.

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TURKEY «The Cluster’s Cradle» Case of Istanbul Health Industry Cluster

We were born from the Bosphorus University; our story began at the University Centre for Life Sciences and Technologies. Now, the cluster acts as a bridge between academia and private sector under the supervision of Teknopark Istanbul.

SEDA ŞENOL Cluster Manager Istanbul Health Industry Cluster

Universities have played an import- The coordinator of the cluster is Te- ant role in the development of Istanbul knopark Istanbul, which is the largest Health Industry Cluster since its estab- technology park in Turkey. Its main du- lishment. The project, which has ulti- ties are to increase cooperation and mately led to the implementation of the interaction between members, organise cluster initiative, is called Inovita. It is a communication events, promote cluster platform for cooperation between busi- companies on domestic and international nesses and R&D organisations in the markets, arrange training programmes, biomedical area founded by the Bospho- strengthen existing academic research rus University Centre for Life Sciences and service infrastructures, guide start- and Technologies. The cluster currently ups in securing funding within the scope includes 19 university R&D divisions. of existing national programmes and Representatives of Bosphorus Unıversity, other mechanisms, and provide shared Acıbadem University, Sabancı University access to research infrastructure. comprise the cluster’s Board of Directors responsible for strategic management.

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A unique path or the mainstream?

Each stage of our research was preceded by specifi c questions. We tried to fi nd out the answers to the following. Which positive eff ects do biomedical clusters create? What does their global

THE MIMC: ITS VALUE FOR THE CAPITAL CITY THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM landscape look like? What exactly makes these clusters successful? The ultimate goal of the study was to summarise worldwide experience and defi ne the Moscow International Medical Cluster’s place in the system of discovered coordinates. Do the factors that determined the success of the world’s leading biomedical clusters also apply to the MIMC or is it travelling its own path? We have tried to answer this question by analysing the professional views of doctors, biomedical researchers, scholars, govern- mental offi cials, and members of the cluster management team regarding the MIMC’s certain features and the role it plays in the development of the Moscow and overall national healthcare systems. Expert opinions collected by interviewing the representatives of the Russian professional community and reviewing the MIMC’s media coverage revealed that the Moscow International Medical Cluster not only fi ts the trends of the world’s biomedical clusters and their best practices, but can off er a number of origi- nal solutions to its peers abroad.

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1. THE MIMC AS A NATIONAL CENTRE FOR DISSEMINATING THE BEST GLOBAL MEDICAL ASSISTANCE AND CLINICAL MANAGEMENT PRACTICES

The mission of the Moscow Interna- tional Medical Cluster is to provide and develop world-class patient treatment services in Russia. Therefore, one of the cluster’s priority goals is introducing advanced international practices in the Russian healthcare system.

SERGEY PETRIKOV, DR MED. SCI., The review of global experiences re- Professor of RAS vealed that the main value clusters cre- Director of N.V.Sklifosovsky Emergency ate for their participants the world over Medicine Research Institute (which subsequently converts into their success) is communication. It can be The main output local (exclusive “members only” events), of the MIMC project is subject-speciﬁ c (between profession- technology transfer. als of the same area, e.g., cardiolo- Clinics that are members of the gists, microbiologists, clinic managers, cluster will employ international nurses, etc.), interdisciplinary (between personnel, but most of their sta patients, doctors, and IT product devel- will be Moscow doctors who will opers), or international (events at home be able to learn and then apply or abroad with global participation). the newly acquired skills at various medical centres in the capital city, public and private ones alike.

Source: [Kommersant special issue, 2018].

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MARAT KHUSNULLIN, PhD The MIMC has Deputy Moscow Mayor for Urban the potential Development and Construction to not only treat patients but share experiences, teach students, improve the skills of doctors countrywide, and integrate Russian and international healthcare systems. THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM

Source: [Kommersant special issue, 2018].

The best international clinics open- academia, business, and govern- ing branches in the MIMC on the ment, interact between themselves one hand, and the cluster’s open- and with the overseas partners. ness to doctors from all over Russia on the other, will help create a new The communication opportuni- platform for international knowl- ties the MIMC off ers are unique edge exchanges. because the cluster gets Rus- sian professionals from all over The MIMC also serves as a platform the country involved in global for consolidating the professional competence transfer, with the community, where medical industry participation of the best health- actors, representing patient care, care players in relevant groups.

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Having branches of leading clinics from various parts of the world located close to each other in the same area can foster the emergence of a new global communication centre in Moscow, promoting exchanges of medical competences. YURY KRESTINSKY Director of Healthcare Development Centre (Moscow School of Management SKOLKOVO), Chairman of the Board at Bionica Group of Companies

Source: exclusive interview.

The cluster is a laboratory for testing and applying advanced technologies in the Russian healthcare system – not just clinical but management ones too. I’m sure the MIMC can become a major international KONSTANTIN TSARANOV, MD, experience sharing PhD, MPA platform. Director of Healthcare Development Centre at the Moscow City Government University of Management Source: [Kommersant special issue, 2018].

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2. THE MIMC AS AN ACCESS POINT TO INTERNATIONAL TRAINING OPPORTUNITIES FOR RUSSIAN DOCTORS

Education and training are at the Not many Russian doctors striving for MIMC’s core, along with research and professional development can afford the provision of medical services. a long internship abroad. The cluster’s In this regard, the cluster’s efforts medical organisations intend to rotate are focused on raising a new genera- their staff on a permanent basis, so with- tion of professionals for the Russian in about two years’ time doctors gain healthcare system on the basis of new knowledge and experience and re- the OECD-approved curricula and turn to their home clinics with a radically teaching techniques. different mentality. The MIMC plans to develop and im- The MIMC’s own training and simulation plement various kinds of training centre is already built. There, doctors will programmes, in particular: be able to upgrade and learn innovative medical techniques applied at leading healthcare management (MBA clinics the world over. The simulation and quality management in centre has equipment which allows one medicine), with the participation of to recreate real-life conditions while

THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM professionals from France, the Re- performing laparoscopic, cardiovascular, public of Korea, the Netherlands, and other operations, applying anaes- Israel, the US, and other countries; thesia, etc. training doctors and nurses The MIMC training programmes’ com- in various specialised fields petitive advantages will be due to the using advanced evidence-based following: medicine models, patient-oriented approaches, and 4P medicine prin- participation of international part- ciples1. ners in each programme; These will be supplemented by sup- adapting them to the Russian porting events such as discussion healthcare system; clubs’ meetings and roundtable talks. accreditation in the continuous med- Internships are a particular area ical education system; of the cluster’s education activities. designing the curricula to match

1 4P medicine is a new healthcare model (“medicine of trainees’ specific requirements. the future”). The name reflects the four basic principles: personalisation, prediction, prevention, and participation.

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We’re already organising training events, consultations, conferences with the participation of leading professionals from all over the world. And these are just the ﬁ rst VLADA SAYFETDINOVA, MD, PhD steps. Next, we plan to integrate Medical Director of the IMC Foundation our international educational programmes into the Russian Ministry of Health’s continuous medical education system, launch management training programmes for medical organisations’ heads, and advanced programmes for nurses.

Source: [Kommersant FM, 2018].

Together with the Strasbourg Uni- sionals, and learning programmes versity’s Medical Education Centre based on advanced educational and and the I.M. Sechenov First Moscow digital visualisation technologies State Medical University, the MIMC (e.g. virtual and augmented reali- plans to open the fi rst private ty, adaptive learning, case studies). international medical university Graduates will receive both Russian in Russia. It will off er internship and international certifi cates. programmes for young profes-

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The educational component will play a major role in the MIMC’s development. Establishing an international medical university with clinical departments based at the patient care organisations within the cluster members YURY KRESTINSKY may be the best solution here. Director of Healthcare Development Such an initiative could lead to Centre (Moscow School of Management the emergence of a new competency SKOLKOVO), Chairman of the Board at Bionica Group of Companies centre for the Moscow and Russian healthcare systems. A double accreditation, with the university diplomas being recognised in Russia and one or more other partner countries, would make it particularly valuable. THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM

Source: exclusive interview.

By implementing its own brand-new training programmes for medical personnel with the participation of world-class scientists and clinicians, the MIMC is opening new career development opportunities for future and currently practising doctors, which would help keep top-skilled professionals in the Russian healthcare system.

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We’ve established a simulation centre, which will allow doctors to practice and sharpen their skills; about 25% MIKHAIL YUGAY, MD, PhD of our member clinics’ personnel will CEO of the IMC Foundation be foreign doctors, from whom other staff will learn new techniques and innovative treatments. Plus, we plan to have medical English courses, The scope for our cluster’s so people will be able to advance educational and training their professional development, activities is huge: we learn about the latest medical invite speakers from abroad, willing discoveries and communi- to share their experience and help cate with foreign adapt it to match Russian realities. colleagues.

Source: exclusive interview.

Many of the international clusters including not only traditional higher whose cases we have analysed noted education institutions but also part- the importance of the educational ner clinics’ training centres and cor- component of their activities. How- porate universities. ever, we did not see such a detailed and customised curricula and training plans in any of them, being at the same time integrated into the national continuous medical education system, and going along with a wide network of international partners,

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3. THE MIMC AS A PLATFORM FOR IMPLEMENTING INTERDISCIPLINARY RESEARCH PROJECTS AND TRANSFERRING THEIR RESULTS INTO HEALTHCARE PRACTICES

The MIMC concept comprises three VALERY MURYLEV, DR MED. SCI., basic elements: the provision of Professor medical services, education and Traumatologist-Orthopaedist, Head of S.P. Botkin Moscow training, and research. According- Endoprosthetic Replacement ly, one of the cluster’s goals is to of Bones and Joints Centre properly intertwine them, speciﬁ - cally to ensure the transfer of R&D results into clinical practice (e.g., The MIMC will help applying genomic research results develop theoretical and to advance longevity medicine) practical medicine alike.

THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM and the training of doctors in new It’s important to study not just specialities (such as IT medics, tis- genetics or stem cells but applied sue engineers, telemedicine physi- issues as well related to healthcare cians, molecular dietitians, etc.). activities. Unlike basic research, the results of the latter kind of studies could be imple- Bundang (one of the MIMC mem- mented immediately, bers) is a fully digital clinic provid- not 10 or 15 years later. ing medical assistance in a wide variety of areas (cardiology, oncology, rehabilitation, traumatology, ortho- paedics, etc.), a research organisation specialising in genetics, and a training centre off ering further education courses for doctors, nurses, pharmacists, and medical technicians, all at the same time. Source: [Lenta.Ru, 2018].

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The cluster plays a key role in pro- YAROSLAV ASHIKHMIN, MD, PhD moting members’ joint projects at Cardiologist, Advisor to CEO of the IMC the junction of various economic Foundation activities and technologies, merging medicine with construction, trans- We’re more than 10 years port, the food industry, and ICT to behind the West in biome- foster innovation in healthcare. dical science. But there is There are more than 11,000 organ- a chance to gain leadership. We need isations in Moscow providing pa- to bring together the best Russian tient care services, producing drugs, and overseas professionals in various medical instruments, and equip- areas – from molecular biology to ment2. Together with the relevant clinical practice. Further, we must leading universities and R&D cen- create a comfortable environment for tres, they make up the pool of po- their fruitful work. This is exactly what tential MIMC members and partners. the MIMC is doing. The cluster’s team managed to bring in the best medical organisations as partners. The cluster amounts to more than just business processes, research, and clinical experience. Members trust each other and share a special attitude to their life’s work: helping people stay healthy. These are the basic values which determine success in medicine.

2 According to the Russian Federal State Statistics Service’s Main Interregional Centre of Processing and Dissemination of Statistical Information (as of January 1, 2018). Source: exclusive interview.

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is typically done in healthcare. Numerous related areas aff ect medicine and patients, such as ICT, wearable gadgets, insurance and transport, equipment, pharmaceuticals, research, and much more. The cluster can have a signiﬁ cant impact upon them all. SERGEY MOROZOV, MPH, For example, IT companies, working DR MED. SCI., Professor together with robot and vehicle CEO of Research and Practice Centre manufacturers in the scope of Medical Radiology, Chief External Expert on Radiologic Diagnostics of of the cluster can off er new Moscow City products to patients, not registered as medical products in Russia The MIMC is a potential but approved in OECD growth point of the countries. And this is healthcare sector and just one example.

THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM related industries. Many processes – medical, construction, information, logistical – will be organised in the cluster diff erently than Source: exclusive interview.

Special foods for the elderly, sen- the joint projects implemented by sors for disabled people’s homes, foreign biomedical clusters. Estab- mobile applications to deal with lished interdisciplinary contacts insomnia, computer games for and links in research, production, preventing dementia, clothes with and clinical practice have deter- health-monitoring sensors – these mined their success, and the MIMC are just a few of the outcomes of is moving on along the same path.

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I believe that areas related to the development of human capital will serve as drivers of the next technological paradigm, specifically medicine and biology. They already account for about 40% of global research. Medicine is a quite conservative field and its advancement is the fastest where it overlaps MIKHAIL YUGAY, MD, PhD with other scientific domains CEO of the IMC Foundation and technologies. I think nanotechnology, biomedicine, information technology, and cognitive science will bring progress in the world. Blending them with one another would transform practically all aspects of people’s lives.

Source: [Zdrav.FOM, 2018].

The cluster’s strategic R&D areas are encouraging interdisciplinary and tech- determined by NBIC convergence, i.e., nological experiments aimed at advanc- merging and producing synergies being healthcare development, could not tween nanotechnology, biotechnology, only promote Russian medical science information technology and cognitive and practices but also open wide op- science, thus promoting the evolution portunities for the emergence of new of the medicine of the future. sectors of the capital’s economy, such A business-like and philosophical as a healthy longevity industry. approach to the MIMC organisation,

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4. THE MIMC AS A TERRITORY OF ADVANCED LEGAL REGULATION FOR HEALTHCARE

The cluster’s core idea is setting The introduction of a special legal up a flexible legal regulation regime in a single cluster shows system on a particular territory. that the government recognises The special International Medical its potential to improve the over- Cluster Law3 established the main all quality of the Russian med- rules for the MIMC operations, ical system. On the one hand, it including the recognition of the meets international practices of members’ diplomas for medical involving clusters in implementing activities issued by the OECD national healthcare programmes, countries, special conditions for which we included in the number hiring foreign professionals, tech- of cluster success factors, while nical regulations, sanitary and on the other, it is almost unique epidemiological norms, etc. for our sample. Very few clusters boast an exclusive regulation that applies to their territory alone. One of them is Daegu Medical Cluster. THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM

Methodologies, technologies, and treatment protocols approved in the OECD countries can be applied at the MIMC without extra licencing. Pharmaceutical MIKHAIL YUGAY, MD, PhD preparations and equipment CEO of the IMC Foundation registered in the OECD member states also can be used in the

3 Federal Law “On the International Medical Cluster and Amendments to Certain Legislative Acts of the Russian Federation.” Dated June 29, 2015 № 160-FZ.

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The MIMC will help make a breakthrough in medicine. In the scope of this project, the best clinics in the world will be coming to Moscow. <…> An appropriate law was passed in the Russian Federation, a territory was made available in Skolkovo, and we already have cluster members. Hadassah and Bundang are just two examples. They bring in their operational rules, standards, resources, and high quality. Any foreign clinic can do the same: come up with an investor and work with its own ALEXEI KHRIPUN, DR MED. SCI., specialists in line with the regulations Professor and using drugs, consumables, and Moscow City Government Minister, technologies, which do not Head of Moscow City Healthcare even have to be licensed Department for use in Russia.

Source: [GOVORITMOSKVA.RU, 2018].

MIMC; the federal requirement either. All this opens access to medical for compulsory registration does assistance of the highest not apply. Foreign doctors may be standards to Russian employed by cluster organisations patients. without any restrictions: their diplomas are recognised and no quotas limiting the number of invitations and work permits apply Source: [Kommersant special issue, 2018].

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5. THE MIMC AS A GRAVITY CENTRE FOR INTEGRATED INFRASTRUCTURE DEVELOPMENT PROJECTS IN MOSCOW

The establishment of an international medical cluster in the Skolkovo innovation centre was supported by the Moscow City Government. The project includes the construction of several major infrastructural facilities, which will signiﬁ cantly contribute to the development of healthcare and medical research in the capital city. In 2018, the Israeli Hadassah MARAT KHUSNULLIN, PhD clinic– the fi rst MIMC member – Deputy Moscow Mayor for Urban opened a diagnostics centre in the Development and Construction

THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM cluster; by 2021, the clinic plans to have the therapy centre construction completed. The Seoul The MIMC is a world- National University together with class project drawing the Korean Ministry of Health and the interest of both Welfare is designing a multifunc- Russian and foreign investors. tional building of the Bundang <…> We’ll build a 20-hectare Smart Hospital of the Future technology park with a medical (scheduled to open in 2022). university, laboratories, In addition, in 2022, the Spanish technology transfer Roman Fernandez clinic is plan- centres, and pilot ning to open the Oncology Centre. production facilities.

Source: [Kommersant special issue, 2018].

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In ten years’ time between 10 and 15 ters and the development of cluster clinics will be opened on the MIMC infrastructure is often a primary area territory, specialising in more common for public funding (suffice it to men- socially significant diseases such as on- tion the pivotal role of the Öresund cological, cardiovascular, neurological, bridge in the establishment of the locomotor disorders, etc. The construc- Danish-Swedish Medicon Valley clus- tion of several R&D facilities is also ter). The Moscow City Government also planned (first of all for live systems and invested in the construction of sev- medical engineering research), along eral MIMC facilities (table 4.1) and set with the international university and reduced land rental rates for cluster pharmaceuticals and clinical equipment members (at 188 roubles per sq. m. production facilities. They will be locat- a year). ed on the territory of the 20-hectare The MIMC’s large-scale development technology park. projects will create brand-new infra- Support by the regional authorities is structure that will contribute to the an important success factor for most advancement of the medicine of the of the international biomedical clus- future in Russia.

Allocated funding Facility (billion roubles)

The first pilot facility: Hadassah Clinical Diagnostics Centre 3.6

The second pilot facility: Hadassah Therapy Centre 3.2

Housing 2.0

Roads, engineering networks 1.0

TOTAL 9.8

Table 4.1. Public Funding Provided by the Moscow City Government for the Construction of the MIMC Infrastructure

Source: compiled by the authors based on the IMC Foundation data.

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6. THE MIMC AS A PATIENT LITERACY CENTRE AND A “ONE WINDOW” ACCESS POINT TO WORLD-CLASS MEDICAL ASSISTANCE

The MIMC’s target audience The MIMC members are convinced is predicted to exceed 300,000 that the patients themselves play people a year. They will receive the key role in protecting their assistance from leading Russian health and could become the doc- and foreign doctors who will be tors’ partners in choosing optimal able to apply treatment protocols treatments for acute illnesses and approved in OECD countries and chronic diseases. Meanwhile, the use advanced safe medicines and WHO studies reveal that people equipment. The cluster will become insuffi ciently literate in this fi eld a single contact point for clinicians tend to feel worse and have a higher and patients across the full range risk of hospitalisation. Increasing of healthcare services from diag- patients’ interest may help make nostics to post-treatment recovery them feel better and more satisfi ed and support. The MIMC’s unique and further produce clinical and value for people coming for medical economic eff ects as well assistance and for everybody who [WHO, 2008]. cares about their health is improv- THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM ing patient literacy.

The cluster’s professionals are focused on ﬁ nding the most advanced, cutting-edge solutions the patients might need, which would help people take care of their health, feel comfortable in the medical environment, VLADA SAYFETDINOVA, MD, PhD and receive services of Medical Director of the IMC adequate quality. Foundation Source: exclusive interview.

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Workshops will be held in the cluster to teach patients to better understand what causes illnesses and which factors affect their health. Leading Russian and international medical professionals will teach people self-diagnostic techniques, the right ways to take medicines, monitor the symptoms and treatment efficiency, how to spot dangerous signs of progress- ing diseases, and doctors will learn advanced patient interaction techniques. Healthy lifestyle practices will be at the core of the MIMC’s educational programmes.

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Consumer behaviour in the ﬁ eld of medicine is changing. Today, there is a shift away from the paternalistic model, when the state declares “I’m the sole owner of your health”, towards a partnership, where each member has speciﬁ c responsibilities. Health is seen as private capital now: people are increasingly willing to invest in ILDAR KHAIRULLIN, MD, PhD, DBA their well-being because they are First Deputy Director aware of its value and realise how of the IMC Foundation important it is to take preventive steps, go to Source: [Kommersant special issue, 2018]. check-ups, etc.

Active interaction between patients electronic polling of Muscovites and doctors is a success factor on relevant urban planning issues.

THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM of many biomedical clusters the Three thousand six hundred online world over. The MIMC plans to adopt polls were conducted in four years’ the widespread “living lab” format time, with more than two million par- to systematically involve Moscow ticipants. One thousand nine hund- citizens (and with time, residents red decisions were implemented of other Russian regions as well) based on the results4. By adopting in projects on improving innovative this successful experience of invol- healthcare products and medical ving citizens in the development assistance quality. The Active of the city, the MIMC will contribute Citizen project initiated by the to increasing patient literacy and capital city mayor may become the introducing 4P medicine in Moscow. cluster’s pillar – a platform for the

4 Active Citizen [offi cial website]. URL: https://ag.mos.ru/info (last accessed on December 25, 2018).

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7. THE MIMC AS AN EFFECTIVE PARTNERSHIP MODEL FOR PUBLIC AUTHORITIES, INVESTORS, AND CLINICS

The MIMC managed to design a speciﬁ c supervisory board, which is the highest organisational model based upon pub- management authority headed by the lic-private partnership mechanisms, capital city’s mayor. using various formats for bringing Membership in the cluster implies together key members with clearly involving investors and operators deﬁ ned roles in the cluster. (i.e., organisations actually providing The Moscow City Government is the medical services) from Russia and the founder of the cluster management OECD member states. Investors provide company, the IMC Foundation, and funds to build and equip facilities (such co-invests in the construction of clin- as clinics, diagnostic centres, etc.) and ics, infrastructure, and other facilities. fi nance current work. It further is represented on the cluster’s

The mayor of Moscow is determined to make the cluster a success and to raise it to the world-class level. The city government allocated about 10 billion roubles to co-invest in the construction of the cluster’s pilot facilities and infrastructure as well as support education and training eff orts. Our ﬁ rst member, the Hadassah clinic (one of the Israeli VLADA SAYFETDINOVA, MD, PhD healthcare leaders), has opened a Medical Director of the IMC branch on the cluster’s territory, Foundation which is the only one in Russia and is already serving patients. Next in cluster members. We’re discus- line are South Korean, Spanish, and sing new projects with them French clinics. So far about 25 major on a co-funding basis. medical centres in the OECD countries expressed interest in becoming Source: exclusive interview.

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Operators bring in personnel and organise the provision of medical assistance (including treatment protocols and the required drugs). There are other possible partnership models, involving Russian and international members.

Under any of them the IMC Foundation provides land and engineering infrastructure and professional management services ZEEV ROTHSTEIN, MD, PhD, Professor (coordinates activities, supports Director General of Hadassah Medical cluster members’ cooperation, helps Organization (Israel) with the promotion of their products and services on the market, the attraction of patients and partners,

THE MIMC: ITS VALUE FOR THE CITY CAPITAL AND FOR THE NATIONAL HEALTHCARE SYSTEM staff training, and so on). The biomed- It’s a great honour ical clusters from other countries that we for the Hadassah clinic have benchmarked apply diff erent pub- to become the cluster’s lic-private partnership models to manage first operator. However, it’s also and fi nance their activities. One of our a responsibility to represent experts confessed that if he could have world-class medicine and gone back in time to the early period share cutting-edge scientific of the cluster, he would have tried to advances. <…> We’ll make involve representatives of the govern- every effort to live up to the mental offi cials in the cluster manage- expectations and accomplish ment and diversify funding sources by our objective, which attracting more public funds. From this we see as preventing, perspective, the logic of engaging mem- identifying, and bers, organising investment schemes and treating diseases. the management system chosen by the Moscow International Medical Cluster

seems to be quite sensible. Source: [Kommersant special issue, 2018].

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A comparative analysis of the key aspects of the Moscow International Medical Cluster’s operations and the success factors of biomedical clusters the world over revealed that the MIMC does follow global trends while also possessing its own know-how. The cluster enjoys powerful support from the authorities, which helps it build infrastructure from the ground up, provides strategic management, and ensures an exclusive legal regime. Accordingly, the MIMC has become a gravity centre for leading international medical researchers and practitioners and is now opening unique opportunities for Russian doctors and patients to provide and receive world-class treatment, professionally improve, increase healthcare literacy, and contribute to the medicine of the future at the junction of nanotechnology, biomedicine, ICT, and cognitive science.

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IN LIEU OF CONCLUSION

Our study was a continuous search for answers to a multitude of questions, the most important of which could be put as follows: what must biomedical clusters have in order to help improve healthcare?

The experience and practices of the MIMC and other clusters around the globe have been scrutinised, which leads us to conclude that their strength lies in diversity: diverse members and partners, various areas of activity, communication channels, management structures, support mechanisms, and so on. We have learned how very different, but in every case very important, decisions were made, such as building a bridge to bring together research, medical, and business organisations from two regions into a single cluster; giving an area a special legal status so the best clinics would be able to apply treatment techniques unavailable outside of the cluster; digitalising the national healthcare system and bringing medical organisations and IT firms together within the scope of a cluster, so that their cooperation would make medical assistance more efficient, user-friendly, and safe. Each of these decisions was based upon a managerial vision, scientific validity, economic sense, political support, and public involvement. However, the key to success was the strong expertise, enthusiasm, and personal stake of the professionals whose mission was to secure people’s health.

As the saying goes, lack of medical personnel’s cordiality is far worse for patients than cardiac failure. In the course of the study we have learned about people with kind and caring hearts who have brought their talents and resources together to make other people’s lives longer and happier.

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Edited by C. Montgomery Translated by V. Korolev Design and desk-top publishing by А. Chumachenko, Y. Molokanova, M. Bogdanova, E. Ivanovskaya, D. Ermakov

Sources of illustrations: https://www.shutterstock.com/ru https://unsplash.com/ https://www.pexels.com/

Format 60×90 1/8. Print sheet 19.5. Pressrun 100 copies.

International Medical Cluster Foundation 5 Nikitskiy Pereulok, 6 bld., Moscow, 125009, Russia

National Research University Higher School of Economics 20 Myasnitskaya Ulitsa, Moscow, 101000, Russia

Medical_Clusters_english_version_4.indd 156 26.03.2019 18:19:54

BIOMEDICAL CLUSTERS WORLDWIDE: SUCCESS FACTORS International Medical Cluster Foundation AND BEST PRACTICES

Institute for Statistical Studies and Economics of Knowledge, National Research University Higher School of Economics

Address: 20 Myasnitskaya Ulitsa, Moscow, 101000, Russia Phone: +7 (495) 621-28-73 https://issek.hse.ru/en/ E-mail: [email protected]

HSE ISSEK Russian Cluster Observatory http://cluster.hse.ru E-mail: [email protected]