Analysis of the health environment and commercial prospects in 6 high-growth emerging markets
For the last few years much interest and effort has been invested to better understand the first tier emerging markets of Brazil, Russia, India and China. But as that understanding matures, the spotlight is increasingly being cast on tier two markets that combine large populations with low median age, significant unmet clinical need, and rising economic performance. These markets have become known collectively since 2009 by the acronym CIVETS.
The CIVETS markets are geographically diverse but in common offer medical device and equipment manufacturers strong reliance on imports and rapid growth rates. At a time when established first-world markets are experiencing growth of 0-3% and with long-term issues around reducing sovereign debt, CIVETS such as Turkey and Indonesia are offering medical market growth rates of 7.4% and 14.5% respectively in the medium-term, albeit from a lower value base.
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Of course, the political and health infrastructure in many of these markets is less stable and developed, and that is why this new report from Espicom is the perfect detailed briefing of significant long-term opportunities in these countries.
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Driven by patient population
All markets, including health, are per capita driven. But simple per capita considerations are not sufficient to appreciate the changing health profile of a country and the demand for health services/infrastructure. Understanding these dynamics will identify the potential for suppliers of medical devices, equipment and supplies and their related support services.
A key aspect which links CIVETS is a growing population that is young, technologically sophisticated and consumer orientated. The median age in the 6 CIVETS markets is 27; in Egypt it is just 24. By comparison, the median ages in the US and UK are 37 and 40, respectively. This profile of large numbers of economically active individuals, along with development of diverse economic activity, often related to mineral wealth, is driving GDP up and hence the improvement in social and health provision.
65+ population group to rise slowly
At the same time, for the medium term, the number of elderly (65+) as a % of the population will rise relatively slowly – this group places the largest demand on health services and hence its impact on health spending is significant. Compare the following stats for an example:
% of population aged over 65 by 2016
While varying widely within the CIVETS group, it is fair to say that the infrastructure and provision of health services in all CIVETS has some way to go before reaching first-world standards. Beyond mostly city based hi-tech health facilities lies much unmet clinical need in poorly provided rural areas, with only the most basic support services available. A further issue to consider is the role played by aid in the development of health services.
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With a population set to reach 50 million by 2015, Colombia is currently the third largest country in Latin America, behind Brazil and Mexico. Despite ongoing unrest around drug trafficking, foreign investors are attracted by Colombia’s natural resources and generally more stable political environment. GDP in 2010 grew to US$288.7 billion and should reach US$329.7 billion in 2011. The Colombian medical device market is heavily reliant on imports, especially in the more high tech sectors. There is some domestic capacity for more basic items and a few multinationals manufacture in the country. The medical device industry is concentrated around the capital Bogota, and within the capital a free trade zone has encouraged international companies to the market.
In 2011, the Vietnamese market for medical equipment and supplies was estimated at US$599 million, or US$7 per capita. It is expected that the device market will continue to expand strongly at 15.2% per annum. This will take the Vietnamese market to around US$1.2 billion in 2016, although the per capita rate will remain low. According to the latest data, an estimated 61.3% of healthcare expenditure is private. An estimated 90.7% of the Vietnamese medical device market is supplied by imports, and the sector is growing rapidly. Singapore, Japan and China are the leading suppliers, accounting for 45.6% of imports in 2009. Local production is limited to basic items. The value of exports has been growing fast, as overseas companies, mainly Japanese, use the country as a manufacturing base.
The government has placed an emphasis on developing its healthcare system, with the goal of establishing a Universal Healthcare System by 2013 as part of its ongoing reforms for the healthcare sector. The prospects for the medical device market in Turkey remain good; buoyed by strong import growth trends, which the country relies heavily on, and the expansion of healthcare facilities coupled with rising health expenditure should see the market grow at an attractive rate of 7.4% in the 2011-2016 period. The market is currently the largest in the region, and is among the top 30 in the world.
The medium-term prospects for the medical device industry looks encouraging; based on current trends, the South Africa medical device market, of which over 90% is supplied by imports, is expected to grow at a CAGR of 1.3% from 2011-2016. A key driver of growth is expected to be the public-private partnerships to develop hospitals in South Africa but this could be tempered slightly, by a depreciating rand against the US dollar and the general state of the South African economy. The AIDS situation is dire in South Africa. According to projections from the EIU, the population of South Africa will start to decline from 2011, not normal for a country which has a relatively low elderly demographic (estimated 5.7% of the total population in 2011) and one of the highest birth rates in the world
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6 Markets Covered