In an important move for foreign companies, the Chinese government has announced that foreign suppliers shall get equal treatment in all government bids, including medical equipment.  

On October 26, 2021, the Ministry of Finance (MOF) issued an official notice titled “Circular of the Ministry of Finance on Implementing Related Policies Concerning Equal Treatment to Domestic and Foreign-invested Enterprises in Government Procurement Activities.”

According to the Notice, government bodies must not discriminate against foreign suppliers for government procurement if their products are produced in China:

“All products produced within the territory of China are entitled to having equal access to government procurement activities, regardless of their suppliers being domestic enterprises or foreign-invested enterprises.”

“To ensure fair competition between domestic and foreign-invested enterprises, no limitations shall be imposed to suppliers in terms of their ownership, organizational structure, shareholding structure, the nationality of investors, product brands and other unreasonable conditions in the process of government procurement activities.” The only exceptions are for procurements related to state security.

This is a turnaround instruction to local authorities regarding government bidding. In past years, the government procurements in China have been increasingly in favor of Chinese brands by setting conditions for bids with “made-in-China” products. Since 2017, local governments have increased the proportion of purchases of made-in-China products in their local government bids. In medical device procurements, many provinces released an imported medical device List to specify which categories of medical equipment can be imported.

This list has become shorter over the years. For example, the number of medical devices on the 2020 Import Medical Device List of Guangdong province was shortened to 46, a drastic reduction from 136 in 2019.  

The shortened list of imported medical devices reflects an increased proportion of made-in-China products in government bidding. This is particularly true in the provinces where domestic medical device manufacturers are strong, such as Guangdong, Jiangsu, and Zhejiang provinces

The made-in-China proportion requirement further increased in May 2021. A document from the central government stipulated that 137 out of 178 types of medical devices should only be procured from made-in-China products. For example, a color doppler ultrasound system is a type of medical device. In all government procurements of color doppler ultrasound systems, only products produced in China can participate in the bids. 

However, there are no official criteria for made-in-China products in any government documents. In practice, these criteria vary from province to province and can be ownership of the supplier, origin of brand, or production location of key components. The made-in-China requirement in government procurements barred foreign companies from participating in the biddings, even ones having production facilities in China. 

Therefore, the latest instruction released by the Ministry of Finance to assure foreign suppliers’ equal participation in government procurement requires a big change of practice among local governments. 

The notice is important because the value of government procurement is significant: it reached ¥3.7tn ($572.5bn) in 2020, accounting for 3.6% of China’s GDP. It grew at a compound annual growth rate of 13.5 percent between 2014 and 2020. 

The timing of this instruction is consistent with a general move of the Chinese government towards greater openness to foreign companies:

• In September 2021, China applied to join the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP), a trade agreement that requires the members to open up their economies, including state-owned enterprises and government procurement.
• On November 22, 2021, Premier Li Keqiang pledged greater strides in opening up the Chinese market to foreign investors during a trip to Shanghai.

China benefits enormously from global trade and receives pressure from members of the World Trade Organisation (WTO) to open its economy to foreign companies and to be more transparent in terms of the government policies related to commerce. In October 2021, during the Trade Policy Review of China, various member countries complained of unequal treatment of foreign companies.

China is the second-largest medical device market in the world; therefore, assuring equal participation in government procurement would grant significantly more business for non-Chinese medical device companies. 

Sally Ye is a health care technology analyst at the Healthcare Technology division of Omdia, a sister research brand of Omnia Health. Located in the US, Europe and China, Omdia’s health care team produces a wide range of syndicated and customised reports, including a monthly China Healthcare Market Update, the Healthcare IT Topical Report, and the Healthcare Equipment Database, as well as in-depth reports and analysis on the medical imaging industry.

Released on September 29, 2021, by the State Council as part of the 14th Five-Year Plan period (2021–25), the National Medical-Security Plan is a continuation of the initiatives “Health for all” (part of the 13th five-year plan) and “Healthy China 2030.”

There are three types of state medical insurance in China: rural resident, urban resident, and employee health insurance. In 2020, 95% of the Chinese population (including children) benefited from inclusion in the three state medical insurance categories. Nearly 330 million Chinese people (23% of the total population) are covered by employee health insurance.

Accessible to all, rural and urban resident health insurance are the two major forms of state cover for over 1 billion people (73% of total population). They charge very low premiums, up to ¥400 per year, and cover major illnesses; 60% of medical treatment expense is reimbursed by the government. 

With government goals of increasing healthcare accessibility across China, the 14th Five-Year National Medical-Security Plan aims to achieve the following targets by 2025:

• State medical insurance coverage for at least 95% of the total Chinese population.
• Medical expenses incurred by patients will be lower than 27% of total treatment cost. Between 2014 and 2019, the compound annual growth rate (CAGR) for the overall national health spending was estimated to be 13%. Estimated personal medical expenses grew at a CAGR of 9.5% over the same period, representing a decline as a proportion of overall national health spending from 33.2% in 2014 to 28.4% in 2019.
• By 2025, drugs purchased through volume-based orders should account for more than 90% of total drugs purchased by public hospitals. For medical consumables, the centralised procurement target is 80% of total spending by hospitals.
• More than 70% of trans-provincial hospitalisation bills will be settled on the spot via medical-insurance accounts and online services. 
• Facilitate commercial health insurers will provide services to China’s healthcare market by issuing supportive policies and improving governance. 
• As part of the “Internet + Healthcare” initiative, a national-level medical information platform to connect healthcare providers will be built so that data can be shared and retrieved across organisations and regions. 

The government push to hit the above targets in the National Medical-Security Plan will significantly impact the healthcare market of China. Omdia foresees the ongoing evolution will lead to a number of changes that are discussed below. 

China’s medical device market will maintain double-digit revenue growth through 2025, supported by universal health insurance coverage. Driven by a growing middle class and aging population, Chinese medical equipment revenue growth was estimated a CAGR of 13.6% between 2016 and 2020 and is projected to maintain a CAGR of around 15% between 2021 and 2025.

Universal health insurance coverage will further boost the medical equipment market, and soaring medical demand will accelerate technology adoption and digital transformation of healthcare provision in China. 

As per the United Nations forecast, nearly 363 million people in China will be aged 60 or older by 2030, accounting for 25% of the total population. This is projected to increase to 450 million people and 32% of the population by 2045.

With a rapidly aging population and universal healthcare access, demand for medical equipment and healthcare provision is projected to soar over the next 10–20 years, which will pose a big challenge to China’s healthcare system in terms of financial resourcing and providing trained healthcare professionals.

Emerging medical technology innovations, including the implementation of telemedicine, robotic process automation, and artificial intelligence (AI), will improve operational efficiency and clinical results. These medical technology innovations, alongside cost reduction, will also help

China’s healthcare system to alleviate challenges related to the shortage of healthcare professionals and to address the uneven distribution of medical resources by region to improve the quality of care in less developed areas. Data sharing and interoperability among healthcare organisations is a must to enable the continuum of care among different healthcare providers and the reimbursement process of healthcare costs incurred by individuals.

Digital transformation, a top priority for China’s healthcare system, will increase implementation as China has good infrastructure, such as 5G adoption, to support this transition. Of all 5G base stations globally, 59% are located in China. 5G smartphone users in China reached 419 million in August 2021 (30% of the Chinese population).

Government-led initiatives, including “Internet + Healthcare” and state-level AI strategy, will propel the digital transformation of China’s medical sector. Omdia projects the medical AI market in China to reach $6bn in 2025, a CAGR of more than 20% over the next four years. China is likely to become a global leader in medical technology innovation.

Another foreseeable trend is the shift of China’s healthcare system from an overreliance on public hospitals to a system supported by multiple pillars consisting of private hospitals and commercial health insurers.

China’s current healthcare system is overly reliant on high-grade public hospitals. Cost containment measures like bulk procurement of medical equipment and supplies will be more widely implemented (as highlighted earlier) to maintain financial stability. The major winners of volume-based procurement will be suppliers of generic drugs and basic-level medical devices.

As patient numbers and hospital attendance increase, medical services in public hospitals will very likely degrade as demand exceeds capacity. More affluent patients will likely seek better and quicker service in private hospitals. The number of private hospitals has outgrown public hospitals.

Even though today China’s private hospitals only account for 16% of outpatient visits, the number of outpatient visits in private hospitals grew at a CAGR of 12% between 2014 and 2019, three times the CAGR of 4% for public hospitals.

Currently, the state’s healthcare insurance is not sufficient to meet increasing demand, so the National Medical-Security Plan explicitly encourages the wider use of commercial health insurers. Between 2011 and 2020, premium revenue for commercial health insurance products grew at a CAGR of 31.57%. Omdia forecasts that further government policies will be introduced to promote a wider offering of commercial health insurance. Private health insurers will become more visible players in the sector, offering an alternative to state healthcare insurance policies.

With a rapidly aging population, healthcare is a pressing topic in China. Universal healthcare coverage will further boost China’s healthcare market growth in the short and longer terms. China’s medical equipment market will maintain its growth momentum. Digital transformation will accelerate China’s health system, supported by multiple pillars of commercial health insurers, private hospitals, and state and national medical policies.

Sally Ye is a health care technology analyst at the Healthcare Technology division of Omdia, a sister research brand of Omnia Health. Located in the US, Europe and China, Omdia’s health care team produces a wide range of syndicated and customised reports, including a monthly China Healthcare Market Update, the Healthcare IT Topical Report, and the Healthcare Equipment Database, as well as in-depth reports and analysis on the medical imaging industry.

In 2018, prostate cancer was the second most common malignancy (after lung cancer) in men globally, with 1,276,106 new cases and 358,989 fatalities (3.8 per cent of all cancer deaths in men). According to WHO, presently there are 1.41 million cases worldwide. Dr. Aftab Bhatti, Consultant Urologist, Tawam Hospital, part of Abu Dhabi Health Services Company (SEHA), Dr. Hosam Al Qudah Consultant and Lead Urologist and Dr. Omer Al-Derwish Consultant Urologist from Fakeeh University Hospital, discuss how diagnostics and treatments have changed through innovation.

Prevention of prostate cancer

Dr. Hosam Al Qudah: Numerous studies indicate that the chances of having prostate cancer can be lowered through a low-fat diet and a healthier lifestyle. Typically, this means decreasing the intake of red meat, eating more fruits and vegetables, daily exercise, and maintaining a healthy weight.

Detection

Dr. Hosam Al Qudah: In the past, detection and diagnosis were through ultrasounds and biopsies, however, now there is a prevalence in using MRIs. MRIs are beneficial for diagnosis, staging and follow-ups for patients with prostate cancer. We use MRIs now in almost all patients before the biopsy of prostate cancer, as it can detect nodules as small as five millimetres in the prostate. It also stratifies the nodules from benign or cancerous. There is a staging class and classification for this, known as PI RADS, which helps us determine if we need to conduct a biopsy or not.

It is key to use new generation MRIs, such as 3 tesla, which are recommended for the use of detection. The old machines are unable to detect accurately due to poor imaging quality.

Dr. Aftab Ahmed Bhatti: MRI scans are performed at the beginning and suspicious lesions are targeted to obtain a tissue sample using an MRI and the ‘Ultrasound of Prostate Fusion’ technique, and with special equipment for MRI Fusion Targeted Biopsies.

This technique is superior to the conventional way of performing biopsies with Ultrasound guidance alone, where most of the time cancerous lesions are not visible.

More importantly, if biopsies are performed after an MRI, these are often far superior compared to those obtained after an ultrasound. As most cancers are not visualised on ultrasound, these biopsies are obtained in the ‘blind’.

In addition, the prostate-specific antigen, or PSA, blood test checks for a protein produced by normal, as well as malignant, cells in the prostate gland. It measures the level of PSA in a man’s blood, with elevated levels often a sign of prostate cancer.

Early detection is key. There have been improvements in the use of the PSA test as a diagnostic tool. The use of a PSA density (PSAD) test helps to further improve the sensitivity of the test and offers a better guide to biopsies of the prostate.

Dr. Aftab Bhatti, Image supplied by Al Tawam Hospital

Treatment

Dr. Omer Al-Derwish: The treatment depends on the stage of the disease. The first step is to evaluate if the cancer is localised, locally advanced or metastatic? For localised prostate cancer, the gold standard is either surgery, which is the removal of the whole prostate and associated glands and sometimes part of the lymphatic system or radiotherapy. In terms of the radical surgery or removal of the prostate, the most advanced technique now is using robotic assisted prostatectomy where we have a detailed view of the prostate. Robotic assisted prostatectomy allows us to have a more detailed and precise resection, as well as the anastomosis of the urethra to the bladder.

Some studies have shown that this improves the tumour control outcome as well as the functional outcome. The main two issues as we know them are urinary incontinence and the risk of sexual dysfunction. Robotic surgery allows us to optimise these outcomes.

Regarding the other techniques, through focal therapy, we can target if the patient has early-stage prostate cancer and if it's localised, then we can target cancer without damaging the rest of the tissue and minimising the local side effects.

With metastatic prostate cancer again, hormonal therapy is the gold standard as prostate cancer depends on the main hormone testosterone for growth and we target the hormone to control cancer. Unfortunately, when the cancer is metastatic, the aim is to control, and the cure rate is lower as we know.

Through efforts to optimise the treatment, we commonly use combination therapy, where we can start with hormonal therapy upfront, in addition to either chemotherapy or second line or monotherapy as well as immunotherapy.

Screening

Dr. Omer Al-Derwish: In the urology community, screening of prostate cancer is one of the challenging and debatable issues. Findings from studies conducted in the U.S. and Europe on the early detection of prostate cancer and its outcomes have been controversial. The European study indicates a mortality reduction up to 29 per cent of the 16 men for early detection of prostate cancer, whilst the American study showed no survival benefit from any detection. What we know from epidemiological studies is that familial or family history of prostate cancer increases your risk. Certain ethnical groups such as Africans also carry an increased risk of having prostate cancer, and hence there are some genetic or gene mutations that can be detected such as BRCA, lynch syndrome and HPC gene 1 and 2. There are no strict guidelines regarding this, but there are methods that we can use for patients who are at high risk for prostate cancer. For early detection, we look at factors such as family history, age (starting at 45), high PSA, clinical examination and using a specific threshold. Genetic studies can then be aligned to predict the risk of having prostate cancer.

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Since our Voice of the Healthcare Industry Market Outlook report in December 2019, the COVID-19 pandemic has affected every single member of the healthcare community, both personally and professionally – and at every level of the supply chain, from manufacture to bedside care.

Through this year's survey, we asked healthcare respondents worldwide about the impact of the events of 2020-21.

Post-pandemic changes

Respondents identified a number of interesting shifts that have taken place as a result of the pandemic and its impact on the industry, which is playing a key role in overcoming the health crisis:

1. A more cautious outlook. While still relatively optimistic, the industry is predicting less of an increase in turnover than in 2019.
2. Value-based healthcare is the future. The industry recognises that it needs to become more cost-effective and sustainable from the ground up, rather than chasing trendy buzzwords.
3. Attracting local patients. With the future of global travel still uncertain, the industry needs to target more local business.
4. Healthcare is moving online. Telemedicine has become a larger focus for a world where face-to-face contact remains a risk to health.
5. Technology is still catching up. Tech overall is having less of an impact than expected. Gaps in tech skills are closing, but not in line with their implementation.
6. Eyes are on the GCC. This region has extremely strong prospects.
7. Medical practitioners are feeling more valued. Doctors and nurses have been on the frontlines of the pandemic, and their work is recognised.
    

About the report

The Voice of the Healthcare Industry Market Outlook 2021 survey was designed by Informa Markets to understand the impact that the pandemic has had on four key areas of the industry: manufacturers and agents, dealers and distributors; clinics and medical practices; private hospitals and public hospitals; government and health regulators; and charities, non-profits and NGOs.

Through GRS Research & Strategy Middle East we asked 1,600 respondents worldwide about the financial and operational impact of the events brought by the pandemic.

The survey also looked to assess how the industry has responded to the pandemic, and how key players have evolved their business strategy. We also asked participants to reflect on how the future will look, and what key trends they are now anticipating. 

Download the full report for free

Click here to download the Voice of the Healthcare Industry Market Outlook 2021

Precautionary measures mandated to combat the transmission of COVID-19 may have resulted in additional health-related challenges, known as disability, experienced by adults who live with HIV.  According to a study physical distancing, community services being on hold, postponement of health appointments and loss of employment were probable factors in patients experiencing social isolation, financial uncertainty and interruption of antiretroviral adherence. To corroborate, WHO states that many countries have warned that they are at risk of stock outs of antiretroviral medicines due to the COVID-19 pandemic.

During the pandemic, disability, in combination with health disparities, stigma, interrupted access to services, drug use, and food or housing instability can make it challenging for individuals with HIV to continue to receive treatment. Participants with HIV reported high levels of uncertainty and mental health issues. All six dimensions of disability rose, with the mental-emotional health domain experiencing the greatest increase.

Strategies that involved retaining a sense of control, as well as optimistic attitudes and beliefs, were related with decreased impairment. A concept derived from the perspectives of patients living with HIV, known as ‘living strategies’, is described as attitudes, beliefs, behaviours and actions to help them cope with multi-morbidity and the disability associated with HIV. This encourages adults who live with HIV to use independent self-care living techniques to subsist uncertainty and the physical, social and mental health issues brought on by of the pandemic.

Solutions guided by technology

Electronic and other new media technologies (eHealth) can help with large-scale information distribution and effective HIV care and preventive activities as well. For treatment and prevention, there has been a proliferation of technology-based delivery methods, including electronic (eHealth) and mobile (mHealth) technology approaches. Mobile and other new electronic technologies, commonly referred to as eHealth, are appealing instruments for health communication and HIV intervention innovation.

These technologies can help with the large-scale distribution of knowledge and effective tool delivery to encourage and maintain behavioural adjustment, HIV testing among uninfected persons, and connection to HIV treatment or PrEP. Smartphone applications (apps) for finding HIV testing services, web-based modules to promote sexual partnership communication, and digital games to teach teenagers about drug use and HIV risk are just a few examples.

Technology is a promising tool for delivering interventions for several reasons, including cost. The cost of implementation once they have been developed is minimal when compared to those that require significant human resources; intervention fidelity is maintained through the standardisation of content; computerised interventions can individually customise intervention content using computer algorithms.

Computer technologies include features such as interactivity and multimedia, which may aid in the fostering of behavioural change; and computerised interventions can be customised by using computer algorithms. Computerised treatments are often brief and adaptable in terms of distribution methods, which might include community-based organisations, healthcare settings, and the Internet.