GenInv – Health and Wellness

The dynamics of healthcare funding in Europe is changing. As governments review their options to meet growing healthcare demands with limited resources, the potential to combine cost reduction with new funding sources will gain support in many countries. Reimbursement decisions in the public sector are becoming increasingly tougher for pharmaceutical and diagnostic manufacturers; the private market offers a potential alternative route to gaining market access.
Private insurers currentl

y play differing roles in European national healthcare systems. This report reviews their role in the major European markets and provides an insight into trends in their coverage of health benefits and products. It highlights selected product areas where private insurance could fill the gaps in public reimbursement . An insight into the European private insurance industry, including overall trends and profiles of leading insurers, provides an indication of future developments within the sector a

nd highlights potential opportunities for pharmaceutical and diagnostic companies to work with private insurers.

Key features of this report

• Reviews healthcare systems and the role of private insurers in the five major European markets of France, Germany, Italy, Spain and the UK.
• Analyzes the healthcare systems in the Netherlands and Switzerland, where mandatory health insurance is purchased from private insurers operating in regulated competitive models. These have parallels with

the State of Massachusetts’ system, which has been considered a blueprint for other US states and for federal reform.
• Examines some of the issues in gaining market access for pharmaceuticals and diagnostics through coverage by private health insurers and highlights initiatives being undertaken by insurers that present potential partnership opportunities for companies.
• Details trends in the private health insurance market, including relative market shares for the main markets in terms of benefits paid for by private insurers.

Scope of this report

• Understand the diverse roles played by private insurance in funding pharmaceutical and diagnostic products in major European markets and the relative importance of private funds in healthcare spending.
• Identify the key players in each market who will be potential targets for gaining market access in the privately-funded sector.
• Review what new opportunities might be afforded in the private sector for products that are denied reimbursement in the public sector.
• Tailor product portfolios to meet differing needs of individual markets.

Key Market Issues

• The function of private health insurance depends on coverage provided by national public healthcare systems. Understanding which type of private health insurance – substitutive/primary, complementary/supplementary or duplicative/competitive – is dominant in each market is key to assessing market potential.
• Gaining reimbursement for medical diagnostic products and treatments in the public sector is becoming increasingly challenging in many countries as the cost and medical necessity of certain products are coming under closer scrutiny by public payors. Some private insurers are showing interest in covering medicines for minor ailments and lifestyle products that are excluded from public reimbursement.
• Managing costs is a challenge for private insurers in the current economic climate as medical inflation and price competition in the industry create additional pressures. Insurers are adapting their portfolios to address market needs, with a focus on disease prevention and promotion of healthy lifestyles.

Key findings from this report

• There are over 84 million Europeans with some form of private health insurance. Germans account for the largest proportion of the privately insured population, with 22.3 million, followed by the Dutch with 16.2 million.
• Healthcare benefits paid by private insurers account for 8% of total European healthcare expenditure, a share that is on course to increase as public payors redefine their benefits package.
• The cost of medicines accounts for a significant proportion of private insurers’ costs in most markets. Around 93% of the French population has complementary health insurance to cover costs not reimbursed by the social health insurance system, with 30% of insurers’ costs going towards the cost of medicines.
• Private insurers provide compr