Healthcare Technologies Resource Guide

A Hot Tip about Medical, Health and Cosmetics Products in Bulgaria

Posted on: 29 Nov 2012

A resource guide jointly sponsored by the U.S. Department of Commerce and Reed Sinopharm on healthcare resources in various countries.

Healthcare Technologies Resource Guide A Reference for U.S. Exporters 2012–2013 Edition Healthcare Technologies Resource Guide A Reference for U.S. Exporters 2012–2013 Edition WHEN IT NEEDS TO GET THERE STAT, CHOOSE THE INTERNATIONAL SPECIALISTS.  With more than 40 years of customs clearance experience and an unparalleled international network – DHL Express guarantees fast, reliable deliveries to and from more places around the world than anyone else. That’s why the life sciences and healthcare industries have come to rely on the International Specialists to get their time-sensitive shipments delivered on time, every time. That‘s the Speed of Yellow. www.simplydhl.com/lifesciences 00000 HTRG_ISCAds_Half.indd 1 9/25/12 11:31 AM 2012 DHL Express (USA), Inc. All rights reserved What Can the U.S. Commercial Service Do for You? The U.S. Commercial Service (CS) is the export promotion arm of the U.S. Department of Commerce’s International Trade Administration. Our global network of more than 1400 trade professionals is located throughout the United States and in U.S. Embassies and Consulates in more than 70 countries. Whether you’re looking to make your first export sale or expand to additional markets, we offer the expertise you need to connect with lucrative opportunities and increase your bottom line. The CS Healthcare Technologies Team works to address issues and trade opportunities specific to the strong and growing healthcare sector, and to ensure you have the information you need to grow your business. This resource guide is just one of the ways we can provide the information you need to set priorities and plan for business growth. Our Services With private and public spending on an upward trend in many countries, the U.S. Commercial Service has the knowledge and expertise to help you develop your international strategy. Market Intelligence • Analyze market potential and foreign competitors • Obtain useful information on best prospects, financing, laws, and cultural issues • Conduct background checks on Potential buyers and distributors Business Matchmaking • Connect with pre-screened potential partners • Promote your product or service to prospective buyers at trade events worldwide • Meet with international industry and government decision makers in your target market(s) Trade Counseling • Develop effective market entry and sales strategies • Understand export documentation requirements and import regulations of foreign markets • Navigate U.S. government export controls, compliance, and trade financing options Commercial Diplomacy • Overcome trade obstacles to successfully enter international markets • Benefit from coordinated U.S. government engagement with foreign governments to protect U.S. business interests • Access U.S. government trade advocacy for your foreign government procurement bids For more information on how CS can help your business increase its international sales, please contact your local CS office. (A list of offices appears at the back of this guide.) We hope you find this guide helpful. Please do not hesitate to contact me directly if I can be of further assistance. We look forward to helping your business achieve its international goals! September Secrist Global Healthcare Team Leader tembi.secrist@trade.gov | iv U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 This Guide Supported in Part by Table of Contents Argentina......................................................................... 2 Australia ........................................................................... 4 Austria .............................................................................. 6 Belgium ............................................................................ 9 Brazil ............................................................................... 11 Bulgaria .......................................................................... 13 Chile ................................................................................ 16 People’s Republic of China ....................................... 19 Czech Republic ............................................................ 22 Denmark ........................................................................ 25 Dominican Republic ................................................... 27 Egypt .............................................................................. 29 European Union........................................................... 31 Finland ........................................................................... 38 The ratings and information in this guide represent the experiences and opinions of the commercial specialists responsible for the healthcare sector at U.S. embassies and consulates worldwide. Sub-sector France ............................................................................. 40 categories are broad and may not all apply to all products within them. The client is encouraged to further Germany ........................................................................ 43 research the market for a particular product or service. Additional barriers to entry (political turmoil, Greece ............................................................................ 49 change in import duties, etc.) may be discovered once a market is further explored. Information in this guide is accurate as of publication date. Guatemala ..................................................................... 54 The U.S. Commercial Service has offices in more than 70 countries, and not all countries are represented in Hungary ......................................................................... 57 this guide. If you are interested in a market not listed here, please contact your nearest local CS office for mor India ................................................................................ 60e information. Contact information may be found in the back of this guide. Disclaimer: The information provided in this report is intended to be of assistance to U.S. exporters. While Indonesia ....................................................................... 63 we make every eort to ensure its accuracy, neither the United States government nor any of its employees Ireland ............................................................................ 65 make any representation as to the accuracy or completeness of information in this or any other United Israel ............................................................................... 68 States government document. Readers are advised to independently verify any information prior to reliance thereon. The information provided in this report does not constitute legal advice. International copyright, U.S. Italy ................................................................................. 70 Department of Commerce, 2012. All rights reserved outside of the United States. Japan .............................................................................. 73 Jordan............................................................................. 76 Kenya .............................................................................. 80 Republic of Korea ........................................................ 82 Kuwait ............................................................................ 85 Mexico ............................................................................ 87 The Netherlands .......................................................... 89 New Zealand ................................................................ 92 Nigeria ............................................................................ 94 Norway ........................................................................... 96 A SCIENTIFIC The Philippines ............................................................ 98 Poland ..........................................................................101 BREAKTHROUGH Portugal .......................................................................105 Romania .......................................................................107 IS MADE IN CHICAGO. Russia ............................................................................109 Saudi Arabia ...............................................................112 THE NEXT DAY IT’S Serbia ...........................................................................117 Singapore ....................................................................121 Slovak Republic .........................................................123 AIDING RESEARCH IN Spain .............................................................................126 Sweden ........................................................................129 MEXICO CITY. Taiwan ..........................................................................132  Turkey ...........................................................................135 Ukraine .........................................................................138 That‘s the Speed of Yellow. United Kingdom (UK) ...............................................141 www.simplydhl.com/lifesciences Resources ....................................................................147 Certification Reference Chart ................................148 Subsector Reference Chart .....................................150 Contacts .......................................................................152 1 00000 HTRG_ISCAds_Quarter.indd 1 9/25/12 11:28 AM Argentina Summary Overall healthcare expenditures in Argentina have traditionally accounted for approximately 7-10 percent of GDP, among the highest in the region. Imports in the overall healthcare sector have been estimated to account for around 70-75 percent of the total market. The United States continues to lead the Argentine import market of medical products and equipment, and currently holds 26 percent market share, particularly in higher-end technology products. Argentina remains a key market for U.S. exports to Latin America. However, market challenges arising from slowing economic activity, inflationary pressures, and a host of import and foreign exchange restrictions imposed by the Argentine Government in late 2011 and early 2012 are expected to adversely affect imports and slow GDP growth in 2012 to 1-2 percent, down from about 8 percent in 2011. Market Entry Imports of medical products must be performed by an importer registered with the ANMAT (the Argentine equivalent to the FDA) as a frequent importer of medical equipment. Imported products appear under the name of the local registered importer who will fulfill the registration process as a representative of the U.S. company. Registration requirements vary according to product classification. The Mercosur common external tariff (CET) applies to imports from countries outside the MERCOSUR area (Argentina, Brazil, Uruguay and Paraguay). The CET currently ranges from zero to 16 percent for medical products plus 0.5 percent in a statistics fee. Current Market Trends Imports of medical equipment, devices and instruments experienced an exceptional surge during 2011 and reached for approximately $778 million, with $198 million of this from the U.S. Import figures may remain sluggish during 2012 and it is unlikely that imports will grow so rapidly during 2012-2013. Main Competitors More than 2000 companies sell medical products and equipment in Argentina, of which 25 percent are manufacturers and 75 percent are importers. Brazil poses strong competition since imports enjoy a zero tariff under Mercosur. U.S., Japanese and European-made equipment is known for its high technology and precision, whereas Argentine equipment, although durable, is generally low- tech. Statistics Contact Capital: Buenos Aires Liliana Paz Population: 41 million Commercial Specialist GDP: USD $380 billion (2010) liliana.paz@trade.gov Currency: Peso (ARS) +54-11-5777-4519 Language: Spanish | 2 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 Domestic production has been growing, although in general it is limited more to lower-middle range equipment and supplies, such as x-ray devices, peripheral equipment, illumination systems, furniture, operating tables, echographs and ECGs, monitors, oximeters, cobalt pumps, anesthesia equipment, sterilization equipment, basic lab equipment, instruments for arthroscopy, fixation instruments, instruments for video endoscopy surgery, wheelchairs, scales, etc Current Demand Medical products that cannot be manufactured locally present opportunities for U.S. exporters, particularly when offering high quality products at competitive prices. Niche opportunities for U.S. exports may include middle and higher-end equipment such as imaging diagnostics equipment, medical ultrasound equipment, and electrocardiograph equipment. There may be potential for implants, stents, cardiac valves, pacemakers, specialized disposables, molecular biology products, and diagnostic reagents. Simpler technology is more easily financed and thus considered mass-market. In this competitive market the demand for these products is for the most part met. In any case, product potential should be determined on a case-by-case basis. Barriers Recent controls have made exporting goods from any country to Argentina more difficult as the Argentine government has imposed more processes that Argentine importers must complete in order to import goods. It is important for would-be exporters to Argentina to confirm that their Argentine customer has: • Received the necessary permission to import; • Received a non-automatic import license if required; and • Obtained permission to purchase foreign exchange to pay for the import prior to shipping goods to Argentina. For more information, please visit export.gov/argentina. Restrictions apply to imports of used medical equipment. Scarce financing available in the local market is an issue. However, two U.S. banks operate in Argentina to offer loans using Ex-Im Bank guarantees to importers of U.S. equipment. Trade Events Expomedical 2012 Buenos Aires • expomedical.com.ar Description: international exhibition of medical equipment, products, and supplies. Parallel seminars. Available Market Research • Medical Equipment, Instruments, and Supplies (2011) • Medical Products Overview (2011) • Dental Products Overview (2011) • Electro Medical Equipment (2010) • Imaging Diagnostics Equipment (2010) • Orthopedic Equipment and Devices (2010) • Clinical Laboratory Instruments and Reagents (2009) | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 3 Australia Summary The medical equipment industry sector has consistently provided good prospects for U.S. exporters. Australia is the eighth largest market for U.S. exporters of medical products. Approximately 80 percent of medical devices and diagnostics used in the market are imports. The three major suppliers are the United States, the European Union, and Japan. U.S. medical equipment is traditionally well received due to its perceived high quality. The market is sophisticated, mature, and quick to adopt new healthcare technologies. Importers seek to obtain cost-effective and innovative products that will improve patient outcomes and reduce healthcare costs. Market Entry Successful market entry strategies for Australia have three common elements: understanding the market, selecting the optimal partner, and providing ongoing support to that partner. It is important to gain an understanding of the Australian context for a product or service, its competitors, standards, regulations, sales channels, and applications. Success in the market will require appointing an Australian distributor or establishing a local subsidiary, and setting up a local sales presence. Typically, distributors for medical products will cover the entire country and some may also have a subsidiary office in New Zealand. Given the Australian continent is the same size as continental U.S., as well as its distance from other countries, local support and service is important. Most of the criteria American firms use to select distributors are applicable to Australia, with expectations adjusted to the scale of the market given the population of 22.6 million. Performing due diligence on potential local partners is just as important as in the United States. Current Market Trends Australia has a high per capita income and there is demand for a full range of medical equipment. The $5 billion market is price sensitive and competitive. Australia spends approximately 9.1 percent of its GDP on healthcare, which is similar to Italy, Spain, and Ireland but less than the United States. Australia’s ageing population will significantly influence the demand for products and products that serve the ageing population are likely to experience growth. The growth of chronic disease in Australia is similar to that in other developed nations. Australians increasingly suffer from asthma; cancer; diabetes; obesity; heart, stroke, and vascular disease; osteoarthritis, rheumatoid arthritis; and osteoporosis. Opportunities exist for technologies that avert or reduce disability because of these diseases. Statistics Contact Capital: Canberra Monique Roos Population: 22.6 million Commercial Specialist GDP: USD 1.507 trillion monique.roos@trade.gov Currency: Australian Dollar (AUD) +61-2-9373-9210 Language: English | 4 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 Main Competitors Imports supply approximately 80 percent of Australia’s demand for medical equipment. Key suppliers include the United States, the European Union, Switzerland, and Japan. Many suppliers in the Australian industry are subsidiaries of overseas corporations. The major American medical companies represented in Australia (either through local representatives or subsidiary offices) include Bard, Baxter Healthcare, Boston Scientific, Cook Medical, Johnson & Johnson Medical, Medtronic, St. Jude Medical, Stryker, and Zimmer. U.S. companies may experience strong competition from American firms or multinationals already in the market. Current Demand Australia’s high standard of medical practice and aging population underpin a continued demand for a range of sophisticated, high quality, and innovative medical equipment. Importers seek to source cost-effective and innovative products that will improve patient outcomes and reduce healthcares cists. Opportunities exist for products that provide a significant improvement in clinical outcomes, and product with clearly differentiated capabilities. There is also a growing demand for products that lead to faster patient recovery, reduce hospital and rehabilitation costs, and alleviate or manage disability and chronic pain. Government healthcare policies and public health influence the volume and pricing of healthcare products and services. Both the public and private sectors provide healthcare in Australia. Federal and State government spending accounts for 70 percent of total healthcare expenditure. The non- governmental sector (individuals and private health insurance) funds are the remaining 30 percent. Approximately 45 percent of Australians have private health insurance. Registration Process The Therapeutic Goods Administration (TGA) regulates the medical equipment industry. Australia’s regulatory framework is based on Global Harmonization Task Force (GHTF) and European Community guidelines. U.S. exporters must appoint an Australian representative/sponsor to obtain regulatory approval from the TGA. U.S.-manufactured medical devices require an EC Certificate from a European Union Notified Body. Alternatively, U.S. manufacturers can apply to the TGA for a Conformity Assessment Certificate. Further information is available at tga.gov.au. Trade Events AusBiotech 2012 October 30–November 2, 2012 • Melbourne Convention & Exhibition Centre • ausbiotechnc.org AusBiotech 2013 October 29–November 1, 2013 • Brisbane Convention & Exhibition Centre • ausbiotechnc.org | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 5 Austria Summary Austria is a dynamic EU member country with an affluent population of 8.4 million German speakers. Austria’s manageable size and stable business environment makes it an attractive market for U.S. exporters, as well as an attractive test market for U.S. firms with an eye toward expanding into neighboring Germany. Austria’s historical and economic ties to the strong growth markets of Eastern and Southeastern Europe also make it a logical base for serving those markets. Currently, 333 U.S. firms have subsidiaries, affiliates, franchisees, and licensees in Austria, of which about 220 have regional responsibilities for Central European, Eastern European, or Balkan countries. U.S. products and services maintain a good reputation in Austria. Austria is currently at the end of an extraordinarily strong immigration-induced population growth phase. Since the mid-eighties, the population has grown by half a million inhabitants to the current 8.4 million, due to the unexpectedly high level of immigration. Since 1996, this dramatic increase in immigration has stabilized. The population will therefore only grow slightly in the coming decades. The Central Austrian Statistics Office estimates that in the year 2020, approximately 8.7 million people will be living in Austria—a 9.5 percent increase from 1996 levels. In 2030, almost 9 million people are expected to live in Austria. This constitutes an increase of 6.9 percent compared to today’s 2011 level. One of the major socio-political health challenges of the coming years is the rapid growth of the elderly population. The number of people over 60 years of age is currently approximately 1.8 million. This figure will have reached at least 2.8 million by the year 2030. At the present time, 20 percent of Austrians have reached retirement age, and it is projected that more than one third of the total population will be retired in the year 2021. In 2010, Austrian imports of medical equipment were $1,865.3 million. We expect the 2011 imports, once published, to show an increase to $1,982.7 million. Total demand for medical devices in Austria added up to $1.2 billion, while exports of this equipment amounted to $1.8 billion. Austria is a transit- trade country with strong trade relationships with Central, Eastern and Southeastern Europe, as well as the Middle East. The re-exportation of products is quite common here; hence the volume of imports exceeds the total market. Taking into consideration these re-exports, imports are expected to increase at an average annual real growth rate of 3%. The Austrian size of the market for medical equipment should also increase about 3% annually over the next three years. Statistics Contact Capital: Vienna Manfred Weinschenk Population: 8.4 million Senior Commercial Specialist GDP: USD 419 billion (2011) manfred.weinschenk@trade.gov Currency: Euro (€) 43 (0) 1-313 39-2285 Language: German | 6 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 Market Entry U.S. firms should plan their market entry very carefully. Given its location in the center of Europe and the size of its market, small enough to allow a quick overview, Austria stands out as a desirable, affluent pilot market for advanced U.S. products. The best strategy is to screen potential distributors and select a qualified local distributor. Austrian distributors are usually knowledgeable and experienced. They regularly call on hospitals, clinics, laboratories, and medical doctors with practices. The majority of distributors are fluent in English. They are also knowledgeable about EU approval procedures and will obtain approval for U.S. suppliers if needed. The successful U.S. supplier should discuss and agree on a marketing strategy with a prospective distributor. Once the agent or distributor is selected, it is preferable to maintain this relationship for a number of years. Abrupt changes in distribution patterns distract users from trusted suppliers and have been detrimental to U.S. suppliers who have taken such action in the past. It may take up to two years to introduce a new product due to the conservative and complex nature of the Austrian market. The metric system of weights and measures is standard in Austria. The electric power supply is 230/400 volt, AC 50, 1 or 3 phases. Current Market Trends U.S.-made products that are on the cutting-edge will have great potential, as Austrians expect hospitals to have the latest technology. The trend, however, is to reduce the number of hospital beds and to close down some hospitals altogether. Therefore, American companies that are interested in hospital construction or in the sale of “routine” hospital equipment and supplies may find their prospects reduced over the next few years. Projected growth rates for different imaging products vary considerably. The Austrian market for medical equipment is constantly evolving and utilizing increasingly sophisticated products. Scanning units have benefited from technological improvements since their introduction about 30 years ago. Most suppliers now offer user-friendly features like image networking, which enable the user to digitally store and project high-quality images. These products should have very good prospects in the future. Austria is an interesting market for echographic units. This ultrasound technique continues to gain popularity as the industry discovers new applications for it. Recent technological advances have enabled manufacturers to implement Doppler technology and sophisticated probes within their designs. Sales of conventional radiology apparatus (traditionally, the most popular type of equipment) have declined over the last several years. The recent ability to digitalize this out-dated equipment, however, has sparked new interest in traditional radiology. Interventionism radiology is the most recent development in the medical imagery field. A combination of radiology and surgery, interventionism radiology has resulted from advances in vascular radiology, digitalization techniques and catheter performance. It promises to have a strong future. There is also an increasing demand for all kinds of in-vitro products in Austria. Main Competitors The great majority of medical equipment used in Austria is imported. U.S. manufacturers have seized a substantial share of the market and are now the second-largest supplier group, following German companies. German competition enjoys the advantages of geographic proximity, a common language, and products with the same standards, no exchange rate problems, and duty-free access through Austria’s membership in the EU. | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 7 The Austrian market for medical equipment is sophisticated and well-served. Industry giants such as Siemens, Philips, Hitachi, and Toshiba are well entrenched. General Electric GmbH, Agilent Technologies Oesterreich GmbH, Nova Biomedical GesmbH, and Tyco Healthcare Austria GmbH are only a few of the Austrian subsidiaries of U.S. medical device suppliers. Against the heavy German competition in this market, American products can usually compete well on the basis of price and innovation. Current Demand The following high-quality products and devices are currently in demand in Austria: • Nuclear medical instruments (nuclear • Scanners, computer tomography imaging magnetic resonance scanners) systems, magnetic resonance imaging • Diagnostic apparatus including cardiology • Dialysis equipment instruments, echocardiography systems, • Pacemakers advanced electrocardiograph equipment, • Sophisticated digitalized x-ray equipment monitoring systems,ultrasound equipment, gynecology and urology diagnostic systems, • Clinical laboratory equipment including blood and endoscopes cell counters, and blood gas analyzers • In-vitro diagnostic products The trend is moving toward miniaturization of electro-medical devices and nano-technology products. Registration Process All U.S. medical devices have to be marked with the mandatory CE (Conformité Européenne) conformity mark. With the CE marking on a product, the manufacturer ensures that the product conforms with the essential requirements of the applicable EC directives. Deviating from sector directives regulating other industrial goods, medical devices have to comply with “essential requirements” as described in Annex I of Directive 93/42/EEC. According to this, medical devices must not only be safe but must also function in a medical-technical way as described in the manufacturer’s “intended purpose.” Compliance with these requirements is proved within a certified quality management system according to EN ISO 13485. Barriers Austria is a highly developed open market with relatively liberal policies and sharp competition. The import climate is favorable towards U.S. products. American exporters, like domestic and European firms, are subject to packaging and other collection, recycling, and reprocessing laws. There are no significant trade barriers or limitations on U.S. medical devices. Trade Events At the present time, there is no general medical fair planned in Austria. Some smaller specialized medical exhibitions are organized in connection with medical conventions. The great majority of Austrian medical importers/distributors regularly attend the most important European medical fair: MEDICA November 14–17, 2012; November 20–23, 2013; November 12–15, 2014 Messe Duesseldorf GmbH, Duesseldorf, Germany Considered the world’s most important and largest international fair for medical equipment, the annual MEDICA draws 134,000 trade visitors from 85 countries. Over 5,200 distributors from 65 foreign countries are able to exhibit with over 2.8 million square feet of space in 17 halls. Available Market Research • Austria—Dental Industry Market Brief 2011 • Austria—In-Vitro Diagnostics 2011 | 8 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 Belgium Summary Belgium produces less than 10 percent of its overall needs for medical equipment. This leaves the market open for heavy competition among suppliers from the U.S., Germany, France and Great Britain. The United States currently has a 20 percent share of total medical equipment imports into Belgium. In 2010, the Belgian market for medical equipment was estimated at $4.2 billion and employed 18,000 people. Belgium imported approx. $1.9 billion worth of medical equipment from the U.S. in 2010. Over the past 5 years, this sector has seen an annual growth of approximately 3 to 4 percent. The Belgian Social Security System, which includes the Health Care System, is considered among the most extensive and efficient in Europe. It covers nearly 100 percent of the population of 10.5 million inhabitants. In 2010, total healthcare expenditure was estimated at $28 billion. Market Entry Belgium is an effective starting point for marketing medical equipment to the rest of Europe due to its geographical location, its effective healthcare system, and its relatively open attitude regarding procurement. Belgium is a distribution center for many multinationals: products are imported into Belgium and exported to other European countries. In order to enter the medical equipment market in Belgium American suppliers should be familiar with the EU directives concerning the registration, marketing, and health/safety standards required throughout Europe as well as regulations specific to Belgium. It is therefore advisable to work with a local partner/ distributor. The following EU directives were transposed into national law: • Directive 90/385/EEC on active implantable medical devices • Directive 93/42/EEC on medical devices • ec.europa.eu/health/medical-devices/regulatory-framework Current Market Trends Belgium’s healthcare system is currently facing several challenges. Belgium’s growing aging population and the higher health expectations will have an important impact on healthcare expenditures in the coming years. The GOB is therefore looking at various cost-saving measures. Thus, innovative technologies and equipment offering cost savings will have a strong market Statistics Contact Capital: Brussels Danny Dumon Population: 10,438,353 Commercial Advisor GDP: USD 418.6 billion (2011) danny.dumon@trade.gov Currency: Euro (€) +32 2 811 5476 Language: Dutch, French, German | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 9 potential. Orthopedic products, homecare products, obesity and diabetes products are as a consequence in high demand. Furthermore, there is a trend towards miniaturization of medical devices allowing more minimally-invasive and non-invasive procedures. Medical software, telemedicine and e-health are also sectors with a strong market potential. Main Competitors Belgium has approximately 800 companies manufacturing or distributing medical products. The majority of these firms are small or medium-sized, employing an average of 20 to 50 people. Belgian suppliers do well in niche markets, including diagnostic imaging, cancer diagnosis, and teleradiology. Belgium is home to many subsidiaries of American companies such as GE Medical Systems, 3M, Abbott Vascular, Baxter, Johnson & Johnson medical, Medtronic, Becton Dickinson, Boston Scientific, Cyberonics and St. Jude Medical. Siemens and Philips also have a strong presence in Belgium. Current Demand Best prospects: • Innovative technologies • User-friendly home care • Consumables products • Minimally invasive and non- • Orthopedic products invasive equipment • E-Health • Implantable products. • Telemetry Registration Process The distribution of medical devices is regulated by Belgian law. Distributors of Medical devices including active implantable devices should notify the Federal Agency for Medicines and Health Products. For more information, please visit fagg-afmps.be/en. Medical devices must bear the CE marking for conformity when marketed. Custom made implantable and non-implantable devices and devices for clinical investigation do not require CE marking. If a notified body has been involved in verifying the procedure of conformity, the CE marking must be accompanied by a four-figure number indicating the notified body. For more information, please visit export.gov/cemark. Barriers There are no significant barriers on U.S. medical devices. Trade Events Healthcare October 2014 • Brussels, Belgium • health-care.be Trade show for home healthcare products. | 10 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 Brazil Summary Brazil is the largest medical equipment market in South America. It may account for approximately U$ 8 billion in sales in 2013. The total market for medical equipment in Brazil should continue to expand approximately 15% through 2012. Brazil is both a major medical equipment producer and importer. Imports of medical products increased 15% in the first months of 2012. The United States accounts for approximately 30% of the import market, with U.S. sales mainly going through local agents, distributors and importers who sell to hospitals and clinics. The market for electro medicine equipment is around US$260 million, which represents approximately 50% of total sales in Latin America. Market Entry For medical products, it is necessary to have a local agent or distributor to import products from manufacturers. Because of regional economic disparities, varying states of infrastructure, and a host of other issues, it is often difficult to find one distributor that has complete national coverage. Main cities are São Paulo, Rio de Janeiro, Belo Horizonte, Brasília, Porto Alegre, Salvador, Recife and Curitiba. Either setting up a company in Brazil or acquiring an existing entity is an investment option for Brazil. Setting up new companies is relatively complex, although the Ministry of Development has signaled a desire to simplify the process. Companies are also joint venturing with Brazilian industries for final assembling and packaging of products. This process reduces import duties and documentations that are required for finished goods. Current Market Trends Brazil’s recently strengthened currency has meant that private and public hospitals have greater purchasing power, and with continued expansion of Brazil’s private health care sector, the market should grow. New opportunities for US exporters abound, particularly for: • Clinical Chemistry, Biomedical and • Disposables and surgical—high advanced medical devices—high consume from private and public demand for new technologies hospitals • Laboratory equipment— • Diagnostic devices and investments in R&D, including monitoring equipment—high some duties and registration demand for innovative products exemptions Statistics Contact Capital: Brasília Jefferson Oliveira Population: 192,000,000 Commercial Specialist GDP: USD 2.367 trillion jefferson.oliveira@trade.gov Currency: Real 55-11-5186-7136 Language: Portuguese | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 11 to replace bigger and more expensive • Dental—Brazil has one of the highest number equipment of dentists in the world • Orthopedics and Implants—high demand of • Drugs, Pharmaceuticals and Nutrition imported products, despite higher sanitary Supplements—high dependency on imported requirements products. New rules to facilitate imports of supplements. High demand for modern life • Health IT—demand in hospitals, including products. education and second opinion programs Main Competitors There are few high-quality Brazilian manufacturers of advanced medical products so Brazil’s reliance on imports should continue for some time. Local buyers view US and other foreign products (mainly Canadian and European) as having comparable quality and reliability. Thus, financing terms often become the differentiating criteria in making a sale. Current Demand An interesting trend in Brazil is the growing market for home health care products, which has increased dramatically in recent years. Brazil has approximately 150 home health care companies compared to approximately 1,440 in the US. In Brazil, these companies are increasingly viewed as good ways to cut hospitalization costs while offering better services for patients. Brazilian health insurance companies are responsible for paying 99% of the costs related to home care treatment, and as such, the U.S. Commercial Service sees the market for home health care products growing dramatically during the coming years. Brazil’s Regional Nursing Council is currently developing procedures on how to regulate this market, including standards for health professionals. In addition to the attractive size of the Brazilian medical market, US exporters should consider the opportunities offered by Mercosur, and use Brazil as a “spring board” for export into Argentina, Uruguay and Paraguay. Since compulsory product registration before sale is required for all of Mercosur countries, US exporters should consult a local lawyer/consultant before signing a contract with any agent/ distributor. Barriers Medical products in Brazil are highly regulated by Anvisa, the Brazilian counterpart of FDA. All products must be registered or be notified in order to be commercialized. For products with higher grade risk, it may be necessary to have additional local certifications, international market data and even inspections in manufacturing plants. Import system is very complex and can add up to 100% fees over products. For a more detailed explanation of this system please visit focusbrazil.org.br/ccg/PDFs/chapter5_traderegulations.pdf. Trade Events Hospitalar May 21–24, 2013 • São Paulo, Brazil • hospitalar.com This is the largest medical event in Latin America and one of the best opportunities to U.S. firms that are looking for business partnership in Brazil. Hospitalar is focused on Medical Equipment, Orthopedic Rehab, Clinical Chemistry, Dental, Pharmacy and Hospital Services. Available Market Research Industry highlights available at export.gov/brazil. | 12 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 Bulgaria Summary The Government of Bulgaria is implementing a fundamental reform of its healthcare sector. The health sector reform project has several components, the first one being reform and sustainability of the primary and ambulatory care sector. It provides practice equipment for primary health care and training in general practitioner (GP) practice management. The project also funds physician’s offices’ information systems, an information campaign and a labor adjustment strategy, as well as a health reform investment program to provide low-interest loans to physicians. The second component targets reform of the hospital system, including introduction of Clinical Paths, similar to Disease Related Groups (DRG), assigning critical-diseases‘ tenders to be run by hospitals instead of Ministry of Healthcare; funding hospital information systems, financing a health reform investment program, reduction in number of hospitals; optimizing their functionality and funding a labor adjustment strategy. The third component aims at assisting the National Health Insurance Fund (NHIF) in establishing the technological infrastructure for efficient functioning of the insurance system, including necessary hardware and software systems, as well as training and technical assistance required. The fourth component is aiming at strengthening the management and institutional capacity of the Ministry of Health, the NHIF, and the health system in general. Another aspect of the healthcare reform relates to measures taken for the eradication of pandemic diseases. As an entry point to EU veterinary markets, Bulgaria is required to undertake strict sanitation and eradication measures relating to veterinary pandemic diseases such as Classic Swine Fever, Foot-and- Mouth disease, and Bird Flu. The Bulgaria Ministry of Agriculture and Food is responsible for these efforts. Bulgaria’s healthcare budget for 2009 and 2010 amounted to 1.573 billion EUR and 1.329 billion EUR respectively. The healthcare budget for 2011 amounted to 1.659 billion EUR (4.2% of GDP) and for 2012 it is estimated at approximately 1.875 billion EUR. For the long-term period 2001 through 2012 the healthcare budget ranged between 3.8 to 4.4% of GDP. The current health sector strategy urges increasing the demand for all subsectors‘ modernization and upgrades, which in general translates into: Statistics Contact Capital: Sofia Uliana Kanelli Population: 7,476,000 Commercial Specialist GDP: USD 53.51 billion uliana.kanelli@trade.gov Currency: Bulgarian Lev +359-2-939-5706 Language: Bulgarian | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 13 • Demand for invasive and noninvasive surgery equipment, oncology, ultrasound equipment, in- vitro diagnostic equipment, urology equipment, laboratory and testing equipment, diagnostic imaging equipment, equipment for haemodialysis, tissue and blood bank related equipment, veterinary turnkey project equipment, hospital care equipment, information systems, modern patient monitoring systems, hospital management systems, new high tech products such as laser instruments, MRI and computerized systems for cosmetic, dental, aesthetic and restorative medicine. • X-ray systems, dental mechanical tools and instruments, dental surgery services, surgical tools, chairs, ultrasound equipment, photopolymer equipment, physiotherapy equipment, abrasive tools, maxillary surgery, anesthetics, sterilizing equipment, fittings, appliances, metal workplaces, ceramic work places and plastic workplaces • Telemedicine and the introduction of an electronic healthcare portal to be based on unified healthcare database files for every Bulgarian citizen fully compatible with EU standards. Market Entry There are no specific challenges to the business environment which could be considered a serious threat. The institutions responsible for regulatory monitoring of market entry rules and laws are the Ministry of Healthcare (www.mh.government.bg), Bulgarian Drug Agency (bda.bg), National Health Insurance Fund (nhif.bg), National Veterinary Institute (vetinst.bg) Current Market Trends Among the healthcare short term priorities outlined by current and former Ministers are the improvement of prophylaxis and prevention in the fields of maternal healthcare, improvement of emergency care, improvement of junior dental healthcare, early diagnostics of breast and prostate cancer; introduction of new non-invasive surgeries, reduction of prices for drugs; introduction of high- tech biotechnology and products. Another aspect of healthcare reform is related to the measures which have to be introduced by the Bulgarian Ministry of Agriculture and its newly established Food Safety Agency concerning sanitation and eradication of pandemic diseases. Being the entry point to the EU veterinary markets, Bulgaria is mandated to carefully and strictly undertake sanitation and eradication measures of any possible veterinary pandemic diseases such as Classic Swine Fever, Foot-and-Mouth disease, Bird Flu. Main Competitors Main competitors are all major EU companies which have maintained a presence in the local market for decades. Some Asian firms are also present in the local healthcare market. Current Demand Best sales prospects are generally outlined in the previous sections of the present report. Registration Process Mandatory required certifications are the CE mark as well as some ISO standards such as ISO 9001, ISO 13485, ISO 13795. Medical equipment and consumables, which are subject to the mandatory registration regime can be viewed on the web page of the Bulgarian Drug Agency (bda.bg). Few exceptions are made in cases where Bulgaria has Mutual Recognition Agreements with individual US companies, which have production facilities outside of the USA. Barriers There are no significant barriers on healthcare products in Bulgaria. | 14 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 Some tariff and non-tariff barriers are reported in the pharmaceutical market sub-segment which are reported by the LAWG in Bulgaria and are included in the National Trade Estimate report. Trade Events Medicus, Dento, Galenia October 30–November 2, 2013 • Plovdiv, Bulgaria Pharmaceuticals, laboratory equipment, and dental technology. BaSS (Balkan Dental Society) Meets annually • Varna, Bulgaria American Healthcare & Natural Products Expo 2013 February 29–March 1, 2013 US healthcare technologies, products, and equipment Available Market Research • Bulgaria Dental Equipment Market Overview • Bulgaria Pharmaceutical Market Overview | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 15 Chile Summary As the United States-Chile Free Trade Agreement (FTA) concludes its eighth year, trade in products and services continue to be a resounding success. As of January 1, 2004, duties were reduced to zero on 90% of U.S. exports to Chile with all remaining tariffs to be phased out by 2015. In 2011, bilateral trade between the United States and Chile reached US$ 24.8 billion, an over 300% increase over bilateral trade levels before the U.S.-Chile FTA was implemented. U.S. exports to Chile in 2011 reached a record US$ 15.8 billion while imports from Chile reached US$ 9 billion. In 2010, the United States and Chile concluded the negotiations of a bilateral tax treaty that has not yet been ratified in either Congress. The United States remains the single largest cumulative direct investor in Chile, representing 24% of all net foreign direct investment from 1974 to 2011. Spain follows closely with 20.8%, and Canada is third at 18.5%. However, Canada has led all nations in investment from 2009 to 2011. Macroeconomic stability and growing integration with international capital markets has earned Chile an A+ credit rating, the highest in Latin America. Chile remains one of the most stable and prosperous developing nations and consistently ranks high on international indices relating to economic freedom, transparency, and competitiveness. It also fares very well in terms of democratic development, gross domestic product per capita, freedom of the press. Chile spends approximately 7% of its GDP in healthcare. The 2012 public healthcare budget considers strengthening primary healthcare attention, and the construction of 24 new outpatient centers. This focus is based on the epidemiologic reality of the Chilean population: there has been an increase in chronic diseases, the population is aging, and many primary healthcare conditions go unsolved. To achieve this goal, the plan considers an increment in the number of healthcare professionals, the reconstruction of 7 hospitals, and investment in information technology for interconnected digital medical records. The public healthcare system is comprised of 183 hospitals: 59 high- complexity, 24 medium-complexity and 100 low-complexity hospitals. In all, the public sector has approximately 26,300 beds. In the private sector, there are 109 hospitals, with approximately 15,000 beds. There are a considerable number of expansion projects currently ongoing in the private sector, and also new investments in the sector are considered nationwide. FONASA, the government-run healthcare insurance system, covers 75% of the population; of the remaining 25%, approximately 5% lacks any type of insurance, and 20% (bordering on 2.6 million people) pay into the private sector insurance system provided by 7 entities called ISAPRES. Since 2005, Chile has a healthcare Statistics Contact Contact Capital: Santiago Veronica Pinto Claudia Melkonian Population: 17 million Commercial Specialist Commercial Assistant GDP: USD 248.9 billion veronica.pinto@trade.gov claudia.melkonian@trade.gov Currency: Peso (56-2) 330-3369 (56-2) 330-3312 Language: Spanish | 16 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 program, consisting of government-funded subsidized healthcare coverage for currently 69 diseases considered to be high-incidence. Information on the pathologies covered by this program may be found at www.fonasa.cl/wps/wcm/connect/Internet/SA-General/Asegurados/Plazos+del+Auge Market Entry U.S. medical equipment and devices are well regarded in Chile. A strategy that has proved successful for U. S. companies interested in the Chilean market is to appoint a qualified agent or distributor. Chilean distributors in the medical sector are usually knowledgeable, experienced, and with a good network of sales people throughout the country. Reliable after sales support is a priority in this market. The metric system of weights and measures is standard in Chile. The electric power supply is 220V 50Hz. Since the implementation of the U.S.-Chile Free Trade Agreement, in 2004, medical equipment, medical devices, and pharmaceuticals enter Chile duty-free, provided a U.S. certificate of origin is presented to Chilean Customs. Imports to Chile, alike all foreign and domestic products are subject to Chile’s 19% VAT (Value Added Tax). Mandatory registration at the Institute of Public Health is required for all pharmaceuticals. Medical devices such as preservatives, gloves, needles, and syringes have to be quality tested. The Ministry of Health is currently discussing imposing special requirements for medical implants in the near future. Current Market Trends U.S. state-of-the-art medical technology has good market potential in Chile, especially in the private sector that has considerable expansion projects. The Chilean private healthcare system is well regarded in the region. Private hospitals receive foreign patients for treatment on a regular basis, Some of these private hospitals have Joint Commission accreditation; therefore maintaining high standards is a permanent goal. Many Chilean physicians have U.S. post-graduate degrees and maintain regular contact with important U.S. healthcare institutions. Main Competitors The majority of the medical equipment present in the Chilean market is imported. Local statistical data shows that the United States has approximately 40% of Chile’s market share, followed by Germany with some 15%, and Japan with approximately 7% market share. Price is an extremely important factor, especially in the public sector where limited funds cover a large segment of the population. The private sector is also price sensitive, but is far more likely to consider recognized brands that have good quality and after-sales reputation. Current Demand The following list of equipment is currently on demand in Chile: • Autoclaves • Echo tomography equipment • Surgical tables • Mobile incubators • Non-disposable and disposable surgical • Trauma equipment instruments • Anesthesia instruments and appliances • Cardiology equipment including pacemakers • Ophthalmoscopes • ECG monitors (low and medium complexity) • Hospital beds • Ventilators Contact • Infusion pumps Claudia Melkonian • Aspiration pumps Commercial Assistant claudia.melkonian@trade.gov • Central monitors (56-2) 330-3312 | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 17 Barriers Chile has a favorable import climate. There are no known barriers to U.S. medical equipment, devices, pharmaceuticals, laboratory equipment, or diagnostic test. Trade Events Expo Hospital July 24–26, 2013 • Espacio Riesco, Santiago, Chile • fisa.cl International trade fair for equipment, devices, technology, and services used in the healthcare industry. Available Market Research • Medical Equipment Industry Overview, 2011 • Nutritional Supplements Industry Market Insight, 2010 • Cosmetics Industry Overview, 2010 • Pharmaceutical Industry Overview, 2009 | 18 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 People’s Republic of China Summary China is now the world’s 2nd largest market for medical equipment. It offers significant potential for U.S. companies interested in expanding into the Chinese market with the huge demand for better healthcare services driven by increasing aging population and improved medical insurance coverage. While the Chinese medical device companies provide low to mid-range technology and products, they generally lack the expertise and experience deemed appropriate by Western standards. The Chinese also view foreign medical device companies as more credible than their Chinese counterparts. The Chinese healthcare market is poised to be explored by those foreign enterprises interested. Market Entry According to statistics from World Trade Atlas (China Customs), by the end of 2011, China’s import and export value reached US$21.6billion, an increase of 23% over 2010. Please see the top three countries in the import and export of medical equipment to China from 2010 to 2011. It shows that U.S. is the top exporter of medical devices to China, accounting for over 30% of the total followed by Germany and Japan: Country/ Medical Device Import Value Medical Device Export Value (in USD billions) (in USD billions) Region 2010 Share % 2011 Share % 2010 Share % 2011 Share % World 7.17 100 8.54 100 10.39 100 13.06 100 U.S. 1.79 32 2.06 30 3.59 33 4.43 32 Germany 0.5 8 0.62 7 1.8 18 2.34 19 Japan 2.83 8 0.96 8 1.68 14 2.07 14 Source: World Trade Atlas (China Customs). HS Code: 9018, 9019, 9020, 9021, 9022,382200,902780,902750,902730,902720 Current Market Trends China is the most promising medical device market in the world. Its annual growth rate has been at 15% to 20% depending on products. Based on the BMI (Business Monitor International) report, China’s medical equipment market reached a total size of RMB117 billion (US$18.2 billion) in 2011. Major Statistics Contact—Beijing Contact—Guangzhou Capital: Beijing Shuyu Sun Lena Yang Population: 1.35 billion Senior Commercial Specialist Commercial Specialist (est. 2011) shuyu.sun@trade.gov lena.yang@trade.gov GDP: USD 7.212 billion 8610-8531-3946 86-20-8667-4011 x612 Currency: Renminbi (Rmb) Contact—Shanghai Contact—Chengdu Language: Mandarin Chinese Lynn Jiao Ling Chen Commercial Specialist Commercial Specialist lynn.jiao@trade.gov ling.chen@trade.gov 86-21-6279-8750 86-28-8558-3992 x6567 | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 19 driving factors include demand for better healthcare services, the increasing aging population, and the improved and full medical coverage for all nationals .Recently, the Ministry of Health (MOH) has issued the notice to promote the development of non- public medical institutions to meet the shortage of medical resources, requiring giving priority approval should be given to privately-invested medical institutions that meet entry standards when adjusting or increasing new healthcare resources. It stated that by 2015 the number of beds and services should account for about 20% of the total. This will lead to greater needs for medical equipment in the future. Main Competitors Depending on the specific type of products, foreign competitors are those from EU or Japan as their respective markets for healthcare are structured and well developed. Current Demand Chinese end users consider U.S. products to be of superior quality and most technologically advanced. China’s hospitals particularly welcome medical equipment and products with high content of technology. At the same time, domestic medical device companies are consolidating, upgrading quality, and beginning to compete in medium-level technology niches. Registration Process All imported medical devices are required to register with the State Food and Drug Administration (SFDA) before being sold in the Chinese market. The SFDA has a comprehensive system for medical device registration and inspection, which includes product type testing and factory audits. Medical devices are divided into three classes depending on levels of risks similar to but stricter than that of USFDA. Clinical trials are required for registration of Class III and some Class II medical devices. The process normally takes from one to three years. Barriers Barriers exist with an uncertain regulatory environment and extensive delays in registration and re- registration of products, although efforts are reportedly being made to reduce the large backlog. Additionally, pricing, tender, and bar code systems also play a role of delaying a company’s entry into the Chinese medical device market. Trade Events China Med 2013 March 28–30 • Beijing • www.chinamed.net.cn/en One of the most influential exhibitions in Chinese medical instruments and equipment industry. China International Medicinal Equipment Fair (CMEF) 2012 Autumn October 18–21 • Chengdu, Sichuan China International Medicinal Equipment Fair (CMEF) 2013 Spring Date TBD • Shenzhen • cmef.com.cn/en Founded in 1979, CMEF is held twice a year in Spring and Autumn. CMEF has become the largest exhibition of medical equipment and related products and services in the Asia-Pacific region. | 20 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 MEDTEC China 2013 September • Shanghai • medtecchina.com/index.php?page=home-en Allows manufacturers access to the latest technologies, techniques, and equipment. Experts now attend MEDTEC China on an annual basis to view and learn, to meet suppliers, and to attend seminars. Care & Rehabilitation Expo China 2013 November • Beijing • crexpo.com.cn/english China’s largest exhibition focused exclusively on the care and rehabilitation industry. SINO-Dental 2013 June 9–12 • Beijing • sinodent.com.cn/en China’s largest dental exhibition, organized by the Ministry of Health. In 2011, 74241 professionals from 80 countries and regions were in attendance. Available Market Research • Clinical Laboratory Market: buyusainfo.net/docs/x_5325735.pdf • Ophthalmic Equipment and Products Market: bit.ly/NkQbIX • Gynecological Devices and Products: buyusainfo.net/docs/x_3244830.pdf • Pre-hospital Emergency Medical Service and Equipment: buyusainfo.net/docs/x_918621.pdf • Measures for the Administration of Medical Device Registration (English Translation): buyusainfo.net/docs/x_525872.pdf | U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 21 Czech Republic Summary The health care sector is very active and prominent in the Czech Republic. Czech healthcare system reform has been one of the most important political topics. Massive changes were prepared in two stages—from January 1st and then from April 1st 2013. The first stage includes changes in fees, above-standard services and a switch of insurance companies. The second stage brings three reform bills—on health services, specific and emergency health services, and an amendment to the Act on Public Health Insurance. The system is predominantly financed by the public sector through mandatory insurance. Approximately 76.6% of total health expenditures are covered by compulsory health insurance; the state and territorial budgets covered 7.2% and private voluntary expenditures covered 16.2%. The share of private expenditure in the total expenditure on health rose particularly after year 2008 due to new regulation fees in health services. Total expenditure on health amounts to nearly $14 billion ($1.330 per capita), which represents about 7.7% of the country’s GDP. The market has proved generally resilient to the economic downturn. Although the government is examining ways to reduce healthcare expenses, including limiting purchases of expensive equipment and pharmaceuticals or adopting e-tenders, which would procure equipment via tenders based solely on the cost of the equipment, the Czech Republic offers strong opportunities for medical device companies. Expected growth in the sector over the next couple years is ca. 7%. Market Entry To import medical devices into the Czech Republic, a foreign producer should have an importer in the Czech Republic. To sell medical devices in the Czech market, several points are important: 1. Medical devices have to obtain the CE mark (if required), 2. Medical devices have to have directions for use enclosed in the Czech language, 3. The Declaration of Conformity has to be submitted (in the Czech language), 4. The Czech importer has a notification duty at Ministry of Health. Medical devices and pharmaceuticals are also subject to a customs duty and a value added tax (VAT). Current Market Trends One of the most basic issues facing healthcare in Czech Republic is the spiraling cost of healthcare. Current market trends reflect increasing life expectancy and unhealthy lifestyles (obesity and heart disease are on the rise). Devices used to Statistics Contact Capital: Prague Veronika Novakova Population: 10.5 million Commercial Specialist GDP: USD 205.950 billion veronika.novakova@trade.gov Currency: Czech Crown (CZK) +420 257 022 437 Language: Czech | 22 U.S. Commercial Service Healthcare Technologies Resource Guide 2012–2013 monitor symptoms and manage disease are in increasing demand. The most common cause of death is circulatory system problems (heart disease, stroke etc.). Czechs continue to be heavy smokers, and the air in many industrial cities is somewhat polluted. Growing interest in joint Czech-U.S. projects in the health care field could generate new opportunities for U.S. medical equipment providers. The most significant project to date is the International Clinical Research Center (ICRC) at St. Anne’s Hospital in Brno, which includes collaboration with the U.S. Mayo Clinic. Other Czech regions are eager to develop similar projects, and U.S. partners are in demand. Main Competitors The Czech Republic has a small but skilled medical device manufacturing sector. Production is at the low to medium end of the technology scale, but is increasingly of good quality. Local producers focus on exports, an estimated three-fourths of production is exported. Around 80% of the medical d
Posted: 29 November 2012

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