Molecular Testing Sweden Health care in Sweden is, by tradition, very hospital oriented and administered by the counties. Private labs are rare and only exist in a few counties.
Country Overview: Sweden 1. General Information Population (000s) 9,556 1 GDP (Billion SEK) 3,487 2 THE as a % of GDP 10.0 3 Hospital beds per 100,000 inhabitants 272.6 4 % change in hospital beds (2000-2010) -23.9 5 Sweden has a decentralized health care system which is predominately funded by the democratically elected parliamentary government. The Swedish National Board of Health and Welfare is the central national authority for running health services and establishes guidelines, while the 21 counties provide financing and direct administration. These counties make up six medical care regions. 2. Healthcare Delivery 2.1 Primary Care Primary care is provided by approximately 1,100 primary care facilities; typically with four to six physicians and associated staff. County councils own the majority of these. Private practices with only one GP also exist, but constitute a small percentage of overall primary care. Outpatient care is often provided by hospital affiliates or private companies (e.g. Capio and Aleris). Recently, there has been a strong focus on increasing the role of the private sector which has the result of increasing competition so that patient choice grows along with quality of care. 1 Source: Eurostat 2013 data 2 Source: IMF 2012 3 Source: WHO 2012 report 4 Source: Eurostat 2010 data 5 Source: based on Eurostat 2010 data Copyright by dii GmbH May 2014 2
2.2 Secondary Care Table 2-1 Number of Acute Hospitals Type of Hospital dii Database 2014 # in % Acute Hospitals* 81 General Acute 72 89% Specialized Acute 9 11% By Size Small (up to 199 beds) 44 54% Medium ( 200 499 beds) 21 26% Large (>500 beds) 16 20% * excludes outpatient clinics, geriatric & psychiatric hospitals There are a variety of hospital types including university hospitals, regional hospitals and county hospitals. The majority of hospitals are public, being owned by county councils, and there are a few private hospitals. 2.3 Insurance, Funding & Reimbursement Only around 4% of the population has private voluntary health insurance with the remaining population being covered by the public system which is primarily funded by taxes. The majority of the medical costs are covered by the state. Approximately 2% of health care costs are paid with patient fees, almost a quarter are paid with a mandatory payroll tax, two-thirds are covered by country, municipal and parish taxes and the rest comes from the central government. The majority of health workers are on salaries and there are various mechanisms for paying health care providers. These mechanisms can include payments based on cases and performance. Private healthcare providers must enter into contracts with the councils. Without such a contract, patients cannot be reimbursed for services. Copyright by dii GmbH May 2014 3
3. Laboratory Landscape The vast majority of diagnostic laboratories are public, with the largest of these belonging to the nine university hospitals. Out of the 81 acute hospitals listed in table 2-1, 73 of them provide diagnostic services. There are two main private laboratory groups, Unilabs and Aleris Medilab. Unilabs operates laboratories at multiple hospitals and some outpatient centers. Aleris Medilab has one primary laboratory in Täby near Stockholm and a number of neighborhood laboratories which process samples. Table 3-1 Number of Laboratories Type of Institution Number of institutions providing routine diagnostic services dii Database 2014 # % 86 Hospitals 73 85% Independent laboratories 13 15% 4. Molecular Testing Molecular Oncology testing is largely constrained to university laboratories and even then some tests are only available at the largest ones. The same is true for genetic testing, though some of these tests might be performed in large hospitals as well. The university hospital laboratories are likely to have separate lab units where molecular testing for infectious diseases is performed, but this is not typically the case with smaller hospitals. The private laboratories, Aleris and the Unilabs, perform molecular testing on a diverse set of markers. Table 4-1 Number of Laboratories Offering Molecular Diagnostics dii Database 2014 Type of Institution # % of labs per segment* Number of institutions offering molecular diagnostics (MolDx) 34 Hospitals 27 38% Independent laboratories 7 54% * percentages are based on # of facilities performing MolDx out of total number of facilities with laboratories shown in table 3-1 Copyright by dii GmbH May 2014 4
5. Methodology 5.1 Universe The Universe, the overall number of hospital and private laboratories for which the results of this market research are relevant, is determined by performing secondary research on official health care statistics and comparing the results with our internal database. This yields a directory of hospitals and private laboratories, classified by type, size, ownership and group affiliation, which is constantly updated through ongoing primary market research. Facilities such as outpatient clinics, rehabilitative institutions, psychiatric hospitals are excluded from the universe calculations. Blood Screening is also excluded except in Italy, where Blood Screening is part of the routine service of hospital laboratories while in all other countries under review, Blood Screening is centralized in specific institutions. Separate Universes were calculated for the in-depth, molecular market analyses based on the numbers of laboratories performing tests in each of the five test areas: Virology, Bacteriology, Coagulation, Genetics, and Oncology. This allows for greater precision in calculating the number of facilities testing each marker and is a more accurate count than the overestimation which occurs when using the total number of MolDx facilities as a basis for each marker regardless of test area. 5.2 Sample Up to 90% of all institutions were profiled to determine the percentage of hospitals providing diagnostic services in general, as well as the percentages of laboratories that perform MolDx. After profiling, in-depth interviews were conducted in MolDx laboratory units. If hospitals had more than one lab unit providing MolDx, e.g. a lab for oncology and a lab for infectious diseases, we tried to collect data from both lab units. Detailed information regarding test volume, volume trends, platforms and reagents was collected on 38 markers from the aforementioned test areas. 5.3 Projections All projections in this study are based on primary research findings projected from the sample to the Universe. This means the projected number represents the number of institutions that can be expected to have each of the respective characteristics. Only facilities are counted rather than the number of laboratories (e.g. if a hospital has three labs that were profiled in our sampling, the data are combined such that this counts as only one facility). 5.3 Analytical tools All analyses for this project were performed using the R programming language and software environment for statistical computing. The following packages were used in the analyses: xlsx, rjava, xlsjars. Exports from the analyses were converted into Microsoft Excel files which accompany this document. Additionally, raw data has been formatted for ease of data-mining in Excel pivot table format. Copyright by dii GmbH May 2014 5
About dii data information intelligence is a full service marketing consulting agency, with a specialization in the IVD industry. We measure market potential, develop market models, identify user demands and evaluate the validity of new, conceptual products to support strategic decisions. This enables our clients to minimize risks and convert business opportunities to commercial successes, regardless if it concerns a product launch, customer loyalty, pricing strategies or the expansion into new markets and new customer groups. dii has developed and operates a database profiling healthcare institutions by type (hospital, laboratory, blood bank, physician office, veterinarian, etc.), size and ownership. This database is constantly verified and updated via our research projects. We estimate that our database covers >95% of all hospitals and independent/private laboratories in Western Europe. The knowledge derived from this database forms the basis for sampling, market segmentation and projections. For more information, see www.dii-healthcare.com. 2014 data information intelligence GmbH Copyright by dii GmbH May 2014 6