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9A Deloitte Research ReportInnovation Indicators for Healthcare in Emerging Countries Understanding and Promoting Innovation in Emerging Markets1IntroductionInnovation plays a critical role in addressing global health needs. As chronic and communicable disease rates continue to climb, governments, private payers, and non-governmental organizations will wrestle with how to provide, disseminate, and pay for adequate prevention and treatment. Increasing the development rate of effective and affordable innovations will be a key factor in addressing this issue, as will improving the diffusion of these innovations in markets throughout the world. Meeting this challenge will not be an easy task, since the development of innovative solutions has become increasingly complex and costly. At the same time, the emergence of targeted medicine makes the prospect of “blockbuster” products and solutions much less likely. Emerging markets* play a key role in addressing the challenge serving as a well-identifi ed source of innovation for multi-national health care companies seeking to increase innovation capacity and/or reduce development time and cost.1The health care and life sciences companies originating in emerging markets are also growing, building on local capabilities and offering advantages to potential partners related to talent, knowledge of local consumer preferences, and the ability to navigate regulatory processes within the country. For organizations located in both developed and emerging markets, emerging nations also represent an expansive and growing source of consumers, as they represent 80 percent of the global population.2Catering to their growing health care needs, coupled with rising income levels, present new opportunities for business growth in emerging markets.3For the governments of emerging market countries, the promotion of innovation offers the promise of addressing long-standing priorities such as communicable diseases (i.e. malaria, tuberculosis, and HIV/AIDS), as well as the increased incidence of chronic diseases brought on by changing lifestyles (i.e. diabetes and cardiovascular diseases). A comparative assessment of innovation indicators for healthcare in emerging markets will be a valuable tool for those seeking to strengthen the pace and reach of innovation to meet pressing global health needs. The objective of this tool is to focus both public and private sector attention on the innovation issue and facilitate discussion and collaborative action among governments and regulatory agencies, non-governmental organizations, public and private payers, the healthcare and life sciences industry, the medical community, and patient groups. The pilot study is built around a framework that recognizes the broad range of components and conditions that are necessary to promote innovation in emerging countries. The scope of the study is solely focused on healthcare products and technologies, and does not seek to touch on healthcare delivery or services.Gauging the Relative Performance of Nations As the promotion of innovation in emerging markets is gaining importance for international and domestic healthcare and life sciences companies, analysis of the relative strengths and weaknesses of each country will become increasingly critical. This paper outlines a proof-of-concept study to benchmark emerging market countries based on each countrys ability to promote innovation relative to its peers. The study features 10 emerging market countries, with four developed countries to serve as a baseline for comparison. A mix of key emerging market countries from Asia, Eastern Europe, Latin America and Africa are included: China, India, Singapore and South Korea from Asia； Czech Republic and Poland from Eastern Europe； Brazil and Mexico from Latin America； and South Africa from Africa. For the purpose of comparison, France, Germany, the United Kingdom and the United States are also included in the study.* Emerging-market countries are typically defi ned as those with low to middle per capita income that are experiencing strong economic growth after working to open their economy through economic development and reform. Emerging-market countries include large, resource-rich nations such as China, India, Russia, and Brazil, as well as smaller countries such as Mexico, Romania, Hungary, Thailand, South Korea, Argentina, Nigeria, and South Africa, among others. Lists of emerging-market countries can vary depend-ing on the specifi c criteria that are used. Source: Reem Heakal, “What is an emerging market economy?” . 2Primary Objectives There are three primary objectives of this initiative:Facilitate a continued public / private dialogue with the goal of a shared, common understanding and a baseline defi nition of how to foster innovation in health care and life sciencesUnderstand what the private / public sector can do to encourage innovation in a given geographyIdentify and prioritize the levers that can have the greatest impact on innovation and help achieve appropriate balance between industrial policy and improved access to innovative health solutionsApproach to Analysis Promoting innovation involves consideration of an array of factors related to four fundamental pillars: Development, Ownership, Diffusion and Environment. Development refers to all of the activities and infl uential factors that come into play in the discovery and creation of new innovations. Ownership refl ects the factors that have an impact on securing a return on investments made in innovation. Diffusion refers to all of the activities involved in the distribution and adoption of innovations. Finally, the Environment pillar encompasses the fundamental conditions required for doing business. These components and conditions are highlighted in Figure 1.4Figure 1. Elements of Promoting InnovationDevelopment(Creating New Products)Diffusion(Ensuring Access)Ownership(Securing a Return on Investment)Promoting InnovationEnvironmentSource: Deloitte ResearchBased on this analytical framework, a set of levers that can be used to assess each pillar have been identifi ed, based on extensive research and expert group inputs. (See Figure 2.) They are “levers” in the sense that public and private actions in these areas can infl uence the promotion of innovation. Several of the levers effectively represent surrogates or indicators of underlying conditions that can signifi cantly impact a given pillar. The key levers affecting Development include appropriate planning, availability of resources including talent, fi nancing mechanisms to fund innovation, and other facilities to foster innovation. Combined, these represent resources to support the R&D process. Similarly, the levers that comprise the Ownership pillar are policies that reward or value innovation and intellectual property, including the ability to price commercially. The Diffusion pillar encompasses coverage of products or services in public or private health plans, uptake capacity, as well as diffusion outcomes and other factors vital for diffusion of innovation. The Environment pillar includes measures of political stability and economic development, as well as other business environment levers.3Each lever is comprised of select measures which capture the quantitative essence of the levers when viewed in sum. Overall, 48 measures (Figure 3) are included in the assessment tool. Each was individually evaluated and selected from the more than 200 measures initially identifi ed and researched. Figure 3.Figure 2.DevelopmentPlanPolicyCoveragePolitical stability & economic developmentBusiness environmentFacilitiesPeopleIntellectual propertyUpdateR&D OutputFinancingAbility to priceOutcomeDiffusionOwnershipEnvironmentInnovation indexDevelopment (13)A. Plan (R&D Focus)1. Total GDP on R&D by government 2. # of researchers B. People1. Public expenditure on education as % of GDP 2. Total tertiary enrollment 3. Research publications C. Financing1. R&D spending by companies 2. Strength of university & industry research collaborations 3. Venture capital availability D. Facilities1. # of science parks 2. Quality of scientifi c research institutions 3. # of clinical trials 4. # of CROs E. R&D Output1. # of pharma patents fi led in the WIPO by fi rms located in the emerging market Ownership (10)A. Policy1. # of pharmaceutical patents in the emerging market 2. IP offi ce staff strength B. Intellectual Property1. Index of Patent Rights 2. Period of data exclusivity for new drugs in years 3. IP protection and enforcement C. Ability to Price1. Price negotiations as a pre-condition of product approval a.Clearly laid out policies for Pricingb.Unbiased policies for imports and local productsc.Opportunity to negotiate price with Government2. Regulations infl uencing pricing a.Absence of National Medicines List/Formulary b.Regulations against parallel importsDiffusion (15)A. Coverage1. Per capita expend. on health 2. Accessibility of healthcare 3. Out-of-pocket expend. on health 4. Pharmaceutical market growth 5. Pharmaceutical imports growth over previous year B. Uptake1. # of hospital beds per capita 2. # of physicians per capita 3. # of nurses/mid-wives per capita 4. Total telephone subscribers (Per 100) 5. Technology readiness 6. Technology usage 7. # of medical schools C. Outcome1. Primary care immunization - national coverage rates 2. # of MRI & CT scanners per capita 3. # of patients organizations (per million) Environment (10)A. Political Stability and Economic Development1. Political stability 2. Real GDP growth 3. Macroeconomic stabilityB. Business Environment1. Ease of Doing Business 2. Regulatory quality 3. Corruption perception index 4. General infrastructure 5. Judicial Independence 6. Financial market sophistication 7. Worldwide Press Freedom Index A comparative assessment of the emerging market countries is based on their individual performance across each of the four pillars. The methodology for individual pillar scores for each country is a function of each measures normalized score and assigned weight. The scores are normalized for each measure on a scale of 17, using a linear-scaling technique that accounts for any outliers. The data are standardized, if necessary, using appropriate factors such as GDP and population. Scores for factors that negatively impact promotion of innovation have been appropriately inverted.4Preliminary Output / FindingsThe preliminary output shows that among the 10 nations included in the initial assessment, the leading emerging markets in terms of promotion of innovation are Singapore, South Korea, Czech Republic, Poland and South Africa. Singapore and South Korea have very strong scores, comparing favorably with developed market scores. In both instances, the countries excel in the Environment and Development pillars. On the other hand, the Czech Republics score in Diffusion compares favorably with the developed markets. Interestingly, most of the selected markets have strong scores in the Environment pillar. Although the sample size may be too small to draw defi nitive conclusions, the preliminary index results begin to point to interesting insights. The emerging market country performance, by individual pillar, is provided in Figure 4.Figure 4.DiffusionBrazilChinaCzech Rep.IndiaMexicoPolandSingaporeSouth AfricaSouth KoreaTurkeyFranceGermanyUKUS3.673.114.332.903.413.613.103.514.353.764.194.414.144.89DevelopmentBrazilChinaCzech Rep.IndiaMexicoPolandSingaporeSouth AfricaSouth KoreaTurkeyFranceGermanyUKUS2.241.883.732.502.112.954.092.513.932.294.554.185.365.25EnvironmentBrazilChinaCzech Rep.IndiaMexicoPolandSingaporeSouth AfricaSouth KoreaTurkeyFranceGermanyUKUS3.173.934.593.463.414.165.754.474.843.524.805.085.224.83OwnershipBrazilChinaCzech Rep.IndiaMexicoPolandSingaporeSouth AfricaSouth KoreaTurkeyFranceGermanyUKUS3.072.593.502.633.523.024.852.143.522.224.845.424.344.705As the data indicate, the larger emerging market countries such as Brazil, China and India tend to perform poorly in certain key areas. Indias performance in the Diffusion pillar is lowest among all the emerging market countries. Chinas performance, on the other hand, is driven by low results in the Development pillar. Similarly, low results in Development also affect Brazils overall outcome.ConclusionsThe study reveals several key fi ndings: Data needed to structure a viable healthcare innovation index are generally available for emerging markets. Scores indicate that Development is generally the weakest pillar for the emerging markets reviewed. Strong Ownership performance tends to correlate well with strong Development scores, suggesting a potential linkage between the two pillars.Selected emerging markets appear to have an environment conducive to promoting innovation. Environment is the strongest pillar for 8 of the 10 emerging countries assessed.Perhaps surprisingly, strong performance in the Environment pillar does not seem to translate into a strong Diffusion score. While these conclusions are intriguing, additional valuable insights that are more specifi c to each country and region could be generated if the number of countries included in the assessment were to expand beyond the current set of ten nations. A larger pool of country scores would allow for a greater number and variety of comparisons, which could help crystallize as yet unidentifi ed issues and drivers related to healthcare innovation. Limitations aside, this study and resulting data and insights certainly bring into focus an important question that must be addressed in the immediate term: How do we connect with governments on this topic and engage in a dialogue that encourages them to support innovation more fully? End Notes1Steve Usdin, “Doing business in India,” BioCentury: The Bernstein Report on Bio-Business, 12:34, August 2, 2004, pp. A1-A24.2 Reem Heakal, “What is an emerging market economy?” accessed October 17,2007 / articles/03/073003.asp.3 Business Monitor International, Ltd, “Tapping the grey dollar: Opportunities in aging populations,” Emerging Markets Monitor, 13:8, May 28, 2007, pp. 1-3.4 Robert Go and Laura Eselius, “Promoting and Protecting Life Sciences Innovation in Emerging Markets”, Jan. 2008, Deloitte Research, Deloitte Services, LP.6AuthorsRobert GoDTT Global Life Sciences and Health Care (LSHC) Industry Leader+1 313 324 1191Neal BatraSenior ManagerDeloitte United States (Deloitte Consulting LLP)+1 212 618 4891AcknowledgementsWe wish to thank:Terry Hisey (Deloitte Consulting LLP, United States), Dean Arnold (Deloitte Consulting LLP, United Kingdom), Matthew Hudes (Deloitte Consulting LLP, United States),Yvonne Wu (Deloitte Touche Tohmatsu CP, China), Charu Sehgal (Deloitte Touche Tohmatsu India Pvt. Ltd, India), Ira Kalish (Deloitte Research, United States), Pete Mooney (Deloitte Consulting LLP, United States), Paul Keckley (Deloitte Center for Health Solutions, United States), Laura Eselius (Deloitte Research) and Patsy Bolduc (Deloitte Touche Tohmatsu) for their insightful comments during the development of this paper. We are also grateful to Anantharaman KV (Deloitte Research, United States) and Shatdal Kumar (Deloitte Consulting LLP, India) for their invaluable contributions throughout the development of this paper.Contact InformationPlease visit the Life Sciences and Health Care Industry site at / lifesciences for more information about our global practice.DTT Global Life Sciences and Health Care (LSHC) Industry LeaderRobert Go+1 313 324 1191DTT Global Life Sciences Sector Leader John Rhodes+1 973 683 7296DTT Global Health Care Sector LeaderDean Arnold+44 20 7303 5199deanarnolddeloitte.co.ukDTT Global LSHC Consulting LeaderPete Mooney+1 617 437 2933DTT Global LSHC Financial Advisory LeaderDavid L. Jones+44 20 7007 2259davidljonesdeloitte.co.ukDTT Global LSHC Tax LeaderDavid Green+1 973 602 6287LSHC - Asia Pacifi cKeiji WatanabeDeloitte Japan+81 3 6213 3493Keiji.watanabetohmatsu.co.jpLSHC - Europe, Middle East and AfricaStuart HendersonDeloitte United Kingdom+44 1223 259392stuhendersondeloitte.co.ukU.S. Industry Leader Health Sciences and GovernmentJohn BigalkeDeloitte United States (Deloitte LLP)+1 407 246 8235U.S. Sector Leader Life SciencesR.T. (Terry) HiseyDeloitte United States (Deloitte Consulting LLP) +1 215 246 23327About Deloitte Research StudiesDeloitte Research studies deliver ideas, fact driven insights, and innovations designed to improveorganizational performance. Through the contributions of research and practice professionals fromthe member fi rms of Deloitte Touche Tohmatsu, and the contributions of academic and industrycontributors, Deloitte Research reports and articles bring ideas that matter to executives, boardsand leading business journals. To access the latest research, please visit /researchor contact Doug Tuttle, Global Director, +1 617 437 2212 or .About Deloitte Touche Tohmatsu (DTT) Life Sciences and Health Care (LSHC) Industry GroupThe DTT LSHC Industry Group, made up of the LSHC specialists from DTT Member Firms, is comprised of more than 4,000 professional in over 47 countries. Their understanding of the industrys challenges and their ability to quickly respond with integrated, comprehensive services put the DTT Member Firms in a unique position to help our clients. The DTT Member Firm LSHC Industry Group professionals work with their clients to help them shape the evolution of the industry. These professionals can help companies in their efforts to bring discoveries to life and improve the quality