Studiu Medical

8/2/2019 Studiu Medical

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General Information

February 2011, Bucharest

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ContentContent

Introduction. 3

Terminology . 4

Legal f ramework 5

Medical services market. 6

Public Romanian Healthcare System. 7

Private Romanian Healthcare System... 8

Private Outpatient Medical Center in Romania.. 9

Distribution 10

Most important outpatient medical center in Bucharest.. 11

Private outpatient specialized clinics... 14

Private hospitals in Romania........................... ........ 15

Synoptic table private hospitals in Romania and Bucharest 20

Private hospital location by map21

The major private healthcare companies 2009...22

Public and private insurance system.23

Sources of revenue25

Comparative prices for available medical services in private hospitals in Bucharest26

Observations.27

Conclusions..29

Apendix

List of hospital regulations

The most frequent chances of developing diseases in RomaniaThe major pharmaceutical companies in 2009 Pro EAST Consulting 2011

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IntroductionIntroduction

This study provides general information on the Private Healthcare System in Romania in terms of both its

current level of development and its future evolution. It is updated monthly.

The studys methodology is centered on the following criteria:

type of medical unit;

medical specialty;

number of beds;

location;

names and nationality of the shareholders affiliation with any medical companies.

New hospital construction projects are classified also according to: amount of investment, surface and

expected launch date.

Pro EAST Consulting 2011

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Therminology

The various private medical units in operation today can be defined as follows:.

Outpatient Medical Centres (for diagnosis and treatment): provide multi-disciplinary ambulatory medical

services. They are currently equipped with laboratories for blood and fluid analysis and will eventually be

equipped with diagnostic imaging devices (CT, Rx, ultrasound or MRI)

Outpatient Specialized Clinics: are medical centres that specialize in a single medical discipline or ailment

such as Ophthalmology, Plastic Surgery etc. They are equipped with the required laboratories and will

eventually acquire the diagnostic imaging devices needed in support of their respective speciality. Patients can

remain hospitalized at the clinic for a maximum of 24 hours.

Specialized Hospitals: are classified as hospitals but with a single principle specialty and as many as two

adjacent specialities (eg.Obstetrics and Gynaecology). Patients can remain hospitalized for periods of greater

than 24 hours. These are hospitals and are therefore equipped with an ICU and Emergency Room services. A

classic example would be a Obstetrical and Gynaecology Hospital.

General Hospitals= provide the full range of medical services for several medical specialities including the

following units: ER, Outpatient, Internal Medicine, Surgery, ICU, and eventually Maternity. General Hospitals

are fully equipped with laboratories and radiology devices. . They have laboratories investigation

departments and imagistica (radiology).


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5

Legal framework

All Hospitals, Medical Centers and Outpatient Clinics, both private and public, are governed by and must

operate in accordance with Romanian law (specifically Law 95/2006 as last updated on 07 Oct 2009).

In addition, the construction and operation of hospitals in Romania are governed by the Ministry of Health

(Order OSMP 914/2006 last updated by1030/2009) Please refer to Appendix 1 for more detailedinformation.

Last but not least, all medical and non medial units of a hospital must be compliant with, and managed

in accordance with, the standards of the European Union.

Medical Services provided by either Public or Private medical units in Romania are VAT exempt.

Romanian legislation permits the establishment of Private General Hospitals and Medical Clinics under Law

No 31/1990. This legislation equally applies to private sector companies.The Administrator and at least

one third of the Board of Directors must be qualified doctors. There is no such restriction on shareholders.

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Medical Services MarketMedical Services Market

The Government of Romania currently allocates 5 % of GDP to the Healthcare Sector which is very low

when compared with the average percentage of GDP allocated in East Central European (6,7% of GDP)

or Western Europe (9,8% of GDP).

The market for private medical services is estimated to have been 430 million Euro in 2009; a 35%

increase over 2008. The rate of growth for 2010 is projected to be at least 20%.


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Public Romanian Healthcare SystemPublic Romanian Healthcare System

ClassificationClassification

Primary Health Care Units provide:

General medical and ambulatory services.

Outpatient clinics but without an operating theatre of specialized investigative labs.

Secondary Health Care Units provide:

Outpatient Medical Centres and Outpatient Specialized Clinics General or Specialized Hospitals . These hospitals have various departments and operating rooms for both basic and

specialized medical services. These specialties would include cardio surgery, neurosurgery, microsurgery, and oncology.

Both Primary Health Care Units and Secondary Health Care Units are located in the locality in either a city or a town

Tertiary Health Care Units are:

University Hospitals located in a major city or Regional Hospitals that are regional in scope (ie. they service one or more

of the 42 counties that make up Romania).

They include Institutes (eg. Contagious Disease Institute) and Hospitals that offer higher learning or a specialization.


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Private Romanian healthcare system classificationPrivate Romanian healthcare system classification

The Romanian Private Healthcare System is organized as follows:

Individual doctors ambulatories

Outpatient Medical Centres (diagnosis and treatment)

Outpatient Specialized Clinics (specialized medicine) Hospitals: both General and Specialized.

All the Private Medical Centres and Private Hospitals are locally based; that is, they do not service an entire

county.

None of the University Hospitals are Private.

None of the existing Private Hospitals specialize in Emergency Care.

None of the Local Hospitals are private


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Private Outpatient Medical CenterPrivate Outpatient Medical Center

Private Medical Centres first started to appear in 1995, primarily in the larger cities.The

majority functioned as local diagnostic and treatment centres.

Multidisciplinary Outpatient Medical Centres focus on diagnostic services and treatment. They are

equipped with laboratories and a radiology unit (Xray, CT, Ultrasound). Eventually their imaging

units will expand to include MRI.

Specialised Clinics. These medical clinics provide medical services of one speciality plus laboratories

and eventually imagistic unit.

The majority of the Specialized Clinics established during the past few years are specialized in the

following medical disciplines: Obstetrics, Gynaecology and Fertilisation, E.N.T (ORL),

Ophthalmology, Plastic Surgery, General Surgery, Orthopaedics, Oncology, Proctology, RadiologyImagistic, Phlebology, Rehabilitation , Stomatology. See slide 14


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DistributionDistribution

Private Outpatient Medical Centres and Specialized Clinics are distributed throughout Romania but are

concentrated in cities with populations over 150.000;

There is a high concentration of private Medical Centres and Specialized Clinics in the capital city ofBucharest. The number of multi-discipline Outpatient Medical Centres located in Bucharest (100) is

almoust equal to the number of such Centres located throughout the Rest of Romania (over 90).

The major players in the healthcare sector are currently the following companies:

Romar (18 centers),

Unirea Medical Center (16),

Medcenter ( 13 )

Hiperdia (12)

Medicover ( 11)

See slide 11


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11

Major private Outpatient Medical Centers in RomaniaMajor private Outpatient Medical Centers in Romania

Name of the medical center

Total no. of

centers in

Romania

No. of

centers in

Bucharest

No. of

centers in

other cities Cities ( Abbreviation*) Web adress

ROMAR 18 4 14

Ct, Is, Pl, Tm, Gl, Braila, Bz Branesti, Hd,

Roman, Tgv, Tg J, Gr* www.romar.ro

CENTRUL MEDICAL UNIREA 16 11 5 Cj, Ct, Pl, Tm*,Bc,Bv www.cmu.ro

MEDICOVER 11 4 7 Bv, Cj, Ct, Fcs, Is, Pl, Tm* www.medicover.ro

MEDCENTER 13 4 9 Bv, Cj, Fcs, Is, Gl, BM,Braila, Bz* www.medcenter.ro

HIPERDIA 12 4 8 Bv, Cj, Pl, Bistrita, SM, Turda, Tm, Gl* www.hiperdia.ro

GRAL MEDICAL 4 2 2 Pit, Sb www.gralmedical.roMEDICAL CITY 9 1 8 Pit, Cv, Ct, Turda, Tm, Arad, Bc, Bz* www.medicalcity.ro

MEDLIFE 10 7 3 Cluj, Timisoara,Bv www.medlife.ro

POLISANO CLINIQUE 6 3 3 Sibiu www.polisano.ro

CLINICA MEDICALA ROMGERMED 2 2 0 Bucuresti www.romgermed.ro

MEDAS 4 4 0 Bucuresti www.medas.ro

PARAMEDICAL CENTER 5 0 5 Cluj www.cmpro.ro

CENTRUL MEDICAL ELIM 4 0 4 Pitesti, Rm Vl,Curtea de Arges www.cmelim.ro

POLIMED 3 1 2 Azuga, Busteni www.polimed.ro

EUROCLINIC 3 3 0 Bucuresti www.euroclinic.ro

SANADOR 3 3 0 Bucuresti www.sanador.roMEDSANA 3 2 1 Ploiesti www.medsana.ro

CENTRUL MEDICAL CLINIMED 3 0 3 Alba Iulia www.clinimed.ro

CENTRUL MEDICAL GALAMED 2 0 2 Constanta www.galamed.ro

MEDICAL CENTER DIAGNOSIS 2 2 0 Bucuresti www.diagnosis.ro

MEDICAL CENTER PRO LIFE 2 2 0 Bucuresti www.pro-life.ro

BIOTERRA MED 2 2 0 Bucuresti www.bioterramed.ro

BIOMEDICA 2 2 0 Bucuresti www.bio-medica.ro

CENTRUL MEDICAL IOWEMED 2 0 2 Constanta www.iowemed.ro

CENTRUL MEDICAL ANIMA 3 2 1 Bucuresti, Pitesti www.anima.ro

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1212

Major private Outpatient Medical Centers in RomaniaMajor private Outpatient Medical Centers in RomaniaContinued slide 11Continued slide 11


CENTRUL MEDICAL PLUS MEDICA 3 3 0 Bucuresti www.pulsmedica.ro

CENTRUL MEDICAL SOLOMED 2 0 2 Pitesti www.solomed.ro

CENTRUL MEDICAL BIOCLINICA 2 0 2 Arad, Timisoara www.bioclinica.ro

CENTRUL MEDICAL ACADEMICA 1 1 0 Bucuresti www.academica-medical.ro

ALSAMED 1 1 0 Bucuresti www.alsamed.ro

ANAIS MEDICAL CENTER 1 1 0 Bucuresti www.anais.ro

ENDOCENTER 1 1 0 Bucuresti www.endocenter.ro

EXCELLENCE MEDICAL CENTER 1 1 0 Bucuresti www.medicalexcellence.ro

MATEI BASARAB MEDICAL CENTER 1 1 0 Bucuresti www.cmmb.roMEDICLASS 1 1 0 Bucuresti www.mediclass.ro

SANYS MEDICAL 1 1 0 Bucuresti www.sanysmed.ro

CENTRUL MEDICAL VERONIKI 1 1 0 Bucuresti www.veronikilife.ro

CENTRUL MEDICAL VICTOR BABES 1 1 0 Bucuresti www.cdt-babes.ro

CENTRUL MEDICAL LUX-RO 1 0 1 Botosani www.lux-ro.ro

CENTRUL MEDICAL ARTRIMED 1 0 1 Cluj

CENTRUL MEDICAL MEDSTAR 2000 1 0 1 Constanta www.medstar2000.ro

CLINICA MACTA (MEDICAL ALALYSIS) 1 0 1 Constanta www.chirurgieunc.ro

CENTRUL MEDICAL MICROMEDICA 1 0 1 Neamt www.micromedica.ro

COMPLEX MEDICAL G&E&N 1 0 1 Oradea www.gen.ro

CENTRUL MEDICAL DR.LUCA 1 0 1 Pitesti,Rm.Vl

CENTRUL MEDICAL SANMED 1 0 1 Rm.Valcea www.sanmed.ro

POLICLINICA VISA MEDICA 1 0 1 Sibiu www.visamedica.ro

CENTRUL MEDICAL DELTA PRO

MEDICAL 1 0 1 Bucuresti www.deltapromedical.ro

CENTRUL MEDICAL MINERVA 1 0 1 Timisoara www.cmminerva.ro

CENTRUL MEDICAL IRINA (EXPERT

MED) 1 0 1 Galati www.expert-med.ro

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Major private Outpatient Medical Centers in RomaniaMajor private Outpatient Medical Centers in RomaniaContinued slide 12Continued slide 12

MARY MEDICAL CENTER 1 1 0 Bucuresti www.marymed.ro

CENTRUL MEDICAL ENDOCENTER 1 1 0 Bucuresti www.endocenter.ro

ALPHA HEALTH CENTER 1 1 0 Bucuresti www.alphamed.ro

MEDICAL CITY BLUE 1 1 0 Bucuresti www.medicalcity.ro

CENTRUL MEDICAL HIPOCRATE 1 0 1 Timisoara www.hipocrate.ro

Total: 175 81 94

13


Note:* Alba Iulia= Ab I,Galati= Gl, Bucuresti = Buc, Giurgiu= Gr, Baia Mare= Bc, Hunedoara= Hd, Botosani= Bots,

Iasi= Is, Brasov= Bv, Neamt= Nt, Braila= Br, Ploiesti= Pl, Buzau= Bz, Pitesti=Pit, Cluj= Cj, Sibiu=Sb,

Craiova=Cv , SatuMare=SM, Constanta= Ct, Tulcea=Tl, Focsani= Fcs, Targu Jiu= Tg J, Timisoara= Tm,

Note: Last update January 2011Source: internet, database


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Private Outpatient Specialized ClinicsPrivate Outpatient Specialized Clinicsin Bucharestin Bucharest

The most common medical specialities for private Outpatient Specialized Clinics (with or without surgical units) are listed below. The restriction of a

maximum 24 hours hospitalization is applicable to all.

Obstretics, Gynecology and Fertilisation 22

ENT (ORL ) 19

Ophthalmology (with surgery) 17

Labor medicine 12

Plastic and reparatory surgery 11

General surgery 9

Imagistic (CT, MRI; eventually PET-CT) 10 *

Orthopedic (without surgery) 8

Proctology 8

Rheumatology 5

Dermatology 4

Cardiology and interventional cardiology with day hospital 3

Radiology and interventional cardiology 2

Diabetic and nutrition diseases 2

Phlebology 2

Rehabilitation Therapy 2

Stomatology, Implantology - minimum 50

TOTAL NO. OF BRANCH MEDICAL CLINICS IN BUCHAREST 181

Note : * Are not included the imagistic departments from the Outpatient Medical Centers


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Private Hospitals in RomaniaPrivate Hospitals in Romania

Of the 24 private Hospitals currently operational in Romania, 14 are General Hospitals and

10 are Specialized Hospitals.

7 out of 10 private Specialized Hospitals are specialize in obstetrical & gynaecology

None of the private hospitals specialize in other high demand, high priority medical

disciplines such as:

oncology and surgical oncology

emergency room /emergency surgery

Just one specialized hospital is specialized in cardiology surgery.

Since 2008, several health care companies have announced their intention to construct new

private hospitals. There are plans to build 15 new private Hospitals 14 in Bucharest by the

year 2013. This new construction would increase existing bed capacity in Bucharest from 281

beds to over 1286 beds . This represents an estimated investment value of minimum 300

million Euros.(see slide 19).


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Private hospitals in Romania


17

Crt.

No. Hospital name

Hospital type No.

of

beds

City/Area of

Romania

Shareholders

Nationali ty Affil iation or Member of a Group/Chain

1 Life Memorial Hospital General 127

Bucharest-

South

IFC, Cristescu Mihaela Gabriela, Nicolae

Marcu, Mihail Marcu, SGAM Eastern

Europe (Societe General)

Great Britain/France/

Romania Medlife

2 Euroclinic Hospital General 100

Bucharest-

South CMU / Eureko Group

Germany/

Holland CMU / Eureko Group

3

CMU ,,Arcul de Triumf

Hospital

General

9

Bucharest-

South

Advent International Investment

Found(80%) ,Mr. Enayati Germany

CMU = Unirea Medical Center

4 Munposan Hospital Branch (Surgery) 35

Bucharest-

South

Becico Victoria, Munteanu Codrut,

Sangiorzan Anton Romania No

5 Genesys Hospital General 45 Arad-West

Guset Grigorie, Jivan Adrian, Miclea

Iulius, Paiusan Lucian Romania Accipiens

6 Laser System Hospital General 11 Arad-West UNK Romania Laser System Medical Center SRL

7 Palade Hospital General 22

Bacau-North-

East UNK Romania Palade Hospital Ltd

8 Clinicco Hospital

Branch (Surgery of

Cardiology and Orthopedic

prosthesis) 35 Brasov-Center UNK Romania No

9 Pelican Hospital General 80

Oradea-North-

West

Adrian Maghiar, Doru Maghiar si

Ovidiu Cacuci Romania No

10 Arcadia Hospital General 220 Iasi-East Fiterman UNK No

11 Polisano Hospital General 50 Sibiu-Center Vonica Ilie, Vonica Daniela Romania Polisano

12 Bethesda Hospital General 48

Suceava-

North-East UNK No

13 Nova Vita Hospital General 126

Targu Mures-

Center Virgil Mailat Romania No

14 Brol Hospital General 41

Timisoara-

West

Marinescu Eva, Bratu Ioan, Bratu

Tatiana Romania No

15 Athena Hospital General 118

Timisoara-

West Konstantions Giatras Greece No




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Private hospitals in RomaniaContinued slide 17Continued slide 17


18

Crt.

No. Hospital name

Hospital type No.

of beds

City/Area of

Romania

Shareholders

Nationality

Affiliation or Member of

a Group/Chain

16 Dr. Irimia Hospital Surgery hospital 16 Pitesti

Fam. Dr. Irimia and

Romano-israelian

Invsestment Found Romania

17 Euromedica Hospital General 40

Baia Mare-

North West

Mociran Mihaela,

Chertif Costache

Mociran Mihaela

Pop Calin FlorinPop Coriolan

Sasaran Mircea Romania Euromedica Hospital S.A.

18 Eva Clinic Branch (Obstetric-gynacology) 35 Brasov-Center UNK UNK

19 Sanovil Clinic Branch (Obstetric-gynacology) 30

Bistrita _

North-West UNK UNK Sanovil Clinic S.R.L.

20 Isis Medical Center Branch (Obstetric-gynacology) UNK

Constanta

South-East UNK UNK Isis Medical Center S.R.L.

21 Gynia Hospital Branch (Obstetric-gynacology) 34

Cluj

North-West UNK UNK Gynia S.R.L.

22 Hipocrate Hospital Branch (Obstetric-gynacology) 7

Cluj

North-West UNK UNK Hipocrate Impex S.R.L.

23

CMU Regina Maria

Hospital Branch (Obstetric-gynacology) 25 Bucharest South

Advent International

Investment Found(80%)

,Mr. Enayati Germany

CMU = Unirea Medical

Center

24 Euromaterna Hospital Branch (Obstetric-gynacology) 20

Constanta

South East

Ion Marius Rusa, Ion

Sebastian Lutescu, Ioana

Lutescu, Florian Dantes,

Dan Mugurel Raica, Rucni

Asan, Rafael Ron-El. Romania Euromaterna S.A.

Total 1284




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Private HospitalPrivate Hospital New Projects to 2013New Projects to 2013


19

Source: articles from online press , internet.We present just the public announced projects.Note: UNK - unknown date

* Medlife investments subtotals also include the Medlife Hospital from Brasov

Company name Hospital type Invest

ment

mil.eu

No.of

beds

Hospital

surface

sqm

Localization Time limit Shareholders Nationality

Medlife Genera l UNK 120 10,000 Buchares t 2011 IFC , Cris tes cu M., Nicolae M., Mihail M., SGAM Eas ten United Kingdom, France / Romania

Medlife &Dermastyle Dermatology & estetical

surgery

3 UNK 1,500 Bucharest 2011 IFC, Cristescu M., Nicolae M., Mihail M., SGAM Easten

Europe

United Kingdom, France / Romania

Medlife Special ized (urology) UNK UNK 3,800 Bucharest 2011 IFC, Cristescu M., Nicolae M., Mihail M., SGAM Easten United Kingdom, France / Romania

Medlife Special ized (pediatrics) UNK UNK 5,200 Bucharest 2011 IFC, Cristescu M., Nicolae M., Mihail M., SGAM Easten United Kingdom, France / Romania

Medlife investments

subtotals 2011-2013 *

45

CMU Specialized (surgery) 10 UNK UNK Bucharest 2011 80% Advent International, Enayati, 3Pi Germany/Romania

CMU General 25 UNK UNK Bucharest 2011-2012 80% Advent International, Enayati, 3Pi Germany/Romania

Gral Medical General (cardioloy, 25 100 9,000 B ucharest 2012 Dr.Gerogeta & D r.Robert Stefan Romania

Medicover General 50 200 12,900 Bucharest 2013 ABC Medicover Holding Sweden

Medicover General 10 75 UNK Bucharest 2011 ABC Medicover Holding Sweden

Medsana General 24 150 UNK Bucharest 2011 Athens Medical Center Greece /Germany

Romar Medical General 25 UNK UNK Bucharest 2012 Dr.Erghin Hagicalil, Dr.Liliana Hagicalil Romania

Medicana General (cardioloy,

oncology, in vitro

fertilization)

30 100 10,000 Bucharest UNK Medicana Group Turkey

Sanador General 50 135 14,000 Bucharest 2011 Dr.Doris Andronescu Romania

Delta Pro Specialized (surgery) UNK 50 2,500 Bucharest Feb-11 Dr.Copaescu, Dr.Jianu Romania

Total Bucharest 294 930

Medlife General UNK 75 6,000 Brasov 2011 IFC, Cristescu M., Nicolae M., Mihail M., SGAM Easten

Europe

United Kingdom, France / Romania

Total Investment

hospitals in other

cities UNK 75

Total general 294 1005


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Synoptic table private hospitals in RomaniaSynoptic table private hospitals in Romania

and Bucharestand Bucharest


20

2011

2011-2013

(new

projects)

2011-2013 ( existing private

hospitals+future projects)

Romania

No. of hospitals 24 15 39

No. of beds* 1284 1005 2289

Bucharest Out of which Out of which Out of which

No. of hospitals 5 14 19

No. of beds* 281 1005 1286

Note: *Not all the future hospitals have reported the number of beds


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Private hospital locationPrivate hospital location --

existing and new projects untill 2013existing and new projects untill 2013


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The Major Private Healthcare CompaniesThe Major Private Healthcare CompaniesThe private medical services market estimatedThe private medical services market estimated

at 430 mil euroat 430 mil euro in 2009in 2009


22

Source:Oficiul National al regsitrului Comertului

Note: * Advent International Investment Fund bought in February 2010 80% from CMU stocks

Largest private healthcare companies owners of hospitals and outpatient medical centers

No.

crt.

Company/Web address Turnover 2009 (mil.

) Employees

General manager/Phone

Shareholders2009 2008 2009 2008

1

MED LIFE

www.medlife.ro 26 21,2 990 844 Mihail Marcu 021/2226415

IFC, Cristescu Mihaela Gabriela, Nicolae

Marcu, Mihail Marcu, SGAM Eastern

Europe (Societe General)

2 CENTRUL MEDICAL UNIREA www.cmu.ro 13,7 10,9 700 350 Wargha Enayati 021/2229294 Enayati family, Advent International

3MEDICOVERwww.medicover.ro 11.6 12,8 NA 428 Marina Otelea 021/3191699 ABC Medicover Holding (Sw)

4

GRAL MEDICAL

www.gralmedical.ro 10.7 10 430 371 Robert Serban 021/3230004 Robert and Georgeta Serban

5

HIPERDIA

www.hiperdia.ro 10 9,3 224 251 Tiberiu Roth 0268/473608 Southeast Europe Equity Fund

6

SANADOR

www.cmsanador.ro 9,7 9,4 450 400 Doris Andronescu 021/3230260 Doris Andronescu

7

CENTRUL MEDICAL ROMAR

www.romar.ro 9 10,6 503 447Liliana Hagicalil 021/3310301 Else Comp. Ltd., RC2

8 CLINICA POLISANO www.clinicapolisano.ro 8,8 4,9 262 160 Dan Rosca 0269/234486 Ilie si Daniela Vonica

9

EUROCLINIC

www.spitaluleuroclinic.ro 8 6,6 341 258 Catalin Popa 021/2006800 Eureko

10

MEDCENTER

www.medcenter.ro 7,2 10 470 510 Florin Balanica 021/2424477 Medicarom

11

MEDSANA BUCHAREST MEDICAL

CENTER www.medsana.ro 5,9 6,2 373 373 Vassilis Chaniotis 021/4087800

Athens Medical Group of Companies

(Greece)

12 EUROMEDIC ROMANIA www.euromedic.ro 5,4 NA 549 414 Anca Petca 021/2224111

Ares Life Sciences, Merrill Lynch Global

private Equity

13

CENTRUL MEDICAL MED-AS 2003

www.medas.ro 4,5 NA NA NA Simona Ateia 021/3102138 Simona Ateia


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Public and Private Insurance System

The NATIONAL HEALTH INSURANCE HOUSE (hereafter called NHIH) is the national health insurance plan

for the country. All citizens insured under the NHIH plan are entitled to healthcare services at any public

institution (ie medical centre or hospital)

All private Hospitals are entitled to sign agreements with the National Health Insurance House which afford

partial reimbursement of medical costs for diagnostic and treatment services provided to patients covered

under NHIH.

The contract regarding the conditions applicable to the NHIH plan including coverage and levels of

compensation is reviewed by the Romanian Government. It can be said that patients covered under the

NHIH plan but treated at a Private Hospital are generally entitled to partial reimbursement of the costs of

their diagnostic and treatment services.

For the year 2011, the average reimbursement provided for under the NHIH for surgery is 350 euros. The

specific amount reimbursed to a Private Hospital for a surgical procedure is governed by the contract

negotiated between the specific Hospital and the NHIH. Such contracts are negotiated annually.

The private healthcare insurance system in Romania is still at the start-up stage. Even though there are anumber of renowned Insurance Companies competing in the Romanian Market (eg. Generali Group, Allianz,

BCR, AIG, BCR, ING Insurance and Adorama), the Healthcare Insurance products on offer are very basic

such as medical check-up insurance. The absence of a more robust and substantial Healthcare Insurance

program is considered the main reason why there are currently only 24 private hospitals for a population

of over 21 million.


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Public and Private Insurance System

We predict that the Private Healthcare Insurance market will expand and become far more developed

starting in the year 2012 when another 15 Private Hospitals will become operational (see slide 19).

It is noted that all announced new hospital construction projects are located in Bucharest. This will result in

disproportionate regional levels of service.

Country Wide - 39 private hospitals in Romania population 21 million ( 1 hospital for 538.461 inhabitants)

In Bucharest - 19 private hospitals estimated population 3 million (1 hospital for 157.894 inhabitants)

Rest of Romania - 20 private hospitals - population 18 million ( 1 hospital for 900.000 inhabitants)

Even though the ratio of hospitals to number of inhabitants is very low compared to other parts of Europe, the new private

hospitals will in fact offer medical services in speciality areas that are seriously under represented today and for which

services are severally lacking. These new hospitals will provide medical services in the high priority areas of cardiology,oncology and major surgery.


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Sources of RevenueSources of Revenue

The main sources of revenues for the Private Healthcare System are:

Patients paying directly to the hospital

Patients with Corporate medical coverage (often included as part of the compensation

package offered to employees of multinational companies). Corporate coverage may be

valid for one service provider (as chosen by the employer) or for any Private Medical

Centre up to a certain financial limit.

Patients with Individual Healthcare Insurance. Both types of healthcare subscriptions are

valid only in an clinics network. (example: Unirea Medical Center subscription can be used just inthe company network clinics and hospitals)

The partial reimbursement offered under the National Health Insurance House , (eg 350euros per surgical procedure.)

Private insurances (limited services)


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ObservationsObservations

The actual growth enjoyed by 10 of the 13 major private healthcare companies in Romania falls within this

range (see slide 21).

Some of the companies that opened Outpatient Medical Centers and Specialized Clinics in Bucharest and

elsewhere in Romania now plan to expand and construct General or Specialized Hospitals.

In present they are only five companies

that have to date opened

private General Hospitals

with more than 100 beds:

Fiterman 220 beds, from IasiLife Memorial Hospital 127 beds, from Bucuresti

Nova Vita San 126 beds, from Targu Mures

Athena 118 beds, from Timisoara

Euroclinic (CMU) 100 beds from Bucuresti


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ObservationsObservations

The public healthcare system is developed throughout Romania and includes all the medical

centers and hospitals categories (slide 5). The hospitals units are generally located in old

buildings and the medical equipment is inadequate in many hospitals. The medical staff has

high level qualification. The same professors and doctors are working also in the private

system .

The medical fee structures applied by the various private hospitThe medical fee structures applied by the various private hospitals in Bucharest are essentiallyals in Bucharest are essentially

identical. The differences are not significant (slide 26).identical. The differences are not significant (slide 26).


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Conclusions

The varioius legislation governing the delivery of healthcare services is relatively new and has been drafted

to respect UE standards.

The Romanian Public Healthcare Sector is under financed. The Government allocation of just 5% of GDP is

grossly insufficient.

The Private Healthcare sector is under developed. To meet current and future market demands, the privatesectors further development must be accelerated.

The Private Healthcare sector is much more developed in Bucharest than the rest of Romania. This may lead

to disproportionate levels of service throughout the country with rural areas being disadvantaged. Given

the high concentration of start ups planned for Bucharest in the coming two years, this disportionate access

to private medical services is likely to occur sooner than later..

There is currently a substantial void of Specialized Clinics or Specialized Hospitals in high priority

specialties such as; general surgery, cardiology,oncology and oncology surgery, emergency services. After

2012, there will be a number of Specialized Hospitals that will focus on one or more of these priority

services.


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Conclusions

The private hospitals are not connected to the 112 emergency number (911 in USA). None of the Private

hospitals are specialized in Emergency Care.

We estimate that the private insurance system will be more developed and diversified starting with 2012

The healthcare private market is maintaining its growth trend 35% in 2009 and 20% in 2010

7 out of top ten healthcare companies had a grow in turnover in 2009 compared with 2008

The main sources of revenues for the private medical units are patients paying directly and subscription to

a medical chain units


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APPENDIXES


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Appendix no.1

List of hospital regulations

The healthcare system in Romania is governed also by:

In addition, the construction and operation of hospitals in Romania are governed by the Ministry of Health

(Order OSMP 914/2006 last updated by1030/2009) which contains 47 pages of very specific rules

regarding internal structure, location and environmental impact.

The design and construction of hospital buildings and installations must be compliant with Regulation NP-015-97; the anesthesiology and intensive care units with regulation 1500/24 and the Emergency Unit with

regulation 1706/2 dated October 2007.

1500/24 November 2009 (regarding the organization and the functioning of the units and the anesthesia

and intensive care departments in hospitals),

1706/2 October 2007 ( regarding the management and the organization of the units and the emergency

room).


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Appendix no 2Appendix no 2

List of Major Pharmaceutical Companies (2009)List of Major Pharmaceutical Companies (2009)


33 Turnover( mil . )

2009 2009% 2008%

1 Sanofi- Aventis/ Zentiva 194,2 10,1 10,7 *

2 Hoffmann La Roche 174,2 9,0 7,3

Pfizer/ Wyeth , , ,

4 GlaxoSmithKline 122, ,4 ,9

5 Novartis 114,0 5,9 6,6

Servier , ,

7 Merck/ Schering Plough 85,2 4,4 3,7 ***

8Ranbaxy

, , ,

9 Astrazeneca 63,3 3,3 2,5

10 Abbott/ Solvay 52,1 2,7 N/A

11 Antibiotice Iasi 49,0 2,5 2,7

Bayer , , ,

Eli Lilly , , ,

14 Menarini 40,4 2,1 2,1

15 Labormed / Ozone 40,0 2,1 New entry

KRKA , , ,

17 Activis 34,3 1,8 1,7

18 Johnosn & Johnson 30,9 1,6 1,6

19 Gedeon Richtel 27, 1,4 1,5

20 Reckitt Benckiser 27,2 1,4 New entry

Total 1. 493,50 77,4

S ur sa : R ap or t ceg eg im pr el ua t d e Zi ar ul fi na nci ar 7 ma i 2 01 0 No ta : Ceg ed im a f ur ni za r va nz ari le i n l ei si au fo st tra ns fo rm at e d e ZF la un cu rs de 4,2 lei pt . u n

* Co ta d e p ia ta cu mul at a a co mpa ni il or S ano fi - A vent is si Zen ti va ; D at el e s un t l a p ret ur i P PP , a di ca la i es ir ea di n f ar maci i.

**Cota de piata doar pentru compania Pfizer

*** cota cumulata pentru Merck si Schering Plough. Aceste cote au fost calculate cumulat de ZF

Market shareCompany/Group/ Web adressPosition


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APPENDIX no 3APPENDIX no 3

High Risk Diseases in RomaniaHigh Risk Diseases in Romania

Between July 2007 - June 2008, the Ministry of Health completed an evaluation of the state

of public health. (Riscograma 2008 )

A total of 11,104,655 persons were evaluated; 57,6% women and 43,4% men.

The risk evaluation identified a total of 4,114,969 persons at risk of being further inflicted

with a disease (37% of the group surveyed).

30% of the group or 3.323.156 persons were found to be at risk of developing mellitius

diabetes 7% of the group or 805.989 persons were found to be at risk of developing cardiovascular

diseases

6% of the group or 671.696 persons presented chances of developing oncologycal

diseases (cancer).


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Studiu Medical

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