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Wen | Flint Industry Brain, author | Flint stone creates Liao Yitao
China's medical service market is huge, driven by the in-depth medical reform, the promotion of hierarchical diagnosis and treatment, the evolution of new medical technologies, the aging of the population, urbanization, wealth growth and the comprehensive coverage of the basic medical security system, and other factors, and the third-party independent medical institutions have gradually become an important starting point for the national and local governments to improve the efficiency of regional medical services and assist the business development of public hospitals.
To this end, the National Health Commission issued the "Detailed Rules for the Implementation of the Regulations on Amending the Regulations on the Management of Medical Institutions" and the "Notice on Deepening the Reform of "Decentralization and Management Services" to Stimulate investment vitality in the medical field" in 2017, proposing the basic standards and management norms of 10 types of independently set up medical institutions, clarifying the future direction of third-party independent medical institutions from the policy point of view, and issuing the "Guiding Principles for The Planning of Medical Institutions (2021-2025)" on January 29, 2022, proposing to encourage social forces to recover, Non-profit medical institutions and medical laboratory laboratories, pathological diagnosis centers, medical imaging diagnostic centers, hemodialysis centers, rehabilitation medical centers and other independent medical institutions are established in the field of nursing and other shortage specialties, so as to strengthen the standardized management and quality control of social medical services and improve the level of homogenization.
In such a large and transformative industry, how should local governments choose to match the direction of their own segments? How to plan the path of innovative development of the medical service industry? How to cultivate new formats and models of third-party medical service industry and promote the transformation and upgrading of regional pharmaceutical and health industry? How should industrial investors optimize their investment layout in the country? With these thoughts in mind, the author combines the market capacity, market competition, investment layout characteristics and other characteristics of China's third-party medical services, focusing on the analysis of the medical technology third-party medical service segments represented by pathological diagnosis laboratories, medical imaging diagnosis centers, medical testing laboratories, disinfection supply centers, etc., in order to provide reference and reference for the government and investors.
01 The overall status quo of the development of the third-party medical service industry
There are many subdivisions. At present, the third-party medical service industry in China is still in the early stage of development, there are more subdivisions, representative areas include medical laboratories, pathology diagnosis centers, medical imaging diagnosis centers, hemodialysis centers, hospice care centers, rehabilitation medical centers, nursing centers, disinfection supply centers, small and medium-sized eye hospitals, health examination centers and other ten categories, the overall industry profit is relatively high.
The market prospect is broad. Driven by favorable policies, technology, capital and demand, the scale of China's third-party medical market continues to expand and maintain a high-speed growth trend. According to statistics, in the past five years, the compound annual growth rate of China's third-party medical institution industry market has exceeded 30%. It is estimated that by 2025, the scale of the third-party medical service market will exceed 500 billion yuan, with huge room for growth.
National policy advancement. In recent years, with the deepening of China's medical reform and the transformation of economic growth mode, the national level has continuously introduced relevant policies to encourage social capital to run medical services and promote the development of third-party medical services as a supplement to the public medical system.
Table 1: Interpretation of China's key policies to encourage the development of the third-party medical service industry in recent years
Source: Flint Creation is based on publicly available information
02 Overview of the development of third-party medical service segments
(1) Medical laboratory: the degree of marketization has gradually increased, and there is a large room for growth
Medical laboratory laboratory, also known as third-party medical laboratory, refers to a medical institution with independent legal personality, independent of the hospital to engage in clinical examination or pathological diagnosis and services, and can independently assume responsibility under the permission of the health administrative department. It is mainly divided into general inspection laboratories and special examination laboratories. From the perspective of the industrial chain, independent medical laboratories are in the middle of the diagnostic industry, the upstream is the manufacturer of testing instruments and reagents, and the downstream is all kinds of medical institutions and inspectors.
The market size continues to expand, and the penetration rate needs to be further improved. Referring to the China Health Statistics Yearbook, Guojin Securities Research Report, Leopard Research Institute, Frost & Sullivan and other multi-party data, Flint Creation preliminary estimates that the market size of the independent medical testing industry in the mainland will be about 30 billion yuan in 2020, and the penetration rate of more than 35% of the mature markets such as the United States, Germany, and Japan, the penetration rate of medical laboratories in the mainland is low, about 6%, and it is expected that in 2025, the industry market size is expected to exceed 50 billion yuan, and the future development potential is huge. At the same time, in the context of the epidemic, in order to alleviate the pressure of nucleic acid testing, the National Health Commission has made it clear that third-party medical inspection services can be purchased in various places, and third-party inspection institutions will also occupy a more important position in the medical service industry because of their large-scale and professional services.
The proportion of the special inspection market exceeds that of the general inspection market. From the perspective of service types, third-party medical testing services mainly include two types of testing services: routine testing and special testing. According to Frost & Sullivan data, the growth rate of China's special inspection market in recent years has been significantly faster than that of the conventional inspection market. In 2020, The proportion of China's conventional testing and special inspection market reached 47.3% and 52.7% respectively. At the same time, in the context of the sharp increase in COVID-19 testing, the market size of special inspection services has shown strong growth potential during the epidemic.
It shows the rapid increase in scale and quantity and the characteristics of the national chain operation of leading enterprises. According to the data disclosed by The China Food and Drug Network, between 2012 and 2020, the number of independent medical laboratories in China has grown from 129 to more than 1,600. At present, most independent medical laboratories in the mainland are small in scale, mainly adopting a regional business model or focusing on specialty testing services. Dean Diagnostics, Jinyu Medical, Daan Gene, Adicos, etc., as the four leading enterprises in China's third-party medical diagnostic industry, account for more than 50% of the market share. In recent years, it has begun to sink from first- and second-tier cities and provincial capitals to third- and fourth-tier cities and county seats, and built a number of new medical testing centers.
Typical case: Dean Diagnosis
Company Profile: Founded in 2001, the company's business covers medical diagnostic services, diagnostic technology research and development, diagnostic product production and marketing, CRO, forensics, health management, cold chain logistics and other fields. It has served more than 20,000 medical institutions across the country, with a cumulative service of more than 300 million people.
Investment layout: At present, there are 40 chain medical laboratories in the country, which has formed a "chain, standardization and scale" development trend of "national coverage and regional penetration". From the perspective of layout direction, it mainly focuses on the Yangtze River Delta region and the Bohai Rim economic circle to steadily advance to south china and northeast China, and then radiates to the central and western regions, and gradually realizes the national layout.
Business model: Dean Diagnostics mainly adopts the integrated business model of "service + product", and goes through three stages, such as channel agency business, diagnosis outsourcing service, and cooperation and co-construction model, to achieve the three-level linkage of "central laboratory, regional testing center and cooperative co-construction laboratory" and build an advanced medical diagnosis ecosystem.
(2) Medical imaging diagnosis center: in the initial stage of development, the market potential of the medical imaging diagnosis center, refers to the independent application of X-ray, CT, magnetic resonance (MRI), ultrasound and other modern imaging technology to examine the human body, issue imaging reports, imaging diagnosis suggestions, can independently assume civil liability of medical institutions (excluding medical imaging diagnosis departments within medical institutions).
In the initial stage of development, the market size showed a high-speed growth trend. Compared with the development history of the United States in the past 40 years, the mainland third-party independent medical imaging diagnosis center started late, is still in the initial stage of industry development, and has initially formed an industrial pattern in which imaging equipment, independent medical imaging diagnostic centers and medical imaging artificial intelligence are coordinated and interconnected. In recent years, driven by market demand and policies, mainland medical imaging centers have gradually developed towards scale and chain. It is estimated that the size of the mainland medical imaging market has exceeded 200 billion yuan.
From the perspective of operation mode, it is mainly divided into two categories: independent imaging centers and hospitals or hosted imaging centers operated in cooperation with hospitals.
(1) Independent image center. Imaging centers in provincial capitals and first-tier cities are mainly positioned to provide differentiated services, focusing on high-net-worth individuals who do not want to queue up in public hospitals and have social security. The imaging centers at the county level are mainly positioned to enhance or supplement the imaging business capabilities of public hospitals.
(2) Cooperative operation or trusteeship with hospitals. The patient is diverted by the cooperative hospital, and then the third party completes the imaging examination and then directs the patient back to the cooperative hospital for surgery, which is equivalent to the hospital outsourcing the imaging department, and the third party charges the service fee.
From the perspective of the main body of enterprises, it is mainly composed of three categories: real estate enterprises, medical imaging institutions and upstream and downstream enterprises in the industry.
(1) Enterprises in the field of real estate, such subjects usually have better industrial resources and financial strength, but lack of medical imaging technology background and operating experience, in order to achieve the diversified investment layout of the group's large health industry, mainly take the way of cooperation with medical and health service institutions to jointly develop independent imaging center business, typical representatives such as Guangyu Group invested in the establishment of Hangzhou Panoramic Medical Imaging Diagnostic Center.
(2) Professional medical imaging service institutions, typical representatives such as Yimai Sunshine adopt the way of self-construction and cooperation to deploy the national chain of imaging centers.
(3) Enterprises related to medical imaging services expand their business upstream and downstream, representing ping an good doctor, Wanliyun, etc.
Typical case: Overview of Yimai Sunshine Enterprise: The company was invested and founded in 2014, specializing in the investment and operation of medical imaging centers, medical imaging cloud platform technology development, medical imaging talent training, medical imaging industry chain services, and has served more than 700 hospitals and served 100,000+ patients a year.
Layout characteristics: The medical imaging center takes clinicians/hospitals as the primary service object, takes collectivization and chaining as the main development model, cooperates with the national regional planning and hierarchical diagnosis and treatment system, allocates corresponding equipment and medical talents in cities, counties and townships, and promotes the development of precision medicine with accurate diagnosis, and the service model includes four categories: regional shared imaging center, independent imaging center, hosted imaging center, and medical imaging medical association.
Development trend: Continue to expand the network and service scope of the center, continuously strengthen coverage in areas with rigid demand for imaging services, and actively seek strategic partnerships, acquisitions or investment opportunities, and continue to enhance the integration of the medical imaging industry and ecological organization capabilities.
(3) Pathology diagnosis laboratory: in the initial stage of market-oriented development, a large number of enterprises have poured in
Pathological diagnosis laboratory refers to an independent legal entity that conducts pathological morphological observation through microscopes, uses immunohistochemistry, molecular biology, special staining and electron microscopy and other technologies, combined with the patient's clinical data, and makes pathological diagnosis reports on human organs, tissues, cells, body fluids and secretions, and can bear corresponding legal responsibilities (excluding the pathology department set up in medical institutions). The service content is mainly divided into histopathology, cytopathology, immunohistochemical pathology and molecular pathology. From the perspective of the industrial chain, the industrial chain of the pathology diagnosis industry includes the upstream raw material market, the midstream reagent equipment market and the downstream demand diagnosis market.
The potential market size exceeds 40 billion, and the market-oriented development needs to be improved. According to the 2020 World Congress of Pathology report, the global pathology market size is expected to reach $44.4 billion by 2024 from $30.3 billion in 2019, with a compound annual growth rate of 6.1%. According to the forecast of Western Securities, the potential market size of China's pathology industry exceeds 40 billion yuan. Among them, the histopathology market size is 2 billion to 3 billion yuan, the cytopathology market exceeds 30 billion, the potential market space of immunohistochemical pathology exceeds 4 billion, and the potential market space of molecular pathology exceeds 5 billion yuan. In recent years, with the rise of precision medicine, pathological diagnosis as the "gold standard" recognized by the medical community for disease diagnosis, its value has been further highlighted, and a large number of enterprises have begun to pour in in order to seize market opportunities.
The existing third-party pathology diagnosis centers in China are mainly established in the type of regional medical association, and there are few market-oriented third-party pathological diagnosis centers. Third-party pathology diagnostic centers mainly use four modes of operation.
(1) Independent third-party pathology diagnosis laboratory. Mainly by the professional department engaged in clinical and pathological testing or medical laboratory enterprise business expansion, focusing on providing various types of disease pathological testing and diagnosis business, typical representatives such as Lanwei Medicine.
(2) Public regional pathology diagnostic centers. Mainly through the idea of large-scale, intensive and professional development, such institutions will strip and integrate the pathology departments of key hospitals in the region, expand the scope of services, and take into account the pathological diagnosis of other local hospitals, typical representatives such as Ningbo Clinicopathology Diagnosis Center.
(3) Pathology laboratory based on universities. It mainly refers to the establishment of a separate pathology laboratory for students to conduct scientific research, practice and provide external testing services in the university or medical school that opens pathology, or the department of pathology of the school as the core and the regional key hospitals jointly build a regional pathology discipline resource integration institution and functional platform, typical representatives such as the Clinical Pathology Center of Capital Medical University.
(4) Pathological diagnosis laboratories that cooperate or are hosted with medical institutions. Mainly in tumor treatment centers and large hospitals, specialized pathology departments or separate pathology centers are hosted, or third-party pathology diagnostic laboratories provide equipment, reagents or personnel, and hospitals provide venues and sample sources.
Representative case: Lan Wei Medical
Company Profile: Founded in 1993, the predecessor of Lanwei Medicine provides third-party medical examination and pathological diagnosis services, well-known brand in vitro diagnostic products and other professional and technical support for medical institutions at all levels to meet the differentiated needs of medical institutions at all levels.
Business model: On the basis of "product agency + third-party inspection", in line with the development direction of the state to promote the construction of medical associations and mutual recognition of test results, the third-party medical inspection business is carried out using the model of "regional medical testing/pathological diagnosis center", relying on regional centers, integrating regional trade business and inspection business resources, achieving regional scale advantages, and continuously providing differentiated services for medical institutions at all levels in the region.
Layout characteristics: Through self-construction and epitaxial mergers and acquisitions, mutual recognition of medical test results in the region and collaborative sharing of pathological diagnosis resources are realized. Actively cover more than ten provinces and cities, build more than ten regional medical testing and pathological diagnosis centers, and form a branded, large-scale and standardized laboratory network.
(4) Disinfection supply center: the rapid development of the industry, the beginning of the emergence of 100 billion blue oceans
Disinfection supply center, refers to in accordance with the mandatory operating standards and quality standards promulgated by the National Health Commission, through standardized management and professional services, to provide medical and health institutions with the use of various types of sterile goods supply units, which are mainly responsible for the reuse of medical institutions of diagnostic and treatment instruments, appliances, clean surgical gowns, surgical items and other items cleaning, disinfection, sterilization and sterile goods supply, and carry out quality control of the treatment process, issue monitoring and testing results, to achieve the whole process of disinfection traceability, Ensure the quality of disinfection and sterilization. From the perspective of the industrial chain, the upstream of the disinfection supply service industry is mainly the manufacturer of disinfection and sterilization equipment and consumables, the middle reaches are third-party disinfection supply service providers, and the downstream is the disinfection service customers, including hospitals, pharmaceutical companies and other institutions.
The market size exceeds 70 billion yuan and is in a period of rapid growth. According to Frost & Sullivan statistics, the mainland third-party disinfection supply center market size reached 17.47 billion yuan in 2018, with the rapid growth of mainland hospitals, dental clinics, medical beauty institutions, social health centers and other medical institutions in recent years, the demand for third-party disinfection supply centers has risen sharply, it is expected that in 2022, China's third-party disinfection supply center industry market size will reach 76 billion yuan, and the compound annual growth rate from 2018 to 2022 will reach 42.2%. In the short and medium term, it may break through the scale of 100 billion.
Hospital disinfection outsourcing has become a trend, and third-party disinfection supply centers are a blue ocean. From the perspective of development trend, the current disinfection supply room for the hospital, the cost of operation management and quality control is too high, and there are multiple problems such as duplicate resource allocation and difficult supervision. With the deepening of medical reform and the rise of third-party disinfection supply services, hospital disinfection outsourcing is the trend of the times, and the development potential of the private disinfection service market is huge. Among them, the regional medical disinfection supply center will become one of the main directions for the development of the management mode of disinfection and sterilization articles, and the addition of the enterprise-oriented quality control and management mode will further drive the change of a series of professional work content and promote the vigorous development of the disinfection supply industry.
From the perspective of construction mode, at present, China's disinfection supply center mainly has three modes: hospital self-built mode, hospital-enterprise joint construction mode and enterprise self-built third-party disinfection supply center.
(1) The hospital's self-built disinfection supply center can be divided into three types according to its business and functional positioning: the traditional hospital disinfection supply center, the hospital disinfection supply center that provides regionalized services, and the disinfection supply center in the hospital that chooses outsourced services.
(2) The hospital-enterprise joint construction disinfection center is mainly built for the cooperation between the benchmark hospital and the leading enterprises in the industry, and the hospital provides the venue, and the enterprise provides operation and service.
(3) The enterprise builds a third-party disinfection supply center, and the investment enterprise purchases or leases land to build a factory building in an area outside the hospital, or leases the on-site plant to invest in the construction of a regional disinfection supply center to provide services to regional medical institutions. The location layout of such institutions is usually close to the regional key hospitals.
Typical case: Julikang
Enterprise Profile: Founded in 2010 and headquartered in Jiading District, Shanghai, the company focuses on providing professional service solutions for medical institutions to clean, disinfect, sterilize and distribute medical devices, and accelerates the construction of third-party disinfection supply centers with the help of technology and capital, and has served hundreds of medical institutions.
Layout characteristics: The investment site selection of enterprises comprehensively considers the economic benefits, hospital acceptance, service program maturity, environmental protection requirements, logistics scope and other factors, mainly adopts the chain replication promotion model, and focuses on the layout in key provinces with rich medical resources. At present, independent third-party medical disinfection supply centers have been set up in Shanghai, Tianjin, Guangzhou, Anhui, Fujian, Shaanxi, Chongqing, Liaoning, Henan and other provinces and cities, and will gradually form a nationwide service network in the future, standardized, chained and branded.
03 Development model of medical service agglomeration area
The development of the third-party medical service industry shows a cluster development trend. From the perspective of industrial organization model, China's third-party medical services are mainly concentrated in large-scale international medical parks, health cities, medical service areas and other areas where a large number of medical resources or medical and health industries are concentrated, typical cases such as Shanghai International Medical Park.
Typical case: Overview of Shanghai International Medical Park: Shanghai International Medical Park was established in 2003, covering an area of 11.88 square kilometers, the park to build Asia's first-class oncology medical center and Zhangjiang Cell Industrial Park as the core, to build a sound "medicine, teaching, research, production" as one of the new health industry ecosystem. At present, it has gradually developed into the largest third-party inspection cluster in China, which can professionally provide comprehensive detection service solutions such as physical and chemical detection, genomics detection, biochemical luminescence detection, immunoassay, histopathology, and cytopathology.
Key enterprises: Shanghai Proton Heavy Ion Hospital, Shanghai Cancer Hospital East Branch Affiliated to Fudan University, Shanghai International Medical Center, National Children's Medical Center, China Taiping International Health Care Community and other more than 10 high-end hospitals. There are more than 25 third-party medical testing institutions such as BGI Genomics, Boao Bio, Jinyu Inspection, Core Super Biologics, Ogishuo Beacon Medical, Kunai Medical Examination, etc.
Layout of testing service areas: Focus on non-invasive prenatal genetic testing represented by BGI Gene and Yirui Medical Examination, tumor gene testing represented by Zhidi and Jikai Gene, as well as judicial identification, paternity testing, transplant matching testing, stem cell storage and other services.
04 Conclusion
In general, China's third-party medical service industry is currently in its initial stage of development, and the development speed is extremely fast. Driven by a series of policy dividends and practical needs, various subdivisions have developed in depth, industrial development standards and norms have continued to improve, the blue ocean of hundreds of billions of scale markets has emerged, and all parties in the industry have accelerated their influx. It is believed that in the future, with the deepening of medical reform, the rise of residents' consumption levels, and the promotion of precision medicine, medical big data, artificial intelligence, telemedicine and other technologies, the third-party medical service industry may usher in a rapid development beyond expectations, and those areas that can deeply grasp the development trend of the third-party medical service industry, accelerate the industrial layout and seize market opportunities may usher in more development opportunities and returns on investment.