Globalization of Healthcare From Crisis to Opportunity Chicago June 1, 2010

22 Globalization of Healthcare Global Marketplace for Healthcare Major Trends that Affect the Market Way Forward Outline

33 Global Marketplace for Healthcare From Local to Global Size of Global Market Sub-markets Economic Zones Aggressive Posturing by Emerging Markets Cross-border Demand Firms Strike Back (Porter’s Five Forces) Outline

44 How Big is the Global Marketplace for Healthcare (IMF) Rounding Up Global GDP US$55 trillion Global Health Spending US$5.5 trillion Spending on Health in all Low Income US$550 billion Spending on Health in Africa US$ billion

55 The Devil is in the Detail (IMF) Rounding Up US GDP US$16 trillion Global Health Spending US$5.5 trillion Financial Bailout US$3.0 trillion US Health Spending US$2.7 trillion New Health plan US$800 billion US derivatives markets US$666 trillion

66 Binding Constraints Fiscal Space Overall level of GDP Share of GDP channeled through the public sector  Share of public sector resources allocated to health care Share of health expenditure in public sector used to pay for health workers and health education Share of GDP channeled directly through households  Household spending of health care Share of private expenditure on health care devoted to health workers and health education

7 Sub Markets

8 The Case for Investing Across Subsectors

9 The Case for Investing Health Services Subsector

10 Economic Zones HiA Facility US$1 Billion Total 500 million loans 300 million equity 200 million for TA Other Zones EU Eastern Europe North America South America Middle East South Asia East Asia

11 Expanding Beyond Borders Old World Major US and European Companies Brave New World South Africa (Netcare) India (Apollo) Multi-nationals

12 Cross Border Demand Medical Tourism US (Mao Clinic, Leahy Clinic, Cleveland Cl) Thailand (Bumrungrad) Jordan (King Hussein) Beyond Tourism Hong Kong Singapore What/Where

How Firms React to Competitive Threats Michael Porter’s Five Forces

14 Major Trends that Affect The Market Opportunities Expansion in Health Insurance Global Financing Mechanisms Epidemiological shits Threats Financial Crisis Technological Arms Race Human Resources Crisis Outline

Scaling up From 40 Million to 4 Billion: Who is Doing it?

Years of Reform in the US – New York Times

17 It is Popular Everywhere

The New and the Old Players in Health Financing

20 7 years of 5% ave. growth …… with reducing inflation … Annual GDP Growth (%), Sub-Saharan Africa, Annual CPI (%), Sub-Saharan Africa, So Four Years Ago Things Looked Rosy

21 The Sky Was the Limit

22 Then Suddenly Everything Changed

23 The World Economy went into a Tail Spin

Normal Market Response

But This Time that Didn’t Work

26 Consumer Confidence Rapidly Collapsed

27 New and Realistic Approaches were Needed in Health Care

28 As in the Past Donor Funding is Already Affected

29 Need for Renewed Political Commitment to Public Spending 1.Ghana 2.Chad 3.Cote d'Ivoire 4.Kenya 5.Namibia 6.Swaziland 7.Senegal 8.Comoros 9.Mauritania 10.Mozambique 11.Sudan 12.Cameroon 13.Congo, Rep. 14.Equatorial Guinea 15.Nigeria 16.Gambia, The 17.Togo 18.Gabon 19.Sierra Leone 20.Burundi 21.Eritrea 22.Guinea 23.Central Afr. Rep. 24.Zambia 25. Lesotho 26. Zimbabwe 27. Seychelles 28. Ethiopia 29. Madagascar 30. Benin 31. Angola 32. Guinea-Bissau 33. Tanzania 34. South Africa 35. Mauritius 36. Mali 37. Uganda 38. Cape Verde 39. Sao Tome & Pri 40. Congo, DR 41. Burkina Faso 42. Botswana 43. Malawi 44. Liberia 45. Rwanda

30 Instead Ministers of Finance Recently Rescinded

31 Need to Capture the Very Valuable Private sector Resources

32 This is Not the First Financial Crisis Great Depression 1930s Oil Crisis of the 1970s Inflation 1980s East European Crisis ( ) East Asian Crisis ( ) Argentinean Crisis (2001) Russian Crisis ( ) Peruvian Crisis ( ) Mexican Crises (1980s and 1990s)

In Healthcare What Goes Down always Comes Back Up World Bank Lending From US$ 20 billion To US$100 billion US Health Spending Up 100 Billion /year

34 Medical Technology Arms Race Hi Tech

35 Human Resources Crisis Outline

36 The Way Forward Strength in Numbers Role of the World Bank Group Role of the IHF Role of Others Discussion