欧洲私人处方市场的潜力

The Potential for thePrivate PrescriptionMarket inEurope MEIKE MADELUNG, Engagement Manager, EMEA Thought LeadershipHELENA BAYLEY, Consultant, EMEA Thought Leadership Table of contents Introduction1Comparative overview of selected European countries1Healthcare coverage and reimbursement1The role of private health insurance3A mature e-health ecosystem as a driver for direct-to-patient markets4Development of the private and self-payer markets in selected Europeancountries5Development of the anti-obesity market7In-depth analysis by country9Denmark9France11Germany13Italy15Poland17Spain19UK21Conclusions and recommendations24Note on data and methods26References27Acknowledgements27About the authors28 Introduction As European healthcare systems face increasingpressure from budget constraints, capacity limitations,and evolving patient expectations, a new frontier isemerging in the pharmaceutical landscape: the privateand self-payer prescription market. This white paperexplores the untapped potential of this market, with aparticular focus on the rise of Anti-Obesity Medications(AOMs) as a catalyst for change. Using the rapid development of the AOM market as ablueprint, the paper highlights strategic opportunitiesfor pharmaceutical companies as well as challenges topharma and healthcare systems alike. Comparative overview ofselected European countries Healthcare coverage and reimbursement While public healthcare remains the backboneof medical access across Europe, its limitations— especially in timely access to innovation — areprompting patients to seek alternatives. The growingwillingness of individuals to pay out of pocket,combined with the expansion of e-health ecosystemsand private insurance offerings, is reshaping howtreatments are accessed and delivered. The degree to which healthcare systems cover the costof treatment as well as their ability to do so is a majordriver of private and out-of-pocket expenditure. For thecountries covered in this paper, there is considerablevariation in the level of coverage provided. This is inpart due to the structure of the healthcare system andits approach to allocating cost of care, but for manysystems there is also a gap between what systemsformally provide and the actual level of provisionavailable under public health insurance. Most systemsoperate under some resource constraints which leadto capacity issues and as a result people often turn toprivate health insurance to cover the gap in coverageor pay for treatment out of pocket (OOP). This paper provides a comparative overview ofhealthcare coverage, reimbursement structures,and regulatory environments across key Europeanmarkets. It examines the dynamics of private healthinsurance, the role of digital health platforms, andthe implications of emerging patient-led demand. manage demand. Patient contributions to the costsof medicines are a frequently employed lever, andalmost all healthcare systems require some form ofco-payment for prescription medicines. In Germany,the UK and Italy these take the form of a fixed fee perscript and are largely nominal. In other countries, thereis a tiered co-pay system based either on drug pricesor on income although there is usually an exemptionfor low-income earners, young people, and pensioners,or contributions are capped above a certain amount.Private health insurance sometimes also reimbursesthese co-payments. This is the case in France, wheremost of the population has additional private healthinsurance, resulting in a low level of co-pays overalldespite the relatively high level of co-pays charged bythe public healthcare system. Hospital treatments, including drugs dispensed inthe course of this treatment, are covered by all publichealthcare systems discussed here, although insome cases a daily fee is levied from patients. Wherepublic hospital capacity is insufficient, patients canbe referred to private hospitals — this is the casein England for instance. In other countries, e.g. inGermany, hospitals in private ownership are part ofthe general infrastructure and cater to both statutoryand private health insurance holders. However,capacity challenges in the hospital system are a mainmotivation for the uptake of private health insurancewhich often ensures faster access to treatment.In Poland, private hospitals can also compete inhealthcare tenders and then also provide care onbehalf of the National Health Fund. Especially in those countries with a high degree ofpublic healthcare provision and low levels of OOPcost, there is an expectation that general healthcareshould be available free of charge which makes anymove to increase the financial burden on the individualvery controversial politically. However, as the currentdevelopment of the AOM market shows, in the rightconjunction of circumstances people are willing toincur significant OOP expenditure. Access to doctors’ appointments, in particularspecialists, and to diagnostic procedures, are anotherdriver for private health in