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At present, there are 35,600 dialysis centers in whole world. And the gaps of market concentration ratio are large due to the different regional operating entities: Expect for Japan, dialysis centers in other Asian countries are operated by state-owned medical institutions. The rankings of countries in terms of market concentration ratio are as follows: North America, Europe, Latin America and Asia-Pacific. North America is the region has the most advanced dialysis services and highest market concentration ratio.
According to the 2013 annual report of Fresenius, the market share of the two Giants in hemodialysis services- Fresenius and DaVita was only 10.7% and 6.6%. The global market concentration was low in that year. The reasons accounted for that are the influence of the government policies and market openness of each country, so the expansion barrier of hemodialysis services is high. For example, Fresenius has completely failed to enter into Japanese market by far. However, on the other hand, regional market of hemodialysis services is under the monopoly of a specific brand. For example, the total market shares of Fresenius and DaVita in America have exceeded 60% in 2013.
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- In 2013, the latest research report of IBIS World states that the market scale of American hemodialysis center has reached USD 19 billion, with CAGR (compound annual growth rate) up to 4.9% in 2008-2013. And it is estimated to reach USD 24.5 billion by 2018. In America, the number of the patients who have received the dialysis services from giants-Davita and Fresenius has accounted for 62.7% of the total in 2013, and that of the 9 medium and small chain dialysis institutions has accounted for 15%, nearly 800 non-chain dialysis centers has accounted for 13.6%, and the dialysis centers in hospital has accounted for 8.7%. In general, the average number of patients in each dialysis center is 60-70 people. However, the patients in hospital dialysis centers are no more than 50 people. Obviously, the service ability of independent hemodialysis centers is much greater than those in hospitals.
- A typical dialysis center in America is equipped with 18 dialysis machines, and each one of them can give dialysis treatment three times a day, six days a week. Personnel allocation includes five nurses, nine technicians and four supporters (administrative staff, nutritionist and clerk), eighteen members in total. In terms of the distribution of the direct operation cost of American hemodialysis center, manpower cost is a quite important part which covers nearly 40% of the total cost.
- Since 1980s, the development scale and level of human resource service industry have been improved constantly in global, especially in Asia. Service fields and contents diversify increasingly, from the original recruitment service and personnel agency to training service, labor services dispatching, employment guidance, talented personnel assessment, management consulting and HR outsourcing etc services and relatively complete service industry chain has been formed.
- As one of the most important markets of HR services, Japanese market has unique speciality: special labor force and special profitability model of HR service industry.
Dialysis cost covers 4-5% of Japanese medical treatment expenses, 8% of Taiwanese medical treatment expenses, 6% of American Medicare and only 0.5% of Chinese medical treatment expenses. Currently, American Medicare has covered about 90% of dialysis patients. In 2012, dialysis cost of this country reaches USD 35 billion. It is estimated that by the end of 2020, Compound Average Growth Rate (CAGR) will be 4.9% with USD 54 billion. Although the absolute cost of dialysis in Medicare is rising, the proportion of dialysis cost is dropping because the overall Medicare cost is rising at a greater speed.
In Taiwan, dialysis cost reaches USD 1.5 billion annually, making it the biggest cost in Taiwan medical insurance cost. Dialysis cost in Japan reaches USD 15-20 billion every year. At present, dialysis cost in Chinese mainland is less than CNY 15 billion every year. However, if the dialysis demands of Chinese ESRD patients were to be covered completely, the annual cost is expected to reach CNY 100 billion, which is about 5% of the total medical treatment cost.
Due to the fact that our life-style has become increasingly westernized, our spectrum of disease is also approaching developed countries. Along with the expansion of governmental medical insurance and income growth, dialysis cost in developing countries will continue to rise. In such developing countries as China, India and Pakistan, 90% end-stage renal failure patients died because they couldn't receive dialysis treatment.
The cost of dialysis treatment in developed countries and regions far surpasses that in developing countries. However, thanks to the sound medical insurance coverage, the proportion of dialysis patients in developed countries and regions is much higher than that in developing countries.