General Information: February 2011, Bucharest

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General Information
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February 2011, Bucharest
Content
2
Introduction. 3 Terminology . 4 Legal framework 5 Medical services market. 6
Public Romanian Healthcare System. 7 Private Romanian Healthcare System... 8 Private Outpatient Medical Center in Romania.. 9 Distribution Most important outpatient medical center in Bucharest.. Private outpatient specialized clinics... 10 11 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 Romania The major pharmaceutical companies in 2009
Pro EAST Consulting 2011
Introduction
3
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.
Therminology
4
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).
Legal framework
5
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 detailed information. 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.
Medical Services Market

6
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%.
Public Romanian Healthcare System Classification

7 Primary Health Care Units provide: General medical and ambulatory services. Secondary Health Care Units provide:
Outpatient clinics but without an operating theatre of specialized investigative labs.
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.
Private Romanian healthcare system classification

8
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 Local Hospitals are private None of the existing Private Hospitals specialize in Emergency Care.
Private Outpatient Medical Center

9
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, Radiology Imagistic, Phlebology, Rehabilitation , Stomatology. See slide 14
Distribution
10
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 of Bucharest. 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
Major private Outpatient Medical Centers in Romania

11
Total no. of No. of No. of centers in centers in centers in Romania Bucharest other cities 18 16 11 13 12 4 9 10 6 2 4 5 4 3 3 3 3 3 2 2 2 2 2 2 3 4 11 4 4 4 2 1 7 3 2 4 0 0 1 3 3 2 0 0 2 2 2 2 0 2 14 5 7 9 8 2 8 3 3 0 0 5 4 2 0 0 1 3 2 0 0 0 0 2 1
Name of the medical center ROMAR CENTRUL MEDICAL UNIREA MEDICOVER MEDCENTER HIPERDIA GRAL MEDICAL MEDICAL CITY MEDLIFE POLISANO CLINIQUE CLINICA MEDICALA ROMGERMED MEDAS PARAMEDICAL CENTER CENTRUL MEDICAL ELIM POLIMED EUROCLINIC SANADOR MEDSANA CENTRUL MEDICAL CLINIMED CENTRUL MEDICAL GALAMED MEDICAL CENTER DIAGNOSIS MEDICAL CENTER PRO LIFE BIOTERRA MED BIOMEDICA CENTRUL MEDICAL IOWEMED CENTRUL MEDICAL ANIMA
Cities ( Abbreviation*) Web adress Ct, Is, Pl, Tm, Gl, Braila, Bz Branesti, Hd, Roman, Tgv, Tg J, Gr* www.romar.ro Cj, Ct, Pl, Tm*,Bc,Bv www.cmu.ro Bv, Cj, Ct, Fcs, Is, Pl, Tm* www.medicover.ro Bv, Cj, Fcs, Is, Gl, BM,Braila, Bz* www.medcenter.ro Bv, Cj, Pl, Bistrita, SM, Turda, Tm, Gl* www.hiperdia.ro Pit, Sb www.gralmedical.ro Pit, Cv, Ct, Turda, Tm, Arad, Bc, Bz* www.medicalcity.ro Cluj, Timisoara,Bv www.medlife.ro Sibiu www.polisano.ro Bucuresti www.romgermed.ro Bucuresti www.medas.ro Cluj www.cmpro.ro Pitesti, Rm Vl,Curtea de Arges www.cmelim.ro Azuga, Busteni www.polimed.ro Bucuresti www.euroclinic.ro Bucuresti www.sanador.ro Ploiesti www.medsana.ro Alba Iulia www.clinimed.ro Constanta www.galamed.ro Bucuresti www.diagnosis.ro Bucuresti www.pro-life.ro Bucuresti www.bioterramed.ro Bucuresti www.bio-medica.ro Constanta www.iowemed.ro Bucuresti, Pitesti www.anima.ro

Continued slide 11
12
12
CENTRUL MEDICAL PLUS MEDICA CENTRUL MEDICAL SOLOMED CENTRUL MEDICAL BIOCLINICA CENTRUL MEDICAL ACADEMICA ALSAMED ANAIS MEDICAL CENTER ENDOCENTER EXCELLENCE MEDICAL CENTER MATEI BASARAB MEDICAL CENTER MEDICLASS SANYS MEDICAL CENTRUL MEDICAL VERONIKI CENTRUL MEDICAL VICTOR BABES CENTRUL MEDICAL LUX-RO CENTRUL MEDICAL ARTRIMED CENTRUL MEDICAL MEDSTAR 2000 CLINICA MACTA (MEDICAL ALALYSIS) CENTRUL MEDICAL MICROMEDICA COMPLEX MEDICAL G&E&N CENTRUL MEDICAL DR.LUCA CENTRUL MEDICAL SANMED POLICLINICA VISA MEDICA CENTRUL MEDICAL DELTA PRO MEDICAL CENTRUL MEDICAL MINERVA CENTRUL MEDICAL IRINA (EXPERT MED) 3 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 0 0 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1
Bucuresti Pitesti Arad, Timisoara Bucuresti Bucuresti Bucuresti Bucuresti Bucuresti Bucuresti Bucuresti Bucuresti Bucuresti Bucuresti Botosani Cluj Constanta Constanta Neamt Oradea Pitesti,Rm.Vl Rm.Valcea Sibiu Bucuresti Timisoara Galati
www.pulsmedica.ro www.solomed.ro www.bioclinica.ro www.academica-medical.ro www.alsamed.ro www.anais.ro www.endocenter.ro www.medicalexcellence.ro www.cmmb.ro www.mediclass.ro www.sanysmed.ro www.veronikilife.ro www.cdt-babes.ro www.lux-ro.ro www.medstar2000.ro www.chirurgieunc.ro www.micromedica.ro www.gen.ro www.sanmed.ro www.visamedica.ro www.deltapromedical.ro www.cmminerva.ro www.expert-med.ro

Continued slide 12
12
13
13
MARY MEDICAL CENTER CENTRUL MEDICAL ENDOCENTER ALPHA HEALTH CENTER MEDICAL CITY BLUE CENTRUL MEDICAL HIPOCRATE
1 1 1 1 1
1 1 1 1 0
0 0 0 0 1
Bucuresti Bucuresti Bucuresti Bucuresti Timisoara
www.marymed.ro www.endocenter.ro www.alphamed.ro www.medicalcity.ro www.hipocrate.ro
Total:
175
81
94
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 2011 Source: internet, database
Private Outpatient Specialized Clinics

in Bucharest
14
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 ENT (ORL ) Ophthalmology (with surgery) Labor medicine Plastic and reparatory surgery General surgery Imagistic (CT, MRI; eventually PET-CT) Orthopedic (without surgery) Proctology Rheumatology Dermatology Cardiology and interventional cardiology with day hospital Radiology and interventional cardiology Diabetic and nutrition diseases Phlebology Rehabilitation Therapy Stomatology, Implantology - minimum TOTAL NO. OF BRANCH MEDICAL CLINICS IN BUCHAREST 22 19 17 12 11 9 10 * 8 8 5 4 3 2 2 2 2 50 181
Note : * Are not included the imagistic departments from the Outpatient Medical Centers
Private Hospitals in Romania

15
Private hospitals arrived on the scene in 2005 10 years after the first private Outpatient Medical Centre opened in Romania. The main reasons for this extraordinary delay are: the long term investment required to undertake such a project and the absence of a robust private heath insurance system. The system that currently exists requires further development and diversification. There are currently only 24 private Hospitals in Romania ( including the maternities and obstetrical and gynecology hospitals) with a total capacity of 1284 beds. This capacity is very little compared to the current demand for medical services. Many patients with the financial means go abroad or elsewhere in the European Union for medical treatment. 5 of the existing 24 private Hospitals are located in Bucharest (estimated population 3 mil). The rest are located in cities with a population between 150.000 350.000. While located in a specific city, their area of service is the entire surrounding region (see slide 21)
Private Hospitals in Romania

16
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).
Private hospitals in Romania

17
Hospital type Crt. No. Hospital name No. of beds City/Area of Romania Shareholders Nationality IFC, Cristescu Mihaela Gabriela, Nicolae Marcu, Mihail Marcu, SGAM Eastern Great Britain/France/ Europe (Societe General) Romania CMU / Eureko Group Advent International Investment Found(80%) ,Mr. Enayati Becico Victoria, Munteanu Codrut, Sangiorzan Anton Guset Grigorie, Jivan Adrian, Miclea Iulius, Paiusan Lucian UNK UNK Germany/ Holland Germany Romania Romania Romania Romania No Accipiens Laser System Medical Center SRL Palade Hospital Ltd Affiliation or Member of a Group/Chain
1 2 3 4 5 6 7
Life Memorial Hospital General Euroclinic Hospital General
127 100 9 35 45 11 22
BucharestSouth BucharestSouth BucharestSouth BucharestSouth Arad-West Arad-West Bacau-NorthEast
Medlife CMU / Eureko Group CMU = Unirea Medical Center
CMU ,,Arcul de Triumf General Hospital Munposan Hospital Genesys Hospital Branch (Surgery) General
Laser System Hospital General Palade Hospital General Branch (Surgery of Cardiology and Orthopedic prosthesis) General General General General General General General
8 9 10 11 12 13 14 15
Clinicco Hospital Pelican Hospital Arcadia Hospital Polisano Hospital Bethesda Hospital Nova Vita Hospital Brol Hospital Athena Hospital
35 80 220 50 48 126 41 118
Brasov-Center Oradea-NorthWest Iasi-East Sibiu-Center SuceavaNorth-East Targu MuresCenter TimisoaraWest TimisoaraWest
UNK Adrian Maghiar, Doru Maghiar si Ovidiu Cacuci Fiterman
Romania Romania UNK Romania
No No No Polisano No
Vonica Ilie, Vonica Daniela UNK Virgil Mailat Marinescu Eva, Bratu Ioan, Bratu Tatiana Konstantions Giatras
Romania Romania Greece
No No No
Private hospitals in Romania

Continued slide 17
18
Crt. No.
Hospital type Hospital name
No. of beds
City/Area of Romania
Shareholders Nationality Fam. Dr. Irimia and Romano-israelian Invsestment Found Mociran Mihaela, Chertif Costache Mociran Mihaela Pop Calin Florin Pop Coriolan Sasaran Mircea UNK UNK UNK UNK UNK Advent International Investment Found(80%) ,Mr. Enayati Ion Marius Rusa, Ion Sebastian Lutescu, Ioana Lutescu, Florian Dantes, Dan Mugurel Raica, Rucni Asan, Rafael Ron-El.
Affiliation or Member of a Group/Chain
16
Dr. Irimia Hospital
Surgery hospital
16
Pitesti
Romania
17 18 19 20 21 22
Euromedica Hospital Eva Clinic Sanovil Clinic Isis Medical Center Gynia Hospital Hipocrate Hospital CMU Regina Maria Hospital
General Branch (Obstetric-gynacology) Branch (Obstetric-gynacology) Branch (Obstetric-gynacology) Branch (Obstetric-gynacology) Branch (Obstetric-gynacology)
40 35 30 UNK 34 7
Baia MareNorth West Brasov-Center Bistrita _ North-West Constanta South-East Cluj North-West Cluj North-West
Romania UNK UNK UNK UNK UNK
Euromedica Hospital S.A.
Sanovil Clinic S.R.L. Isis Medical Center S.R.L. Gynia S.R.L. Hipocrate Impex S.R.L. CMU = Unirea Medical Center
23
Branch (Obstetric-gynacology)
25
Bucharest South
Germany
24
Euromaterna Hospital Total
Branch (Obstetric-gynacology)
20 1284
Constanta South East
Romania
Euromaterna S.A.
Private Hospital New Projects to 2013

19
Company name Hospital type Invest No.of Hospital Localization Time limit Shareholders ment beds surface mil.eu sqm UNK 120 10,000 Bucharest 2011 IFC, Cristescu M., Nicolae M., Mihail M., SGAM Easten 3 UNK 1,500 Bucharest 2011 IFC, Cristescu M., Nicolae M., Mihail M., SGAM Easten Europe UNK UNK 45 UNK UNK 3,800 Bucharest 5,200 Bucharest 2011 2011 IFC, Cristescu M., Nicolae M., Mihail M., SGAM Easten IFC, Cristescu M., Nicolae M., Mihail M., SGAM Easten Nationality
Medlife General Medlife &Dermastyle Dermatology & estetical surgery Medlife Specialized (urology) Medlife Specialized (pediatrics) Medlife investments subtotals 2011-2013 * CMU CMU Gral Medical Medicover Medicover Medsana Romar Medical Medicana Specialized (surgery) General General (cardioloy, General General General General General (cardioloy, oncology, in vitro fertilization) General Specialized (surgery)
United Kingdom, France / Romania United Kingdom, France / Romania United Kingdom, France / Romania United Kingdom, France / Romania
10 25 25 50 10 24 25 30
UNK UNK UNK UNK 100 9,000 200 12,900 75 UNK 150 UNK UNK UNK 100 10,000
Bucharest Bucharest Bucharest Bucharest Bucharest Bucharest Bucharest Bucharest
2011 2011-2012 2012 2013 2011 2011 2012 UNK
80% Advent International, Enayati, 3Pi 80% Advent International, Enayati, 3Pi Dr.Gerogeta & Dr.Robert Stefan ABC Medicover Holding ABC Medicover Holding Athens Medical Center Dr.Erghin Hagicalil, Dr.Liliana Hagicalil Medicana Group
Germany/Romania Germany/Romania Romania Sweden Sweden Greece /Germany Romania Turkey
Sanador Delta Pro Total Bucharest Medlife Total Investment hospitals in other cities Total general
50 UNK 294 UNK
135 50 930 75
14,000 Bucharest 2,500 Bucharest
2011 Feb-11
Dr.Doris Andronescu Dr.Copaescu, Dr.Jianu
Romania Romania
General
6,000 Brasov
2011
IFC, Cristescu M., Nicolae M., Mihail M., SGAM Easten Europe
United Kingdom, France / Romania
UNK 294
75 1005
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 Pro EAST Consulting 2011
Synoptic table private hospitals in Romania and Bucharest

20
2011 Romania No. of hospitals No. of beds* Bucharest No. of hospitals No. of beds*
2011-2013 (new projects) 15 1005
2011-2013 ( existing private hospitals+future projects) 39 2289 Out of which 19 1286
24 1284
Out of which Out of which 5 14 281 1005
Note: *Not all the future hospitals have reported the number of beds
Private hospital location existing and new projects untill 2013
21
The Major Private Healthcare Companies

The private medical services market estimated at 430 mil euro in 2009
22
Company/Web address No. crt. MED LIFE 1 www.medlife.ro 2 CENTRUL MEDICAL UNIREA www.cmu.ro MEDICOVER 3 www.medicover.ro GRAL MEDICAL 4 www.gralmedical.ro HIPERDIA 5 www.hiperdia.ro SANADOR 6 www.cmsanador.ro CENTRUL MEDICAL ROMAR 7 www.romar.ro 8 CLINICA POLISANO www.clinicapolisano.ro EUROCLINIC 9 www.spitaluleuroclinic.ro MEDCENTER 10 www.medcenter.ro MEDSANA BUCHAREST MEDICAL 11 CENTER www.medsana.ro Turnover 2009 (mil. ) 2009 2008
Largest private healthcare companies owners of hospitals and outpatient medical centers
General manager/Phone Shareholders IFC, Cristescu Mihaela Gabriela, Nicolae Marcu, Mihail Marcu, SGAM Eastern Europe (Societe General) Enayati family, Advent International ABC Medicover Holding (Sw) Robert and Georgeta Serban Southeast Europe Equity Fund Doris Andronescu Else Comp. Ltd., RC2 Ilie si Daniela Vonica Eureko Medicarom Athens Medical Group of Companies (Greece) Ares Life Sciences, Merrill Lynch Global private Equity Simona Ateia Employees 2009 2008
26 13,7 11.6 10.7 10 9,7 9 8,8 8 7,2 5,9
21,2 10,9 12,8 10 9,3 9,4 10,6 4,9 6,6 10 6,2
990 700 NA 430 224 450 503 262 341 470 373
844 350 428 371 251 400 447 160 258 510 373
Mihail Marcu 021/2226415 Wargha Enayati 021/2229294 Marina Otelea 021/3191699 Robert Serban 021/3230004 Tiberiu Roth 0268/473608 Doris Andronescu 021/3230260 Liliana Hagicalil 021/3310301 Dan Rosca 0269/234486 Catalin Popa 021/2006800 Florin Balanica 021/2424477 Vassilis Chaniotis 021/4087800 Anca Petca 021/2224111 Simona Ateia 021/3102138
12 EUROMEDIC ROMANIA www.euromedic.ro 5,4 NA 549 414 CENTRUL MEDICAL MED-AS 2003 13 www.medas.ro 4,5 NA NA NA Source:Oficiul National al regsitrului Comertului Note: * Advent International Investment Fund bought in February 2010 80% from CMU stocks
Public and Private Insurance System

23
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 a number 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.
Public and Private Insurance System

24
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.
Sources of Revenue
25
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 in
the company network clinics and hospitals)
The partial reimbursement offered under the National Health Insurance House , (eg 350 euros per surgical procedure.) Private insurances (limited services)
Fee Schedules for Private Hospitals located in Bucharest.

26
MEMORIAL LIFE HOSPITAL (General Hospital)

Hospitalization fee/day Specialist visit Professor visit Radiology mammography CT abdominal Abdominal ultrasound Apendicectomy Laparoscopic cholecistectomy Physiological birth Cesarean birth Mammoplasty 78 EUR double 149 EUR single 25 EUR 55 EUR 44 EUR 68-120 EUR 39 EUR 620 EUR (without hospitalization fee) 1098 EUR (without hospitalization fee) 1902 EUR (without hospitalization fee) 1342 EUR (without hospitalization fee)
976-1951 EUR (without hospitalization fee)
EUROCLINIC General Hospital

79-121 EUR (regular) 212 EUR VIP 22 EUR 33 EUR 62- 80 EUR 117 EUR 50 EUR 1707 EUR (included hospitalization fee) 1527 EUR (included hospitalization fee) 1707-1829 EUR (included hospitalization fee) 2376 EUR (included hospitalization fee) 2583 EUR (included hospitalization fee)
REGINA MARIA Gynecology HOSPITAL( UMC)

100 EUR 25 EUR 30 EUR 20-34 EUR 61- 120 EUR 42 EUR 1000-1200 EUR 1200-1600 EUR 1516 EUR 1760 EUR 3000-4000 EUR
Observations
27
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 Iasi Life 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
Observations
28
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 hospitals in Bucharest are essentially identical. The differences are not significant (slide 26).
Conclusions
29
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 private sectors 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.
Conclusions
30
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
APPENDIXES
31
Appendix no.1 List of hospital regulations

32
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 NP015-97; 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).
Appendix no 2 List of Major Pharmaceutical Companies (2009)

33 Position
Company/Group/ We b adre ss Turnove r( mil. ) 2009 194,2 174,2 126,6 122,6 114,0 105,3 85,2 76,5 63,3 52,1 49,0 48,4 44,6 40,4 40,0 36,3 34,3 30,9 27,6 27,2 1. 493,50 2009% 10,1 9,0 6,6 6,4 5,9 5,5 4,4 4,0 3,3 2,7 2,5 2,5 2,3 2,1 2,1 1,9 1,8 1,6 1,4 1,4 77,4 Marke t share 2008% 10,7 * 7,3 5,2 ** 6,9 6,6 6 3,7 *** 4,6 2,5 N/A 2,7 2,5 2,2 2,1 New entry 2,3 1,7 1,6 1,5 New entry
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Sanofi- Ave ntis/ Ze ntiva Hoffmann La Roche Pfiz e r/ Wye th GlaxoSmithKline Novartis Se rvie r Me rck/ Sche ring Plough Ranbaxy Astraz e ne ca Abbott/ Solvay Antibiotice Iasi Baye r Eli Lilly Me narini Laborme d / O z one KRKA Activis Johnosn & Johnson Ge de on Richte l Re ckitt Be nckise r Total
Sursa: Raport cegegim preluat de Ziarul financiar 7 mai 2010 * Cota de piata cumulata a companiilor Sanofi - Aventis si Zentiva;
Nota: Cegedim a furnizar vanzarile in lei si au fost transformate de ZF la un curs de 4,2 lei pt. un euro. Datele sunt la preturi PPP, adica la iesirea din farmacii.
**Cota de piata doar pentru compania Pfizer *** cota cumulata pentru Merck si Schering Plough. Aceste cote au fost calculate cumulat de ZF
APPENDIX no 3 High Risk Diseases in Romania

34
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).

General Information: February 2011, Bucharest

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General Information: February 2011, Bucharest

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February 2011, Bucharest

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The studys methodology is centered on the following criteria:

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Pro EAST Consulting 2011

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Pro EAST Consulting 2011

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Pro EAST Consulting 2011

Medical Services Market

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Pro EAST Consulting 2011

Public Romanian Healthcare System Classification

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

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Pro EAST Consulting 2011

Private Romanian healthcare system classification

The Romanian Private Healthcare System is organized as follows:

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Individual doctors ambulatories

Pro EAST Consulting 2011

Private Outpatient Medical Center

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Pro EAST Consulting 2011

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Medicover ( 11) See slide 11

Pro EAST Consulting 2011

Major private Outpatient Medical Centers in Romania

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Major private Outpatient Medical Centers in Romania

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Pro EAST Consulting 2011

Major private Outpatient Medical Centers in Romania

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Bucuresti Bucuresti Bucuresti Bucuresti Timisoara

www.marymed.ro www.endocenter.ro www.alphamed.ro www.medicalcity.ro www.hipocrate.ro

Pro EAST Consulting 2011

Private Outpatient Specialized Clinics

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Private Hospitals in Romania

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Pro EAST Consulting 2011

Private Hospitals in Romania

Just one specialized hospital is specialized in cardiology surgery.

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Pro EAST Consulting 2011

Private hospitals in Romania

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Life Memorial Hospital General Euroclinic Hospital General

BucharestSouth BucharestSouth BucharestSouth BucharestSouth Arad-West Arad-West Bacau-NorthEast

Medlife CMU / Eureko Group CMU = Unirea Medical Center

35 80 220 50 48 126 41 118

Brasov-Center Oradea-NorthWest Iasi-East Sibiu-Center SuceavaNorth-East Targu MuresCenter TimisoaraWest TimisoaraWest

UNK Adrian Maghiar, Doru Maghiar si Ovidiu Cacuci Fiterman

Romania Romania UNK Romania

Romania Romania Greece

Private hospitals in Romania

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Hospital type Hospital name

Affiliation or Member of a Group/Chain

Dr. Irimia Hospital