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transcript
Athens, June 2nd 2016
Nikos Vettas
Professor, Athens University of Economics and Business
General Director of IOBE
www.iobe.gr
vettas@iobe.gr, http://www.aueb.gr/users/vettas
1
Challenges for tomorrow: the Greek economy and the health care sector
52nd AESGP Annual MeetingThe future of self-care: Shaping the new environment
GDP per capita
Source : AMECO
2
0
5
10
15
20
25
30
35
€ t
ho
usa
nd
Εuro area (12 countries) Greece
Key Macroeconomic and Financial Figures
3
Key Macroeconomic Figures 2009 2013 2014 2015 2016 2016*
GDP -3.1 -3.2 0.7 -0.2 -0.3 -1.0
Unemployment 9.5 27.5 26.5 24.9 24.7 25.2
General Government Balance1 -15.6 -12.4 -3.6 -7.2 -3.1 -3.0
Current Account Balance -14.4 -2.2 -3.0 -0.2 0.6 0.2
Harmonised Inflation 1.3 -0.9 -1.4 -1.1 -0.3 -0.2
Gross Fixed Capital Formation -13.7 -9.4 -2.8 0.7 -0.9 -4.0
1Including State aid to the banking sector on the deficit* IOBE projectionsSources: Eurostat/European Economic Forecast, spring 2016, European Commission
Real effective exchange rate
4
Real Effective Exchange Rate (deflator: CPI - against 37 trading partners)Real Effective Exchange Rate (deflator: unit labor costs in total economy - against 37 trading partners)
Source: Eurostat
80
85
90
95
100
105
110
Real Effective Exchange Rate (CPI), 2005=100
Greece Portugal
80
85
90
95
100
105
110
Real Effective Exchange Rate (ULC), 2005=100
Greece Portugal
InvestmentsGross Fixed Capital Formation (% of GDP)
5
Source: AMECO
0
5
10
15
20
25
30
Euro area (12 countries) Greece
Foreign Direct Investment (% of GDP)
6
FDI as a % of GDP
2000-2008 2009-2015
Germany 3.0% 1.7%
Ireland 21.0% 27.9%
Greece 1.1% 0.6%
Spain 4.2% 2.1%
Portugal 3.7% 4.3%
Source: Eurostat
-10%
0%
10%
20%
30%
40%
50%
60%
Germany Ireland Greece Spain Portugal
Trade balance (Goods and Services)
7
Sources: ELSTAT/European Economic Forecast, spring 2016, European Commission
-31,8
-24,3-19,5
-12,9
-6,6 -4,5 -4,9 -2,9 -2,6 -2,0
-40
-20
0
20
40
60
80
100
bil
lio
n €
Balance Imports of goods and services Exports of goods and services
Harmonized Inflation
8
Sources: Eurostat/European Economic Forecast, spring 2016, European Commission
-2%
-1%
0%
1%
2%
3%
4%
5%
6%
ΕA-19 Greece
Budget Primary Balance (% of GDP)
9
Source: European Economic Forecast, spring 2016, European Commission
-12
-10
-8
-6
-4
-2
0
2
4
Greece ΕA-19
Pensions Payments (% of GDP)
10
Sources: Social Budget 2009, Ministry of Labour & Social Security, 2010/Eurostat
5,0
7,0
9,0
11,0
13,0
15,0
17,0
% G
DP
Greece EA-18
Public spending on Health (% of GDP)
11
2
3
4
5
6
7
8
EA-19 Greece
Public Spending categories (% of GDP)
12
0
1
2
3
4
5
6
7
8
Defence Health Education
Source: Eurostat
Poverty and social exclusion
13
Source : Eurostat
0
5
10
15
20
25
30
35
40
% p
op
ula
tio
n
Greece ΕA-18
Direct taxation (% of GDP)
14
* Projection ** ForecastSource: State Budget, 2005-2016, Ministry of Finance
0%
2%
4%
6%
8%
10%
12%
14%
Direct Taxation - Total Profits-Income Real Estate Property Past Years
Public Revenue- Expenditure – Primary Balance (% of GDP)
15
-12
-10
-8
-6
-4
-2
0
2
4
0
10
20
30
40
50
60
70
Gen. Government Expenditure (l.h.s.) Gen. Government Revenue (l.h.s.) Primary Balance (r.h.s.)
Health expenditure, 2013 (% GDP)
Source: OECD, Health Data 2015,SHA, (1) Estimations (2) Data 2012
16
0
2
4
6
8
10
12
14
16
18
USA
Th
e N
eth
erl
and
s
Sw
itze
rlan
d
Ge
rman
y
Sw
ed
en
Fran
ce
De
nm
ark
Can
ada
(1)
Be
lgiu
m
Jap
an
Au
stri
a
Ne
w Z
eal
and
(1)
Po
rtu
gal
(1)
Sp
ain
(2)
No
rway
Avg
OE
CD
Ital
y
Au
stra
lia (
2)
Slo
ven
ia
Ice
lan
d
Gre
ece
Fin
lan
d
UK
Ire
lan
d (
2)
Slo
vaki
a
Isra
el (
1)
Hu
ng
ary
Ch
ile
Ch
ezh
Rep
.
Ko
rea
Luxe
mb
urg
(2)
Po
lan
d
Me
xico
Est
on
ia
Tu
rke
y
% G
DP
Average per capita health expenditure growth, 2005-2009 vs. 2010-2013
17
Πηγή: OECD, Health Statistics 2015
-7,2
-4,3 -4 -3
,3
-1,6
-1,6 -0
,8 -0,3
-0,2
-0,1
0,3 0,5
0,5 0,6
-2,3
0,9 1 1 1,3 1,7 2 2,
3
5,4
-0,4
5,3
1,3
3,5
0,5
3,4
3,2
5,4
3,6
6,7
3,2
3,4
11,3
0,8 1,
5 2,2
1,7
1,7
3,3
2,8
8,4
-10
-5
0
5
10
15
2005-2009 2009-2013
Health Expenditure, Public Health Expenditure (in mil. €)
18
Πηγές: System Health Accounts 2013, EL.STAT, 2015, Data processing: ΙΟΒΕ
23.177 22.269
19.599
17.106
15.777
14.712
16.098 15.582
13.188
11.408
10.021
8.776
0
5.000
10.000
15.000
20.000
25.000
2009 2010 2011 2012 2013 2014
health expenditure mil.euro
Current health expenditure Current public health expenditure
Per capita net public pharmaceutical expenditure in Greece, EU and EZ-15
19
Source: System of Health Accounts (SHA) 2013, EOPYY 2014, State Budget 2014: Executive Summary, OECD Health Data 2015, Eurostat, data processing IOBE.
456
404
337
257
216
183
284 286 276 265 260
323 323 311
300 295
-
50
100
150
200
250
300
350
400
450
500
2009 2010 2011 2012 2013 2014
€
Greece EU (22) EZ (17)
Breakdown of NHS hospitals expenditures, 2012-2014 (in mil. €)
20
740 615 531
368
331 316
62
61 62
163
154 134
505
440
360
200
185
215
2.038
1.786
1.618
-
500
1.000
1.500
2.000
2.500
0
500
1000
1500
2000
2500
2012 2013 2014
Medicines Medical Supplies Orthopedical materials
Chemical Reactors Services Outsourcing/ other expenses
Total
Source: Ministry of Health
Monthly average pharmaceutical purchases and receipts in the kind of households, 2008 - 2014
Source: EL.STAT. 2015, data processing IOBE
• During the economic crisis period there was a shift of household expenditure towardspharmaceuticals and hospital care.
21
19,3% 19,2% 22,1% 22,1%27,4% 32,4% 33,3%
15,2% 17,5%20,0% 23,3%
27,4%
27,9% 29,3%29,8%29,4%
26,7% 23,3%
18,8%16,1% 15,0%
21,2% 20,1% 18,0% 17,3%14,3% 11,7% 10,8%
10,7% 9,7% 9,3% 9,2% 8,5% 8,7% 7,8%
2,9% 2,6% 2,3% 3,3% 2,3% 1,7% 1,5%1,1% 1,5% 1,5% 1,5% 1,4% 1,5% 2,3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008 2009 2010 2011 2012 2013 2014
Pharmaceutical products Hospital services Dental servicesMedical services Paramedical services Therapeutic appliances and equipment
Added Value Pharmaceutical Sector Production
22
Source: Eurostat,2015, data processing IOBE
805
746
672
505 519
624 616
507474
533
4,6%
4,0%
3,4%
2,8%
3,4%
3,8%
3,2%3,0% 2,9%
3,1%
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
3,0%
3,5%
4,0%
4,5%
5,0%
0
100
200
300
400
500
600
700
800
900
1.000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
%mil.€(2010)
Value added mil.€ (2010=100) Share of pharmaceutical sector in total manufacturing
Pharmaceutical sales in value,Greece, 2008-2014 (bln €)
23Source: EOF 2015 (Pharmacies/Wholesalers at retail prices and Hospitals at hospital prices)
6,55
7,00
6,03
5,56
4,61
3,96 3,88
1,47 1,47 1,31 1,20 1,36 1,34 1,40
0
1
2
3
4
5
6
7
8
2008 2009 2010 2011 2012 2013 2014
bil. euro
Pharmacies/Wholesalers Hospitals/EOPYY farmacies
Approximately 73,5% of total sales were supplied to wholesalers and private pharmacies and 26,5% of sales to hospitals & EOPPY pharmacies
Pharmaceutical Sales in Greece, volume, 2008-2014
24
Source: EOF 2015 *Possible smaller packaging replacements
469,0 465,8434,3 424,3
394,8 404,6 416,1
97,5 96,8 86,9 88,1 84,5 80,0 77,1
566,5 562,5
521,2 512,4
479,4 484,6 493,2
0
100
200
300
400
500
600
2008 2009 2010 2011 2012 2013 2014
mil. packages
Pharmacies/Wholesalers Hospitals/EOPYY farmacies Total
OTC sales, 2012-2014 (in mil. €)
25
Source: AESGP, 2015, IMS, 2015Note: Depending on the source of information used, there may be deviations over EOFs’ sales data.
258,4
292,3
331
78,283,5
95,9
0
20
40
60
80
100
120
0
50
100
150
200
250
300
350
2012 2013 2014
mil.euromil.euro
Value Volume
OTC total Sales across countries, 2014
26Source: AESGP, 2015 *Note: Different definition of OTC in Greece and other European counties
44
46
54
59
75
166
211
212
261
331
387
471
575
623
642
741
774
997
999
1.344
1.541
2.429
2.734
6.200
6.502
0 1.000 2.000 3.000 4.000 5.000 6.000 7.000
Turkey
Estonia
Croatia
Latvia
Lithuania
Denmark
New Zealand
Portugal
Finland
Greece
Hungary
Argentina
Sweden
Belgium
Switzerland
Netherlands
Austria
Spain
Ukraine
UK
Mexico
Italy
Poland
Brazil
Germany
OTC share in Greece isamong the lowestcompared with the restof Europe.However, the respectivemarket shares dependcrucially on the range ofnon-prescriptionmedicines included ineach country.
OTC sales by group in Greece, in mil.€
27
Source: AESGP, 2015, data processing IOBE
OTC groups 2012 2013 2014 %13/14
% of
total,
2014
Cough and cold 54.5 60.1 66 9.8% 19.9%
Analgesics 56.3 58.9 67 13.8% 20.2%
Digestives 17.3 20.6 24 16.5% 7.3%
Skin treatment 24 27 28.5 5.6% 8.6%
Vitamins and minerals 49.8 62.1 76.2 22.7% 23.0%
Others 56.5 63.6 69.3 9.0% 20.9%
Total 258.4 292.3 331 13.2% 100%
Vitamins and Minerals had the greatest share of the market, followed by analgesics and cold remedies
From July 2016, 216 OTCpharmaceutical products (from atotal of 1.582), will be availablefrom supermarkets (exceptpharmacies)• 87% of OTC will be available
only from pharmacies• 13% of OTC will be available
and from other sales pointsStrict criteria in order to ensurethat the easy access won’t bedetrimental for the public health