New Dawn

NEW GuideDAWN Conducting effectiveIntelligent thinking market researchin emerging marketsConnectedpatientsAdopting a patient-centricapproachShift to preventativehealthcare+ Willingness to pay | Segmenting the market Latin America & the Caribbean | Aesthetics

Letter from This magazine is published by The Research Partnershipthe Editor in 2018. All rights reserved. No part of this publication may be copied, reproduced, transmitted, photocopied, recorded or stored on any retrieval system without the prior written consent of the publishers.We’re witnessing a new dawn in global healthcare. In this issue:Populations are growing and ageing, advances in treatmentare accelerating and technology is changing every facet of 1healthcare delivery and engagement. Emerging marketsoffer particularly exciting opportunities, as a large and ever- Connected patientsexpanding middle class demand access to high quality,affordable healthcare. But although emerging markets offer Adopting a patient-centric approach innew potential, access and navigation in these lesser-known emerging marketsterritories can be tricky. What works in mature marketsdoesn’t always translate to more emerging economies. 2In this magazine, we wanted to address some of the key Shift to preventative healthcarethemes and challenges for marketers and market researchprofessionals looking for support in ensuring success Opportunities for screening, diagnosticsin emerging markets. We hope to demonstrate how and vaccinationevidence-based insights can help you avoid the pitfalls andmaximise the opportunities available within a global arena of 3approximately 4.1 billion patients. Patients’ willingness to payA key challenge can be gaining a proper understanding ofthe patient journey. With some countries having no primary Considerations when developing an appropriatecare system and no formalised pathways, the patient pricing strategybecomes the only constant in the journey. With manypatients paying out-of-pocket for their treatment, they also 4become the primary stakeholder. This has led to patientsin emerging countries becoming much more educated Navigatingand invested in decisions about their treatment. We will unchartered territorylook at this phenomenon and consider the implicationsfor patient centricity, the trend which is becoming the A guide to conducting effectivebyword for success in mature healthcare markets. Along market research in emerging marketsthe same theme, we will look at patients’ willingness to payand discuss the importance of developing the right pricing 5strategy, with patients in mind, in order to ensure optimumbrand take-up. Comparing apples and orangesIf you have a responsibility for commissioning primary Is a global segmentation transferable?market research in emerging markets, you might beinterested in our best practice guide, which is also available 6-7as a handy desktop piece, on page 4. We also take a lookat some of the trends and themes in the key markets of Dónde estoy, onde estou,Latin America, Asia Pacific, Central Eastern Europe, Middle où suis-je, where am I?East and Africa. If you want to know more about a particularmarket or issue, you can sign up to one of our RP Informs Defining the regions of Latin Americacustomised tutorials. More details can be found on the back and the Caribbeanpage. 8-9I hope you find the magazine of interest. Our EmergingMarkets team, consisting of 18 specialist researchers, Beauty Boomincluding 8 Directors, is always happy to talk about ourexpertise and capabilities. Find out more about our team What’s driving the aestheticsmembers on the back page. growth in emerging markets?Marc YatesDirector

Connected patientsAdopting a patient-centric approach in emerging marketsSue ReesThe concept of patient from being reactive patients to proactive discover that the required medicine iscentricity and putting the consumers. not in stock or healthcare staff are notpatient at the heart of care available. Mobile health applicationsis being widely adopted by Undoubtedly there are challenges can be used to inform patients whenthe healthcare industry – the within emerging markets in the and where the appropriate medicine isgeneral consensus being that form of lack of resources and available and how to find the nearestit’s going to be critical to infrastructure and limited numbers health centre with a suitable healthcarefuture success. of healthcare workers. It’s essential worker on duty. for pharma to start thinking aboutMany pharmaceutical companies do designing systems around patients In addition patients can benefit frommore now for patients than just deliver and adopting ways to bring care remote diagnoses from doctors andsafe and effective drugs – they offer closer to them. specialists in cases where physical travelsupport beyond the pill such as utilising is problematic. In Malaysia a smartphonedigital technology to engage patients. Healthcare technology, including app called Doctor2U is revolutionisingBut very often the focus has been on genomics, mobile and internet connected mobile medicine. Launched in 2015 bymore developed markets. Arguably devices, and big data analytics, generates BPL Healthcare Group the app allowsthere is more need, and benefit, for a a vast amount of insights which allow patients to request a home visit bypatient-centric approach to be taken healthcare providers to make better and a doctor on demand and a qualifiedin the emerging and growth markets faster diagnoses and more informed physician will arrive within 60 minutes.where we know that patients are the treatment decisions.key stakeholders and need to be fully In order to develop these systemsengaged in the treatment decision. While we’re undoubtedly many years successfully, a good grasp of the markets from this becoming the norm in emerging is required. There is a complex range ofFrequently in these emerging markets the markets, one approach that is gradually patient types driven by a broad range ofpatient pays out of pocket (either 100% being adopted is the use of mHealth attitudes, behaviours, needs and culturalor co-pay depending upon the market) solutions (mobile health) - the use of influences and understanding how tofor their medicines. So there is a much mobile phones and other wireless appeal and remain relevant to this rangestronger investment, both emotional technology in medical care. The mHealth of patients is the key to success.and practical in ensuring that the right market in Brazil reached USD$531millionmedicine is taken. Patients decide when in 2016 and is set to top USD$1.43 billion Read ourto start or stop their medication and this by 2020. articlein turn impacts on the treatment duration,adherence and outcomes. Mobile network connectivity is spreading New opportunities fast. Even in some of the most remote in emerging marketsWith the expanding middle class and parts of the world patients are becomingincreasing wealth in markets such as ‘connected’. Mobile health solutions can researchpartnership.com/new-Brazil, India, China and Mexico, more be used to guide patients and caregivers opportunities-emerging-marketspatients are able to afford essential care to the right place at the right time. Foror purchase private health insurance. In example, they can help prevent patientsaddition, patients are becoming better travelling long distances from rural areasconnected, more informed, and moving to their nearest health centre only to 1

Shift topreventativehealthcareOpportunities forscreening, diagnosticsand vaccinationRachel HowardAcross emerging marketswe are seeing a shift towardsprevention in healthcarepolicy, as governmentsseek to contain spirallingtreatment costs.There is a growing, if long overdue, for a greaterrecognition among policy-makers that screening, extent than inthe cost of prevention can be cheaper diagnostics and mature markets. The belief thatthan the cost of treating the disease vaccines are all vaccines are for babies, for example, canitself. China’s ambitious primary care poised to benefit from this limit uptake of adult vaccines.creation project aims to focus increased increasingly prevalent mindset ofattention on preventative healthcare, while wellness promotion. This mindset also Social stigma associated with takingin Saudi Arabia, the Ministry of Health’s paves the way for increasing access to PrEP constitutes a barrier to uptake‘Vision 2030’ recognises primary care as medicines for prophylactic use, such in mature markets, and this can be‘the most important component in the as anti-thrombotics to be taken before magnified in emerging markets.health system’ and aims to reform and surgery to reduce risk of deep veinrestructure its delivery to improve disease thrombosis (DVT), and HIV pre-exposure An in-depth understanding of the localprevention. prophylaxis (PrEP) and treatment as nuances at play, and how the challenges prevention (TasP) among high-risk they present can be overcome, isPrivate health insurance plans, populations. essential for success. Drawing on ourwhich are increasingly gaining knowledge of preventative diseasestraction among middle classes However, emerging markets can be and vaccines, we are happy to providein emerging markets, also challenging environments for preventative guidance and advice of the keyincentivize preventative healthcare products to enter. Deeply considerations that need to be taken intohealthcare among enrolees. ingrained cultural and educational account when designing a study in order barriers can be encountered. Attitudes to effectively achieve this understanding.While there is still a long way to go to healthcare may generate resistance tofor emerging markets to realise their presenting to a healthcare professional,preventative healthcare goals, products or reluctance to accept a vaccination to The vaccine opportunity in Asia Download our China South Korea infographic China has banned drug wholesalers from selling vaccines and is demanding South Korea has the most thorough coverage for adultThe vaccine more accountability, following a scandal in which improperly stored vaccines vaccination against influenza, and is the only marketopportunity in Asia were sold nationwide. The WHO has joined the Chinese health authorities to that provides Varicella vaccination for all infants. promote trust in vaccines on Child Vaccines Awareness Day.researchpartnership.com/ Thailandvaccines-asia-infographic India Thailand is one of only three Asian countries In India, more than 1.2 million children die to have introduced rotavirus vaccine before their fifth birthday. It is estimated that, sub-nationally. No Asian country has introduced in 2015, more than 140,000 deaths were rotavirus vaccine nationally. attributed to pneumonia and 24,000 deaths to meningitis amongst under-5s. Vietnam Malaysia In 2016, the health ministry called for increased efforts to provide effective and safe vaccines under the National Expanded Programme on Immunisation (EPI) to all children in the country. Malaysia has the world’s first halal Philippines vaccine facility in Bandar Enstek, with gross development value (GDV) of RM330 The Philippines is the first Asian market to introduce million. It will be operational in early 2018. a Dengue vaccine. Through a national immunization drive, 150,000 children have now received it. Singapore Indonesia2 Medisave, Singapore’s compulsory individual healthcare Some members of the Indonesia's Muslim majority are concerned that savings scheme for all workers, can be used to pay for some vaccines contain ingredients such as swine enzymes, 10 types of vaccination, including influenza and reportedly found in polio vaccines. These are considered haram, pneumococcal for adults.

Patients’ When launching a new specific product or service attributeswillingness product, it’s critical that coupled with social-demographic factorsto pay pharma chooses the right such as age, gender and family situation, pricing strategy to achieve can all influence patients’ acceptance of aConsiderations the optimal balance between product price.when developing sales volume and unit cost.an appropriate In many emerging markets thepricing strategy In emerging markets, pricing is made physician is the primary source of more sensitive by the fact that frequently trustworthy product information forNicole Bender a high proportion of healthcare costs are patients. However, because theyMoreira paid for out-of-pocket by consumers and are often time-poor, consultation their families, making them key decision- times can be limited, which can makers. In the past, pricing models in have direct implications on patients’ emerging markets were often developed ‘willingness to pay’. using patient affordability assumptions. A lack of knowledge about the worth of Our approach to informing the right the product may give rise to objections pricing strategy involves uncovering the about cost. Added to this, the patient value patients or healthcare consumers themselves may come with a further layer believe a product or service can provide of considerations familiar to the consumer to them as well as understanding what world - such as brand loyalty, belief in proportion of their disposable income they efficacy from their own online research, are willing to spend. While it is related or perceptions regarding the brand or the to affordability and personal income manufacturer. (‘ability to pay’), it is not the same. In fact, the World Health Organisation (WHO) As gatekeepers, the views physicians has shown that there is no correlation or other healthcare practitioners between an individual’s income and recommending the product have certainly willingness to pay for healthcare products. are important – they transfer their beliefs about the product on to the patients. Once we have established what However, the pharma company should proportion of the population can afford factor in the patient perspective when the product and what they can realistically developing any pricing strategy. To be pay for the healthcare product or service successful, pharma needs to begin with in question, we seek to understand an understanding of the target patients’ what proportion of the affordable cohort willingness to pay for their product, is willing to pay. This starts with an whether it is a drug, device, vaccine or understanding of the underlying factors supplement. that will motivate patients to pay. For example, symptom severity, impact on quality of life, importance placed on Relative revenue (per patient per year) 800 700 600 500 400 300 200 100 0 Price point 1 Price point 2 Price point 4 Free Price point 3 Watch our webcast Understanding patient willingness to pay in emerging markets researchpartnership.com/patient-willingness -to-pay 3

Navigating unchartered territory A guide to conducting effective market research in emerging markets Pei Li Teh Emerging markets present Step 1: Understand the environment an exciting opportunity for growth for the pharmaceutical Understanding the environment is critical to ensure the project scope is defined industry, as traditional in the best way to achieve the project objectives. This will help you answer the Western markets mature and following questions regarding your research design: there are a limited number of new products in the pipeline • Which emerging market(s) to select? offering blockbuster revenues. • Which cities to research? • Which stakeholders to interview? Many emerging markets, not just confined to BRIC countries, are experiencing It is worth considering building in a definition phase to define the project scope. double-digit growth, as well as burgeoning public and private health care systems. A Step 2: Select the best method demographic of wealthy urban patients who can afford better quality health care To determine which research methodologies are possible and appropriate in is on the rise, with an appetite for Western emerging markets you need to understand which methodologies are culturally lifestyles and products. permissible and which methods are technologically possible. To successfully launch in these markets, Step 3: Build in stringent quality checks and balances however, pharma manufacturers need an in-depth understanding of the To achieve high quality research in emerging markets, additional quality control environment in which they are planning steps, which are not always necessary in developed markets, are recommended: to operate and this can be challenging as many lack reliable data intelligence. • Moderators must be highly experienced in interviewing healthcare professionals Custom market research can plug the and must demonstrate therapeutic expertise gaps in knowledge and help marketers make more effective strategic decisions. • When there are numerous materials to test, extended briefings should be undertaken using webcams and even dummy interviews if necessary to ensure Based on our experience in managing understanding research projects involving emerging markets, here is a three-step guide to • During the fieldwork period, allow time to review the interview transcripts for conducting effective market research in quality control reasons and to re-brief the moderator if necessary these territories. • Because emerging markets are often new for the commissioning client, additional questions may be generated after the research has been completed. Read the full guide A guide to undertaking health care market research in non-western markets researchpartnership.com/best-practices-emerging-markets4

Comparing When our clients are considering primaryapples and market research in emerging markets theyoranges typically face two challenges - a lack of good local data and budget.Is a global segmentationtransferable? The absence of reliable and up-to-date information in emerging markets should mean that a greater budget is allocated to primary market research. However, in reality the opposite is true. Consequently, our clients want to know if they can tailor global studies to reflect the nuances of different emerging markets.Marc Yates A good example is with segmentation studies. Increasingly we are being asked whether we can evaluate how accurately a global segmentation solution reflects an individual market without repeating the whole study. While a solution can be developed, it involves a degree of compromise. If budget allows we recommend that the original segmentation approach is replicated, allowing for local market factors to be considered. However, we live in the real world and budgets do not always allow this. So we havedeveloped a hybrid solution using the foundation of the global segmentation solution and adapting it to reflect thelocal market. To validate the segmentation, we have developed a protocol consisting of the following 4 steps:1. Definition phase 2. Segmentation 3. Qualitative 4. Delivery typing tool trial deep diveWe review existing segment A typing tool is a list of 5-10 We will recruit a sample of Finally, we pull all thedefinitions with key client questions which are highly physicians from each of the information together tostakeholders at a regional predictive in identifying which final segments (identified from develop a hybrid segmentationand local market level. The segment a respondent belongs typing tool trial) and conduct that truly reflects the localaim is to achieve alignment to. If a typing tool already in-depth qualitative interviews market and is actionable.and feedback on suitability exists, we will trial the typing to validate any meaningful This typically involvesof segments for each of tool amongst a sample of local market differences by developing customer portraitsthe emerging markets in external respondents within the segment. Reactions to the of all priority segmentsthe study. We recommend emerging market. If there isn’t client’s target product profile and developing a segmentinvolving different roles across a typing tool, we will create one and targeted messaging can appropriate communicationthe company (e.g. Sales, using discriminant analysis. also be explored at this stage. plan. We will work with theMarketing and Medical) in this Based on this data, we will size Sales team to refine theconsultation phase. each segment and highlight segment identification tool potential segment differences to ensure that it can be used within the emerging market. by the Sales Force to profile each of their customers and to deliver the appropriate messages.Using this approach, we believe global segmentation solutions can be adapted to accuratelyreflect the emerging markets of interest. The key critical success factor is to engage and workin partnership with the Global / Regional and local market teams, building on the knowledgeheld within the organisation and developing a hybrid approach, aligning the global strategy withthe local environment. Download our whitepaper Punching above your weight: Combining behavioural and attitudinal data to strengthen segmentations researchpartnership.com/strengthening-segmentations 5

Dónde estoy, onde estou, où suis-je, where am I? Defining the regions of Latin America and the Caribbean Paul Reed Although we have conducted a headquarters and / or key individuals American? Caribbean? Jamaican or lot of research studies in Latin based out of disperse satellite offices. Brazilian? The simple answer is yes, all America and the Caribbean Sub-regional groupings are typically of these. Certain terms have become (LATC), we couldn’t, as a team, formed around market clusters which increasingly less fashionable, even agree exactly what defines this are regularly based on collective market politically incorrect. For example, while region and its boundaries for sizes - meaning Brazil and Mexico may ‘Hispanic’ is still used in the US census, our clients. be classed as one region in its’ own it has for many years now been seen right, while smaller Central American and as a way of focusing only on those with This is because our clients structure their Caribbean states may be grouped under European Spanish ancestors and as a tool LATC divisions in different ways. They a single management team. to distance the Hispanic population from often decide how to structure themselves the African and indigenous people. based on where the best talent is located Consequently, at Research Partnership within the region and then balance that we took the decision to define the LATC ‘Latino’ is generally acceptable, however against proximity to strategic regions and region as all markets south of the USA it implies a speaker of Spanish or US offices. As a result LATC operational and north of the southern tip of Chile, Portuguese. This means that French, teams vary by organisation. There is no including all of the Caribbean islands English and Dutch speaking nations, standard blueprint. such as Barbados, Cuba, the Dominican such as Guiana, Guyana and Suriname Republic, Haiti and Jamaica. In its entirety respectively, cannot be neatly defined by Having said that, a common characteristic the area has a land mass of 19.2 million this label. There has also been criticism among healthcare companies is the square kilometres and a population of of the gender bias in the term. In Spanish establishment of individual country teams, over 650 million. grammar the grammatical gender of the often with sub-regional management term ‘Latino’ is masculine, while ‘Latina’ is teams e.g. South Latin America, Central The next question we had to ask feminine – and much less frequently used. America, Caribbean etc., and a pan- ourselves was: how do people in In recent years, there has been a growing regional senior management team. Latin America and the Caribbean see effort by campaigners and activists to The latter may be located within a US themselves? Do they class themselves as use the term ‘Latinx’ in order to promote Latino or Hispanic? What about Central6

gender neutrality. However, the movement Download our interactive infographichas drawn criticisms for its invented LATAM market comparisonorigins and its perceived corruption of theSpanish language. researchpartnership.com/latam-infographicWhile many people may have a pan- 7Latino or Caribbean identity, one’s nationalself-image, even bonds to a particularcity, town or neighbourhood community,can be hugely important. Each countryhas different cultures for food, art, music,public holidays and sporting teams(although the West Indies cricket teamis a successful example of multi-islandpartnership). Economies, healthcaresystems and business environmentcan be radically different even amongneighbouring countries.Those considering the LATC region shouldtake care - we may approach the LATCregion as a whole from an operationalefficiency point of view, but healthcaremarket success should be based on anin-depth understanding of its consumers,the market and healthcare environment ata very local level.

BBoeaoumty What’s driving the aesthetics growth in emerging markets? Helen Ansell Aesthetics have always In emerging markets, the gradual been a lucrative area for the breakdown of cultural, societal and pharmaceutical and healthcare gender barriers over time has enabled industries, particularly in more women to receive an education and developed markets. join the workforce. As these women join the ‘urban elite’, they are delaying getting In the US alone the aesthetics market is married and having children and as a expected to reach USD $4.4 billion by result, have more disposable income and 2021. However, what has really grabbed the freedom to choose how this is spent. my attention as a researcher specialising in emerging markets and cosmetics, is Of course, women hold their own the huge growth in demand in developing personal opinions about whether or markets over the past few years, strongly not they want to undergo cosmetic reinforcing the opportunities for healthcare procedures. However, different parts of companies across the globe. the world have specific beauty ideals which can, and do, influence women’s There are several factors contributing to desire to change their appearance. growth in the aesthetics market. Women In the east there is a high demand for today have more spending power than skin whitening, especially in South East ever before. Asian countries such as Malaysia, The Philippines and South Korea. Jawline According to research by Ernst contouring is a treatment that is on the and Young, the global incomes of rise, particularly in China where women hope to achieve a more oval or heart- women are predicted to reach shaped face. In the west, particularly USD $18 trillion in 2018 and Latin America, women aspire to achieve women are expected to the culturally ingrained aesthetic ideal, control nearly 75% of and although women’s attitudes differ discretionary spending depending on the region - North, Central worldwide by 2028. or South America, they share a standard that comes with slim but curvaceous bodies. As a result, more women than ever are getting breast enlargement and buttock augmentation surgery. The growth in medical tourism positions countries such as Thailand, South Korea and Latin America as key ‘aesthetic markets’ of interest. Affordability is a key driver for choosing to receive treatment overseas. In addition, we see that women also choose to receive treatment in countries where trends originate. The8

Brazilian butt lift is one of the main draws So, while the US remains the largest Watch ourfor its namesake location as Brazil medical developed market for medical aesthetics, videotourism continues to attract scores of the demand for cosmetic procedures andoverseas patients for cosmetic surgery. treatments is picking up fast in emerging Women’s health inAnother factor which has significantly economies. Mexico, Brazil, China and emerging marketscontributed to industry growth is the India are amongst the four largest marketsincrease in expats living globally for aesthetics products and researchpartnership.com/womens-and working abroad, particularly in the represent an exceptional opportunity for health-in-emerging-marketsMiddle East. the pharmaceutical industry. However, the potential for growth in emerging marketsThe desire to stop the aging comes with its own set of risks – anprocess, which is increasingly more understanding of the culture, expectationshighly valued in countries where sun and priorities of customers within eachexposure is high, and ‘urban living’ market is key.has helped provide repeat businessfor many clinics Download our interactive infographic Men vs. women in emerging marketsOur interactive infographic compares the lives of men vs women in theBRIC emerging markets, and explores how societal factors impact theirrespective health outcomes.While a wide range of societal and economic factors influence health outcomes, one of the mostsignificant factors is gender. In addition to overall morbidity and mortality, certain health issues aremore commonly associated with one gender. But while biology plays a role, it is predominantlythe way in which society structures and shapes men’s and women’s lives that result in healthinequalities. Gender norms, roles and expectations vary between cultures, particularly inemerging markets, and affect the way in which health care is accessed.researchpartnership.com/men-vs-women-in-emerging-markets 9

RP InformsYour understanding of mature markets is second-to-none, but perhapsyour knowledge of emerging markets is less comprehensive.We can bring you up to speed with RP Informs - complimentary, customisedtutorials delivered by emerging markets experts, covering key geographies andmarket research techniques designed to improve your market understanding. RP Informs is a range of free, interactive and engaging tutorials specifically designed for pharma marketers, which can be tailored to fit your information needs. Choose from a range of growth markets, regions, or market issues, or a combination of all of these, to create your ideal session. • Hosted on-site at your offices, at a date and time to suit you • Comprehensive overview of selected growth markets and their key characteristics To find out more and request a session, please visit: researchpartnership.com/rpinforms-emContactMarc Yates, Director Sue Rees, DirectorT: +44 7585 139 721 T: +44 20 8069 5013E: [email protected] E: [email protected] Li Teh, Director APAC Helen Ansell, Associate DirectorT: +65 6222 4456 T: +44 20 8069 5055E: [email protected] E: [email protected] Reed, Director Nicole Bender Moreira, Associate DirectorT: +34 608 452 676 T: +65 6222 9939E: [email protected] E: [email protected] Howard, Director researchpartnership.com/emergingmarketsT: +1 646 934 6324E: [email protected] Partnership is one of the largest independent healthcare market research and consulting agencies in the world,with headquarters in London and offices in Lyon, Singapore, Boston, New York, Philadelphia and San Francisco.