Germany Healthcare Insurance Analysis Sample Report

Germany Healthcare
Insurance Market
Analysis
A sample report on
www.insights10.com
Includes Market Size, Market Segmented by Types
and Key Competitors (Data forecasts from 2022 – 2030F)

This report presents a strategic analysis of the Germany Healthcare
Insurance Market Analysis and a forecast for its development in the
medium and long term. It provides a comprehensive overview of the
market value, dynamics, segmentation, types of clinical diagnostics, point-
of-care testing, main players, growth and demand drivers, challenges &
future outlook, etc. This is one of the most comprehensive reports about
the Germany Healthcare Insurance Market Analysis, and offers
unmatched value, accuracy, and expert insights

3
A Sample Report on Germany Healthcare Insurance Market Analysis Analysis I Confidential
Report Scope
Report Attribute Details
Number of Pages 70-80
Base Year for Estimation 2022
Forecast Period 2023-2030
Report Coverage
Market Overview, Revenue Forecast, Market Segmentation, Growth Factors and Trends,
Competitive Landscape, Key Company Profiles, Government Policies, Regulatory Landscape,
Reimbursement Scenario
Quantitative Units Revenue in USD Million/Billion (Mn/Bn)
Research Approach Secondary Research (60%), Primary Research (40%)
Click on the icon to know the detailed methodology

4
Table of Content
CONTENT PG. NO.
1. Healthcare Diagnostics Overview 12-25
1.1. Overview
1.2. Germany Overview
1.3. Economic Overview: Germany
1.4. Healthcare Insurance in Germany
1.5. Healthcare Services Market in Germany
1.6. Healthcare Scenario in Germany
1.7. Health Insurance Coverage: Germany
1.8. Budget of the Government for Public Insurance
1.9. Mergers and Acquisitions
2. Market Size and Forecasting 26-31
2.1 Market size and forecasts (Excel and Methodology)

5
Table of Content
CONTENT PG. NO.
2.2. Market Segmentation
2.2.1. By Provider
2.2.2. By Coverage type
2.2.3. By Demographics
3. Market Dynamics 32-35
3.1. Market Growth Drivers
3.1.1. Germany Healthcare Insurance Market Analysis Driver 1
3.2. Market Restraints
3.2.1. Germany Healthcare Insurance Market Analysis Restraint 1

6
Table of Content
CONTENT PG. NO.
4. Competitive Landscape 36-46
4.1. Major Market Share
4.2. Key Company Profile
4.2.1. DKV Deutsche Krankenversicherung
4.2.1.1. Overview
4.2.1.2. Product Applications & Services
4.2.1.3. Recent Developments
4.2.1.4. Partnerships Ecosystem
4.2.1.5. Financials (Based on Availability)
4.2.2. SIGNAL IDUNA Krankenversicherung
4.2.2.1. Overview

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Table of Content
CONTENT PG. NO.
4.2.3. AXA Krankenversicherung
4.2.3.1. Overview
4.2.4. DAK-Gesundheit
4.2.4.1. Overview

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Table of Content
CONTENT PG. NO.
4.2.5. Kaufmännische Krankenkasse (KKH)
4.2.5.1. Overview
4.2.6. HEK - Hanseatische Krankenkasse
4.2.6.1. Overview

9
Table of Content
CONTENT PG. NO.
4.2.7. BARMER GEK
4.2.7.1. Overview
4.2.8. SIGNAL IDUNA Krankenversicherung
4.2.8.1. Overview

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Table of Content
CONTENT PG. NO.
4.2.9. Generali Deutschland Krankenversicherung
4.2.9.1. Overview
4.2.10. Aetna International
4.2.10.1. Overview

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Table of Content
CONTENT PG. NO.
5. Reimbursement Scenario 47-54
5.1. Reimbursement Regulation
5.2. Reimbursement Process for Diagnosis of Diseases
5.3. Reimbursement Process for Treatment of Diseases
5.4. Reimbursement Process – Medicare
5.5. Reimbursement Process - Medicaid
6. Methodology & Scope 55-60

Germany Healthcare Insurance Market Analysis
1. Healthcare Insurance Overview

13
1.1 Statistics at a Glance: The Scenario of Healthcare Insurance in the World
Scope of Healthcare Insurance ▪ Please be aware that this sample report is
intended to provide you with a brief
overview of the kind of information and
analysis that will be presented in the final
report
▪ In this section you will get an
understanding of the topic, which includes
the prevalence of the disease, the
application of medical devices, new
technology, and other details related to the
topic
▪ In order to obtain access to all of the
information that you are seeking, you will
need to purchase the final report
▪ Final report will be comprehensive and
detailed, and it will include data, analysis,
trends, and other relevant information
related to the topic or subject matter of
interest
$1.98 Tr
Global Health
Insurance market stood at
USD $1.98 Tr in 2021
5.98%
Insurance segment in
globe is projected to grow
by 5.98% (2023-2027)
resulting in a market
volume of $598.684 Bn in
2030
69.98%
non-communicable
diseases are responsible
for 69.98% of all fatalities
in World

14
1.1 Statistics at a Glance: The Scenario of Healthcare Insurance in the World
(continued)
North America
~ Market Size of
$XX Bn
Europe
~Revenue to reach
$XXBn by 2027
Asia
-Fastest CAGR
Africa
~Market Size of
$XX Bn
Egypt Market
~$XX MnMarket
Illustrative

15
1.2 Germany Overview
84.54 Mn
Is the population of
Germany, in 2022
44.9
Is the median age
in Germany, in
2022
4259.53 Bn
Is the Gross
Domestic Product
(GDP) in Germany in
2023
$51,203.25
per capita was the
amount of national
health expenditures in
2021
▪ Please be aware that this sample report is
report
understanding of the demographics of the
country/region, which includes the
population, GDP, healthcare expenditure
and other details related to the topic
interest

16
1.3 Economic Overview: Germany
XX
XX
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2023F
Population of Germany, (2020-2030)
XX
XX
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2023F
GDP of Germany, (2020-2030)
Population Split (2023)
55-64
0-14
15-24
25-54
65+
Male
49%
Female
51%
By Age Group
By Gender
▪ In this section you will get an understanding of the demographics
of the country/region, which includes the population, GDP,
healthcare expenditure and other details related to the topic
▪ In order to obtain access to all of the information that you are
seeking, you will need to purchase the final report
▪ Final report will be comprehensive and detailed, and it will
include data, analysis, trends, and other relevant information
related to the topic or subject matter of interest
Illustrative

17
1.1 Statistics at a Glance: The Scenario of Healthcare Insurance in the
Germany
Scope of Healthcare Diagnostics ▪ Please be aware that this sample report is
report
understanding of the topic, which includes
the prevalence of the disease, the
application of medical devices, new
technology, and other details related to the
topic
interest
63598.27 Mn
Germany Insurance market
stood at USD 6259.27 Million
in 2021
6.28%
Insurance segment in
Germany is projected
to grow by 6.28% (2023-
2027) resulting in a market
volume of US$489.65 in
2027
$5.698 billion
Germany’s healthcare
expenditures are expected to
double to $5.698 billion by
2028
71.59%
non-communicable
diseases are responsible
for 71.59% of all fatalities
in Germany

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1.5 Healthcare Services in Germany
xx xx xx xx xx xx xx xx xx
2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Germany Healthcare Services Market Forecast, 2022-2030 (in $Bn)
▪ Please be aware that this sample report is intended to provide you with a brief overview of the kind of information and analysis that will be
presented in the final report
▪ In this section you will get an understanding of the overall Healthcare Services market in Germany, which includes the market size, current
trends and other details related to the topic
▪ In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
▪ Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the topic or
subject matter of interest
Illustrative

19
1.6 Healthcare Scenario in Germany
Healthcare Insurance Development Process: The process of developing a cancer drug is complex and involves many stages, from preclinical
research to clinical trials to regulatory approval. Here is a simplified diagram of the cancer drug development process:
o Preclinical Research: Researchers identify potential drug candidates and test them in the lab
o Phase 1 Clinical Trials: Small studies are conducted to test the safety and dosage of the drug in humans
o Phase 2 Clinical Trials: Larger studies are conducted to test the effectiveness of the drug in treating cancer
o Phase 3 Clinical Trials: Even larger studies are conducted to compare the new drug to standard treatments and evaluate its safety and
effectiveness
o Regulatory Approval: The drug is reviewed by regulatory agencies such as the FDA and approved for use in the US market
Fast Track
▪ Fast track is a process designed to facilitate the development, and expedite the review of drugs to treat
serious conditions and fill an unmet medical need
Breakthrough
Therapy
▪ A process designed to expedite the development and review of drugs which may demonstrate substantial
improvement over available therapy
Accelerated
Approval
▪ These regulations allowed drugs for serious conditions that filled an unmet medical need to be approved
based on a surrogate endpoint
Priority Review ▪ A Priority Review designation means FDA’s goal is to take action on an application within 6 months
FDA has developed several approaches to making drugs available as quickly as possible, while still ensuring their safety and
effectiveness. Here are four of these approaches:
Illustrative

20
1.6 Healthcare Scenario: Patient Journey and Reimbursement
Presentation Diagnosis Treatment Follow up
A suspected diagnosis is
usually made, based on
physical examination and
detailed patient and family
history
Prenatal screening/
Neonatal screening
Initial Diagnosis
Complete blood count
(evaluate number &
quality of RBCs, Hb &
WBCs)
Imaging (confirm bone
related changes or
respiratory problems)
Bacterial cultures of
blood, sputum, urine,
stool (detect any
infection)
Genetic testing (detect
the type of SCD)
Confirmatory Diagnosis
Prevention and management of
crisis:
• For VOC and Splenic
Sequestration: HU, Endari,
Adakveo, Oxbryta
• For infections: Antibiotics,
Vaccines
Prevention and management of
complications:
• Stroke: Chronic transfusions, HU
• Long term follow-up is required for
patients with SCD
• Annual assessment: CBC and
reticulocyte count, iron status, liver
and renal function tests, urinalysis,
LDH, vitamin D level and
neurocognitive assessment
• ESOD (End Stage Organ Damage)
evaluation starting from age 7
• Yearly Transcranial Doppler test to
determine risk of stroke
Stakeholders
PCP, paediatrician,
neonatologist,
haematologist and genetic
counsellor
PCP, pediatrician, medical geneticist,
hematologist, gynecologist and pathologist
PCP, pediatrician, medical geneticist,
cardiologist, hematologist,
endocrinologist, psychologist and
psychiatrist
PCP, pediatrician, neonatologist,
endocrinologist, cardiologist,
hematologist, orthopedist, psychologist
and psychiatrist
Depending on the organ complications,
the treatment involves different
specialists at different times
Illustrative

21
1.7 Health Insurance Coverage: Germany
1.0
18.9
18.4
35.7
2.5
3.5
10.2
54.3
66.0
91.7
8.3
VA and CHAMPVA
Medicaid
Medicare
Any public plan
TRICARE
Marketplace
Direct-purchase
Employment-based
Any private plan
With health insurance
Uninsured
▪ In 2021, most people (91.7%) had health insurance coverage at some point during 2021 and 8.3 % of people were uninsured for the entire
calendar year
▪ More people had private health insurance (66%) than public coverage (35.7%)
▪ Employer-based insurance was the most common subtype of health insurance in the civilian, noninstitutionalized population (54.3%),
followed by Medicaid (18.9%), Medicare (18.4%), direct-purchase insurance (10.2%), TRICARE (2.5%), and VA and CHAMPVA health care
(1%)
Coverage Type 2020 2021 Change %
Total 327,521 328,074
Any health plan 299,230 300,887 0.4
Any private plan 217,896 216,366 –0.6
Employment-based 178,737 178,285 –0.2
Direct-purchase 33,869 33,555 –0.1
Marketplace coverage 10,924 11,389 0.1
TRICARE 9,165 8,299 –0.3
Any public plan 112,925 117,095 1.2
Medicare 58,541 60,226 0.5
Medicaid 58,778 61,940 0.9
VA and CHAMPVA 2,967 3,151 0.1
Uninsured 28,291 27,187 –0.4
% of People by Type of Health Insurance Coverage
(2021)
Number of People By Health Insurance Coverage
Illustrative

22
1.8 Budget of Germany Government for Public Insurance
Proposed Budget By Category
Outlays 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2022-31
In Billions Of Dollars
Medicare $769 $709 $766 $841 $840 $947 $1,014 $1,085 $1,227 $1,178 $1,325 $1,412 $10,633
Medicaid $458 $521 $571 $582 $616 $645 $674 $698 $734 $768 $801 $837 $6,926
As % Of GDP
Medicare 3.7% 3.2% 3.3% 3.4% 3.3% 3.6% 3.7% 3.8% 4.1% 3.8% 4.1% 4.2% 3.7%
Medicaid 2.2% 2.4% 2.4% 2.4% 2.4% 2.4% 2.4% 2.4% 2.5% 2.5% 2.5% 2.5% 2.4%
▪ National Health Expenditures (NHE) grew 2.7% to $4.3 trillion in 2021, or $12,914 per person, and accounted for 18.3% of Gross Domestic Product (GDP)
▪ Medicare spending grew 8.4% to $900.8 billion in 2021, or 21% of total NHE
▪ Medicaid spending grew 9.2% to $734.0 billion in 2021, or 17% of total NHE
▪ Private health insurance spending grew 5.8% to $1,211.4 billion in 2021, or 28% of total NHE
▪ Out of pocket spending grew 10.4% to $433.2 billion in 2021, or 10% of total NHE
▪ Other Third Party Payers and Programs and Public Health Activity spending declined 20.7% in 2021 to $596.6 billion, or 14% of total NHE
▪ Hospital expenditures grew 4.4% to $1,323.9 billion in 2021, slower than the 6.2% growth in 2020
▪ Physician and clinical services expenditures grew 5.6% to $864.6 billion in 2021, slower growth than the 6.6% in 2020
▪ Prescription drug spending increased 7.8% to $378.0 billion in 2021, faster than the 3.7% growth in 2020
▪ Largest shares of total health spending were sponsored by the federal government (34%) and the households (27%). The private business share of health
spending accounted for 17% of total health care spending, state and local governments accounted for 15%, and other private revenues accounted for 7%
Illustrative

23
1.9 Mergers and Acquisitions
$6.0
$7.7
$10.5
$16.7
$6.8
$11.7
1H 2020 2H 2020 1H 2021 2H 2021 1H 2022 2H 2022
82
112 107 107
89
110
1H 2020 2H 2020 1H 2021 2H 2021 1H 2022 2H 2022
57% of the total deal volume are done by strategic buyers and the rest 43% are done by financial buyers in 2020
RCM M&A Deal Value Trend ($Bn) RCM M&A Deal Volume Trend
Buyer Composition: Strategic Vs Financial (2020)
59%
41% 41%
59% 58%
42%
61%
39%
$0- $25 $25-$50 $50-$100 $100+
Strategic Buyers
Financial Buyers
Buyer Type by Deal Size
($Mn)
Illustrative

24
1.9 Mergers and Acquisitions (continued)
Company Name Type
Amount /
Duration
Year Key Pointers
Oracle acquisition of
Cerner
Acquisition $28.3 Bn June, 2022
▪ Oracle’s acquisition of Cerner is big tech’s latest foray into the
healthcare system, promising better outcomes
▪ Oracle acquire Cerner through an all-cash tender offer for $95.00
per share, or approximately $28.3 Bn in equity value
▪ Cerner is a leading provider of digital information systems used
within hospitals and health systems to enable medical
professionals to deliver better healthcare to individual patients
and communities
GSK acquisition of
BELLUS Health
Acquisition $2 Bn April 2023
▪ GSK has acquire BELLUS for US$14.75 per share of common
stock in cash representing an approximate total equity value of
US$2.0 billion
▪ BELLUS is a late-stage biopharmaceutical company working to
better the lives of patients suffering from persistent cough
▪ Acquisition further strengthens specialty medicines and
respiratory pipeline with camlipixant, a highly selective P2X3
antagonist and potential best-in-class treatment for refractory
chronic cough
Latest Deals In Germany
Illustrative

25
1.9 Mergers and Acquisitions (continued)
Company Name Type
Amount /
Duration
Year Key Pointers
Merger March 2023
Merger Jan 2023
Latest Deals In Germany
Illustrative

2. Market Size and Forecasting

27
2.1 Market size and forecasts (Excel and Methodology)
XX
XX
2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Germany Healthcare Insurance Market Forecast, 2022-2030 (in $Bn)
▪ Please be aware that this sample report
is intended to provide you with a brief
analysis that will be presented in the
final report
understanding of the overall Healthcare
Insurance market in Germany, which
includes the market size, current trends
and other details related to the topic
information that you are seeking, you
will need to purchase the final report
detailed, and it will include data,
analysis, trends, and other relevant
information related to the topic or
Click on the icon to know the
methodology and assumption
2023 2024 2025 2026 2027 2028 2029 2030
Major Markets Patient
(Mn)
2.74 2.82 2.90 2.94 2.98 3.02 3.07 3.12
Germany Patient Size
(Bn)
0.51 0.61 0.68 0.69 0.70 0.71 0.72 0.73
% of US Patients 18.75% 21.70% 23.56% 23.45% 23.42% 23.39% 23.34% 23.45%
Global Market Size (Bn $) 3,620 3,780 3,950 4,128 4,314 4,508 4,711 4,937
Germany Market Size (Bn
$)
61 74 84 87 91 95 99 106
Illustrative

28
2.2 Snapshot of Insurance Market Segmentation
▪ In this section you will get an understanding of the segmentations which will cover the Germany Healthcare Insurance Market
Analysis
▪ In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
By Provider
Public
Private
By Coverage
Life Insurance
Term Insurance
By Demographics
Minor
Adults
Senior

29
Germany Healthcare Insurance Market Share, By Provider (2022)
Public
Private
▪ Private Insurance in Germany is a
significant component of the overall
Healthcare market
▪ It has the maximum market share in
Germany health insurance market with
approximately xx%
final report
2.2.1 Market Segmentation: By Provider

30
Germany Healthcare Insurance Market Share, By Coverage (2022)
Life Insurance
Term Insurance
2.2.2 Market Segmentation: By Coverage
▪ Health Insurance market in Germany is
a significant component of the overall
Health market
▪ It has the maximum market share in
Germany Health insurance market with
approximately xx%
final report

31
Germany Health Insurance Market Share, By Demographics
(2022)
Minor
Adult
Senior
2.2.3 Market Segmentation: By Demographics
▪ Minor have the maximum market share
in Germany Insurance market with
approximately xx%
final report

3. Market Dynamics

33
3.1 Market growth drivers
▪ Germany operates under a social health insurance system, which
mandates that all residents must have health insurance coverage.
▪ This mandatory requirement ensures a consistent demand for health
insurance and contributes to market growth.
▪ Technological advancements in healthcare, such as digital health
solutions, telemedicine, and health monitoring devices, are driving the
demand for health insurance products that cover these services.
▪ Insurers are incorporating digital health services into their offerings,
leading to market growth.
▪ Germany, like many developed countries, has an aging population. With
an increase in the elderly population, there is a higher demand for
healthcare services and health insurance coverage, driving the growth of
the health insurance market.
2010 2022 2030
3.1.1 In 2021, 7.21% of Germany's population was above the age of one, up from 4.58% in 2017. By 2050, more than
16.59% of Germany's population would be above the age of 65 due to the country's ageing population.
Population in Germany
Illustrative

34
3.1 Market growth drivers (continued)
3.1.2 In 2021, Germany's health spending increased to $515.32 billion. That amounted to $6229.98 per person.
▪ Healthcare costs in Germany, like in many countries,
continue to rise due to various factors such as inflation,
increasing demand for healthcare services,
▪ The cost of advanced medical technologies. Health
insurance helps individuals manage these rising healthcare
costs by providing financial protection and coverage for
medical expenses.
2010 2022 2030
Healthcare Spending in Germany
Illustrative

35
3.2 Market restraints
3.2.1 In 2022, the
average cost of a Health
Insurance services in
Germany was over
$1639.58
Affordability can be a significant
restraint for certain segments of the
population, particularly those with
lower income levels or inadequate
health insurance coverage. The cost
of healthcare diagnostics, including
laboratory tests, imaging
procedures, and specialized tests,
may pose financial constraints for
individuals, impacting their ability to
access and undergo necessary
diagnostic services.
3.2.2 Average cost of
developing a Insurance
Market that is ultimately
approved by the Regulatory
authority in Germany is over
$1925.58
▪ Regulatory processes and
compliance requirements can
pose challenges for companies
operating in the Healthcare
Insurance. The approval and
registration of diagnostic
products, technologies, and
services by regulatory authorities
can be time-consuming and
costly. Compliance with quality
standards, data privacy
regulations, and other regulatory
aspects adds complexity to the
market.
3.2.3 62.1% of men and women
had at least one of the 17 chronic
health conditions in Germany
▪ The increasing prevalence of
chronic diseases in Germany
presents a significant challenge
for health insurance providers.
Chronic diseases often require
long-term management,
specialized treatments, and
comprehensive coverage.
Adequately addressing the
needs of individuals with chronic
conditions while managing costs
and risk can be demanding for
insurers.
Our analysis will thoroughly investigate the key restraints that may significantly impact business
operations and growth.
Illustrative

4. Competitive Landscape

37
4.1 Major Market Share
XX
Other
▪ Germany cancer market is a highly
competitive space, with many companies
developing and marketing cancer
treatments
▪ Some of the top companies in Germany
cancer market based on revenue and
market share include
▪ Roche is a Swiss multinational healthcare
company that develops and markets
cancer treatments, including targeted
therapies and immunotherapies
▪ In 2020, Roche's oncology sales were
approximately $24 Bn, making it one of the
largest players in Germany cancer market
Revenue of Major players in Germany Healthcare
Insurance Market ($ Mn)
Illustrative

38
4.2 Key Company Profile
▪ Here is the list of top 10 companies which
will cover in the final report
▪ Each company will have slides for
o Overview
o Key details
o Offerings
o Name of products
o Recent activities/ Press Coverage
o Distribution and Vendor Partners
o Mergers, Acquisitions and
Collaboration
o Financials
▪ If there are specific companies that you
would like to be included in the report,
please let us know via email
1
DKV Deutsche
Krankenversicherung
3 AXA Krankenversicherung
5
Kaufmännische Krankenkasse
(KKH)
7 BARMER GEK
9
Generali Deutschland
Krankenversicherung
2
SIGNAL IDUNA
Krankenversicherung
4 DAK-Gesundheit
6
HEK - Hanseatische
Krankenkasse
8
SIGNAL IDUNA
Krankenversicherung
Aetna International
10
Key Note:

39
4.2.1 DKV Deutsche Krankenversicherung
Founded in: 11 Jan 1927
HQ: Cologne, Germany
Type: Private
Revenue: $ 4.975 Mn
Website: www.dkv.com
▪ DKV Deutsche Krankenversicherung AG is a private health
insurance company.
▪ More than 80 successful years in the market of private health
insurance have the view of DKV for the essentials in the field of
health sharpened.
▪ The company provides coverage, health services and medical
care from a single source. This corporate strategy makes DKV
even stronger for the challenges of the future.
Solutions offered by DKV
Deutsche Krankenversicherung
➢ Health Insurance
➢ Medical Care
➢ Health Financing
➢ Patient Support
Recent Activity / Press Coverage
Productive partnership between IBM Consulting and DKV Deutsche Krankenversicherung AG is still going strong. People with DKV
insurance will soon be able to manage their health data, medical findings, or prescription plans themselves and communicate them digitally
with doctors and chemists because of the addition of an electronic patient record to the "My DKV" app. The two businesses recently agreed
to a similar partnership pact
A 19 percent share in the first private health insurance firm in the People's Republic of China has been acquired by DKV Deutsche
Krankenversicherung AG, a German health insurance group. The new organization's name will be PICC Health Insurance Company of
China Limited
DKV has acquired substantial experience in Chinese insurance market during the last seven years of presence

40
4.2.1 DKV Deutsche Krankenversicherung (continued)
Major Distribution Partners Major Vendor Partners
Partnerships Ecosystem
One of the largest pharmaceutical
distributors in the United States, McKesson
has been a long-standing distribution
partner for Roche
Cardinal Health is a Fortune 500 healthcare
services company that provides
pharmaceutical distribution services to
Roche
It is one of the largest drugstore chains in
the United States and Europe, and its
extensive network of retail locations and
distribution centers make it an important
distribution partner for Roche
A leading healthcare services provider in
Asia, Zuellig Pharma is a distribution
partner for Roche in several Asian countries
One of the largest pharmaceutical
wholesalers in Europe, PHOENIX Group
distributes Roche's products in several
European countries
Roche has been working with SAP, a
leading software company, to develop digital
solutions for its healthcare products
A leading Swiss biotechnology company,
Lonza provides Roche with contract
manufacturing services for the production of
its biologics and pharmaceuticals
Roche has a strategic partnership with
Microsoft to leverage its cloud computing
and AI technologies in the development of
new healthcare products
Thermo Fisher Scientific is a leading
provider of analytical instruments, reagents,
and laboratory services
GE Healthcare provides Roche with
advanced medical imaging and diagnostics
technologies, including CT scanners and
MRI machines
Illustrative

41
Company Name Type
Amount /
Duration
Year Key Pointers
Lilly
Collaboration - March, 2023
▪ Roche and Lilly will collaborate on the development of Roche
Diagnostics’ Elecsys Amyloid Plasma Panel
▪ Elecsys Amyloid Plasma Panel has demonstrated clinical
performance and is currently undergoing additional investigation
to ensure clinical validation
▪ Once approved, could help healthcare professionals to streamline
the journey to diagnosis for more patients
GenMark Diagnostics
Merger $1.8 Bn March 2021
▪ Roche to acquire GenMark Diagnostics for US$ 24.05 per share
with the expectation to close in the 2nd quarter of 2021
▪ GenMark provides molecular diagnostic tests that are designed to
detect multiple pathogens from a single patient sample
▪ GenMark’s ePlex platform delivers rapid and actionable results so
clinicians can determine the cause of infection and the most
effective treatment, potentially saving lives and alleviating the
healthcare burden
Latest Deals - Mergers and Acquisitions
Illustrative

42
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Revenues ($Bn), 2020-2030
▪ According to Roche's 2020 financial report,
the company had sales of CHF 58.3 Bn
(Swiss Francs) in 2020
▪ This is equivalent to approximately $63.3
Bn USD, based on exchange rates at the
end of 2020
▪ Company's Pharmaceuticals Division
generated sales of CHF 49.9 Bn in 2020,
while the Diagnostics Division generated
sales of CHF 8.4 Bn
▪ Revenue generated by Roche in 2020
reflects the company's continued growth
and success in the healthcare industry
Breakdown of Net Revenue by Segment, 2022
1 2 3 4
Illustrative

43
4.2.2 Company 2
Founded in:
HQ:
Type:
Revenue:
Website:
Solutions offered by Company
Drugs Indications
Drugs for Cancer Recent Activity / Press Coverage
Illustrative

44
4.2.2 Company 2 (continued)
Major Distribution Partners Major Vendor Partners
Partnerships Ecosystem
Illustrative

45
Company Name Type
Amount /
Duration
Year Key Pointers
Latest Deals - Mergers and Acquisitions
Illustrative

46
xx xx xx
2020 2021 2022 2023F 2024F 2025F 2026F 2027F 2028F 2029F 2030F
Revenues ($Bn), 2020-2030
▪ Please be aware that this sample report is
report
▪ In this section you will the understating of
financial overview of the company, which
includes revenue forecasting, segment
revenue and other key details as per
availability
interest
Breakdown of Net Revenue by Segment, 2022
1 2 3 4
Illustrative

5. Reimbursement Scenario

48
5.1 Reimbursement Regulation
The reimbursement scenario in the US cancer market is complex and can vary
depending on the specific treatment, setting of care, and insurance coverage.
Here are some key points to consider:
▪ Medicare:
o Medicare is a federal health insurance program for people aged 65 and
older, as well as people with certain disabilities or health conditions
o Medicare covers many cancer treatments, including chemotherapy,
radiation therapy, and some immunotherapies
o However, coverage can be subject to strict guidelines and restrictions,
such as the requirement for prior authorization
▪ Medicaid:
o Medicaid is a joint federal-state program that provides health insurance
for people with low incomes
o Medicaid coverage for cancer treatments can vary by state, and may be
subject to limits on the amount and type of treatment covered
▪ Private Insurance:
o Private insurance coverage for cancer treatments can also vary widely
depending on the insurer and the specific policy
o Some policies may have high out-of-pocket costs, such as deductibles
and co-pays, while others may have more comprehensive coverage
Medicare and Medicaid together provide
health insurance coverage for more than
4 in 10 Americans
Medicare
17%
Medicaid
and CHIP
21%
Employer-Sponsored
49%
Other Private
3%
Other Public
1%
Uninsured
9%
Health Insurance Coverage, 2022
Illustrative

49
5.1 Reimbursement Regulation (continued)
▪ Affordable Care Act:
o Affordable Care Act (ACA) includes provisions to help improve access to cancer treatments by requiring insurers to cover
certain preventive services, including cancer screenings, without co-pays or deductibles
o It also includes protections for people with pre-existing conditions, such as cancer
▪ Reimbursement for New Treatments:
o Reimbursement for new cancer treatments can be a complex and lengthy process, as insurers and government programs
often require evidence of safety and effectiveness before providing coverage
o This can create challenges for companies developing and marketing new treatments
▪ Value-Based Care:
o There is a growing trend towards value-based care, which aims to improve outcomes and lower costs by focusing on the
value of treatments rather than simply the volume of treatments
o Value-based care models can include payment models that tie reimbursement to outcomes or performance metrics
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the
topic or subject matter of interest
Illustrative

50
5.1 Reimbursement Regulation (continued)
Coverage Penetration (% Total Population) Source of Funding
Spend on Healthcare (%of Current Health Expenditure)
Reimbursement Market Trends
 Public healthcare coverage is provided by the government and includes programs like
Medicare and Medicaid
 Medicare is a federal program that provides healthcare coverage to individuals who
are 65 years of age or older, as well as certain younger people with disabilities
 Medicaid is a joint federal-state program that provides healthcare coverage to
individuals with low income and limited resources
▪ Shift towards value-based care has been a significant trend in the US healthcare system, with payers and providers increasingly focused on improving patient
outcomes and reducing costs
▪ This has led to the development of alternative payment models such as accountable care organizations (ACOs) and bundled payment arrangements, which
incentivize providers to deliver high-quality, cost-effective care 38.9%
37.1%
35.6%
32.5%
31.5%
44.0%
46.0%
47.7%
51.0%
51.8%
2017 2018 2019 2020 2021 2022 2023
Government Expenditure
Private Health Insurance
Out of Pocket
Other
NA NA
100% 100% 100% 100% 100%
xx xx xx xx xx
2012 2013 2014 2015 2016
Public Healthcare
Coverage
Private Coverage
6.3% 4.08% 5.1% 3.8% 2.2% 2.4% 3.6% GDP Growth (yoy)
14.7% 11.3% 15.5% 7.5% 4.2% NA NA HC Spend Growth (yoy)
Illustrative

51
5.2 Reimbursement Process for Diagnosis of Diseases
The reimbursement process in the US healthcare system can be complex and can vary depending on the type of healthcare service,
the healthcare provider, and the insurance coverage. Here are the general steps involved in the reimbursement process:
▪ Service or Treatment Provided: The healthcare provider performs a service or treatment for the patient
▪ Billing: The healthcare provider submits a claim to the insurance company or other payer, requesting reimbursement for the
service provided
▪ Adjudication: The insurance company or other payer reviews the claim to determine whether it meets the criteria for
reimbursement. This can involve verifying the patient's eligibility, reviewing the treatment provided, and checking for any potential
errors or fraud
▪ Payment: If the claim is approved, the insurance company or other payer reimburses the healthcare provider for the service
provided, based on the negotiated payment rates or fee schedule
▪ Patient Responsibility: Depending on the patient's insurance coverage, they may be responsible for paying a portion of the cost
of the service, such as deductibles, co-payments, or co-insurance
In order to obtain access to all of the information that you are seeking, you will need to purchase the final report
Final report will be comprehensive and detailed, and it will include data, analysis, trends, and other relevant information related to the
topic or subject matter of interest
Illustrative

52
5.3 Reimbursement Process for Treatment of Diseases
The reimbursement process in the US healthcare system can be complex
and can vary depending on the type of healthcare service, the healthcare
provider, and the insurance coverage. Here are the general steps involved
in the reimbursement process:
▪ Service or Treatment Provided: The healthcare provider performs a
service or treatment for the patient
▪ Billing: The healthcare provider submits a claim to the insurance
company or other payer, requesting reimbursement for the service
provided
▪ Adjudication: The insurance company or other payer reviews the claim
to determine whether it meets the criteria for reimbursement. This can
involve verifying the patient's eligibility, reviewing the treatment
provided, and checking for any potential errors or fraud
▪ Payment: If the claim is approved, the insurance company or other
payer reimburses the healthcare provider for the service provided,
based on the negotiated payment rates or fee schedule
FDA
Private Payers Public Payers
Health Technology Assessment
Payment
Coverage
Coding
Coding depends on availability code while coverage and
payment process decisions are made through an HTA.
Market Authorization
1 3
2
Illustrative

53
5.4 Reimbursement Process - Medicare
Medicare
Population Covered
▪ 100% population is covered under this scheme
▪ Citizen’s contribute to this scheme which then earns an interest. There is Basic Healthcare Sum (BHS) cap which limits the maximum contribution to an
individuals Medicare account
Provider Restrictions/
Selection
Services can be claimed from Medicare-approved institutions only (14 public hospitals, 10 private hospitals, 7 public community centers, 1 private community
center and over 100 surgery centers, dialysis centers, colonoscopy centers and screening centers)
Services Covered
▪ Medicines under SDL and MAF Plus can be bought from the money saved in this account
▪ Money can be also be claimed for antiretroviral drugs for HIV, Desferrioxamine drug for treatment of thalassemia and immuno-suppressant drugs for organ
transplant
▪ Money from this account can be used to pay Medishield premiums and Integrated Shield Plan premiums, subject to withdrawal limits
▪ Patients above 65 years of age can claim under Flexi-Medicare and further reduce their out-of-pocket expenses by using up to $200 per patient per year from
their Medicare account
▪ Excluded: Traditional drugs such as Herbal and Ayurveda cannot be claimed from Medicare account; Drugs used for cosmetic purposes such as slimming pills
and hair loss pills cannot be claimed from this account
Level of Coverage/ Assurance
▪ Approved chronic conditions and vaccinations, health screenings as outpatient treatments can be paid with Medicare up to $500 per account per year, however
a cash copayment of 15% is applicable
▪ Inpatient hospitalization, up to $450 per day + surgical limits according to Table of Surgical Procedures
▪ Approved day surgeries up to $300 per day + surgical limits according to Table of Surgical Procedures
▪ Outpatient scans/ diagnostics for cancer up to $600 per year per patient, and up to $300 for other medical conditions
▪ Chemotherapy (includes analgesic medication and suppressive treatments such as neuroendocrine and nuclear medicine treatments) up to $1,200 per month
per patient
▪ Renal dialysis up to $450 per patient per month
▪ Other treatments are also approved with various sub-limits for withdrawal
Mechanism of Coverage
▪ DRG with Activity Based Funding for public providers
▪ Block funding with DRG for providers not covered under ABF
Financial Feasibility ▪ The Basic Healthcare sum has been increased by more than 4.4% in 2017 on account of increasing costs of healthcare. This is an individual account
Illustrative

54
5.5 Reimbursement Process - Medicaid
Medicaid
Population Covered
▪ 38% population is covered under this scheme
▪ Medicare covers individuals who are aged 65 and older, as well as those with certain disabilities or end-stage renal disease
Provider Restrictions/
Selection
Services can be claimed from Medicaid-approved institutions only (14 public hospitals, 10 private hospitals, 7 public community centers, 1 private community
center and over 100 surgery centers, dialysis centers, colonoscopy centers and screening centers)
Services Covered
▪ Medicines under SDL and MAF Plus can be bought from the money saved in this account
▪ Money can be also be claimed for antiretroviral drugs for HIV, Desferrioxamine drug for treatment of thalassemia and immuno-suppressant drugs for organ
transplant
▪ Money from this account can be used to pay Medishield premiums and Integrated Shield Plan premiums, subject to withdrawal limits
▪ Patients above 65 years of age can claim under Flexi-Medicaid and further reduce their out-of-pocket expenses by using up to $200 per patient per year from
their Medicaid account
▪ Excluded: Traditional drugs such as Herbal and Ayurveda cannot be claimed from Medicaid account; Drugs used for cosmetic purposes such as slimming pills
and hair loss pills cannot be claimed from this account
Level of Coverage/ Assurance
▪ Approved chronic conditions and vaccinations, health screenings as outpatient treatments can be paid with Medicaid up to $500 per account per year, however
a cash copayment of 15% is applicable
▪ Inpatient hospitalization, up to $450 per day + surgical limits according to Table of Surgical Procedures
▪ Approved day surgeries up to $300 per day + surgical limits according to Table of Surgical Procedures
▪ Outpatient scans/ diagnostics for cancer up to $600 per year per patient, and up to $300 for other medical conditions
▪ Chemotherapy (includes analgesic medication and suppressive treatments such as neuroendocrine and nuclear medicine treatments) up to $1,200 per month
per patient
▪ Renal dialysis up to $450 per patient per month
▪ Other treatments are also approved with various sub-limits for withdrawal
Mechanism of Coverage
▪ DRG with Activity Based Funding for public providers
▪ Block funding with DRG for providers not covered under ABF
Financial Feasibility ▪ The Basic Healthcare sum has been increased by more than 4.4% in 2017 on account of increasing costs of healthcare. This is an individual account
Illustrative

6. Methodology & Scope

Research Methodology
▪ Insights 10’s research methodology delves deeper into the market, covering the macro and micro aspects of the industry. We identify the
key growth drivers, opportunities, and restraints that might promote or hinder the future industry growth along with an expansive
overview of the competitive landscape to help our clients make informed strategic decisions
▪ We implement a mix of primary and secondary research for our market estimate and forecast. The secondary research forms the initial
phase of our study where we conduct extensive data mining, referring to verified data sources such as independent studies, government
and regulatory published material, technical journals, trade magazines, and paid data sources
▪ For forecasting, the following parameters are considered:
❑ Market drivers and restraints along with their current and expected impacts
❑ Technological scenario and expected developments
❑ End use industry trends and dynamics
❑ Trends in the consumer behavior
❑ Regulatory scenario and expected developments
❑ Current capacity and expected capacity additions up to 2030
▪ We assign weights to these parameters and quantify their market impacts using the weighted average analysis to derive the expected
market growth rate
▪ We appoint data triangulation strategies to explore different areas of the market. Our qualitative and quantitative assessments are time-
sensitive, reflecting the most recent value and volume of the market across regions
▪ All our estimates and forecasts are verified through exhaustive primary research with the Key Industry Participants (KIPs)
▪ Currency used in the report is the US dollar (USD), with the market size indicated in USD million/billion (Mn/Bn)

Analysis Methodology
Our Analysis Methodology involves three critical stages:
Market Trends
Market Sizing &
Analysis
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Insights
Presentation &
Reporting
Market Data Analysis
& Statistical Model
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Secondary
Research
Proprietary
Database
Data
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Primary
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Data Triangulation & Data Validation
Bottom Up Approach
Summarization of revenue
generated from companies
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Revenue generated by products &
services offered by companies
Validation from
Primary Interview
Final
Market
Size
Top Down Approach
Final Market size break up to
rest of segmentation
Arriving at market size
of each segment
Validation from
Primary Interview
Final
Summary

Key Benefits for Stakeholders from this Report
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Our tools provides stakeholders with a cohesive understanding of the industry outlook, considering the qualitative and
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