Current economic conditions dominate business strategies. While healthcare has fared better than other industries, it will not be immune from the effects of the current recession. But what aspects of healthcare will be impacted' How much of spending will be out of the consumer's pocket' How will some novel trends (retail clinics, medical tourism) fit into this economy' It is commonly asserted that OTC and generic drugs sales will be boosted. Will this pan out' What will be the possible effects of various types of healthcare plans that might be implemented' In Healthcare in a Recession,Kalorama Information has examined all of the key medical markets in the past and has witnessed change and in some sector's profits due to economic conditions. Kalorama has consulted its experts in key areas and asked about the effect of the recession. This report takes a broad look at the healthcare market in a recession from the many areas of healthcare that Specifically the report address: The State of the Pharmaceutical Industry Outsourcing and Offshoring Generic Drugs: A Coming Boom' Over the Counter Drugs Possible impact of Healthcare Legislation Out of Pocket Healthcare Spending: Current and Future The Retail Clinic Phenomenon Availability of Health Insurance Medical Tourism: Boom or Bust' Influential PharmacistsAs part of its research, Kalorama has profiled and detailed the activities of several companies in the pharmaceutical, retail, healthcare financing and information technology fields that likely to play some role in the healthcare economy of 2009: APFUSA Atlantic Care Aurora Quick Care Capitol One Healthcare Finance Care Credit Cerner Corporation Credit Medical CSI Financial Services E- Financing Solutions GlaxoSmithKline Hospira Inc. Med Basics McKesson Corporation Medco Health Solutions, Inc. Merck & Co. Inc Med choice Financial MedDirect Minute Clinic Novartis My Healthy Access Now Medical Centers PFS Quick Health Rediclinic Reliance Medical Finance Solantic Take Care Health Systems Target Clinic Medical Associates TEVA Pharmaceutical Industries, Ltd. Wyeth (Pfizer) Siemens Medical Solutions Wal - Mart

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Healthcare in a Recession (OTC, Generics, Out of Pocket Spending,
Healthcare Legislation, Retail Clinics, Outsourcing and Other
Topics)
Published on March 2009
Report Summary
Current economic conditions dominate business strategies. While healthcare has fared better than other industries, it will not be
immune from the effects of the current recession. But what aspects of healthcare will be impacted' How much of spending will be out
of the consumer's pocket' How will some novel trends (retail clinics, medical tourism) fit into this economy' It is commonly asserted
that OTC and generic drugs sales will be boosted. Will this pan out' What will be the possible effects of various types of healthcare
plans that might be implemented'
In Healthcare in a Recession,Kalorama Information has examined all of the key medical markets in the past and has witnessed
change and in some sector's profits due to economic conditions. Kalorama has consulted its experts in key areas and asked about
the effect of the recession. This report takes a broad look at the healthcare market in a recession from the many areas of healthcare
that Specifically the report address:
The State of the Pharmaceutical Industry
Outsourcing and Offshoring
Generic Drugs: A Coming Boom'
Over the Counter Drugs
Possible impact of Healthcare Legislation
Out of Pocket Healthcare Spending: Current and Future
The Retail Clinic Phenomenon
Availability of Health Insurance
Medical Tourism: Boom or Bust'
Influential Pharmacists
As part of its research, Kalorama has profiled and detailed the activities of several companies in the pharmaceutical, retail, healthcare
financing and information technology fields that likely to play some role in the healthcare economy of 2009:
APFUSA
Atlantic Care
Aurora Quick Care
Capitol One Healthcare Finance
Care Credit
Cerner Corporation
Credit Medical
CSI Financial Services
E- Financing Solutions
Healthcare in a Recession (OTC, Generics, Out of Pocket Spending, Healthcare Legislation, Retail Clinics, Outsourcing and Other Topics) Page 1/9

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GlaxoSmithKline
Hospira Inc.
Med Basics
McKesson Corporation
Medco Health Solutions, Inc.
Merck & Co. Inc
Med choice Financial
MedDirect
Minute Clinic
Novartis
My Healthy Access
Now Medical Centers
PFS
Quick Health
Rediclinic
Reliance Medical Finance
Solantic
Take Care Health Systems
Target Clinic Medical Associates
TEVA Pharmaceutical Industries, Ltd.
Wyeth (Pfizer)
Siemens Medical Solutions
Wal - Mart
Table of Content
CHAPTER ONE: EXECUTIVE SUMMARY
Out of Pocket Spending
Healthcare Legislation
State of the Pharmaceutical Industry, 2009 ' Meeting Investor Expectations ' Erosion of Blockbuster Sales ' Increased Generic
Competition ' Pricing Pressures ' Pipeline Output Slowing Compared to ROI ' Mergers &Aquisitions
Retail Clinics
OTC/Generic Drugs
CHAPTER TWO: INTRODUCTION
The U.S. Healthcare System Today
Overview THE NEED FOR ALTERNATIVES
High Cost of Care
Healthcare Reform
CHAPTER THREE: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2009
Types of Expenditures
Insurance Co-Payments
Healthcare in a Recession (OTC, Generics, Out of Pocket Spending, Healthcare Legislation, Retail Clinics, Outsourcing and Other Topics) Page 2/9

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Direct Payments
Premiums and Plan Fees
Cash or Check
Credit Cards
Loans and Lines of Credit
Flexible Spending Accounts
Health Savings Accounts
Medical Financing
Elective Procedures
Non-Elective Procedures and Prescription Drugs Consumers Who Pay Out Of Pocket
The Uninsured and Underinsured
Medicaid Recipients
The Disabled
Senior Citizens
The Mentally Ill
The Obese
Persons with Chronic Conditions
CHAPTER FOUR: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2009 - 2013
Out-of-pocket Expenditure Growth Drivers
Payment Methods
Consumers Who Pay Out-of-pocket
CHAPTER FIVE: OVER THE COUNTER DRUGS: IN POSITION
United States Market
OTC and Recession: Avoiding the Copay
Behind the Counter Drugs'
CHAPTER SIX: INFLUENTIAL PHARMACISTS
Markets - Pharmacists Impact
The Prescribing Pharmacist
Main Drivers For Increased Pharmacist Prescription Authority
CHAPTER SEVEN: MEDICAL TOURISM: BOOM OR BUST'
Motivations for Medical Tourism
Impact of Recession
True Medical Tourism vs. All Healthcare for Foreigners
CHAPTER EIGHT: STATE OF THE PHARMACEUTICAL MARKET: OFFSHORING AND OUTSOURCING
Meeting Investor Expectations
Healthcare in a Recession (OTC, Generics, Out of Pocket Spending, Healthcare Legislation, Retail Clinics, Outsourcing and Other Topics) Page 3/9

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Erosion of Blockbuster Sales
Increased Generic Competition
Pricing Pressures
Pipeline Output Slowing Compared to ROI
M&A Offshoring Clinical Trials
Size and Growth of the Market
Outsourcing: No Longer Optional For Pharma
Strategic Outsourcing
Outsourcing Manufacturing Operations
CHAPTER NINE: GENERIC DRUGS: COMING BOOM'
Overview
Issues in Generics
CHAPTER TEN: RETAIL CLINICS
Retail Clinics Business
Competition with Primary Care Providers
Regulation
CHAPTER ELEVEN: IMPACT OF HEALTHCARE LEGISLATION
Overview
Change for Pharma
Focus on Cost - Cutting
Healthcare Reform
CHAPTER TWELVE: COMPANY PROFILES
APFUSA
Atlantic Care
Aurora Quick Care
Capitol One Healthcare Finance
Care Credit
Cerner Corporation
Products and Service
Key Competitors
Credit Medical
CSI Financial Services
E- Financing Solutions
GlaxoSmithKline
History and Lines of Business
Strategic Alliances
Vaccine Products
OTC Products
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Financial Information
Hospira Inc.
Med Basics
McKesson Corporation
Company Overview
Products and Service
Medco Health Solutions, Inc.
Merck & Co. Inc
History and Lines of Business
Strategic Alliances
Vaccine Products
Financial Information
Med choice Financial
MedDirect
Minute Clinic
Novartis
History and Lines of Business
Strategic Alliances
Vaccine Products
My Healthy Access
Now Medical Centers
Pfs
Quick Health
Rediclinic
Reliance Medical Finance
Solantic
Take Care Health Systems
Target Clinic Medical Associates
TEVA Pharmaceutical Industries, Ltd.
Wyeth (Pfizer)
History and Lines of Business
Vaccine Products
OTC Products
Financial Information
Siemens Medical Solutions
Key Competitors
Growth Strategy
Locations
Wal - Mart
LIST OF EXHIBITS
CHAPTER TWO: INTRODUCTION
Figure 2-1:National Health Expenditures (NHE) and NHE as a Percent of GDP, 1980 - 2013
Figure 2-2: Unnecessary Deaths Resulting From Variations in Health Care Quality, by Condition (Prenatal Care, Diabetes Care, Beta
Blocker Treatment, Breast Cancer Screening, Cholesterol Management, High Blood Pressure, Diabetes)
Figure 2-3:HEDIS Scores by Quality of Health Care Plan, 2008
Table 2-1: U.S. Health Care Coverage by State, 2008
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CHAPTER THREE: OUT-OF-POCKET EXPENDITURES THE MARKET IN 2009
Figure 3-1:Premium Increases vs. Increases in Workers Earnings and Prices, 1989 - 2008
Figure 3-2: Consumer Out-of-pocket Health Care Expenditures,
Figure 3-3:Consumer Out-of-pocket Health Care Expenditures by Payment Type,2008
Table 3-1: Credit Card Debt of Consumers With Medical Debt, 2007
Table 3-2: Credit Card Debt of Consumers With Medical Debt, 2007
Table 3-3: Main Business Activities of Selected Medical Financing Companies,
Figure 3-4:by Percentile of Total Health Spending,
Figure 3-5:Methods of Financing Elective Procedures,
Figure 3-6: Average Share Paid Out-of-pocket by U.S. Residents with Health Care Spending by Type of Service, 2008
Figure 3-7: by Percentile of Total Health Spending and Type of Service, 2008
Figure 3-8: Distribution of Out-of-pocket Spending on Non-Elective Procedures for the Average Person, 2008
Figure 3-9: Distribution of Out-of-pocket Spending for the Average Person, by Spending Level, 2008
Figure 3-10: Drug Cost Coverage by Payor Type (Public, Private, Cash) 1965, 1986, 2000, 2004, 2008
Table 3-4: Obesity in the United States, 1980 - 2013
Figure 3-11: Proportion of Adults Under Age 65 With Chronic Conditions, 2008
CHAPTER FOUR: FORECASTED OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2009 - 2013
Table 4-1: Selected Rx-to-OTC Switches in the United States, 1990 - Present
Table 4-2: Rx-to-OTC Switch Candidates in the United States, 2009 - 2013
Table 4-3: Consumer Out-of-pocket Expenditures per Worker 2003-2013 (in $)
Table 4-4: Consumer Out-of-pocket Expenditures by Type, 2003-2013
Figure 4-1: Proportion of Consumer Out-of-pocket Spending by Type of Health Care Expenditure
Table 4-5: Consumer Out-of-pocket Expenditures by Type, 2001-2011
Figure 4-2: Proportion of Consumer Out-of-pocket Spending by Payment Type, 2003, 2008, 2013
Table 4-6: Amount of Consumer Out-of-pocket Expenditures for Elective Procedures That Are Financed, 2003-2013
Table 4-7: Amount of Consumer Out-of-pocket Expenditures for Non-Elective Procedures That Are Financed, 2001-2011
Figure 4-3: Proportion of Consumer Out-of-pocket Spending for Elective ProceduresThat is Financed (All Methods),
Figure 4-4: Distribution of Out-of-pocket Spending on Non-Elective Procedures for the Average Person, 2008, 2013
Figure 4-5: Proportion of Consumer Out-of-pocket Spending for Non-Elective Procedures That is Financed (All Methods),2008 - 2013
Table 4-8: Size of High Risk Groups for High Out-of-pocket Health Care Expenditures, 2003-2013 (Millions of Persons)
CHAPTER FIVE: OVER THE COUNTER DRUGS: IN POSITION
Table 5-1: Projected US OTC Revenues 2008-2012
CHAPTER SIX: INFLUENTIAL PHARMACISTS
Figure 6-1: Declining Drug Purchases Not Influenced By Pharmacists, 2006-2012
Table 6-1: Pharmacists Influence in Drug Selection and/or Therapy Aspect: 2007 and 2012
Table 6-2: States Likely to Implement Independent Prescribing First
CHAPTER SEVEN: MEDICAL TOURISM: BOOM OR BUST'
Table 7-1: Cost Savings From Medical Tourism For Various Procedures, 2008
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Figure 7-1: US 'True Medical Tourism' Revenues, 2008, 2010
CHAPTER EIGHT: STATE OF THE PHARMACEUTICAL MARKET,: OFFSHORING AND OUTSOURCING
Table 8-1: Clinical Trial Market in Select Countries 2006-2012
Table 8-2: Global Prescription Pharmaceutical Contract Manufacturing Market Primary, Secondary and Biomanufacturing 2003-2013
CHAPTER NINE: GENERIC DRUGS: COMING BOOM'
Table 9-1: US Generic Drug Market 2008-2012
CHAPTER TEN: RETAIL CLINICS
Figure 10-1: Growth of U.S. Retail Clinic Services
CHAPTER ELEVEN: IMPACT OF HEALTHCARE LEGISLATION
Table 11-1: Likely Impact of Events and Proposed Legislation (Propsed Change, Probability, Positive Impact, Negative Impact)
CHAPTER TWELVE: COMPANY PROFILES
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