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KEY NOTE HEALTHCARE UK (Market Review) : February 2003

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This report covers: National Health Service, Hospital & Community Health Care, Family Health Services, Private Healthcare, Psychiatric Care, clinical negligence, Private Medical Insurance, failing hospitals, bed blocking fines, foundation hospitals, primary care groups, Private Finance Initiative, Family health Services, Hospitals, Community health Services, hospices, private healthcare,palliative care, alternative healthcare, healthcare supplies, psychiatric care, long-term care, private health insurance, pharmaceuticals, general practitioners, dentists, opthalmic opticians, nurses, ambulance staff, waiting lists, health, fitness, cosmetic surgery, NHS, The Aromatherapy Organisations Council, The British Acupuncture Council, the British Chiropractic Association, the Complementary Medicine Association, The Faculty of Homeopathy, the General Chiropractic Council, The General Osteopathic Council, the Register of Chinese Herbal Medicine, The Research Council for Complementary Medicine, Palliative & Hospice Care,

Companies covered include: Anchor Trust, AXA PPP Healthcare, The Boots Company, Boots Retail, Boots Retail Interantional, Boots Helathcare International, BUPA Care Services, Capio Healthcare UK, Four Seasons Health Care, General Healthcare Group, Handbag.com, HCA International,Bristol Contributory Welfare Association, The British United Provident Association, Capio Healthcare UK, Care UK, Four Seasons Healthcare, Nestor Healthcare Group, Norwich Union Healthcare, Nuffield Nursing Homes Trust, Partnerships in Care Ltd, Priory Healthcare, Royal & Sun Alliance, Standard Life Healthcare, St Andrews Group,Western Provident Association, Westminster Health Care Group, Westminster Senior Living, AON Health Solutions, Previa UK,

EXECUTIVE SUMMARY

The UK healthcare market continues to be dominated by the National Health Service (NHS), the large and comprehensive public sector, which remains the world-leading public healthcare service, according to the World Health Organization (WHO). The NHS is funded by general taxation and National Insurance (NI) contributions. Since its inception in 1948, it has provided comprehensive healthcare services to all UK citizens on the basis of need and not on their ability to pay. Although there is overlap between the different sectors of the healthcare market, the NHS constituted 74.3 percent of all healthcare spending in the UK in 2002, including private medical insurance. Total expenditure on UK healthcare (public, private and complementary) was worth £69.73bn in 2002. Expenditure on UK medical supplies amounted to £14.29bn.

Of the two main arms of the NHS, hospital and community health services, which consists of hospital-based care and certain community services, was the largest in 2002, with a 70.3 percent share of NHS services. The other branch of the NHS, responsible for primary care services (family health services), accounted for the remaining 29.7 percent of expenditure on public healthcare services.

The UK private healthcare market consists of both commercial and charitable interests, which fund and provide healthcare. The public sector is becoming a major commissioner of services in the private sector. In 2002, private healthcare, including private medical insurance, was estimated to constitute 24.3 percent of the UK healthcare market. The main market sectors in private healthcare are long-term care, acute hospital care, psychiatric care and primary care services. In 2002, long-term care was the largest individual sector, constituting 67.5 percent of all expenditure in the private sector (excluding private medical insurance).

The remaining healthcare markets include palliative care, which is organised and provided largely by the voluntary sector, often in partnership with the NHS. Complementary healthcare consists of a wide range of different therapies and treatments provided as an alternative, or in addition to, orthodox medicine. Some of the most popular and well-regulated therapies such as chiropractic, acupuncture and osteopathy, as well as reflexology, aromatherapy counselling, hypnotherapy, massage disciplines and other relaxation therapies, are becoming integrated into mainstream medicine and healthcare. Expenditure on palliative care constituted 0.5 percent of all healthcare spending in the UK in 2002, while complementary healthcare constituted 0.9 percent of all expenditure.

Table 1: Profile of the UK Healthcare Market† by Sector Share ( percent), 2002
percent of Total
NHS	74.3
Private healthcare	24.3
Complementary medicine	0.9
Palliative care	0.5
Total	100
† — including private medical insurance
Source: Key Note

In the market for healthcare supplies, the single largest sector was that of prescribed pharmaceuticals, which constituted more than half (57.3 percent) of all expenditure in 2002. Over-the-counter (OTC) pharmaceuticals had the highest level of growth, primarily because of new product introductions expanding the market, but constituted only 12.2 percent of the market. Medical equipment and consumables was the second-largest sector, constituting 17.5 percent of expenditure, while equipment for the disabled accounted for 13 percent.

Table 2: Profile of the UK Medical Supplies Market ( percent), 2002
percent of Medical Supplies Market
Market Sector
Prescribed
pharmaceuticals	57.3
Medical equipment
and consumables	17.5
Disabled equipment	13
OTC pharmaceuticals	12.2
Total	100
OTC — over the counter
Source: Key Note

The combination of an ageing population and the expanding scope of treatments, together with a demanding public, is significantly increasing the need for healthcare services. This, and the rising cost of care, has caused healthcare expenditure to rise. Successive governments have introduced a variety of reforms aimed at rationalising care, improving efficiency, cost-effectiveness and containing costs, but expenditure continues to grow and the NHS, in spite of unprecedented funding increases, continues to suffer problems, although recent figures indicate improvements in waiting lists.

The Private Finance Initiative (PFI) is generating capital and resources towards the outdated and ageing infrastructure of the NHS, although such projects are complex, costly and highly bureaucratic. There are concerns that the initiative may mean short-term gain at the cost of the long-term future and cause delays. Chronic staff shortages are fast becoming a point of crisis, particularly as significant numbers of staff are nearing retirement age or planning early retirement as a result of poor staff morale. The Government is attempting to attract former nurses through advertising campaigns and family-friendly policies, increasing training places and improving career structures and salaries. In the short term, agency staff are being employed and healthcare professionals recruited from abroad.

Although high growth is forecast in expenditure on the NHS as a whole and the Government is trying to build up primary care services, improving early cost-effective access to care, hospital expenditure is likely to continue to grow rapidly as the boundaries of care expand and greater numbers of patients enter the system.

The private healthcare market is much smaller than the comprehensive public sector. However, in the face of continuing problems with the NHS, it is beginning to develop and expand into new areas of care. The sector is increasingly operating in partnership with the NHS, or running NHS services, which is likely to continue with the advent of Primary Care Trusts (PCTs) and the `concordat' agreement. The concordat is an agreement between the NHS and the private sector for the use of private facilities for NHS patients at times of pressure on services. It was signed in October 2000. The NHS is becoming a major commissioner of private healthcare services.

Within the private sector, primary care services are hampered by the `gatekeeper role' taken by the public sector, with general practitioners (GPs) able to refer patients to either the public or private sector and patients able to access a GP within a reasonable time, unlike waiting lists to see NHS hospital consultants. The private acute care and psychiatric services sectors are both developing greater levels of partnership with the NHS to supply services, rather than competing with the public sector. These two sectors are growing significantly.

In the UK, the principal source of funding for private healthcare is private medical insurance, although self-paying schemes are becoming more popular, particularly in fields such as cosmetic surgery. Many providers now offer fixed price agreements and loan schemes for patients. Although insurance is set to show some growth, it is still hampered by the lack of government incentives for people to take out insurance, since taxpayers cannot redirect NHS payments into private schemes and they must also pay insurance premium tax. Funding for long-term residential care remains a significant problem and Scotland agreed to fund care costs in full in January 2001 following the Royal Commission report in March 1999. England announced partial funding in December 1999.

The palliative care sector also has funding problems, particularly as the majority of its finances come from voluntary/charitable sources. The market for complementary medicine is growing steadily as certain established therapies are increasingly integrated into orthodox healthcare. Greater regulation is likely in this area.

In the medical supplies sector of the market, expenditure on prescribed pharmaceuticals is set to continue to rise in spite of generic prescribing and clinical guidance from the National Institute for Clinical Excellence (NICE). The OTC pharmaceutical market is also set to grow as more pharmaceuticals are delisted and broaden the current limited availability. Expenditure on medical equipment is increasing, as hospitals are refurbished and built under PFI schemes and healthcare organisations replace outdated equipment. Expenditure will grow as the number of people with mobility and health problems rise in an ageing population.

Given the political pressures to improve healthcare in the UK, there are likely to be opportunities and growth in most sectors of the market, public, private and voluntary. The boundaries between the public and private sectors are likely to continue falling, as are the boundaries between orthodox medicine and at least some complementary therapies. In the long-term care sector, however, unless funding issues are completely resolved, market growth is likely to be significantly affected in spite of high and increasing demands for services in that area.

TABLE OF CONTENTS

Executive Summary	1
Table 1: Profile of the UK Healthcare Market by Sector Share ( percent), 2002	2
Table 2: Profile of the UK Medical Supplies Market ( percent), 2002	3
1. Market Overview	7
INTRODUCTION	7
MARKET DEFINITION	7
Public Healthcare	7
The National Health Service	7
Hospital and Community Health Services	7
Family Health Services	7
Private Healthcare	8
Private Medical Insurance	8
Other Healthcare Services	8
Complementary Medicine	8
Palliative and Hospice Care	8
INDUSTRY STRUCTURE	9
Table 1.1: UK Employee Profile of the National Health Service (number of employees), 2000	9
TOTAL MARKET SIZE	11
The National Health Service	11
Table 1.2: The Total UK Expenditure on the National Health Service by Sector by Value (£m), 1998-2002	11
Figure 1.1: The Total UK Expenditure on the National Health Service by Sector by Value (£m), 2002	12
The Private Sector	12
Table 1.3: The Total UK Private Healthcare Market by Sector by Value (£m), 1998-2002	13
Figure 1.2: The Total UK Private Healthcare Market by Sector by Value (£m), 2002	14
Other Healthcare	14
Table 1.4: The Total UK Other Healthcare Market by Sector by Value (£m), 1998-2002	15
Figure 1.3: The Total UK Other Healthcare Services Market by Sector by Value (£m), 2002	16
Outside Suppliers	16
Table 1.5: The Total UK Medical Supplies Market by Sector by Value (£m), 1998-2002	17
Figure 1.4: The Total UK Medical Supplies Market by Sector by Value (£m), 2002	18
MARKET SEGMENTATION	18
The National Health Service	18
Hospital and Community Health Services	19
Family Health Services	19
Pharmaceutical Services	19
Medical Services	19
Dental Services	19
Ophthalmic Services	20
Private Healthcare	20
Long-Term Care	20
Acute Care	20
Psychiatric Care	20
Primary Care	21
Private Medical Insurance	21
Complementary Medicine	21
Palliative and Hospice Care	21
KEY TRENDS	22
Demographics	22
Table 1.6: The UK Actual, Estimated and Projected Population by Age (million people), 1971-2026	22
Figure 1.5: The UK Actual, Estimated and Projected Population by Age (million people), 1971-2026	23
Table 1.7: The UK Actual and Projected Population (million people and percent), 1961-2026	24
Figure 1.6: The UK Actual and Projected Population (million people), 1961-2026	25
Life Expectancy	25
Table 1.8: UK Expectation of Life at Birth by Sex (years), 1901, 1961, 1991, 1998, 2001 and 2021	26
Infant Mortality	26
Table 1.9: Infant Mortality in the UK per 1,000 Live Births, 1990-2002	26
Death Rates	27
Table 1.10: Th UK Death Rate by Sex (per 1,000 people), 1900-2001	28
Figure 1.7: The UK Death Rate by Sex (per 1,000 people), 1900-2001	29
PUBLIC HEALTH	29
Table 1.11: Number of Deaths by Major Causes in England and Wales, 2000	30
Figure 1.8: Number of Deaths by Major Natural Causes in England and Wales, 2000	31
Table 1.12: UK Incidence of Notifiable Diseases (number of cases), 1989, 1999 and 2000	32
Legal Abortions	33
Table 1.13: Actual Number of Legal Abortions in the UK, 1990-2000	33
Figure 1.9: Actual Number of Legal Abortions in the UK, 1990-2000	34
Figure 1.10: Actual Number of Legal Abortions Among Under 15 Year-Olds in the UK, 1990-2000	35
CHARITIES	35
PEST ANALYSIS	36
Political Factors	36
Funding	36
National Institute of Clinical Excellence	36
Nursing and Staff Shortages	36
Waiting Lists and Cardiac Care	36
NHS Direct	37
Devolution	37
The NHS Plan	37
National Service Framework for Cancer	38
National Service Framework for Coronary Heart Disease	38
Regulatory Impact Unit	38
Public Private Partnerships	38
Economic Factors	38
Economic Status	38
International Activity	39
Long-Term Care	39
Social Factors	39
Lifestyle	39
Health Targets	39
Obesity	40
Smoking	40
Drug and Alcohol Abuse	40
Complementary Healthcare	40
Technological Factors	41
MMR	41
Meningitis C Vaccine	41
New Surgical Techniques	41
IT	41
A GLOBAL PERSPECTIVE	41
2. Key Note Field Research	43
INTRODUCTION	43
CONSUMER CHARACTERISTICS	43
Table 2.1: Summary Profile of Consumer Characteristics ( percent of adults), 2002	44
Thinking About the Last 12 Months, Which, If Any, of These Statements Apply to You?	44
Had a Full Medical Check-Up	44
Table 2.2: Penetration of Having a Full Medical Check-Up by Sex, Age, Social Grade and Region ( percent of adults), 2002	45
Stopped/Reduced Smoking	46
Table 2.3: Penetration of Adults Stopping or Reducing Smoking by Sex, Age, Social Grade and Region ( percent of adults), 2002	46
Reduced Alcohol Intake	47
Table 2.4: Penetration of Reduced Alcohol Intake by Sex, Age, Social Grade and Region ( percent of adults), 2002	48
Improved Diet	49
Table 2.5: Penetration of Improved Diet by Sex, Age, Social Grade and Region ( percent of adults), 2002	49
Increased Exercise Levels	50
Table 2.6: Penetration of Increased Exercise Levels by Sex, Age, Social Grade and Region ( percent of adults), 2002	51
Gave Blood	52
Table 2.7: Penetration of Giving Blood by Sex, Age, Social Grade and Region ( percent of adults), 2002	52
Gave Money to Medical Charities	53
Table 2.8: Penetration of Giving Money to Medical Charities by Sex, Age, Social Grade and Region ( percent of adults), 2002	54
Took Out/Renewed Private Medical Insurance	55
Table 2.9: Penetration of Taking Out/Renewing Private Medical Insurance by Sex, Age, Social Grade and Region ( percent of adults), 2002	55
Used Herbal Medicines/Remedies	56
Table 2.10: Penetration of Herbal Medicines/Remedies by Sex, Age, Social Grade and Region ( percent of adults), 2002	57
Waited For an NHS Operation	58
Table 2.11: Penetration of Waiting For an NHS Operation by Sex, Age, Social Grade and Region ( percent of adults), 2002	58
Had Cosmetic Surgery	59
Table 2.12: Penetration of Cosmetic Surgery by Sex, Age, Social Grade and Region ( percent of adults), 2002	60
Had Physiotherapy	61
Table 2.13: Penetration of Physiotherapy by Sex, Age, Social Grade and Region ( percent of adults), 2002	62
None of These	63
Table 2.14: None of These by Sex, Age, Social Grade and Region ( percent of adults), 2002	63
CONSUMER AttITUDES	64
Table 2.15: Summary of Consumer Attitudes Towards Healthcare in the UK ( percent of adults), 2002	65
Which of the Following Actions Do You Consider to be Necessary to Improve the Healthcare Service?	65
More NHS Funding	65
Table 2.16: More NHS Funding by Sex, Age, Social Grade and Region ( percent of adults), 2002	66
Recruiting More GPs	67
Table 2.17: Recruiting More GPs by Sex, Age, Social Grade and Region ( percent of adults), 2002	67
Recruiting More Nurses	68
Table 2.18: Recruiting More Nurses by Sex, Age, Social Grade and Region ( percent of adults), 2002	69
Cutting NHS Waiting Lists	70
Table 2.19: Cutting NHS Waiting Lists by Sex, Age, Social Grade and Region ( percent of adults), 2002	70
Better Regulation of GPs	71
Table 2.20: Better Regulation of GPs by Sex, Age, Social Grade and Region ( percent of adults), 2002	72
Monitoring Hospitals’ Performance	73
Table 2.21: Monitoring Hospitals’ Performance by Sex, Age, Social Grade and Region ( percent of adults), 2002	73
Encouraging More Self-Medication	74
Table 2.22: Encouraging More Self-Medication by Sex, Age, Social Grade and Region ( percent of adults), 2002	75
Encouraging More Private Healthcare	76
Table 2.23: Encouraging More Private Healthcare by Sex, Age, Social Grade and Region ( percent of adults), 2002	76
A Change in Government	77
Table 2.24: A Change in Government by Sex, Age, Social Grade and Region ( percent of adults), 2002	78
Educating the Public on Health Matters	79
Table 2.25: Educating the Public on Health Matters by Sex, Age, Social Grade and Region ( percent of adults), 2002	79
3. Competitor Analysis	81
INTRODUCTION	81
MAJOR PLAYERS	81
Anchor Trust	81
AXA PPP Healthcare Group PLC	82
The Boots Company PLC	83
Boots Retail	84
Boots Retail International	84
Boots Healthcare International	84
Handbag.com	84
Bristol Contributory Welfare Association Ltd	85
The British United Provident Association Ltd	85
Capio Healthcare UK Ltd	87
Care UK PLC	87
Four Seasons Health Care Ltd	88
General Healthcare Group Ltd	89
Nestor Healthcare Group PLC	90
Norwich Union Healthcare Ltd	91
Nuffield Nursing Homes Trust	91
Western Provident Association Ltd	92
Westminster Health Care Ltd	93
4. The National Health Service	95
INTRODUCTION	95
KEY TRENDS	95
National Health Service Investment	95
National Health Service Staffing Shortages	95
Clinical Negligence	97
The NHS Plan	97
Failing Hospitals	98
Bed Blocking Fines	98
Foundation Hospitals	98
MARKET SIZE	98
Table 4.1: The Total UK Expenditure on the National Health Service by Value (£m and percent), 1998-2002	99
Figure 4.1: The Total UK Expenditure on the National Health Service by Value (£m), 1998-2002	99
INDUSTRY STRUCTURE	100
NHS Trusts	100
Primary Care Groups	100
Monitoring of Standards	101
The Private Finance Initiative	101
National Health Service Organisation	101
Key Trade Associations	102
British Medical Association	102
General Medical Council	102
Royal College of Nursing	102
FORECASTS 2003 to 2007	102
Table 4.2: The Total Forecast UK Expenditure on the National Health Service (£m and percent), 2003-2007	102
5. Hospital and Community Health Services	103
INTRODUCTION	103
KEY TRENDS	103
MARKET SIZE	104
Table 5.1: The Total UK Hospital and Community Health Services Market by Value (£m and percent), 1998-2002	104
Table 5.2: Hospital Activity Profile for England by Number of Episodes and Admissions (000), 2001/2002	104
INDUSTRY STRUCTURE	105
BUYING BEHAVIOUR	106
Table 5.3: Hospital Episodes by Main Diagnostic Group (number, days, years and percent), 2001/2002	106
Figure 5.1: Hospital Episodes by Main Diagnostic Group by Number of Finished Episodes, 2001/2002	107
FORECASTS 2003 to 2007	107
Table 5.4: The Total Forecast UK Hospital and Community Health Services Market by Value (£m and percent), 2003-2007	108
Figure 5.2: The Total UK Hospital and Community Health Services Market by Value (£m), 1998-2007	108
6. Family Health Services	109
Introduction	109
KEY TRENDS	109
MARKET SIZE	109
Table 6.1: The Total UK Family Health Services Market by Sector by Value (£m and percent), 1998-2002	110
Figure 6.1: The Total UK Family Health Services Market by Sector by Value (£m), 2002	111
Pharmaceutical Services	111
Introduction	111
Key Trends	112
Market Size	112
Table 6.2: The Total UK Pharmaceutical Services Sector by Value (£m and percent), 1998-2002	112
Table 6.3: Number of Prescriptions Dispensed in the UK (million and percent), 1998-2002	113
Figure 6.2: Number of Prescriptions Dispensed in the UK (million), 1998-2002	114
Industry Structure	114
Table 6.4: Number of Pharmacies Contracted to Health Authorities in England, Years Ending 31st March 1997-2001	115
Major Players	115
Boots the Chemist	115
Lloyds Pharmacy Ltd	115
Moss Pharmacy	116
National Co-operative Chemists	116
Key Trade Associations	116
The National Pharmaceutical Association	116
Royal Pharmaceutical Society of Great Britain	116
Buying Behaviour	116
Forecasts 2003 to 2007	117
Table 6.5: The Total Forecast UK Pharmaceutical Services Market by Value (£m and percent), 2003-2007	117
Medical Services	117
Introduction	117
Key Trends	118
Market Size	118
Table 6.6: The Total UK Medical Services Market by Value (£m and percent), 1998-2002	118
Industry Structure	118
Table 6.7: Number of UK General Practitioners Contracted to the National Health Service (number and percent), 1998-2002	119
Table 6.8: Average Number of Patients per GP per Country (number), Year Ending September 2001	119
Buying Behaviour	120
Forecasts 2003 to 2007	120
Table 6.9: The Total Forecast UK Medical Services Market by Value (£m and percent), 2003-2007	120
DENTAL SERVICES	120
Introduction	120
Key Trends	120
Market Size	121
Table 6.10: The Total UK Dental Services Market by Value (£m and percent), 1998-2002	121
Industry Structure	121
Table 6.11: Number of Adult Courses of Dental Treatment in the UK (000 and percent), 1998-2002	121
Table 6.12: New Dental Patients in England (000 and percent), 1998-2002	122
Funding for Dental Services	122
Key Trade Associations	123
General Dental Council	123
The General Dental Practitioners’ Association	123
Buying Behaviour	123
Forecasts 2003 to 2007	123
Table 6.13: The Total Forecast UK Dental Services Market by Value (£m and percent), 2003-2007	123
OPHTHALMIC SERVICES	124
Introduction	124
Key Trends	124
Market Size	124
Table 6.14: The Total UK Ophthalmic Services Market by Value (£m and percent), 1998-2002	125
Industry Structure	125
Table 6.15: The Actual Number of UK Ophthalmic Practitioners Under National Health Service Contract by Type (number), 1998-2002	126
Sight Tests	126
Table 6.16: Number of UK National Health Service Sight Tests and Spectacles Redeemed (million, number and percent), 1998-2002	127
Table 6.17: Health Authority Contracted Opticians by Number of Premises in England, 1996-2002	128
Major Players	128
Boots Opticians Ltd	129
Dollond & Aitchison Ltd	129
Specsavers Optical Group	129
Vision Express	130
Key Trade Associations	130
The Association of British Dispensing Opticians	130
The Association of Optometrists	130
The College of Optometrists	130
The Federation of Ophthalmic and Dispensing Opticians	130
General Optical Council	131
The Royal College of Ophthalmologists	131
Advertising and Promotion	131
Table 6.18: Main Media Advertising Expenditure by Opticians (£000), Year Ending September 2002	131
Buying Behaviour	132
Table 6.19: Penetration of Spectacles and Contact Lenses by Sex, Age, Social Grade and Region ( percent of adults), 2002	132
Forecasts 2003 to 2007	133
Table 6.20: The Total Forecast UK Ophthalmic Services Market by Value (£m and percent), 2003-2007	134
Family Health Services Forecasts 2003 to 2007	134
Table 6.21: The Total Forecast UK Family Health Services Market by Sector by Value (£m and percent), 2003-2007	134
Figure 6.3: The Total UK Family Health Services Market by Value (£m), 1998-2007	135
7. Private Healthcare	137
INTRODUCTION	137
Table 7.1: The Total UK Private Healthcare Market by Sector by Value (£m), 1998-2007	138
Figure 7.1: The Total UK Private Healthcare Market by Sector by Value (£m), 1998-2007	139
LONG-TERM CARE	139
Key Trends	139
Market Size	140
Table 7.2: The Total UK Private Long-Term Care Market by Sector by Value (£m and percent), 1998-2002	141
Figure 7.2: The Total UK Private Long-Term Care Market by Sector by Value (£m), 2002	142
Industry Structure	142
Table 7.3: Nursing and Residential Care Places by Sector (number of places), April 2002	142
Table 7.4: Structure of the UK Private Long-Term Care Market by Ownership ( percent of total beds), 2001	143
Figure 7.3: Structure of the UK Private Long-Term Care Market by Ownership ( percent of total beds), 2001	144
Key Trade Associations	144
The National Care Homes Association	144
The Registered Nursing Home Association Ltd	145
Major Players	145
Table 7.5: Selected Major Private Long-Term Care Companies Ranked by Number of Homes and Places/Beds, 2002	145
Anchor Trust	145
BUPA Care Services	145
Four Seasons Health Care	146
General Healthcare Group (BMI Healthcare)	146
Westminster Senior Living	146
Advertising and Promotion	146
Buying Behaviour	146
Forecasts 2003 to 2007	147
Table 7.6: The Total Forecast UK Private Long-Term Care Market by Sector by Value (£m and percent), 2003-2007	148
Acute Care	148
Key Trends	148
Market Size	150
Table 7.7: The Total UK Private Acute Care Market by Value (£m and percent), 1998-2002	150
Industry Structure	150
Table 7.8: The Total UK Private Acute Care Market by Number of Hospitals and Beds, 1998-2002	151
Table 7.9: Ownership Status of Private Acute Care Providers ( percent of total beds), 1998 and Year Ending June 2002	151
Figure 7.4: Ownership Status of Private Acute Care Providers ( percent of total beds), Year Ending June 2002	152
Private Care in the National Health Service	152
Key Trade Associations	153
Major Players	153
Table 7.10: Leading Private Acute Care Providers by Number of Hospitals and Beds (number), 2002	153
Table 7.11: Leading Private Acute Care Providers by Acute Care Revenue (£m), 2001	154
Private Care in the National Health Service	154
BUPA Hospitals Ltd	154
Capio Healthcare UK Ltd	154
HCA International Ltd	155
Nuffield Hospitals	155
Buying Behaviour	155
Forecasts 2003 to 2007	156
Table 7.12: The Total Forecast UK Private Acute Care Market by Value (£m and percent), 2003-2007	156
Psychiatric Care	156
Introduction	156
Key Trends	156
Market Size	157
Table 7.13: The Total UK Private Psychiatric Care Market by Value (£m and percent), 1998-2002	157
Industry Structure	157
Table 7.14: The Total UK Independent Acute Care Market by Number of Beds and percentage Share of the Total Market (number and percent), 2002	157
Major Players	158
Table 7.15: Leading Players in the UK Psychiatric Care Market by Number of Hospitals and Beds, 2002	158
Partnerships in Care Ltd	158
Priory Healthcare Ltd	158
St. Andrews Group	159
Advertising and Promotion	159
Buying Behaviour	159
Forecasts 2003 to 2007	159
Table 7.16: The Total Forecast UK Private Psychiatric Care Market by Value (£m and percent), 2003-2007	160
PRIMARY CARE	160
Key Trends	160
Market Size	161
Table 7.17: The Total UK Private Primary Care Market by Sector by Value (£m and percent), 1998-2002	161
Industry Structure	162
GP Services	162
Occupational Health Services	162
Table 7.18: The Total UK Private Primary Care Market by Sector Share ( percent), 2002	163
Major Players	163
AON Health Solutions	164
BMI Health Services	164
BUPA Occupational Health Ltd	164
Previa UK Ltd	164
Buying Behaviour	165
Forecasts 2003 to 2007	165
Table 7.19: The Total Forecast UK Private Primary Care Market by Sector by Value (£m and percent), 2003-2007	166
8. Private Medical Insurance	167
INTRODUCTION	167
KEY TRENDS	167
MARKET SIZE	168
Table 8.1: The Total UK Private Medical Insurance Market by Subscription Income (£m and percent), 1998-2002	168
Figure 8.1: The Total UK Private Medical Insurance Market by Subscription Income (£m), 1998-2002	169
INDUSTRY STRUCTURE	169
Number of Subscribers	170
Table 8.2: Total UK Private Healthcare Policies by Number of Subscribers (000 and percent), 1998-2002	171
Cost of Claims	171
Table 8.3: The Total UK Private Medical Insurance Market by Cost of Claims (£m and percent), 1998-2002	171
MAJOR PLAYERS	172
AXA PPP Healthcare Group PLC	172
BUPA Occupational Health Ltd	173
Norwich Union Healthcare	173
Royal & SunAlliance	173
Standard Life Healthcare Ltd	173
Table 8.4: Leading Private Medical Insurers by Market Share ( percent), 2001	174
Key Trade Associations	174
Association of British Insurers	174
Advertising and Promotion	174
Table 8.5: Main Media Advertising Expenditure on Healthcare Insurance (£000), Year Ending September 2002	175
BUYING BEHAVIOUR	175
Table 8.6: Purchasers of Private Healthcare Insurance by Source of Payment ( percent of adults), 2002	176
Forecasts 2003 to 2007	176
Table 8.7: The Total Forecast UK Private Healthcare Insurance Market by Subscription Income (£m and percent), 2003-2007	176
9. Complementary Medicine	177
INTRODUCTION	177
KEY TRENDS	177
MARKET SIZE	179
Table 9.1: The Total UK Complementary Healthcare Services Market by Value (£m and percent), 1998-2002	179
INDUSTRY STRUCTURE	179
Table 9.2: UK Complementary Therapists by Number of Practitioners/Outlets, 2001	181
MAJOR PLAYERS	181
The Aromatherapy Organisations Council	181
The British Acupuncture Council	181
The British Chiropractic Association	181
The Complementary Medicine Association	182
The Faculty of Homeopathy	182
The General Chiropractic Council	182
The General Osteopathic Council	182
The Register of Chinese Herbal Medicine	183
The Research Council for Complementary Medicine	183
ADVERTISING and Promotion	183
BUYING BEHAVIOUR	183
FORECASTS 2003 to 2007	184
Table 19.3: The Total Forecast UK Complementary Healthcare Market by Value (£m and percent), 2003-2007	184
Figure 9.1: The Total UK Complementary Healthcare Market by Value (£m), 1998-2007	185
10. Palliative and Hospice Care	187
Introduction	187
KEY TRENDS	188
MARKET SIZE	190
Table 10.1: The Total UK Hospice and Palliative Care Services Market by Value (£m and percent), 1998-2002	190
INDUSTRY STRUCTURE	190
Table 10.2: Number of Hospices by UK Provider (number and percent), 1997-2001	191
Figure 10.1: Number of Hospices by UK Provider (number), as of 1st January 2002	192
Table 10.3: Number of UK Hospice Beds by Provider, 1997-2001	193
Table 10.4: Specialist Hospices by Number of Units and Beds, 2000 and 2001	193
Table 10.5: The Total UK Palliative Care Market by Number of Hospices and Beds by Country (number and percent), 2001	194
Figure 10.2: The Total UK Palliative Care Market by Number of Hospices and Beds by Country (number), 2001	194
Table 10.6: UK Hospital Support and Community-Based Palliative Care Services by Provision Type and Country (number and percent), January 2002	195
Key Trade Associations	195
Help the Hospices	195
Hospice Information Service	196
National Council for Hospice and Specialist Palliative Care Services Action Group	196
MAJOR PLAYERS	196
Macmillan Cancer Relief	196
Marie Curie Cancer Care	197
The Sue Ryder Foundation	197
Advertising and Promotion	197
Table 10.7: Main Media Advertising Expenditure by Charities (£000), Year Ending September 2002	198
Buying Behaviour	198
Profile of Use	198
Table 10.8: Profile of Patient Usage of Palliative Care Facilities and Services (number of patients per year), 2001	199
Patient Profile	199
FORECASTS 2003 to 2007	200
Table 10.9: The Total Forecast UK Hospice and Palliative Care Market by Value (£m and percent), 2003-2007	200
11. Strengths, Weaknesses, Opportunities and Threats	201
STRENGTHS	201
WEAKNESSES	201
OPPoRTUNITIES	202
THREATS	203
12. The Future	205
FUTURE PROSPECTS	205
Technological Factors	206
FORECASTS 2003 TO 2007	206
The National Health Service	206
Table 12.1: The Total Forecast UK Expenditure on the National Health Service (£m and percent), 2003-2007	207
Figure 12.1: The Total Forecast UK Expenditure on the National Health Service (£m), 2003-2007	207
The Private Sector	208
Table 12.2: The Total Forecast UK Private Healthcare Market by Sector by Value (£m and percent), 2003-2007	208
Figure 12.2: The Total Forecast UK Private Healthcare Market by Value (£m), 2003-2007	209
Private Medical Insurance	209
Table 12.3: The Total Forecast UK Private Medical Insurance Market by Subscription Income (£m and percent), 2003-2007	209
Figure 12.3: The Total Forecast UK Private Medical Insurance Market by Subscription Income (£m), 2003-2007	210
Other Healthcare Services	210
Table 12.4: The Total Forecast UK Other Healthcare Market by Sector by Value (£m and percent), 2003-2007	211
The TOTAL HEALTHCARE MARKET	211
Table 12.5: The Total Forecast UK Healthcare Services Market by Value (£m and percent), 2003-2007	211
Figure 12.4: The Total Forecast UK Healthcare Services Market by Value (£m), 2003-2007	212
Outside SUPPLIERS	212
Table 12.6: The Total Forecast UK Medical Suppliers Market by Sector by Value (£m and percent), 2003-2007	213
Figure 12.5: The Total Forecast UK Medical Supplies Market by Sector by Value (£m), 2003-2007	214
13. Further Sources	215
Associations	215
Publications	218
General Sources	219
Bonnier Information Sources	219
Government Publications	220
Understanding TGI Data	221
Number, Profile, Penetration	221
Social Grade	222

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