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MS75021 MSI PRIVATE HEALTHCARE: UK: MARCH 2001

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TABLE OF CONTENTS

1 Executive Summary 1
2 INTRODUCTION 3
2.1 Definitions 3
2.2 Methodology 4
2.3 UK Economy 5
2.3.1 Overview 5
2.3.2 Interest Rates 7
2.3.3 Inflation 8
2.3.4 Exchange Rates 8
2.3.5 Taxation 9
2.3.6 Household Income And Consumer Expenditure 10
2.3.7 Manufacturing Output 11
2.3.8 Services 12
2.3.9 Investment 12
2.3.10 Forecasts 13
2.4 Exchange Rates 14
2.5 Abbreviations 14
3 Regulation 16
3.1 Overview 16
3.2 Community Care Act 1993 16
3.3 Care Standards Act 2000 17
3.4 Royal Commission On Long Term Care For The Elderly 17
3.5 Mental Health Bill 2000 18
3.6 Human Rights Act 1998 18
3.7 Minimum Wage Directive 18
3.8 Working Time Directive 19
4 Private Healthcare Market 20
4.1 Market Size And Trends, 1996-2000 20
4.2 Market Segmentation, 1996?2000 21
4.3 Forecast Market Segmentation, 2001?2005 23
5 Independent Care Homes For the Elderly 26
5.1 Market Overview And Trends, 1996?2000 26
5.2 Market Segmentation 28
5.2.1 Nursing Homes 28
5.2.2 Residential Homes 31
5.3 Factors Affecting Demand 33
5.3.1 Demographic Changes 33
5.3.2 Government Policy 35
5.3.3 Funding 37
5.4 Forecast Segmentation, 2001?2005 38
6 Independent Acute Hospitals And Clinics 40
6.1 Market Overview And Trends, 1996?2000 40
6.2 Market Segmentation 42
6.2.1 By Type Of Treatment 42
6.2.2 By Region 44
6.2.2.1 Number Of Hospitals 44
6.2.2.2 Number Of Beds 45
6.2.3 Funding 46
6.3 Factors Affecting Demand 48
6.3.1 Overview 48
6.3.2 PMI 48
6.3.3 Government Policy And National Health Service Reforms 51
6.4 Forecast Segmentation, 2001?2005 53
7 Independent Care for the Mentally Ill 55
7.1 Market Overview And Trends, 1996?2000 55
7.2 Market Segmentation 56
7.2.1 Long Term Care 56
7.2.2 Acute Care 59
7.3 Factors Affecting Demand 62
7.3.1 Government Policy 62
7.4 Forecast Segmentation, 2001?2005 63
8 Private Treatment IN NHS Hospitals 65
8.1 Market Overview And Trends, 1996?2000 65
8.2 Factors Affecting Demand 67
8.3 Funding 68
8.4 Forecast Segmentation, 2001?2005 69
9 Opportunities For Suppliers 71
9.1 Overview 71
9.2 Independent Care Homes For The Elderly 71
9.3 Independent Acute Hospitals And Clinics 73
9.4 Hospital Construction 74
10 Purchasing Strategies 77
10.1 Overview 77
10.2 Independent Care Homes For The Elderly 77
10.3 Independent Acute Hospitals And Clinics 78
10.4 Independent Care For The Mentally Ill 78
10.5 Private Treatment In NHS Hospitals 79
11 Industry Structure 80
11.1 Overview 80
11.2 Independent Nursing And Residential Homes For The Elderly 80
11.3 Independent Acute Hospitals And Clinics 80
11.4 PMI 81
11.5 Company Profiles 82
11.5.1 The British United Provident Association 82
11.5.1.1 Overview 82
11.5.1.2 Business Profile 83
11.5.2 Four Seasons Health Care 85
11.5.2.1 Overview 85
11.5.2.2 Business Profile 86
11.5.3 General Healthcare Group 87
11.5.3.1 Overview 87
11.5.3.2 Business Profile 88
11.5.4 Nuffield Nursing Homes Trust 89
11.5.4.1 Overview 89
11.5.4.2 Business Profile 90
11.5.5 PPP healthcare 90
11.5.5.1 Overview 90
11.5.5.2 Business Profile 91
11.5.6 Western Provident Association (WPA) 92
11.5.6.1 Overview 92
11.5.6.2 Business Profile 92
11.5.7 Westminster Health Care Group 93
11.5.7.1 Overview 93
11.5.7.2 Business Profile 95
12 MAGAZINES 96
13 Trade Associations 98
List of Tables
1.     Economic Indicators On The UK Economy, 1995-2002 7
2.     UK Market For Private Healthcare, 1996-2000 20
3.     UK Market For Private Healthcare, By Sector, 1996-2000 21
4.     Forecast UK Market For Private Healthcare, 2001-2005 24
5.     Forecast UK Market For Healthcare, By Sector, 2001-2005 25
6.     UK Market For Independent Care Homes For The Elderly, By Sector, 1996-2000 26
7.     Places In UK Independent Care Homes For The Elderly, By Sector, 1996-2000 27
8.     Comparison Between The Price Of Independent Healthcare And Local Authority Care, By Sector, 2000 28
9.     UK Market For Independent Nursing Homes For The Elderly, By Type Of Provider, 1996-2000 29
10.  Places In UK Independent Nursing Homes For The Elderly, By Type Of Provider, 1996-2000 30
11.  Occupancy Rates In Private And Voluntary Nursing Homes For The Elderly In The UK, 1996-2000 30
12.  UK Market For Independent Residential Homes For The Elderly, By Type Of Provider, 1996-2000 31
13.  Places In UK Independent Residential Homes For The Elderly, By Type Of Provider, 1996-2000 32
14.  Occupancy Rates In Private And Voluntary Residential Homes For The Elderly In The UK, 1996-2000 33
15.  Actual And Forecast Population In England And Wales, By Age Group, 1994-2031 34
16.  Proportional Importance Of The Actual And Forecast Population In England And Wales, By Age Group, 1994-2031 35
17.  Funding Of Residents In Independent Care Homes For The Elderly, By Type Of Funding, 2000 38
18.  Forecast UK Market For Independent Care Homes For The Elderly, By Sector, 2001-2005 38
19.  UK Market For Independent Acute Hospitals And Clinics 1996-2000 40
20.  Independent Acute Hospitals And Clinics, In The UK, By Number Of Hospitals And Beds, 1985-2000 42
21.  UK Market For Independent Acute Hospitals And Clinics, By Type Of Treatment, 1996-2000 43
22.  Regional Distribution Of Independent Acute Hospitals And Clinics In The UK, 1980 And 2000 44
23.  Regional Distribution Of Beds In Independent Acute Hospitals And Clinics In The UK, 1980 And 2000 46
24.  Funding Of Treatment In Independent Acute Hospitals And Clinics, By Type Of Funding, 1996 and 2000 47
25.  UK Value Market For Private Medical Insurance, 1996-2000 48
26.  UK Market For Private Medical Insurance, By Number, 1996-2000 49
27.  Customer Profile Of The UK Private Medical Insurance Market, By Type Of Policy, 2000 50
28.  Regional Analysis Of Market Penetration By Private Medical Insurance In Great Britain, 1999 51
29.  Forecast UK Market For Independent Acute Hospitals And Clinics, 2001-2005 54
30.  UK Market For Independent Care For The Mentally Ill, By Type Of Care, 1996-2000 55
31.  Independent Places For The Mentally Ill In The UK, By Type Of Care, 1996-2000 56
32.  UK Market For Independent Long Term Care Homes For The Mentally Ill, By Sector, 1996-2000 57
33.  Places In Independent Long Term Care Homes For The Mentally Ill, By Sector, 1996-2000 58
34.  Funding Of Residents In Independent Long Term Care Homes For The Mentally Ill, By Type Of Funding, 2000 58
35.  UK Market For The Acute Care Of The Mentally Ill, 1996-2000 59
36.  Regional Distribution Of Independent Acute Care Hospital Beds In The UK, 2000 60
37.  Funding Of Residents In Independent Acute Hospitals For The Mentally Ill, By Type Of Funding, 2000 61
38.  Major UK Operators Of Acute Care For The Mentally Ill, 2000 62
39.  Forecast UK Market For Independent Care For The Mentally Ill, By Type Of Care, 2001-2005 64
40.  UK Market For Private Treatment In NHS Hospitals, 1996-2000 65
41.  Regional Distribution Of Beds In NHS Private Patient Units In The UK, 2000 66
42.  Forecast UK Market For Private Treatment In NHS Hospitals, 2001-2005 69
43.  Expenditure On Supplies By Care Homes For The Elderly In The UK, By Product Sector, 1996-2000 72
44.  New Construction Output In The Healthcare Market, By Sector, 1996-2000 75
45.  Regional Distribution Of PFI Hospital Schemes, 2000 75
46.  Market Shares In The UK PMI Market, 2000 82
47.  Financial Summary Of BUPA, 1995-1999 84
48.  Turnover Of BUPA, By Segment, 1995-1999 85
49.  Financial Summary Of Crestacare, 1994-1998 86
50.  Financial Summary Of General Healthcare Group, 1997-1999 88
51.  Financial Summary Of Nuffield Nursing Homes Trust, 1995-1999 90
52.  Financial Summary Of PPP healthcare, 1997-1999 91
53.  Financial Summary Of Western Provident Association, 1995-1999 93
54.  Financial Summary Of Westminster Health Care Group, 1996-1999 95
List of Diagrams
1.     UK Market For Private Healthcare, By Sector, 2000 23

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EXECUTIVE SUMMARY

MSI estimate that the value of the UK private healthcare market has increased by some 10 percent during the review period. However, the 1999 level of £9 536 million (€15 353 million) increased by less than 1 percent to £9 579 million (€16 093 million) in 2000. MSI believe that this was mainly due to the decline in the value of the UK market for care homes for the elderly.

The largest sector within the private healthcare market was the market for care homes for the elderly throughout the review period. This sector represented some 65 percent of the total market in 2000. However, due to the lack of fees from the NHS and local authorities, the market declined in 2000.

The value of the independent acute hospitals and clinics sector reached a level of £2.16 billion (€3.63 billion) in 2000. This represented an increase of 16 percent compared with 1996. MSI believe that this growth rate is largely due to the increase in the number of self-paying patients, as a result of the long waiting lists in the NHS.

The UK market for independent care for the mentally ill increased by some 15 percent during the review period.

MSI believe that this increase was due to the long term trend towards the closure of NHS hospitals and homes for the mentally ill, and the subsequent use of the independent sector to treat the mentally ill.

MSI believe that the value of private treatment in NHS hospitals has increased by as much as 24 percent during the review period. Indeed, the value of the market increased by 5 percent to £309 million (€519 million) in 2000 alone. This is due to an increase in the number of private patient units in public sector hospitals, as a result of the continuing problems faced by the NHS.

MSI believe that demand for private healthcare in the UK is affected by a number of factors. These include:

MSI believe that the private healthcare sector will increase by some 8 percent in real value terms between 2001 and 2005. It is expected that the market will increase modestly in 2001 and 2002. However, after this point the market will increase by some 7 percent between 2002 and 2005.

The market for care homes for the elderly is expected to recover slightly during the forecast period. Although there is likely to be a further decline in 2001 and 2002, MSI believe that the market will increase by 4 percent between 2002 and 2005. This is due to the impact of the contraction of the market, as well as an increase in fees from local authorities. In addition, the increasingly elderly population will continue to stimulate demand.

The value of the market for independent acute hospitals and clinics is expected to increase by 20 percent between 2001 and 2005. MSI believe that this growth in value will occur as a result of the increased opportunities presented by the Concordat between the public and the private sectors. It is expected that this will also have an impact on the market for private treatment in NHS hospitals, which MSI believe will also increase during the forecast period.

MSI believe that the market for independent care for the mentally ill will increase by some 10 percent in real terms during the forecast period. This is largely due to the increased closures of NHS homes and hospitals, as well as the growing prevalence of drug and alcohol related illnesses in society. Mounting pressure on the government to provide adequate care to people with mental illnesses will also lead to increased expenditure on services from the independent sector.

Text © 2001 MSI

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Last updated by Duncan Nottage 5th May 2001