Abstract
The global economy is being transformed by an explosion of information unleashed by the internet, the digital revolution, communications and increased international mobility. This transformation is manifesting in many ways, including rapid development of countries such as China, commoditization of public services, mobilization of workforces, shifting of market control from suppliers to consumers, interlinked rises in product demand and customer expectations, and problems regulating international business competition. As Asia is home to half of the world's population, and offers both a large relatively low-cost workforce in some countries and a potentially huge retail market, this region could be central to the future of the global economy. Like other industries, the pharmaceutical industry faces a new array of Asia-specific opportunities and challenges. Success in meeting these challenges will go to those pharmaceutical companies that best understand the unique strengths and constraints of Asia's diverse cultures, talents and markets.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Meng, Q. et al. The impact of China's retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals. Health Policy Plan. 20, 185–196 (2005).
Ha, N. T., Berman, P. & Larsen, U. Household utilization and expenditure on private and public health services in Vietnam. Health Policy Plan. 17, 61–70 (2002).
Schieber, G. J. & Puollier, J. P. International health care spending. Health Aff. 5, 111–122 (1986).
Hopkins, S. Economic stability and health status: evidence from East Asia before and after the 1990s economic crisis. Health Policy 75, 347–357 (2005).
Yidong, G. Pharma moves ahead cautiously in China. Science 309, 735 (2005).
Smith, R. D. Foreign direct investment and trade in health services: a review of the literature. Soc. Sci. Med. 59, 2313–2323 (2004).
World Health Organization. The World Health Report 2000 — Health Systems: Improving Performance. WHO web site [online], (2000).
Central Intelligence Agency. CIA World Factbook 2006. CIA, Washington D.C., 2006).
Doherty, J. et al. What is next for pharmacoeconomics and outcomes research in Asia? Value Health 7, 118–132 (2004).
Simonet, D. An analysis of the pharmaceuticals market in Vietnam. Sante 11, 155–160 (2001) (in French).
Stenson, B., Syhakhang, L., Eriksson, B. & Tomson, G. Real world pharmacy: assessing the quality of private pharmacy practice in the Lao People's Democratic Republic. Soc. Sci. Med. 52, 393–404 (2001).
Ridley, D. B. Price differentiation and transparency in the global pharmaceutical marketplace. Pharmacoeconomics 23, 651–658 (2005).
Bryant, J. & Prohmmo, A. Payment mechanisms and prescriptions in four Thai hospitals. Health Policy 73, 160–171 (2005).
Chen, X. Y. Clinical bioethics in china: the challenge of entering a market economy. J. Med. Philos. 31, 7–12 (2006).
Chou, Y. J. et al. Impact of separating drug prescribing and dispensing on provider behaviour: Taiwan's experience. Health Policy Plan. 18, 316–329 (2003).
Kwon, S. & Reich, M. R. The changing process and politics of health policy in Korea. J. Health Polit. Policy Law 30, 1003–1026 (2005).
Vanhonacker, W. Entering China: an unconventional approach. Harv. Bus. Rev. 75, 130–140 (1997).
Sharma, R. N. The runaway corruption-cynicism syndrome in Asian cultures: its redemption and the future of bioethics. Formos. J. Med. Humanit. 1, 56–62 (2000).
Wertheimer, A. I., Chaney, N. M. & Santella, T. Counterfeit pharmaceuticals: current status and future projections. J. Am. Pharm. Assoc. 43, 710–717 (2003).
Fan, R. Reconstructionist Confucianism and health care: an Asian moral account of health care resource allocation. J. Med. Philos. 27, 675–682 (2002).
Lau, J. T., Leung, E. M. & Tsui, H. Y. Predicting traditional Chinese medicine's use and the marginalization of medical care in Hong Kong. Am. J. Chin. Med. 29, 547–558 (2001).
Cho, H. J. & Kim, C. B. Prescription behaviours of office-based doctors to standardized common cold patients in Korea. Pharmacoepidemiol. Drug Saf. 11, 401–405 (2002).
Patel, V., Vaidya, R., Naik, D. & Borker, P. Irrational drug use in India: a prescription survey from Goa. J. Postgrad. Med. 51, 9–12 (2005).
Chong, S. A., Ravichandran, N., Poon, L. Y., Soo, K. L. & Verma, S. Reducing polypharmacy through the introduction of a treatment algorithm: use of a treatment algorithm on the impact on polypharmacy. Ann. Acad. Med. Singapore 35, 457–460 (2006).
Lee, Y. C., Yang, M. C., Huang, Y. T., Liu, C. H. & Chen, S. B. Impacts of cost containment strategies on pharmaceutical expenditures of the National Health Insurance in Taiwan, 1996–2003. Pharmacoeconomics 24, 891–902 (2006).
Sorkin, A. L. Financing health development projects: some macro-economic considerations. Soc. Sci. Med. 22, 345–349 (1986).
Liu, S. Z. & Romeis, J. C. Assessing the effect of Taiwan's outpatient prescription drug copayment policy in the elderly. Med Care 41, 1331–1342 (2003).
Yip, W. & Eggleston, K. Addressing government and market failures with payment incentives: hospital reimbursement reform in Hainan, China. Soc. Sci. Med. 58, 267–277 (2004).
Meng, Q. et al. The impact of urban health insurance reform on hospital charges: a case study from two cities in China. Health Policy 68, 197–209 (2004).
Okamura, S., Kobayashi, R. & Sakamaki, T. Case-mix payment in Japanese medical care. Health Policy 74, 282–286 (2005).
Ikegami, N., Ikeda, S. & Kawai, H. Why medical care costs in Japan have increased despite declining prices for pharmaceuticals. Pharmacoeconomics 14 (Suppl. 1), 97–105 (1998).
Wang, H., Yip, W., Zhang, L., Wang, L. & Hsiao, W. Community-based health insurance in poor rural China: the distribution of net benefits. Health Policy Plan. 20, 366–374 (2005).
Broomberg, J. Managing the health care market in developing countries: prospects and problems. Health Policy Plan. 9, 237–251 (1994).
IMS Health. IMS World Review (IMS Health, Norwalk, 2003).
Einhorn, B. Asian health care's IT injection. Business Week (19 Oct 2004).
Mukherjee, A. India's next export: doctors. International Herald Tribune (27 June 2005).
Lai, E. C. & Lau, W. Y. The continuing challenge of hepatic cancer in Asia. Surgeon 3, 210–215 (2005).
Hulse-Post, D. J. et al. Role of domestic ducks in the propagation and biological evolution of highly pathogenic H5N1 influenza viruses in Asia. Proc. Natl Acad. Sci. USA 102, 10682–10687 (2005).
Jones-Engel, L. et al. Primate-to-human retroviral transmission in Asia. Emerg. Infect. Dis. 11, 1028–1035 (2005).
Huxley, R. et al. Ethnic comparisons of obesity in the Asia-Pacific region. Obes. Rev. 6, 193–198 (2005).
Sim, H. G. & Cheng, C. W. Changing demography of prostate cancer in Asia. Eur. J. Cancer 41, 834–845 (2005).
Woodward, M. et al. Smoking, quitting, and the risk of cardiovascular disease among women and men in the Asia-Pacific region. Int. J. Epidemiol. 34, 1036–1045 (2005).
Lim, S. T. et al. Gefitinib is more effective in never-smokers with non-small-cell lung cancer: experience among Asian patients. Br. J. Cancer 93, 23–28 (2005).
Segev, L., Paz, A. & Potasman, I. Drug abuse in travelers to southeast Asia. J. Travel Med. 12, 205–209 (2005).
Suk, W. A. et al. Environmental threats to children's health in Southeast Asia and the Western Pacific. Environ. Health Perspect. 111, 1340–1347 (2003).
Alger, L. Drug Discovery and Development Asia-Pacific Conference 2005: fulfilling the unmet needs of Asia. IDrugs 8, 635–638 (2005).
Harris, G. Why drug makers are failing in quest for new blockbusters. The Wall Street Journal (New York) (18 April 2002).
Editorial. Is that it, then, for blockbuster drugs? Lancet 364, 1100 (2004).
Baker, D. A free market solution for prescription drug crises. Int. J. Health Serv. 34, 517–526 (2004).
Tesoriero, H. W. Entrepreneur found big profit, then trouble in online drug sales. The Wall Street Journal (Asia) (31 Aug 2005).
Moy, P. Drug piracy is serious, industry complains. South China Morning Post (22 Aug 2005).
Hexter, J. & Lin, S. The right way to protect IP. The Wall Street Journal (Asia) (29 June 2005).
French, H. W. An economic revival minted in counterfeit. International Herald Tribune (Hong Kong) (3 Aug 2007).
El Feki, S. Prescription for change: a survey of pharmaceuticals. The Economist (18 June 2005).
Henry, D. & Lexchin, J. The pharmaceutical industry as a medicines provider. Lancet 360, 1590–1595 (2002).
Arrunada, B. Quality safeguards and regulation of online pharmacies. Health Econ. 13, 329–344 (2004).
Fung, C. H., Woo, H. E. & Asch, S. M. Controversies and legal issues of prescribing and dispensing medications using the Internet. Mayo Clin. Proc. 79, 188–194 (2004).
Quon, B. S., Firszt, R. & Eisenberg, M. J. A comparison of brand-name drug prices between Canadian-based Internet pharmacies and major U. S. drug chain pharmacies. Ann. Intern. Med. 143, 397–403 (2005).
ThaiWebSites. Pharmacies, medication distribution in Bangkok. ThaiWebSites web site [online], (2005).
Gurwitz, J. H., McLaughlin, T. J. & Fish, L. S. The effect of an Rx-to-OTC switch on medication prescribing patterns and utilization of physician services: the case of vaginal antifungal products. Health Serv. Res. 30, 672–685 (1995).
Findlay, S. D. Direct-to-consumer promotion of prescription drugs. Economic implications for patients, payers and providers. Pharmacoeconomics 19, 109–119 (2001).
Knowlton, B. US plays it tough on copyright rules: via trade, its standards pervade globe. International Herald Tribune (15 Oct 2005).
Rothstein, E. A fast-forward debate. International Herald Tribune (6 Oct 2005).
Elworthy, S. Who needs books? Science 312, 199–200 (2006).
Walsh, B. Where's the music? MP3 players are hot in Asia, but online stores such as iTunes are still closed to the region's market. Time (6 Sept 2004).
Giles, J. Internet encyclopaedias go head to head. Nature 438, 900–901 (2005).
Frost & Sullivan . Cost-effective R&D outsourcing attracts global pharmaceutical industry to India and China. HireBio web site [online], (31 Aug 2005).
Ernst & Young . Progressions 2006 — the Ernst & Young Annual Global Pharmaceutical Report. (2006).
Senzer, N., Shen, Y., Hill, C. & Nemunaitis, J. Individualised cancer therapeutics: dream or reality? Expert Opin. Ther. Targets 9, 1189–1201 (2005).
Petricoin, E. F. 3rd et al. Mapping molecular networks using proteomics: a vision for patient-tailored combination therapy. J. Clin. Oncol. 23, 3614–3621 (2005).
Jain, K. K. Personalised medicine for cancer: from drug development into clinical practice. Expert Opin. Pharmacother. 6, 1463–1476 (2005).
Bronchud, M. H. The yin and yang of cancer therapeutics. Curr. Opin. Drug Discov. Devel. 8, 184–198 (2005).
Shen, Y., Senzer, N. & Nemunaitis, J. Individualised cancer therapeutics: dream or reality? Therapeutics construction. Expert Opin Biol Ther 5, 1427–1441 (2005).
Cohen, J. AIDS drugs. Brazil, Thailand override big pharma patents. Science 316, 816 (2007).
Park, C. Taking the fight to their realm: the role of patent oppositions in the struggle for access to medicines. HIV AIDS Policy Law. Rev. 11, 84–85 (2006).
Dionisio, D., Cao, Y., Hongzhou, L., Kraisintu, K. & Messeri, D. Affordable antiretroviral drugs for the under-served markets: how to expand equitable access against the backdrop of challenging scenarios? Curr. HIV Res. 4, 3–20 (2006).
Cyranowski, D. Property rights go East. Nature 438, 420–421 (2005).
Howard, K. Patent fights rumble in China. Nature Rev. Drug Discov. 3, 988–989 (2004).
Tanner, J. A. WTO TRIPS and its effect on the supply and development of medicines in China. Hong Kong Med. J. 12, 84–86 (2006).
Gerster, R. How WTO/TRIPS threatens the Indian pharmaceutical industry. Third World Network [online], (2000).
Grace, C. The effect of changing intellectual property on pharmaceutical industry prospects in India and China. Considerations for Access to Medicines. Department for International Development web site [online], (2004).
PriceWaterhouseCoopers (PWC). Asia to be the powerhouse of the global pharmaceutical industry. PWC web site [online], (2007).
Wonacott, P. US medical firms take shot in China: opportunities abound, as do questions on ethics. The Wall Street Journal (Asia) (21 Oct 2005).
Gregson, N., Sparrowhawk, K., Mauskopf, J. & Paul, J. Pricing medicines: theory and practice, challenges and opportunities. Nature Rev. Drug Discov. 4, 121–130 (2005).
National Intelligence Council. Mapping the Global Future: Report of the National Intelligence Council's 2020 Project 27–46 (Government Printing Office, Pittsburgh, 2005).
Emilien, G. Future European health care: cost containment, health care reform and scientific progress in drug research. Int. J. Health Plann. Manage. 12, 81–101 (1997).
Roberts, B. Should the FDA create an expedited approval process for generic biologic drugs? A Report to the Science, Technology, and Economic Policy Board of the National Research Council. KSG Harvard web site [online], (2007).
Vainio, H. The need for preventive drugs and vaccines in global cancer control: a challenge for public health and for industry. Toxicol. Ind. Health 18, 84–90 (2002).
Pal, S. K. & Mittal, B. Fight against cancer in countries with limited resources: the post-genomic era scenario. Asian Pac. J. Cancer Prev. 5, 328–333 (2004).
Glass, G. Pharmaceutical patent challenges – time for reassessment? Nature Rev. Drug Discov. 3, 1057–1062 (2004).
Searls, D. B. Data integration: challenges for drug discovery. Nature Rev. Drug Discov. 4, 45–58 (2005).
Shoemaker, R. H. et al. Application of high-throughput, molecular-targeted screening to anticancer drug discovery. Curr. Top. Med. Chem. 2, 229–246 (2002).
Devine, J. W., Cline, R. R. & Farley, J. F. Follow-on biologics: competition in the biopharmaceutical marketplace. J. Am. Pharm. Assoc. 46, 193–201 (2006).
Barton, J. H. & Emanuel, E. J. The patents-based pharmaceutical development process: rationale, problems, and potential reforms. JAMA 294, 2075–2082 (2005).
Wagner, J. L. & McCarthy, E. International differences in drug prices. Annu. Rev. Public Health 25, 475–495 (2004).
Kondo, M. & Toi, M. Cost-effective treatment options in first-line therapy for advanced breast cancer in Japan. Expert Rev. Anticancer Ther. 6, 197–204 (2006).
Hopkins, A. Are we running out of biological targets? Is the low-hanging fruit mostly picked? Nature Publishing Group web site [online], (2004).
Glassman, R. H. & Sun, A. Y. Biotechnology: identifying advances from the hype. Nature Rev. Drug Discov. 3, 177–183 (2004).
Anonymous. India' s pharmaceutical sector set for rapid growth. The Hindu (15 April 2006).
Mehl, B. & Santell, J. Projecting future drug expenditures — 2001. Am. J. Health Syst. Pharm. 58, 125–133 (2001).
Saul, S. Court papers shed light on alleged Bristol–Myers pact on Plavix. New York Times (17 Aug 2006).
Hong, S. H., Shepherd, M. D., Scoones, D. & Wan, T. T. Product-line extensions and pricing strategies of brand-name drugs facing patent expiration. J. Manag. Care Pharm. 11, 746–754 (2005).
Probyn, A. J. Some drugs more equal than others: pseudo-generics and commercial practice. Aust. Health Rev. 28, 207–217 (2004).
Lexchin, J. The effect of generic competition on the price of brand-name drugs. Health Policy 68, 47–54 (2004).
Kirking, D. M., Ascione, F. J., Gaither, C. A. & Welage, L. S. Economics and structure of the generic pharmaceutical industry. J. Am. Pharm. Assoc. 41, 578–584 (2001).
Dong, H., Bogg, L., Rehnberg, C. & Diwan, V. Drug policy in China: pharmaceutical distribution in rural areas. Soc. Sci. Med. 48, 777–786 (1999).
Yang, D., Plianbangchang, P., Visavarungroj, N. & Rujivipat, S. Quality of pharmaceutical items available from drugstores in Phnom Penh, Cambodia. Southeast Asian J. Trop. Med. Public Health 35, 741–747 (2004).
Rataboli, P. V. & Garg, A. Confusing brand names: nightmare of medical profession. J. Postgrad. Med. 51, 13–16 (2005).
Spino, M., Tsang, Y. C. & Pop, R. Dissolution and in vivo evidence of differences in reference products: impact on development of generic drugs. Eur. J. Drug. Metab. Pharmacokinet. 25, 18–24 (2000).
Wang, Y. R. The Chinese pharmaceutical market at the crossroads: pro-competition solutions to improve access, quality and affordability. Appl. Health Econ. Health Policy 4, 147–151 (2005).
Epstein, R. J., Leung, T., Mak, J. & Cheung, P. Utility of a web-based predictive algorithm for multidisciplinary adjuvant breast cancer management. Cancer Invest. 24, 367–373 (2005).
Solomon, H., Man, J., Gill, J. & Jackson, G. Viagra on the internet: unsafe sexual practice. Int. J. Clin. Pract. 56, 403–404 (2002).
Keen, A. The Cult of the Amateur: How Today's Internet is Killing Our Culture (Doubleday, New York, 2007).
Lineberry, T. W. & Bostwick, J. M. Taking the physician out of “physician shopping”: a case series of clinical problems associated with Internet purchases of medication. Mayo Clin. Proc. 79, 1031–1034 (2004).
Cohen, J. C. & Illingworth, P. The dilemma of intellectual property rights for pharmaceuticals: the tension between ensuring access of the poor to medicines and committing to international agreements. Dev. World Bioeth. 3, 27–48 (2003).
Serajuddin, H. K. & Serajuddin, A. T. Value of pharmaceuticals: ensuring the future of research and development. J. Am. Pharm. Assoc. 46, 511–516 (2006).
Adams, M. Rising popularity of medical tourism reveals deterioration of US healthcare system. News Target (21 April 2005).
Yuanjia, H., Ung, C., Ying, B. & Yitao, W. The Chinese pharmaceutical market. J. Med. Mark. 7, 18–24 (2007).
Li, Z. China's pharmaceutical industry lacks innovation, lags behind. China Watch web site [online], (2006).
Economy, E. & Lieberthal, K. Scorched earth: will environmental risks in China overwhelm its opportunities? Harv. Bus. Rev. 85, 88–96, 141 (2007).
Ramaswamy, S. Rational design of cancer-drug combinations. N. Engl. J. Med. 357, 299–300 (2007).
Lohr, S. Dr. Microsoft and Dr. Google. International Herald Tribune (13 Aug 2007)
Acknowledgements
Thanks to B. S. Mann of the Center for Drug Evaluation and Research, FDA, Rockville, Maryland, USA, for appraisal of the manuscript.
Author information
Authors and Affiliations
Ethics declarations
Competing interests
The author declares no competing financial interests.
Related links
Rights and permissions
About this article
Cite this article
Epstein, R. Growth of the Asian health-care market: global implications for the pharmaceutical industry. Nat Rev Drug Discov 6, 785–792 (2007). https://doi.org/10.1038/nrd2360
Issue Date:
DOI: https://doi.org/10.1038/nrd2360
This article is cited by
-
Effectiveness of audit and feedback in addressing over prescribing of antibiotics and injectable medicines in a middle-income country: an RCT
DARU Journal of Pharmaceutical Sciences (2019)
-
Has discovery-based cancer research been a bust?
Clinical and Translational Oncology (2013)