China

China’s rapidly urbanisation, income growth and aging population, have caused a rise of non-communicable diseases and resulted in a significant expansion of the Chinese healthcare demand. Ageing population continues, and from 160 million (>65Y) in 2019 expected to exceed 250 million by 2030. The availability of universal health coverage has increased the pressure on the public health care system resulting in long waiting times and quality issues, in particular in the highest level hospitals. 

The Healthy China 2030 strategy focuses on the shift from treatment to prevention and improving the quality and efficiency of China’s healthcare system. Health Technology including Artificial intelligence (AI) is considered to be one of the key instruments to achieve this goal. The Covid-19 outbreak has accelerated the digital transformation of health care delivery models. China itself is becoming a frontrunner in innovative E-health solutions such as health monitoring and prevention, online consultations, health surveillance of elderly people. In addition it is expected that Covid-19 will also result in more public health care resource optimisation and setting up a disease prevention infrastructure.

From the perspective of the Netherlands the following market trends in China are  worth of attention:

Trade

1.     Health Technology

• Medical diagnosis and treatment
• Wearables and medical devices
• Online patient and healthcare processes management (Mobile Healthcare Apps)
• Growing demand of licencing-in foreign technogolies by Chinese LSH companies 

2.     From treatment to prevention

• Support evidence-based health promotion programmes
• Tailored disease prevention
• Training of health professionals to support the implementation of these programmes.

3.     Elderly care

• Age-proof housing (including smart furniture & corresponding data infrastructure)
• Elderly care management models
• Training and education of staff

4.   Sustainable healthcare

• Reduce emission, resource consumption, wastage
• Circular healthcare
• Less pharmaceutical residues in surface water
   

Research & innovation

1. China’s investments in biomedical R&D
2. China’s research on geriatric diseases (Alzheimer)
3. China’s research on non-communicable diseases
4. China’s development of AI in healthcare, medical robotics (especially robot-assisted Surgical Systems)
5. China’s growing intrest in attracting multi-regional clinical trials at an early stage
    

Invest

Invest in Holland will not proactively work on acquisition in the LSH sector in China. The Invest in Holland Life Sciences & Health team together with the NFIA director in China will investigate specific the possibilities for Chinese companies to contribute to the goal of the Netherlands in finding solutions that deliver better, affordable and sustainable healthcare and strengthen our Life Sciences & health ecosystem in close collaboration with the relevant ministries.

• China is one of the largest API producers in the world.  Some big API producers have begun to invest in R&D of new drugs R&D.
• Innovative SMEs in both biopharmaceutical and medical device have been emerging and more actively seeking globalisation. We’ve seen Chinese companies landing their certified products (both innovative drugs and medical device) in EU.
• The Netherlands ranked the 7th as China’s top 10 export markets in medical devices. (source: CCCMHPIE 2018)
• Promising provinces in China include Jiangsu, Guangdong, Zhejiang and Beijing. Till 2019 most Chinese companies did set up a subsidiary in Zuid-Holland and Noord-Holland.

1. In November 2017 the decision was made by the EU to relocate the EMA (European Medicines Agency) to the Netherlands. The relocation of the EMA is a trigger to attract more Foreign Direct Investments to the Netherlands. Though that hasn’t converted into an immediate increase of Chinese companies investment into the Netherlands.
2. Factors that cause Chinese companies to rethink their company globalisation are Supply Chain, talent, and compliance (CE marking). For example, new MDR since May 2021 stimulates Chinese medical device companies to expand in Europe by the need to appoint EAR in an EU country.
3. One important factor is that the Netherlands boosts excellent research universities specialised in LSH..
4. The Dutch Life Sciences & Health sector is Europe’s connected Life Sciences & Health metropolis. In the past we have organised together with the Invest in Holland Life Sciences & Health team digital workshops (webinars) for companies and organisations that are looking for expansion in Europe. We will investigate the possibility how Chinese companies can contribute to the societal challenges we have in the Netherlands and Europe in line with the new strategy of the Invest in Holland network and the policy of the relevant Dutch ministries 

Events：

Sino-Dutch Workshop on Medical Devices Regulation and Investment in cooperation with our LSH colleagues at NFIA HQ and LSH teams at the embassy and CG Shanghai (May 2021)

Biopharma Roadshow IA (Nov 2021, support NFIA)

Articles:

The Netherlands: Emerging European LSH Center (Apr 2021)

How the Netherlands Became a Key Player for Vaccine Development (July 2021)

The Innovations of the Top Dutch Biopharmaceutical Companies (Dec 2021)
 

Regional priorities
Traditionally focus on first tier cities Beijing, Shanghai and Guangzhou, there is growing importance of second tier cities. Eastern China occupies a significant part of high quality medical resources (46%) to be compared with central & western areas of China.

It is also worthwhile to explore and make use of the special/preferential policies for the LSH sector, in the recently established Free Trade Zones, including for example the Hope City (Lecheng)  at the Hainan Free Trade Port.

The Dutch interest in China is high. Each year multiple trade missions from the Netherlands to China have been organized. In 2019 RVO has dealt with 99 China related requests from Dutch organisations that are active in the LSH sector. In 2020 the number decreased to 90 requests. Prominent multinationals that are active in China are Philips, Elsevier and Danone-Nutricia. When looking at Dutch knowledge institutes, for example UMC Groningen, Maastricht UMC, Erasmus MC, TU Eindhoven and Zuyd University of Applied Sciences are active in China. The majority of Dutch companies active in China can be found in the category of small and medium sized businesses.

Most prominent NL value chains

1. The Digital Transformation of Health and Care: The application of both digital information and communication to support and / or improve health and healthcare processes. In the context of China, specifically E-health and Artificial Intelligence. 

• Demonstrated (or expected) impact and activities: 
  • ZiuZ uses near infrared (NIR) image analysis technologies to check the packaging of medicine bags or pouches.
  • A Dutch company’s product in the field of ophthalmology has been used in the Hope City, and the product is now applying for special procedures of using Real World Data study toward the NMPA market approval. 
• Potential opportunities: growing importance of smart technologies to improve the quality and efficiency of China’s healthcare; medical robots, remote medical technology 
• Barriers:
  • Chinese competitors, China is a frontrunner, main challenge is to have a new or complimentary solution in this field
  • Complex tender projects
  • Long decision-making processes
  • Copy-right related issues

In addition to these value chains medical insurance and long term care insurance are topics that may also offer opportunities for Sino-Dutch cooperation. The Netherlands has a very well organised insurance scheme, which is essential in maintaining the quality/ stimulating innovation of care and curbing the cost increase. 

• Potential opportunities: 
  • The Dutch insurance scheme is well recognised by relevant Chinese ministries. There is big interest from Chinese side to learn more about the Dutch experience on insurance scheme design and operation. 
  • There is a growing demand for commercial medical insurance (in addition to the basic medical insurance package which is run by government), especially insurance for high-end services at private hospitals/clinics
  • It might be an idea to inquire with Dutch insurance companies about their interest in China
• Challenges: insurance business is a strictly regulated field. It is important to find a complementary and reliable Chinese partner. 

2. Healthy Living & Ageing: Research and solutions that contribute to maintaining (prevention), strengthening and recovering (rehabilitation) physical and mental wellbeing, by increasing people’s independency. In the context of China, specifically mobility and vitality.

• Demonstrated (or expected) impact and activities
  • ChangZheng Hospital, located in Shanghai is working with UMC Groningen on research on prevention and treatment on lung cancer, COPD and cardiovascular diseases.
  • The Sino-Dutch geriatrics programme between the University of Chengdu and Zuyd University of Applied Sciences.
  • Buurtzorg in China
  • Jan Booij & Suzhou Social Welfare Institute 
  • Age-proof housing projects of Hans Bekker 
• Potential opportunities: 
  • Innovative Products for elderly use, e.g. products which help senior people living an mobile and independent life. 
  • Exchange & cooperation with growing number of new Chinese rehabilitation hospitals/centers, e.g. training of professionals, know-how on setting up a new rehabilitation center with high-end innovative equipment,, joint search/study, etc.
• Barriers: Long and complex decision making processes, difficulties for international travel due to covid-19, growing trend of localisation in public hospital procurement.
• Preferred regions: regions with advanced ageing population, and/or regions with Chinese pilot elderly (policy) projects

Overview milestones & flagships

• G2G (MoU, state visits)
• Trade (PIBs, market study E-health (2019)
• Innovate (joint R&D projects, specific bilateral calls)
• Invest (significant investments in the Dutch LSH sector)

Collective Activities to China
2018

• Economic Mission with Mark Rutte and minister Bruno Bruins
• Signing PIB Elderly Care China

2019

• Elderly Care Mission China led by Minister Hugo de Jonge
• Memorandum of Understanding (MoU) between Dutch Ministry of Health Welfare and Sports (MinVWS) with China’s National Development and Reform Commission (NDRC)

2020

• Virtual mission to China BioMed Innovation and Investment Conference
• Trade mission to Hainan for Dutch companies based in China

2021

• PIB study and publication: Identification of potential partners for cooperation in Chinese elderly care
• Sino-Dutch Workshop on Medical Device Regulation and Investment on 14th May, during the CMEF in Shanghai
• Visit to Qingdao Rehabilitation University with relevant Dutch companies in May
• Kick-off webinar elderly care programme with NDRC on June 3
• A roadmap document of special procedure for Dutch medical products entering the Hope City (Lecheng Pilot Zone) at Hainan Free Trade Port has been drafted by the embassy
• Dutch pavilion at the 2021 the Jiangsu (Nanjing) International Senior Care Services Expo 15-17 September
• Roundtable meeting connecting Dutch and Chinese experts in the field of midwifery, 21st September
• Access Biotech China, 14-15 October 2021 in Leiden. New conference and partnering event organised by Hyphen Projects
• China – Health~Holland Digital Reconnect, 4 November. Organised by TFHC, Health department of Dutch Embassy in Beijing and Health~Holland. 
• Expert session on medical device and Expert Session on Biopharma, during the China Business Week 
• BioPharma in China Webinar sessions, 4 & 17 November. Organised by Netherlands Innovation Network and Health department of Dutch Embassy in Beijing, in cooperation with BOM and Trade and Innovate.
• Dutch pavilion at CISSE, Beijing organised by embassy (postponed due to covid-19)
• Dutch pavilion at Silver Industry Expo Suzhou 19-21 November, organised by NBSO Nanjing

The way forward

During the validation session with Dutch SMEs active in the Life Sciences & Health sector doing business or wanting to do business in China, providing market information came out as the type of support most relevant. Besides, matchmaking, trade fairs/expos and funding opportunities were mentioned as relevant types of support. Next to the sector of elderly care, participants saw opportunities for strong partnerships in the areas of chronic care, rehabilitation and sustainability in health care.