HEALTHCARE

PHARMA IS ONE OF THE MOST ADVANCED SECTORS IN THE CR

CLINICAL STUDIES BRING INVESTMENTS TO THE CZECH REPUBLIC MEDICAL DEVICE MANUFACTURE IS ONE OF THE MOST INNOVATIVE INDUSTRIES CZECH SPA TOURISM IS ON THE RISE

HEALTHCARE 1 2019

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BETTER CHOICES, BETTER HEALTH, BETTER LIVES

CZECH BUSINESS AND TRADE

Czech Business and Trade – With a Tradition of 90 Years Economic Magazine is Designed for Foreign Partners, Interested in Cooperation with the Czech Republic Issued by PP AGENCY s.r.o. in cooperation with n Ministry of Industry and Trade of the Czech Republic n Ministry of Foreign Affairs of the Czech Republic n Ministry of Regional Development of the Czech Republic n Confederation of Industry of the Czech Republic n Confederation of Employers‘ and Entrepreneurs‘ Associations of the Czech Republic n Czech Chamber of Commerce n CzechTrade PARTNER OF THE MAGAZINE: ICC Czech Republic EDITORIAL BOARD: Vladimír Bärtl, Jiří Hansl, Marcela Havlová, Jaromír Kohlíček, Dagmar Kuchtová, Martin Lukáš, Karel Machotka, Marie Pavlů, Tomáš Seidl, Miroslav Somol, Jarmila Škvrnová, Martin Tlapa, Jan Wiesner MANAGING EDITOR: Pavla Podskalská EDITOR: Jana Pike TRANSLATION: Vlasta Benešová PROOFREADING: Ivana Kadlecová, Pearl Harris

n INTRODUCTION

Questions of the Month for Adam Vojtěch, Minister of Health of the CR

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n MEDICINE

Achievements of Czech Medicine

n PHARMACY

Pharma Is One of the Most Advanced Sectors in the CR Clinical Studies Bring Investments to the Czech Republic

n MEDICAL DEVICES

Medical Device Manufacture Is One of the Most Innovative Industries LINET Medical Bed – Europe´s Number One

n CZECH TOP

Cayman Pharma s.r.o., a Subsidiary of US-based Cayman Chemicals Company, Inc. KARLOVY VARY REGION - Region of World-renowned Spas

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GRAPHIC DESIGN: Stanislava Podaná COVER PHOTO: L I N E T spol. s r.o.

DEADLINE: 29/2/2019

n SPA INDUSTRY

An Increasing Number of Guests Have Visited Czech Spas over the Past 10 Years Czech Spa Tourism Is on the Rise

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© PP Agency ADDRESS: Myslíkova 25, 110 00 Praha 1 Czech Republic e-mail: journal@ppagency.cz www.ppagency.cz, www.doingbusiness.cz Press run: 10 000 copies. It is not allowed to reproduce any part of the contents of this journal without prior consent from the Editor.

Attitudes expressed by the authors of articles carried by CBT need not necessarily be consistent with the standpoint of the Publisher.

MK ČR E 6379, ISSN 1211-2208 „Podávání novinových zásilek povoleno Českou poštou, s. p., odštěpný závod Přeprava, č. j. 3468/95, ze dne 24/10/1995“

n WE SUCCEED

Comprehensive and Intensive Spa Rehabilitation is Increasingly Popular with Clients

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n PRESENTATION OF FIRMS

BERNDORF BÄDERBAU s.r.o.; BEZNOSKA, s.r.o.; BMT Medical Technology s.r.o.; Bohemia - lázně a. s.; Cayman Pharma s.r.o.; ERILENS s.r.o.; Grand Hotel Marienbad Betriebs s.r.o.; Léčebné lázně Mariánské Lázně a. s.; L I N E T spol. s r.o.; PAPILLONS a.s.; Reitenberger s.r.o.; Státní léčebné lázně Janské Lázně; VAMED Health Projects CZ s.r.o.; WALMARK, a.s.; ŽIVÝ KRAJ - DESTINAČNÍ AGENTURA PRO KARLOVARSKÝ KRAJ, Z.S.

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INTRODUCTION

Questions of the Month for Adam Vojtěch, Minister of Health of the CR

2019 will be a year of the greatest change for the past 20 years as regards medical devices to be covered by the public health insurance system. What will the implementation of the new regulation look like?

You are referring to the new Public Health Insurance Act Amendment, which introduces new rules for the financial regulation of medical devices paid from the public health | 4

The Czech healthcare system is in a very good condition, according to the latest OECD analysis, despite the relatively low sums of money being invested in it by the state. How will you respond to its conclusions?

We are taking the OECD recommendations very seriously and will work with the conclusions of the analysis in future. I am glad that many of the recommendations are fully in agreement with the current strategy of the Ministry. The recommendations concern several key areas of our healthcare system and its strategy. One of the recommendations, for example, provides for less emphasis to be placed on the regulations concerning medical devices covered by the health insurance system and giving more space to negotiations between the health insurance companies and the healthcare providers. In keeping with this strategy, agreement was reached last year for the first time in history, during conciliation proceedings, on the financial coverage between all the 14 segments of healthcare providers and the health insurance companies. Another area is the creation of a plan for raising the capacity of the Faculties of Medicine, increasing the number of students with the help of scholarships and ensuring sustainable financing of universities. In compliance with this recommendation, we have adopted an 11year Action Plan for increasing the number of medical students and their tutors. The recommendation in the area of primary medical care,

too, is fully in keeping with the position of the Ministry. OECD recommends an increase in the role of General Practitioners, who should act as guides through the healthcare system and channel the patient to the most appropriate place for further treatment. For this purpose, we are preparing the reform of primary medical care, which in fact copies the OECD recommendations. In addition, the Ministry of Health is working on the reform of psychiatric care, aimed at improving the entire psychiatric care in the Czech Republic and making it more efficient. This is linked with another recommendation in which OECD suggests that the Ministry should support a healthier lifestyle, including better healthcare literacy, and ensuring further development in the area of education, disease prevention, and screening programmes.

Do you perceive any strong trend or expectation that will influence the medical sector?

The trend in the Czech Republic, the same as in other countries, is to concentrate highly specialised care in larger centres. There the specialists work in one place, they have greater experience, with more cases passing through their hands and the use of top standard equipment. Another thing is that we must rebuild the system so that it will be able to absorb new preparations. The existing system does not always make possible the entry of expensive drugs into the market, or such entry takes too long to materialise. We must especially ensure the faster inclusion of highly innovative drugs and orphan drug programmes into the system of items covered by health insurance companies, giving a broader spectrum of patients access to efficient treatment. At the same time, sustainable financing of the programmes must be guaranteed. The aim of the recently passed Act Amendment is to ensure that drugs for the treatment of rare diseases are assessed according to soft criteria, such as the seriousness of the disease, improvement of the quality of the patient´s life and the expected benefit of the treatment, and not only according to their cost efficiency as is the case today. Electronisation, as I have already mentioned, is incontestably a very strong trend.

My opinion is that Artificial Intelligence will be widely used in Medicine. We can see the first foray already, such as a number of partial projects in progress in Oncology, and I can feel that this may really be an important instrument in patient care.

Photo: Ministry of Health of the Czech Republic archives, BIOCEV archives

Which are your three highest priorities as Minister of Health?

One of the priorities of the Ministry of Health is, unequivocally, the stabilisation of the personnel situation, which has been very tense for a long time and requires a number of measures to prevent doctors and nurses from quitting their jobs. The second, equally important priority, is solving the problem concerning drugs for the treatment of rare diseases and speeding up the process of including highly innovative drugs into the system of drugs covered by the health insurance system, so as to ensure the availability of such treatment to a broader spectrum of patients, while guaranteeing its financing on a sustainable basis. Thinking of my third priority, it is definitely the reform of primary medical care, which would bring the status of General Practitioners to a level similar to that existing in western countries. The idea is that the General Practitioner will be a kind of gatekeeper and guide, taking the patient through the intricacies of the healthcare system. General Practitioners should be required to solve most cases at their level of proficiency and send only the more complicated ones to the outpatient specialists and the hospital.

insurance system. Under the new regulation, a wide range of medical devices will become fully covered by the health insurance system, while minimising its economic impacts. The changes will be implemented step by step, according to the time plan, which the readers can find on the websites of the National Medical Device Information System (also available in the English version).

At the beginning of this year, a consolidated list of medical devices covered by the health insurance system, including individually made medical devices, was published. Later this month, an information system will be made available with instructions for wouldbe applicants and, one month later, a testing period will be launched. The new system will be put into operation in October. In November, the State Institute for Drug Control (SĂšKL) will launch a control system for potential transgressions and, in December, the new system will be fully operational.

CZECH BUSINESS AND TRADE

Achievements of Czech Medicine The Czech healthcare system has much to be proud of, on the European as well as global scale. The high standard of Czech medical and research workplaces is a great asset, benefiting the population by making it possible to introduce the most up-to-date methods of treatment in practice and to assist patients in the Czech Republic and in the world in general. This country takes credit for a number of discoveries in Medicine.

n DIFFERENTIATION

OF BLOOD GROUPS

The differentiation of blood groups is the discovery of Czech physician and scientist, Jan Jánský, who presented his findings in 1907. In 1901, three blood groups were discovered by the Viennese scientist, Karl Landsteiner, but Jánský came up with the discovery of all four groups (A, B, AB, 0).

n CONTACT LENSES The first inventor of glass contact lenses was the Czech scientist, Otto Wichterle.

Glass contact lenses, however, irritated the retina of the eye and were later substituted by the lenses developed by William Feinbloom, which are used to this day.

n THE LOCOMOTOR SYSTEM Never-ending inspiration, natural healing phenomenon, in today´s diction the guru of global hydrotherapy – all this is Vincenz Priessnitz. He is the personality who, in the 19th century, made the little village of Gräfenberg, the present-day

Jeseník, world famous. Hydrotherapy, his method used in the treatment of patients with problems of the locomotor system, attracted members of the European aristocracy, artists and physicians from the entire old continent to the spa. This is testified by the fact that in the years 1833-1851, i.e. during Priessnitz´s lifetime, some 200 books featuring his hydrotherapy method were published.

n FIRST WOMAN TO WIN THE

NOBEL PRIZE IN PHYSIOLOGY AND MEDICINE

Gerty Cori, Czech-American physician and biochemist of Jewish descent, was the first woman ever to win the Nobel Prize in Physiology and Medicine. A graduate of Prague´s Charles University, she discovered the function of the hormones in sugar metabolism in the frontal pituitary lobe.

n PIONEERS OF SURGERY In the 16th century, the first Professor of Surgery at the University of Vienna

was Franz Emerich, born in Opava, North Moravia. Professor Leopold von Dittel, a native of Fulnek, also in North Moravia, is considered the founder of modern Urology. He was a pioneer of diagnostics based on the use of the cystoscope.

The instrument used in the treatment of urethral stenosis is named after him – Dittel Urethral Probe. Several other specialists coming from Silesia who founded new surgical branches were, for example, the orthopaedist Adolf Lorenz of Vidnava near Jeseník and gynaecologist Rudolf Chrobak of Opava. Professor Chrobak, founder and Head of the Vienna Gynaecological Clinic, is considered a co-founder of Gynaecology. Adolf Lorenz, in turn, is known worldwide as the father of Orthopaedics.

n CARDIOLOGY The Czech Republic can pride itself on having the best network, in Europe, of centres of care for persons with acute heart attack. In these centres, physicians 5 |

MEDICINE

can easily clear a blocked artery and prevent even minor damage to the heart.

Surgeons in the Czech Republic can perform surgery on bicuspid and tricuspid aortic valves and heart walls and can eliminate heart rhythm disturbances laparoscopically with a few pricks. This method is much more patient-friendly, as there is no need to open up the chest.

In 2003, the Czech Republic was the first country in Eastern Europe to use the “mechanical heart”. This is in fact a temporary cardiac substitute which assists the patient to bridge the period until a suitable organ has been found for transplant.

In 2018, Prague´s Institute of Clinical and Experimental Medicine (IKEM) became a world training centre for physicians to learn how to implant the Carmat artificial heart. The device fully substitutes the human heart and is used for patients with total heart failure.

Regarding organ transplantation, Czech clinics and physicians are doing top quality work and, in many respects, could serve as an example. Since the end of last year, surgeons in the Czech Republic have also been performing refractive surgery, during which a special contact lens is inserted in

the patient´s eye to significantly correct vision. An essential step in practical medicine is the Da Vinci Robot. This is a device with several “tentacles” controlled by the surgeon, who can access the patient´s body through a much smaller incision than if he had to perform the surgery himself. In addition, the surgeon can target his

Not Only the Past, but Also the Future of Czech Medicine In 2018, scientists at Prague´s Institute of Organic Chemistry and Biochemistry of the Academy of Sciences published information about a substance which they had prepared in the laboratory and which, in the first tests, proved to be a promising killer of cancer cells. It is based on a natural substance produced by soil bacteria found in Peru 60 years ago. The substance was already proved to be effective against tumours by several former clinical studies and was first tried x out in the late 1950s. The substance actually destroyed tumours, but at the same time had too many side-effects. It always failed in tests and was never placed on the market. Currently Czech scientists have found a way to eliminate these unfavourable effects. They are working on it with their American colleagues at the prestigious John Hopkins University,

one of the world´s top medical schools.

Testing on patients, at least in the first phase, will take place in the USA and will be combined with immunotherapy. The American scientists found that it was in combination with this type of cancer treatment, which suppresses immune reactions to cancer cells, that the substance can be extraordinarily effective.

If the substance proves to be successful and safe, scientists will offer it to large pharmaceutical companies, to be placed on the market and offered to patients.

In 2017, scientists at the research centre in Vestec near Prague developed a new drug against breast cancer, one of the most aggressive forms of this disease.

They forced the tumour cells to apoptosis, i.e. to suicide. The preparation, named MitoTam, has already undergone laboratory and pre-clinical testing. The new preparation is a modification of the drug Tamoxifen, which has already

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intervention more accurately and move inside the body more easily. In future, up to 500 patients per year could be treated using this method.

In April 2005, surgeons in Brno carried out a triple transplantation, in which three organs – the heart, kidney and liver – were implanted simultaneously in a patient been used for some time. While Tamoxifen only acts against a certain type of cancer, the new form, according to preliminary results, can destroy even the most aggressive types, which resisted the older drug. In the Czech Republic, approximately 20 % of female cancer patients suffer from this aggressive form.

Scientists at the BIOCEV research centre focused on the greater sensitivity of the new substance on the mitochondria of tumour cells, i.e. on their cell powerhouses. The new substance discards the energy source of the tumour cell, which itself “commits suicide”. At the moment, the new preparation by Czech scientists, led by Professor Jiří Neužil, has moved to the phase of clinical testing. This is Phase I, which means that the team is monitoring the tolerability of the drug regardless of the type of the disease, seeking the optimum dosage and monitoring pharmacokinetics.

Photo: BIOCEV archives

n SURGERY

CZECH BUSINESS AND TRADE

from a single donor. Another astounding feat was when, in 2004, Czech surgeons implanted a special optical prosthesis (biocompatible ceratoprosthesis) in a patient´s eye burnt by concentrated acetic acid, after which the patient could see up to a distance of two metres. In 2005, the Orthopaedic Clinic in České Budějovice became the first workplace in Central and Eastern Europe in which surgeons used a new method of artificial hip joint replacement.

The Czech plastic surgeon, Bohdan Pomahač, became famous when he carried out the first successful complete face transplant in the USA. He has been professionally active in the USA since the 1990s. He devotes himself to research, clinical Plastic Surgery and, in 2007, became Head of the Burn Centre in Boston.

n PLASTIC SURGERY In 1932, thanks to the work of Professor Arnold Jirásek, at that time President of the Czechoslovak Medical Chamber, with the assistance of Dr Burian, Plastic Surgery was recognised worldwide as a full-fledged medical discipline. The credit for this recognition goes to Czech surgeons, although this discipline enjoys its greatest popularity in the USA. The original specialisation of the two professors, however, was intended not

to enhance beauty, but to assist patients with serious and congenital defects, burns, etc. Surgery leading to rejuvenation, slimming, wrinkle reduction and breast correction is only a recent specialisation.

The town of Příbor in Moravia is known as the birthplace of the renowned physician, Sigmund Freud. He became famous not only as the founder of Psychoanalysis, but also as a psychotherapist in general. He developed a method of treatment using psychological means, based on the mutual relationship between the patient and the therapist. Freud was nominated 32 times for the Nobel Prize in Medicine and once in Literature. Johann Paul Karplus, coming from Opava in Moravia-Silesia, was an important neuropsychologist and psychiatrist, who is known for his work concerning the interaction between the two hemispheres of the brain. In collaboration with the physiologist, Alois Kreidl, he discovered what is now called the Karplus-Kreidl Centre, situated in the lower part of the middle brain.

assist in the treatment of millions of people all over the world. He concerned himself with basic research, which resulted in the development of an effective agent against the HIV virus and hepatitis. To date, his parent institute (the Institute of Organic Chemistry and Biochemistry) is one of the leading institutions in the Czech Republic.

The well-known antiviral drug, Viread, is manufactured on the basis of the licence of his original discoveries, similarly to other effective drugs acting against the herpes zoster virus, the viral pox virus, and the viral inflammation of the mucous membrane of the eye, as well as the antiviral preparation, Hepsera, a successful treatment for type B viral hepatitis. In collaboration with an American team, Czech scientists have also developed Truvada, a drug against AIDS, for the development of which Antonín Holý also has great credit. In the early stage, this drug radically suppresses the HIV virus, prolonging patient life and improving the quality of life. In 2016, the European Commission confirmed the possibility of using Truvada for the prevention of HIV infection in risk groups of the population.

n NEW DRUGS

n NANOFIBRES

Professor Antonín Holý became famous for the development of preparations which

The nanofibre is a raw textile fibre with a diameter of less than 1 000 nanometres (nm). It has an up to 1 000 times larger surface layer than the microfibre, high porosity, toughness and solidity. It is used, for example, in the production of plaster and bandages with self-disinfecting surfaces. Besides in medicine, it can also be used in electronics, filtering, IT, the automobile industry, etc. Great credit for the success of the first experiments in this sector goes to the team of Professor Jirsák at the Technical University in Liberec.

Professor Jirsák invented a device which he named the Nanospider. This device makes nanofibres in large quantities for industrial use. In collaboration with hospitals, Liberec scientists are currently testing a special cover for surface wounds, both acute and chronic. Its advantage is its great flexibility, which makes it possible to shape an accurate copy of the wound relief. In addition, nanofibres can also work inside the human body. For example, in the role of a construction or scaffolding, giving the organism a signal to start forming cells in a specific site. At the end

n DISCOVERIES IN THE FIELD

OF PSYCHOLOGY

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MEDICINE

n GENE WHOSE MUTATION

IS RESPONSIBLE FOR A SERIOUS EYE DEFECT

Czech scientists have discovered a gene the mutation of which causes a serious hereditary corneal defect, often leading to blindness. The discovery makes it possible to determine the diagnosis more easily, and in future may facilitate targeted treatment. Thanks to the discovery of the gene, the disease may be identified relatively easily only from blood. In young children, demanding examinations of the eye to be carried out under general anaesthesia will thus not be needed. The discovery will make it possible for affected families to prevent the transfer of the gene to the next generation, as it is possible to examine the embryo in the test tube and choose the one which shows no mutation.

The twenty-member team of Assistant Professor Kmoch is uncovering genetic | 8

and molecular causes of rare diseases, which can determine the role played by rare genetic variants in their development.

On the basis of the results, the team is developing new diagnostic methods and treatments. Expert opinions can be found in the National Centre of Medical Genomics, which associates research teams of Charles University in Prague, the Medical Faculty of Charles University in Plzeň, the Institute of Molecular and Translational Medicine of Palacký University in Olomouc and the Masaryk University Central European Technological Institute in Brno.

n AWARD FOR CONTRIBUTION

TO INTERNATIONAL NEUROPSYCHOLOGY

In 2018, the International Neurological Society (INS) accorded the Early Career Award to Ondřej Bezdíček, Head of the research programme of the Neuropsychological Laboratory of the Neurological Clinic of the Medical Faculty of Charles University and the General Faculty Hospital in Prague, for his scientific contribution to international Neuropsychology. INS appreciated a series of his diagnostic tests which make it possible to discover in patients with Parkinson´s disease a potential cognitive disorder leading to dementia.

It is the first time in history that a Czech scientist has won this Award.

n IN 2018 CZECH SCIENTISTS

ACQUIRED AN AMERICAN PATENT FOR A TECHNOLOGY DESIGNED FOR CARDIOLOGISTS

The new device can determine the electrical activation of the heart chambers and, with the precision of units of milliseconds, measure their mutual delay. This makes it possible to specify more easily the treatment of the individual patient with a failing heart, thus significantly lengthening life expectancy.

Another advantage is its affordability. The new technology uses the high-frequency components in the electrocardiogram signal. These components will determine the distribution of electrical activation in different parts of the heart chambers and will show a potential time delay. This numerical indication in milliseconds will give the physician valuable information as to whether a therapy is available for the patient. In addition, the technology will aid in the better setting of the stimulator in a heart already being treated, so as to achieve the best possible performance of the organ. Experts of the Institute of Instrumentation Technology of Czech Academy of Sciences, the International Centre of Clinical Research of St. Anne University Hospital in Brno (FNUSa-ICRC), and the M & I Praha firm have participated in its development.

Photo: Balneopark Vincenze Priessnitze archives; pixabay

of the process, a new vessel could form, or, if necessary, a nerve in the spinal cord.

Alternatively, owing to their extreme thinness, and consequently large surface, nanofibres could function as drainage, i.e. carry away liquids, for example, within the eye, which may be the cause of glaucoma.

All these methods count on the fact that the inserted nanofibres will disintegrate by themselves and be absorbed by the body.

CZECH BUSINESS AND TRADE

Pharma Is One of the Most Advanced Sectors in the CR The pharmaceutical industry is a hi-tech manufacturing sector based on demanding research and development work, with massive financial means being invested in the development of new drugs each year (usually 15-20 per cent of annual revenue). Its production portfolio is very wide and comprises original drugs, which are protected by patent, and generic medicines, whose patent protection has expired.

Because of high costs, leading manufacturers in the Czech Republic focus on generics, where this country belongs among the world´s best.

In 2017, pharmaceutical firms sold in the Czech Republic more drugs than in the preceding year. In that year, the total value of the drugs sold exceeded the CZK 70 billion mark, a 6-per cent increase year on year. The last time that such a high sum was spent on drugs was 10 years ago. This volume also comprises preparations sold to other countries, which were primarily manufactured for export, or were re-exported. In the latter case, businessmen buy the drugs in packages with Czech inscriptions, repack them or insert a leaflet in another language, and sell them in some other country at a higher price with profit.

The volume of the Czech drug market with drugs being distributed exclusively in the Czech Republic increased by nearly 6 per cent and reached the sum of CZK 67.9 billion, according to the State Institute for

Drug Control. The prices and the number of the packs sold are strongly influenced by government policy. Restrictions and the rapid price reduction and compensation were also reasons of the great market failure in 2008. After 2008, the volume of the market dropped below CZK 60 billion, most probably by the effect of the regulation mechanism, and it took five years for it to stabilise above this level.

In financial terms, the domestic drug market has been growing steadily since 2013.

Economic Indicators In the period from 2008 to 2017, the development of selected indicators within the sector showed a fall in 2014 and 2015 in the number of units and employed persons. On the other hand, revenue, value added, productivity of labour and average wages in that period were growing and their growth continued until the end of 2017 (more recent data are not available). The price development was neutral and in 2012 it reached its peak. Stagnation, or rather a moderate price decline in the past few years, was caused by the situation in the drug market, which was stagnant or was slightly declining. In terms of efficiency, measured by Spread, the sector was doing best in 2008. Until 2011, the pos-

A special group termed “centre drugs” is undergoing a boom. These are expensive preparations administered exclusively in specialised centres, mostly modern biological drugs against cancer, multiple sclerosis and other serious chronic diseases.. These preparations are also leading the table of medicines earning the highest revenue.

The preparation ranking first in the table is Humira, developed by AbbVie, which last year earned CZK 822.7 million in production prices from its sales to Czech healthitive and negative Spread values alternated. In 2012 and 2013, the value was moving slightly below zero. Between 2014 and 2017, the Spread values were positive, even though in 2017 the value was lower than in 2014. In 2017, the value of economic profit was positive, but in year-on-year comparisons, it declined (CZK -1.4 billion). The reason was a decline in the value of EBIT/Revenue, which caused a CZK 2.0 billion decline in EVA and was responsible for a decline in the value of EBIT/Assets (causing a decline in EVA by CZK 1.7 billion) and a decline in the value of ROE (decrease in EVA value by CZK 1.4 billion). Only group 21.2 (Manufacture of Basic Pharmaceutical Products) showed a positive EVA value in 2017.

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PHARMACY

n PHARMA – SHIFT TOWARDS

GENERIC DRUGS

The pharmaceutical sector is represented by approximately 80 companies, mostly with foreign participation, according to the State Institute for Drug Control. Just as the chemical industry, the pharmaceutical sector, too, is formed mainly by large enterprises, which generate 73 per cent of revenue and 72 per cent of value added and account for 70 per cent of the total number of employees. Traditionally the largest market for Czech pharmaceutical products is Germany, which last year accounted for 26 per cent of Czech pharmaceutical exports, followed by Denmark with 18 per cent and Slovakia with 12 per cent. In import, too, Germany remained the Czech Republic´s largest supplier of pharmaceuticals (19 per cent), followed by France with a share of 9 per cent. Pharmaceutical firms invest nearly CZK 2 billion in the Czech Republic each year.

The largest pharmaceutical companies represented in the Czech Republic are Teva, Roche, Novartis, Baxter, Pfizer, Merck & Co., | 10

Janssen, GlaxoSmithKline, Takeda, and AbbVie. Innovative drug manufacturers, too, are present in the Czech Republic. Their production activities, however, are limited. In the past few years, the Czech Republic has been a demanding market, where the impact of the recession in the Eurozone and the need to harmonise healthcare expenses with prices put great pressure to bear on the market players. Due to the high value of innovative and patented drugs, the sale has shifted towards generic medicines.

Teva Czech Industries s.r.o., formerly Galena, is an important pharmaceutical manufacturer with a very long history. Its broad portfolio comprises generic medicines – mainly antiasthmatics, cytostatics, immunosuppressives, hypolipidemics, anti-

Photo: Zentiva archives; pixabay

care facilities, according to the Drug Control Institute. More than 42 000 packs of the drug were sold. Humira is used in certain cases of rheumatoid arthritis, non-specific intestinal inflammations and other diseases. Humira is said to be a drug generating the highest revenue, even in global terms.

The year before last, USD 16 billion worth of this drug was sold globally.

hypertensives, etc. – in the form of tablets, capsules and liquid drugs, as well as overthe-counter drugs (OTC), active pharmaceutical ingredients (API), and plant extracts.

In 2018, the important firm of Zentiva changed ownership. The French Sanofi group sold Zentiva to the Advent International Investment Company based in the USA. The company has its seat in Prague and operates in more than 50 markets. It has a strong position in Eastern Europe, especially in the Czech Republic, Slovakia, and Romania. Its manufacturing plants are located in Prague and Bucharest and they manufacture and distribute more than 350 million packs of drugs. Advent International is planning to make Zentiva an independent European leader in the area of generic drugs. Zentiva´s roots go back 530 years in the past, with its origin linked with the “U Černého orla” (The Black Eagle) pharmacy, a small family firm in Prague.

The Roche subsidiary in the Czech Republic was founded in 1992. Its focus is on the marketing and sale of drugs in the area of Oncology, Virology, and Haematology. The company employs 190 people and imports the products it is selling. The companies Novartis Czech Republic, Pfizer, Merck & Co. (MSD), Janssen, GlaxoSmithKline, AstraZeneca, Takeda, and AbbVie have a similar structure. The 10 largest firms have an approximately 40-per cent share of the market, according to the Sprinx Index.

PROMED.CS Praha is a Czech pharmaceutical company with its own scientific and research base for the development of human medicines. It specialises in the

CZECH BUSINESS AND TRADE

manufacture of tablets, coated tablets, and capsules. Its daily output is more than two million pieces.

n FROM GENERICS

TO BIOSIMILARS?

Up to two-thirds of the daily doses of drugs used by Czech patients are generics, which account for one-third of expenses from the healthcare system. Generics are drugs whose protection by patent has expired, and which are produced as copies by a manufacturer other than the holder of the original patent. The Czech Republic is one of the leading manufacturers of generics, which it exports to the whole world. In 2017 alone, firms belonging to the Czech Association of Pharmaceutical firms (of which Angelini, BB Pharma, Glenmark, Omega Pharma, Teva, ÚJV Řež and Zentiva manufacture the drugs in the Czech Republic) earned CZK 10.8 billion and exported drugs worth CZK 6.6 billion outside the European Union. Their generic drug export accounts for 42 per cent of their revenue. The future potential of generic drugs is tremendous. However, there is one imminent threat. This is the problem which is now being tackled by the EU, concerning production exceptions from additional protection certificates. After the expiry of a patent, the manufacturers of the original drugs may be granted additional time for which their exclusivity in the market will be extended in compensation for the very

long time needed for obtaining the patent, which is exactly the time phase after which clinical studies must be carried out, at the end of which registration can be obtained and manufacture can begin. The Czech Republic is planning to start work towards the development of biosimilars. These cheaper substitutes of biological drugs have been pushing ahead in the Czech market for the past six years and are being used in Rheumatology, Gastroenterology, Oncology, and Haemato-oncology.

n CHALLENGES FACING

THE SECTOR

The pharmaceutical industry is a sector with the highest proportion of investments going from net revenue into research and development. In the Czech Republic, pharmaceutical firms invest nearly CZK 2 billion per year. Experts are agreed that here the Czech Republic is taking advantage of its geographical position in the heart of Europe, the forthcoming approach of physicians to clinical studies, well-kept medical documentation, and the still rather low costs. The pharmaceutical industry is currently facing challenges in the form of growing pressure on serialisation in the manufacturing process and stricter legislative requirements. In addition, this segment of industry is under strong pressure from rival manufacturers, which forces it to continually seek ever more efficient methods of production.

Extraordinary Interest in Czech Firms at 2018 Nordic Life Science Days Czech firms present themselves successfully at annual fairs, such as the Nordic Life Science Days held in Sweden. Nordic Life Science Days is the largest Scandinavian and one of the largest business-to-business (B2B) events of its kind in Europe. It is attended by representatives of the most important institutions and firms operating in the Life Sciences sector (Biotechnology, Genetics, Neurology, Pharmacy, and Medical Equipment), and by experts working in scientific and research organisations and workplaces.

Czech firms and research institutions presented themselves at the 2018 Nordic Life Science Days in a joint exhibition entitled “Land of Life Sciences”.

Czech companies which participated in the event last year included Apigenex, Enantis, Generi Biotech, Medi Tox, Oncomed, Quinta – Analytica, Riocath, and representatives of the Biological Centre of the Academy of Sciences CR, the Technology Transfer Centre of Charles University Prague and Masaryk University Brno, and the International Clinical Research Centre – St. Anne´s University Hospital Brno. The separate presentation of Czech institutions proved to be very successful, as it made it possible for Czech participants to present themselves with a more distinctive exposé and to take advantage of the opportunities offered to them. Exceptional interest was shown in Czech firms, which had more than 20 pre-arranged B2B negotiations in the course of two days within the framework of the partnering system.

The firms which attended the event are no newcomers to the region, not only because of their repeated participation, but also because many of them are already carrying out clinical testing for their Nordic partners, or are developing specialised pharmaceuticals or procedures in Genetics and Neurology on the basis of specific demand, or are offering finished products. Scientific cooperation is taking place with Sweden´s Lund University.

11 |

CZECH TOP

Cayman Pharma s.r.o., a Subsidiary of US-based Cayman Chemicals Company, Inc.

For further details, please visit www.caymanpharma.com. Please feel free to contact us at caymanpharma@caymanpharma. com. For the management of glaucoma, our prostaglandin derivatives Latanoprost, Travoprost, Bimatoprost, and Tafluprost, all have validated GMP routes and regulatory approvals needed for export worldwide.

Our ophthalmology APIs are the front-line medications for the treatment of glaucoma, | 12

a condition resulting in blindness due to the death of retinal ganglion cells. These prostaglandins act by lowering intraocular pressure, a major risk factor for glaucoma that represents the second most common cause of blindness. Management of pulmonary hypertension is facilitated by our vascular API Epoprostenol. Our historically oldest veterinaty API, Cloprostenol, is used for the synchronisation of mating season for large animals. Majority of produced material in the form of API leaves the Czech Republic and is exported to 57 countries around the world to local manufacturers of final formulations.

Even though Cayman Pharma is a part of the Cayman global concept, the atmosphere inside of the company is retained on a very close personal level in a family-like

environment. Majority of the employees stay with the company for most, if not all, of their professional career and actively participate in the development of prostaglandin know-how. Prostaglandins are hormones like compounds that can be found in practically all organs of the body and have many different physiological functions. Chemically, they are derived from arachidonic acid and through the change of chemical groups and substituents, they gain specific pharmacological properties. Production of prostaglandin APIs is one of most technologically challenging processes in the pharmaceutical industry. From starting material to the final API, pro-

duction processes take up to 6 months due to the complexity of prostaglandin chemistry. Although the quantities sold are indicated in grams, the material produced has great added value due to the multistep manufacturing process.

Photo: Cayman Pharma s.r.o. archives

Cayman Pharma s.r.o., a subsidiary of US-based Cayman Chemicals Company, Inc. (Ann Arbor, Michigan), is one of the world’s most reliable and versatile sources for prostaglandin active pharmaceutical ingredients (APIs). Located in Neratovice, near Prague, Cayman Pharma has over 40 years of commercial prostaglandin manufacturing experience, is ISO certified, and has an excellent track record with customers and regulatory authorities worldwide, including the FDA and European regulatory authorities. With 140 employees, Cayman Pharma is a dynamic employer with emphasis on employee career development and GMP compliance.

ISO 9001-certified, FDA-approved facility

CGMP (+)-Cloprostenol (sodium salt)

CGMP Epoprostenol (sodium salt)

CGMP (Âą)-Cloprostenol (sodium salt)

CGMP Travoprost CGMP Latanoprost CGMP Bimatoprost CGMP Taďƒ&#x;uprost

www.caymanpharma.com 13 |

PHARMACY

Clinical Studies Bring Investments to the Czech Republic “The most important area is Oncology. This is not a Czech speciality – as regards the development of new medicines, Oncology is the most dynamic sector worldwide. Studies of medicines in the area of Rheumatology, the treatment of cardiovascular and neurological diseases, too, are strongly represented, as are studies in Immunology/Infectology,” says Jakub Dvořáček, Director of the Association of Innovative Pharmaceutical Industry.

dising or cutting down taxes, but ensuring a good and efficient administration of application, simplification of the approval process, etc. In brief, it would be necessary to reduce the administrative burden, especially to shorten the time it takes for a study to start after the application has been filed.

Alternatively, to support cooperation with patient organisations, which may help with recruiting patients for the studies.

In the past few years, innovative medicines have dramatically changed physicians’ treatment possibilities in all the medical branches, thus improving patients’ prospects of recovery, or at least of improving their condition. How much money do pharmaceutical firms in the Czech Republic invest in the development of new medicines each year?

Although the primary research of new medicines is not strongly represented in the Czech Republic, there is a relatively large number of clinical studies being carried out.

This requires a big investment. Studies are usually financed by pharmaceutical firms or a consortium of firms, with thousands of new patients being included each year. Clinical studies bring investments to the Czech Republic worth approximately CZK 1.5 billion and create a large number of jobs. | 14

Photo: Association of Innovative Pharmaceutical Industry archives, Pixabay

Do you consider the money being expended on the research of innovative medicines in the Czech Republic adequate, or can you see any gaps and, if so, where?

Naturally it would be welcome if investment in research could increase, or if at least it could be stabilised at the current level. Competition from other countries is keen, and there are indicators showing that the volume of clinical testing might be reduced in future.

That is why the state should support these investments. This does not mean subsi-

Can you mention the benefits and the specific results of collaboration across the sector in the development and research of new innovative medicines in the Czech Republic?

There are benefits galore. Physicians participating in the clinical evaluation benefit from being able to acquire valuable expert experience of medicinal preparations, which in future may become the common standard. Often the studies focus on diseases for which no efficient treatment exists. An experimental drug may be prescribed to a patient suffering from a serious disease, having reached a stage where all the available treatment has failed and the study is his or her last hope. Here the testing acquires a tremendous moral dimension. The economic effect is high on both the individual level (the patient pays nothing; on the contrary, in the early phases of the research project, volunteers are paid) and the macroeconomic level.

CZECH BUSINESS AND TRADE

to treat each individual patient more specifically and more efficiently.

Last year the government approved an Amendment to the Medicines Act. What are its benefits?

The Medicines Act is being amended practically continuously. The Amendment passed in autumn 2018 means a step ahead in that it has opened up the way towards introducing what is called the patient´s medication record and towards broader electronisation in healthcare. This process will lead to savings and greater safety. Procedures are currently in process to push through another Amendment to the same Act in connection with the implementation of EU legislation against the counterfeiting of medicines.

Which, in your opinion, are the most interesting current clinical studies taking place in the CR in this area? In which areas are new medicines being developed?

The most important area is Oncology. This is no Czech speciality – as regards the development of new medicines, Oncology is the most dynamic branch worldwide. Other strongly represented areas in the CR are studies of medicines in the area of Rheumatology, the treatment of cardiovascular and neurological diseases. And in the area of Immunology/Infectology.

Does the Czech Republic figure among the more active and more advanced countries in the development of new medicines, or is it lagging behind?

I have already mentioned the development of new medicines. Primary development, too, is faring well. The most active is the academic sphere and several private workNew Effective Cancer Treatment?

The likelihood is increasing that a new efficient drug for treating ovarian cancer will appear in the market. In 2018, the Czech Sotio firm presented the results of their research at the world´s most prestigious Oncological Congress in Chicago. It is the first Czech firm to be given the opportu-

places, but we are not a centre of development as, for example, the USA or Japan. The area of clinical studies has reached an advanced level in this country, so that: we are neither lagging behind, nor do we belong among the leaders.

Can you say whether there is any breakthrough medicine against any insidious disease expected to appear in the next few years?

Breakthrough medicines appear each year.

Again, I would like to mention Oncology and Haemato-oncology, where a number of diseases have been changed from fatal to chronic, or even curable. On the other hand – we´ll hardly be served a panacea that will miraculously “wipe out” all oncological or all neurodegenerative diseases. Medicine is rather becoming specialised. Groups of patients are falling into narrower and more precisely defined units, making it possible nity to present the results of its research in an oral paper at such an important expert forum. The firm is clinically testing three types of its DCVAC cell preparation. their greatest progress has been made in the development of a drug for the treatment of prostate cancer. Some 1 200 patients from Europe and the USA have been in-

What, in your opinion, are the prospects of pharmaceutical research in CR? I am confident that, thanks to cooperation between the academic sphere and industry, the ideas of Czech brains will be further developed and translated into practice. Maybe some of the Excellence Centres will come forward with an equally breakthrough discovery as the development of antivirotics by the team of Professor Holý. We are following with suspense the story of the Sotio company of Petr Kellner, which started the development of its own cancer drugs.

cluded in the 3rd phase of an international study, i.e. the highest phase of clinical testing. The results will be known within approximately two years. Sotio is developing yet another variant of DCVAC, intended for the treatment of lung cancer.

The studies to date signal a 50 % decline in the probability of patient death.

15 |

MEDICAL DEVICES

Medical Device Manufacture Is One of the Most Innovative Industries The manufacture of medical devices has a long and very successful tradition in the Czech Republic. This is evidenced by a number of worldwide Czech patents and innovative products and inventions, such as polarography, contact lenses, biodegradable stents, etc.

n EXPORT MARKETS The Czech export leader in the sector is LINET with its affiliations in many countries.

Its most successful export markets are the countries of the former Soviet Union, the South American markets, and traditional European states such as Germany, Italy, and Spain. Last year, a very successful and important presentation of Czech medical firms took place in London as part of the | 16

PROPED Economic Diplomacy Project under the auspices of the Czech Ministry of Foreign Affairs on the occasion of the centenary celebrations of the founding of the Czech Republic. A successful mission was also organised to Finland. This is evidence of the manufacturers´ successful penetration of advanced European markets.

n FOREIGN MISSIONS A number of missions to selected countries are planned this year, in cooperation with the Ministry of Foreign Affairs under the PROPED project. During the missions, the firms´ representatives have an opportunity to meet their trade partners, hospital officials and doctors. Missions are frequently organised in connection with important medical fairs in other countries. Currently three missions are being prepared, to Jordan, Greece and Cyprus, and Egypt. The missions are organised with the support of high-ranking state representatives and promoted through the participation of government officials, this time the Minister of Health, who leads a delegation to Jordan. New trade and business opportu-

nities are opening up more widely in that country for Czech firms, thanks to the support of the Ministry of Foreign Affairs and donations of medical equipment granted to Jordan in the past two years. The mission to Greece and Cyprus will be led by the Deputy Minister of Health. Similar support will be given to several other missions currently under preparation.

n THE LATEST TRENDS

IN THE CZECH MEDICAL DEVICE INDUSTRY

In general, the trend is to continuously improve and innovate medical devices and other equipment. This process always takes place in collaboration with the physicians, universities, etc. Another trend on which AVDZP (Association of Manufacturers and Suppliers of Medical Devices) wants to focus, partly thanks to the foreign development cooperation project, is the preparation and realisation of a more comprehensive offer of the products of our members, for example the construction and furnishing of hospital wards, operating theatres, field hospitals and also

Photo: LINET archives

One of the final Czech products priding itself on high quality is hospital beds, armchairs and other medical devices, as well as implants. One of the world´s largest production lines turning out high-standard hospital beds is to be found in the production halls of the Czech firm LINET, which exports its products to the whole world and is the most successful exporter in the area of medical devices. Another international success was achieved by the Czech manufacturer of microscopes.

Owing to the small Czech market, most other manufacturers in the healthcare sector, too, are export-oriented and sell their products to countries all over the world.

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VAMED Group has so far implemented more than 900 projects in around 90 countries in Europe, Asia, Africa, the Middle East, Latin America, and Australia/Oceania. VAMED’s portfolio ranges from project development, planning and turnkey equipment via maintenance, technical, commercial and infrastructure services, to the total operational management of healthcare facilities. With its portfolio of services, VAMED covers the entire range of healthcare, from health tourism and preventive medicine via medical care and nursing to aftercare and rehabilitation.

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As an exporting company VAMED HEALTH PROJECT CZ benefits from its access to various specialists within the Czech healthcare system. From construction and engineering through project development, consulting, operational management and medical expertise. Thanks to this high quality supply chain and the sustainable approach, the projects which VAMED implements worldwide deliver first class healthcare to the patients.

Thanks to this high quality chain of suppliers, the projects with VAMED Group can be really complex and you can be sure of its first-class results.

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17 |

MEDICAL DEVICES

larger projects. This naturally requires closer cooperation of firms – members of the Association.

n TASKS FOR THE ASSOCIATION

OF MANUFACTURERS AND SUPPLIERS OF MEDICAL DEVICES (AVDZP) IN 2019

Czech Firms Participate in International Undertakings More than 5 200 exhibitors from 66 countries the world over presented their portfolios at the MEDICA fair held in Düsseldorf from 12 to 15 November 2018, reaffirming the leading global position of this event and the accompanying COMPAMED trade fair in the area of healthcare.

Well-founded interest in being represented there was shown by the following 12 Czech firms, which had a joint exhibition there, organised under the auspices of the Ministry of Industry and Trade: Advanced Medical Solutions s.r.o., COMPEX spol. s r.o./JETT MEDICAL, Faculty of Information Technologies, Technical University in Brno, Global Biomedica, s.r.o., MEDIN a.s., Kettex Development s.r.o., Biomag s.r.o., Special Medical Technology, s.r.o., Synthesia, a.s., VUP Medical, a.s., Watek s.r.o. and ZDRAVOPRO s.r.o. The exhibitors in the Czech exposition were both traditional medical device manufacturers and young firms presenting their products at this prestigious fair for the first time. One of these was Global Biomedic s.r.o., whose Sales Manager, Marek Remiš, reviewed the presentation of his firm at the fair with the following words: “For our firm, using the most up-to-date 3D titanium printing technology, the presentation of products we have developed is very important. Medica 2018 gave us the opportunity to establish new, very important contacts with counter-

| 18

parts in all parts of the world. We would therefore like to thank the Czech Ministry of Industry and Trade and the Association of Manufacturers and Suppliers of Medical Devices for making it possible for us to participate in the Medica 2018 trade fair.”

The Director of Special Medical Technology, s.r.o., Jan Horák, also valued the firm´s participation in the fair as important, saying: “For SMT, this exhibition is of key importance for three reasons – the possibility of meeting and negotiating with existing clients – 30 firms from different countries at one place within one week, which means a great saving of time and money; another reason is the possibility of meeting new potential clients – presentation of products and new items – to some 10 or 15 new potential trade partners and, last but not least, visiting the stands of SMT suppliers, seeking new business opportunities and making comparisons.

In addition, negotiations took place on some supplies to Indonesia and Bangladesh, which are expected to exceed CZK 15 million in 2019.” The Czech Ministry of Industry and Trade organised an official Czech exhibition at the Arab Health 2019 international trade fair and the Congress of Medical Equipment, which took place in Dubai International Convention and Exhibition Centre of the World Trade Centre from 28 to 31 January 2019. The Czech exhibition covered a surface area of 90 sq. metres and the exhibitors comprised the

firms Avanso s.r.o., Biomag Medical s.r.o., ELLACS, s.r.o., Lázně Darkov, a.s., MALÍK a spol. s.r.o., MEDIATRADE s.r.o., MEDIN, a.s., Special Medical Technology, s.r.o., Synthesia, a.s., TEREZIA COMPANY s.r.o., and WATEK s.r.o. MUDr. Mohamed El-Nakhala, Director of MALÍK a spol., s.r.o, commented on his firm´s participation in Arab Health 2019 as follows: “It was our first trade fair which helped us establish new contacts, make our firm known in the Arab world and gain contacts for the presentation of our firm.” A traditional exhibitor at the trade fair was also the company Biomag Medical s.r.o. Its Export Manager, Petr Hrnčíř, said: “At the Arab Health 2019 trade fair, I had an opportunity to meet our existing trade partners and establish contacts with new potential sales representatives in the territory. ”Lukáš Krotil, International Operations Manager of MEDIATRADE s.r.o., reviewed his company´s participation with the following words: “We very much appreciate the support we received from the Czech Ministry of Industry and Trade in our participation in the Arab Health 2019 trade fair. Our presence there helped us to extend our contacts in the territory and find new clients for our products. It was also an important opportunity to meet our existing clients in the entire UAE and neighbouring states. And, last but not least, we had an opportunity to meet some of the suppliers of components for our products.” jp

Photo: Ministry of Industry and Trade archives

The Association´s emphasis is on research that will lead to high technical parameters and innovativeness of new products and methods of treatment. Medical device manufacturers know that good medicine cannot do without technical devices.

Medical practitioners themselves say that progress in medicine requires innovation, such as visualisation systems, equipment and instruments for microsurgery, and the use of computers. That is why manufactur-

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www.beznoska.com 19 |

MEDICAL DEVICES

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Association collaborates very closely with the Ministry of Industry and Trade (MIT ) and the CzechTrade Agency. In recent years, it has been increasingly collaborating with the Czech Ministry of Foreign Affairs and other institutions and partners.

As in the past few years, the Association initiates efforts to obtain support within the framework of the MIT programme of Czech official participation, which makes it possible for member firms to present

themselves and their products, medical technology and services at the most prestigious fairs, such as MEDICA Düsseldorf and Arab Health in Dubai, at minimum cost. Small and medium-sized medical device manufacturers can also use other programmes of support at international trade fairs, such as the NOVUM programme managed by CzechTrade. Each year the Association also prepares the incoming mission project for potential

Photo: EGO Zlín, spol. s r.o. archives; LINET archives

ers also focus on other branches, such as nanotechnology and microsystems for the construction of apparatus, equipment for the minimisation of invasive methods, introduction of information technologies in healthcare, urgent medicine, cardiac surgery, and other branches of modern medicine. To achieve these aims, firms must cooperate with university research workplaces and top doctors and hospitals. In their research projects, firms are also using different forms of support and grants controlled or administered by the Ministry of Industry and Trade (MIT). The Association also cooperates with the academic sphere.

For example, it organises presentation seminars for university students, and leads dialogue with the academic sphere on the transfer of R&D results into practice in the area of healthcare.

Promotion of export and penetration of new markets – support in the form of subsidised participation in trade fairs, preparation of missions within the framework of PROPED, creation of a platform of medical device manufacturers in the area of foreign development cooperation.

The Association systematically supports the development of the export activities of its members and searches for new trade opportunities. In this respect, the

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• Since 1921 BMT Medical Technology s.r.o. has already supplied thousands of own products to important and top-quality customers all over the world

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Cejl 157/50, Zábrdovice, 602 00 Brno Czech Republic

Tel.: +420 545 537 111 E-mail.: mail@bmt.cz Facebook: www.fb.com/bmt.cz

protecting human health 21 |

MEDICAL DEVICES

Successful Firms within the Sector These are mostly companies whose production is closely linked with their own development, thus showing their way to success in competition with rival firms. An example is ELLA-CS, s.r.o., a purely Czech company without any foreign capital, which operates worldwide. It is represented in more than 70 countries the world over. The company specialises in the development and production of stents for the gastrointestinal tract, which include oesophageal stents, pyroduodenal stents, and biliary and colorectal stents. ELLA-CS is the only manufacturer of the following medical devices: biodegradable stents – a globally unique product, allowing a new approach to the treatment of benign oesophageal strictures, without the need for stent extraction; danis stent – a unique medical device used for stopping acute bleeding of oesophageal varices; extractor – original instrument for the removal of oesophageal stents, which are no longer needed within the oesophagus. On the basis of own development, BMT Brno supplies a wide range of steam, hot-air and chemical sterilisers, laboratory driers and incubators. The firm has a tradi-

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Export Guarantee and Insurance Corporation (EGAP) and the Czech Export Bank (CEB). This year, thanks to a grant from the Czech Development Agency coming under the Ministry of Foreign Affairs, the Association will start building a plattion of more than 80 years and more than 40 years of export experience. It has affiliations in Ukraine, Germany, Russia, Spain, the USA, and Slovakia, and is a member of the international MMM-Group based in Munich; ING corporation devotes itself to the development, manufacture and sale in the area of orthotics and prosthetics. It manufactures orthotic components for individual braces and limb prostheses, and diagnostic and manufacturing equipment for orthotics and prosthetics.

BTL, founded in 1993, is one of the world´s largest manufacturers of medical equipment. It develops and manufactures physical therapy equipment, such as electrotherapy devices, ultrasound devices, lasers, magnetic therapy devices, lymphatic drainage instruments, full-body and limb bathtubs, therapeutic beds, gynaecological chairs, pneumological and cardiological devices, patient monitors, infusion equipment, devices for general practitioners and aesthetic medicine instruments.

EGO Zlín is an important manufacturer and supplier of complete biological protection systems, logistic decontamination systems, urgent medicine devices, and long-term care equipment. The firm is

form of medical device manufacturers for recipients of benefits from the foreign development cooperation programme.

Members of the Association are showing great interest in the platform. The project is intended to become a gateway to deworking on development programmes, based on the specific requirements of clients or prompted by urgent worldwide needs. Since its founding in 1992, it has established commercial cooperation with final users all over the Czech Republic and in other countries, including the Slovak Republic, Poland, Austria, Germany, Croatia, Spain, Turkey, Russia, Belarus, Ukraine Kazakhstan, Saudi Arabia, Japan, South Korea, Brazil, and Canada.

MZ Liberec is continuing its tradition of medicinal and technical gas distribution system manufacture dating back to 1958.

The company designs, manufactures, supplies and installs medicinal and technical gas distribution systems. An indivisible part of its production programme is the manufacture of end distribution elements, such as ramps, source bridges, revolving ceiling systems and medical equipment for operating theatres, intensive care units, anaesthesiology and resuscitation departments and standard inpatient wards all over the world. The company also ensures the delivery and assembly of medicinal gas distribution systems, i.e. oxygen generators and compressors, vacuum, reduction, and evaporating stations. jp

Photo: EGO Zlín, spol. s r.o. archives

trade partners and health institutions from selected countries, for which it receives financial support from a special MTI programme.

A very popular form of support among medical device manufacturers in recent years has been the PROPED project of the Ministry of Foreign Affairs, supporting economic diplomacy. The export of medical devices must meet a large number of specific requirements, from the obligation to have expertly trained distributors who will be able to communicate with local healthcare institutions, to undergoing the often complicated and expensive process of obtaining the required certificates in the particular countries. Specifically targeted projects, however, assist exporters to succeed even under these demanding conditions.

Currently some firms are focused on complete plant deliveries, such as hospitals and other healthcare facilities. In this area, they often use the services of the

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ERILENS s.r.o. Company has been helping integrate people with reduced mobility into normal life since 1992.

We deal with the production of locomotion aids such as forearm crutches, underarm crutches, walking sticks and other medical equipment. In our products, we emphasise quality, functional properties and design.

Therefore, our experienced development and production team follows the current trends and the needs of our customers.

Our company is the only producer of locomotion aids in the Czech Republic and is currently one of the biggest distributors on the domestic market. A significant percentage of our sales also comes from export.

Locomotion aids:

ERILENS s.r.o.

Papírenská 114/5 160 00 Prag 6 CZECH REPUBLIC

Jana Dupalová

Export Manager e-mail: jdupalova@erilens.cz phone: +420 777 336 912

• • • • •

forearm crutches underarm crutches child crutches walking sticks accessories (anti-skid extensions, overshoes, loops, holders...)

Other medical equipment: • • •

finger splints irrigators anti-decubitus pads

www.erilens.com 23 |

MEDICAL DEVICES

AVDZP AVDZP members currently employ nearly 9 000 people. Their aggregate revenue is CZK 19 billion per year, with exports accounting for more than 40 per cent. In the case of certain manufacturers, it is more than 80 per cent. Their medical device portfolio is wide, comprising approximately 500 000 items, from dressing material to orthopaedic implants and cardiostimulators.

| 24

rules lead to considerably higher costs, but the new strict controls being introduced will result in a continuing reduction in the number of notified persons within the framework of the entire EU. Until recently, there were about 100 notified persons in the Czech Republic. However, now their number has dropped to less than 50, the result being the victory of the big over the small, not better quality. The remaining number of notified persons is absolutely insufficient to evaluate even the existing number of medical devices, let alone new ones. The price of those devices is multiplying and the time before a new device can be placed on the market is increasing.

Before long, it will take not months, but whole years to place a device on the market. In the final analysis, this will liquidate in particular the small and medium medical device manufacturers, who will hardly be able to survive such turbulences. This cheerless situation needs support and prompt solutions at the level of the Ministry of Industry and Trade and the Ministry of Foreign Affairs. And even if such support is obtained, it will be very difficult to face up successfully to the pressure of supranational companies. Owing to insistence by the Association, the Ministries under their new management have at last begun to deal with this serious situation.

Due to intensive contacts and discussions with the European Commission, the situation concerning Czech notified persons

Jana VykoukalovĂĄ Managing Director Association of Manufacturers and Suppliers of Medical Devices e-mail: Jana.vykoukalova@avdzp.cz www.avdzp.cz

Photo: LINET archives

veloping markets and an opportunity to participate in foreign tenders for the developing world.

Legislation Concerning Medical Devices – Upholding the Existence of Czech Notified Persons.

In 2017, after about eight years of discussion, new regulations were adopted which introduce stricter conditions for both manufacturers and notified persons that control the processes taking place on the part of medical device manufacturers to ensure that they meet the regulations and, in a positive case, to accord to the manufacturer the certificate concerned.

The manufacturer cannot place his products on the market without such a certificate. Of late, however, medical device manufacturers have to face up to very difficult conditions. Not only will the new

is becoming stabilised. Their existence is absolutely essential if Czech manufacturers are to cope with this difficult situation, without having to close down or sell their firms. This is all the more important as medical device production is one of the most innovative sectors, generating an extremely high value added. From this point of view, the support of the state and the ministries concerned is essential for the tradition of Czech medical device manufacture to continue.

E ducation and Cooperation with the Academic Sphere Each year, the Association prepares educational seminars for its members and partners on topical legislative subjects concerning the sector, and invites leading representatives of the ministries and other state institutions for discussion, so as to enable its members to participate interactively in the solution of the most pressing issues.

The Association discusses the possibilities with academics of transferring new research results into practice and prepares presentation seminars for university students on the research, development, and manufacture of innovative products.

These are some of the opportunities for winning over students to become their new colleagues.

P roduction, Supporting Procedures in the Manufacturing Process Round-table conferences of members of the Association serving the mutual exchange of experiences in different areas of the manufacturing, legislative and other processes among medical device manufacturers H ealthcare financing Negotiations with the VZP health insurance company, seeking an improvement of the compensation conditions for medical devices D evelopment of international cooperation with foreign associations and partners

CZECH BUSINESS AND TRADE

LINET Medical Bed – Europe´s Number One manufacture of hospital beds. The largest portion of our revenue is generated in advanced countries, e.g. Germany, France and Sweden. About CZK one billion is generated in the American market. But we are also expanding to the Asian market and are growing in China, the Near East, and Australia.

The history of Linet Company comprises one of the most impressive stories among firms founded on the Czech market after the Velvet Revolution in 1989.

The firm, set up in 1990 in Želevčice near Slaný, north-west of Prague, today exports its beds to more than 100 countries worldwide. Its output is some 100 000 beds per year. Zbyněk Frolík, founder of Linet, spoke to us about his firm´s strategic plans. The following are his answers to our queries:

Linet has a record year behind it, with an output, in 2018, of 110 000 medical beds, the most in its history. Its revenue for that year is between EUR 270 and 280 million.

Although your firm now already exports its products to the whole world, its further development, as you say, is forcing you to increase your annual turnover fourfold, to one billion euros. There are rumours about an investor, who would bring Linet closer to that goal…

Linet has been growing at a two-digit rate year by year. We are ahead of the market development, which means that we are growing at the expense of our rivals. This could be quite satisfactory, but our vision is going much farther. Our plan is to get among the world’s three largest manufacturers. Currently we are in fourth position with a distance, and are therefore trying to find a way to gather force by making a suitable acquisition, in addition to organic growth. We have acquisition targets that could shift us ahead quickly. But as this is very demanding financially, we are looking for a financial partner.

Which moments have been crucial to your firm?

There have been many of them – the original idea, the first achievements, more than a dozen patents, ideas and improvements, which have been pushing us ahead. The point was finding excellent new people, capable of helping us to turn our ideas into reality.

What creates the largest proportion of your firm´s profit?

The overwhelming part of our revenue is from the sale of our beds. At the same time,

we are promoting our business in the area of services, mainly as regards the renting of our beds and mattresses. In future, it will be this segment that will be growing significantly.

That is why we have, for example, invested in the purchase of a specialised provider of these services in France.

You started as an engineering firm, and now you have partly become an electrical engineering company, with your beds being provided with ever more sophisticated gadgets, each having a different function.

How far could Linet get in 10 years?

Thirty years ago, beds were just items of furniture in which the patient could, at most, lie down. Now our beds are provided with electronic devices comparable with those used in automobiles. They make it possible to position the patient so as to prevent bedsores and to check on his condition, for example, by measuring his blood pressure and body temperature and monitoring his sleep. The beds also assist the personnel. The nurse can seat the patient more easily and help him on to his feet. In ten years, the bed will become a key telemedical component. People will be lying at home and the bed will send the attending physician data for making the diagnosis.

You export your products to more than 100 countries. But considering the high level of sophistication of your beds, your key market for them will most likely be the advanced countries in Europe and North America. Which countries are most interested in using your beds as a form of service?

We are indeed number one in Europe in the

What is your penetration like in the US markets, where you have the strongest rivals among the world´s top firms, such as Stryker and Hill-Rom? It is the largest world market. There the hospitals demand the highest possible quality, and the main reason why Linet keeps winning tenders there is the high quality of its products and top-standard services, another important aspect. A few years ago, the media described as a fantastic thing that, in the popular serial “House of Cards”, the American President was lying in a Linet bed. They asked us how much we’d had to pay and whether this was an efficient way of penetrating the American market. The fact is that we paid nothing at all, except that we had to take the bed on to the stage and teach the actors how to use it.

Are you considering entry in any new markets?

We can export our products to practically all countries the world over. But what we have found useful is to have our representations, our people in foreign countries, who can concentrate more on the particular territory, learn the mentality of the local people, establish links with them and find local people to help.

Wherein are you better than your rivals?

The world´s top firms are doing it well; in principle, our rivals make no essential mistakes we could use to our advantage. Therefore I´ll start from the other side. I think that we have brought essential innovations to the world market, for example, column units, which make the patient´s positioning much easier. We also attach great importance to feedback from medical personnel, and that is why we are so strong in providing services and staff training.

How do you personally see Linet´s future?

As I have mentioned before, I would like to see Linet figuring among the world´s top three manufacturers. I am persuaded that in future Linet will be indispensable in healthcare worldwide – as an innovator and supplier of the highest quality products and top standard services.

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CZECH TOP

KARLOVY VARY REGION Region of World-renowned Spas

The term ‘balneology’ comprises three parts: medicine, prevention, and wellness. You may come to the region´s spas for recovery after a disease or for relief from a chronic ailment, for slimming, rejuvenation, or just for a good rest after the everyday hustle and bustle. There all your cares will vanish as you stroll through the historical colonnades with a drinking cup filled with curative

spring water and enjoy the warm mineral water baths or mud wraps, not to forget the expert and sensitive treatment by the capable hands of a master masseur.

Here, the centuries-long spa tradition goes hand in hand with the latest discoveries in medicine, balneology, and wellness. You can try out the fruits of this cooperation in Karlovy Vary, Mariánské Lázně, Františkovy Lázně, Lázně Kynžvart, or Jáchymov. There you´ll find relief and recovery, for which your body will be grateful.

Karlovy Vary Karlovy Vary is one of the most beautiful spa resorts in Europe, named after Charles IV, Czech King and Holy Roman Emperor, who founded the spa in 1370. The more than 650-year-old tradition of balneological treatment and the curative effects of the 15 local thermal springs have won the spa a global reputation.

Mariánské Lázně This famous spa town, with perfectly maintained parks, unique spa architecture, beautiful countryside and famous history, has been attracting guests for more than 200 years.

Františkovy Lázně Františkovy Lázně spa town, founded in 1793 by Emperor Franz I, is a world-renowned mud-bath spa resort. Its unique characteristics are based on its mineral springs with a high carbon dioxide content.

The spring water is used in the treatment of gynaecological diseases and disorders of the circulatory and locomotive systems.

Jáchymov Jáchymov Spa was founded in 1906 as the world´s first radon spa. The unique radon water is used for the treatment of the locomotive system. Such a high radon content is unique in all Europe.

Lázně Kynžvart This small spa resort is located in the midst of the Slavkovský les, a mixed forest situated at an altitude of 670 metres a.s.l., which creates a suitable climate with extraordinarily pure air. The spa specialises in the treatment of children with respiratory and skin problems.

Destination Agency for the Karlovy Vary Region, z.s.

Závodní 379/84a, 360 06 Karlovy Vary Phone: +420 354 222 243, info@zivykraj.cz www.zivykraj.cz

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Photo: CzechTourism archives, Ladislav Renner

Since the 14th century, the region´s powerful curative mineral springs sprouting from the depths of the earth have been tamed to help people to regain their physical and mental strength. The Karlovy Vary region is the pulsating heart of Czech balneology, where guests from all continents arrive to find rest and recuperation.

The region´s ancient spa towns are wide open to all, so don´t hesitate to come and see for yourselves, and experience the welcoming atmosphere with all your senses.

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SPA INDUSTRY

An Increasing Number of Guests Have Visited Czech Spas over the Past 10 Years Czech spas and watering places are among the best in Europe and have much to offer their visitors…“Spa sojourns are of key importance for tourism in the regions, for foreign arrivals, longer stays, and regular returns,” says, Eduard Bláha, President of the Czech Spa Association.

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What can the foreign visitor expect of Czech spas?

Fortunately, and at the same time, regrettably, the foreign visitor expects a good price and, at the same time, increasingly higher quality. The latter is what he is getting – better quality from year to year.

However, considering the lack of skilled personnel in the services and in the boundary regions in particular, I fear that this trend will not be tenable for long.

the services offered by the spas are covered by the public healthcare insurance system. It is also important to distinguish between the spa and the provider of the spa treatment, and the watering place itself, i.e. including other hotels in the locality. The town itself is a spa in the true sense of the word, because it creates an accompanying infrastructure for the spa and generates what is called the genius loci.

What are the latest trends in the area of spas and watering places?

Like elsewhere in Europe, spas focusing on spa rehabilitation, especially services covered by the public healthcare insurance

Altogether 839 999 guests visited Czech spas in 2017, 385 000 of whom were guests from other countries. Half of the foreign guests visiting Czech spas are from Germany, followed by Russians (17 per cent). Are these good figures?

What is your estimate for 2018?

The figures are very good and I don´t expect any radical change for 2018. It is much more important how long foreign guests stay on average and how much they spend per day. This is what really matters in our branch. Usually they stay longer than Czech self-payers and buy more expensive sojourns. Some 80 per cent of foreign spa visitors visit spas in the Karlovy Vary region. In this connection, it must be said that the foreign guest boom is over, while the number of domestic guests has been growing in recent years.

Photo: Czech Spa Association archives; CzechTourism archives, Ladislav Renner

How do Czech spas hold up in comparison with other European countries? Do Czech spas and watering places have their specific features?

Czech spas and watering places definitely compete well with their European counterparts. They are venues offering both traditional and modern treatments, as well as relaxation and rest, social encounters and culture, which, like the spas in other countries, administer or use local curative sources in the treatment of patients and guests.

In comparison with spas in the traditional spa countries, such as Germany or France, Czech watering places differ in the structure of the services they offer, which is due to the environment of the specific market.

Differences are in legislation, the scope of the financial coverage of the sojourns and the ownership structure of the spas. All this has an influence on what facilities and services the spas offer. As in other countries, in the Czech Republic, too, there are spas of Five-Star accommodation standards, modern gastronomy, top level rehabilitation cures and excellent accompanying wellness services. At the same time, however, there are also spas which are affordable to all. The most important thing is that, thanks to the registration and regulation system and state supervision, together with domestic and foreign competition, there are no spas of a poor standard. In addition, a substantial issue is to what extent

system, are increasingly being separated from those oriented towards self-payers.

Currently, an ever greater part of spa facilities is focused on holiday-making at spas, wellness stays, etc.

CZECH BUSINESS AND TRADE

There are about 90 providers of therapeutic rehabilitation care using the baths´ natural mineral waters and operating in 231 spa facilities located in 32 towns and communities across the Czech Republic.

Companies of all sizes are represented, from the smallest firms to companies with revenues of hundreds of millions of crowns per year. Are there any opportunities for more players or is there a tendency to amalgamate?

No big amalgamation is in sight, and while politicians have for years been talking about Chinese investment in Pasohlávky, it is practically impossible to build a new spa in a completely unknown locality. The emergence of new spa facilities in traditional locations, however, is very likely, although this will probably concern smaller companies.

How, in your opinion, has the position of spa facilities changed in relation to other services offered in tourism?

Their importance has massively increased over the past 10 years, although this may not seem so, from the viewpoint of the number of visitors at a time of cheap flights or Prague´s Euro-weekends or the concentration of business trips. Spa sojourns are of key importance for tourism in the regions, especially as regards foreign arrivals, longer stays, and regular returns.

Wherein do you see the greatest opportunities and the greatest dangers in Czech spa tourism?

Demography and the obvious growth of domestic demand are tremendous opportunities. Risks are potential international tension or crises and especially general economic problems – the shortage of skilled labour, shortage of medical personnel, depopulation of regions where the spas are located, and the reluctance of the younger generations to work in the services sector. All these are factors that in time will change the structure of the offer. A real risk is state bureaucracy and absurd over-regulation.

Does the Czech Spa Association collaborate with the European Spa Union?

As much as it can. The fact that our colleague, Martin Plachý, is a former Presi-

dent of ESPA, speaks for itself. Currently, Martin Plachý is Managing Director of ROYAL SPA, which is a family chain of spa hotels and resorts which has operated on the territory of the Czech Republic for more than 20 years. ROYAL SPA operates spas in Mariánské Lázně, Velké Losiny, Luhačovice, and Ostrožská Nová Ves. What is your vision as President of the Czech Spa Association of the future development of Czech spas?

I have been at the head of the Association for 12 years, and during that time I have noted the favourable development of Czech spas. They accommodate social demand and know how to overcome unfavourable developments and to respond to changing demands and conditions. I see no reason why this course should alter. The labour shortage is currently a limiting factor, but it is an all-society problem, which in the final analysis will result in a change of the offer and the price policy. The interest of Czech people to spend their holidays at spas has been growing for several years, and Czech spas are also highly rated by foreign guests, especially those coming from other European countries. The most popular places they come to see, after Prague and Český Krumlov, are the spas.

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WE SUCCEED

Comprehensive and Intensive Spa Rehabilitation is Increasingly Popular with Clients Reitenberger Spa Rehabilitation Care Centre is a healthcare facility specialising in providing comprehensive and intensive rehabilitation in combination with in-patient spa care. This form of care shows faster and more efficient results in the treatment of locomotor system problems.

Reitenberger Centre is

n FOCUS ON REHABILITATION Problems of the locomotive system and rehabilitation are becoming increasingly topical subjects. The number of young people having sedentary jobs and leading a sedentary lifestyle without adequate movement is increasing, and so is the number of people having problems with | 30

Reitenberger is a modern rehabilitation and balneal treatment centre, covering a surface area of about 1 200 sq. metres. The Centre comprises a swimming pool, whirlpool, saunas, a salt cave, a fitness centre, spaces for massage, therapy and rehabilitative exercises, hydrotherapy bath tubs, spaces for spa rehabilitative procedures (dry CO2 baths, peat and paraffin packs, magnetotherapy, lymph drainage, etc.)

their locomotive systems. Such people must receive due care and assistance to improve the quality of their lives.

The aim of the Reitenberger Spa and Rehabilitation Centre is to give people more possibilities of rehabilitation, as the existing options are limited and their intensity is inadequate. Under the current Czech healthcare system, where healthcare is covered financially through health insurance companies, patients usually receive a limited number of rehabilitation sessions spread over several weeks. This system, however, cannot ensure such good results as rehabilitation during a stay in a healthcare facility, with the possibility of daily exercise and supporting rehabilita-

tive care. In contrast, our Centre provides intensive curative rehabilitation, targeted to each patient individually. The character of the care provided by our Centre lies between out-patient and in-patient rehabilitative treatment. In addition, the stay will be reminiscent of an active holiday, in the pleasant environment of the spa town, with accommodation in hotel-type rooms and the availability of curative procedures all under one roof. Staying in our Centre, the patient will recharge his or her batteries, soothe the nerves, and work intensively on remedying mobility problems.

n INDIVIDUAL APPROACH At the beginning of his or her stay, each patient undergoes an initial medical examination. After ascertaining the patient´s condition, physicians, together with their physiotherapeutic colleagues, will draw up the patient´s individual programme of treatment to best meet his or her needs. During the stay, patients are in personal contact with the physician in order to check on the effect of the treatment. At the end of the rehabilitation stay, the patient’s condition is evaluated and further procedures are recommended.

Photo: Reitenberger archives

situated in Mariánské Láznĕ near the main spa colonnade.

It is located in a 19th-century building, the former seat of Abbot Karl Kaspar Reitenberger, founder of the Mariánské Lázně spa. Situated close to the colonnade and the Slavkovský les Forest, it is an ideal venue for spending time during a treatment sojourn.

CZECH BUSINESS AND TRADE

lems or patients after orthopaedic surgery and fractures, so as to achieve a long-term effect. In these cases, the care is focused on the soft tissues, the strengthening of the muscles, correction of motion stereotypes and minimising post-surgical and post-injury aftermaths. The result is quicker post-surgical regeneration and an earlier return to ordinary life, including work.

TOP Medical Package (7-day, 14-day and longer sojourns) accommodation category Superior * half-board with light lunch * initial consultation with a physician and a physiotherapist * final medical examination * free use of the swimming pool, the sauna world, and the fitness centre. weekly: 8 sessions with the physiotherapist, 10 procedures, two salt-cave sessions

n TEAM OF MEDICAL

PROFESSIONALS

It has to be pointed out that experts from among occupational therapists, nurses, massage therapists and other medical personnel participate in providing patient care, in addition to the physicians and physiotherapists. This is evidence that the health programme is realised by a large team of specialists.

n IN-PATIENT REHABILITATIVE CARE The healthcare programmes are set up in a standard way and are timed for the

duration of from one to three weeks, but the stay can be prolonged for an additional period.

One-week stays are recommended for patients with less serious movement difficulties or as rehabilitative preparation before supportive joint surgery. In this case, the rehabilitation is focused on the protraction of the soft tissues, strengthening of the muscles, general improvement of the patient´s condition, and improvement of his or her mental well-being. Longer stays are recommended for patients with chronic prob-

n WHO IS THE STAY INTENDED FOR? The care provided by the Centre has its limitations, the main one being the patient´s self-sufficiency. In the case of post-surgical patients, the care is suitable in the later phases of the convalescent process, when nursing care is no longer needed and there are no vertebrogenic difficulties. Stays in the Centre, however, are not limited to patients with problems of the locomotive system, but are also intended for those who are problem-free, but need the rest and wish to recharge their energy, which becomes rapidly depleted by the present hectic times.

MUDr. Jan Buzek Chief Rehabilitation Physician Reitenberger Centre www.reitenberger.cz 31 |

SPA INDUSTRY

Czech Spa Tourism Is on the Rise

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n SPA TOURISM IN THE CZECH

REPUBLIC

Spas and watering places in what is today the Czech Republic have been used from time immemorial. The long tradition of balneology, the therapeutic use of natural mineral waters, 37 spa resorts, hundreds of curative springs and rich deposits of peloids (mud, bogs and peat) rank the Czech Republic among the world powers in this area. In the past, the most exclusive clients used to spend time in Karlovy Vary and Teplice spas, which prided themselves on hosting distinguished visitors such as Peter the Great, Albrecht of Wallenstein, or the English King Edward VII. In later history, frequent guests to Czech spas were also giants of European culture, for example Goethe, Schiller, Chopin, Beethoven, and Wagner.

The grandiose era of spa development had its climax at the end of the 19th and beginning of the 20th century. The growing interest in spas in the 19th century was caused by many factors. One of these was the development of Medicine and Balneology which, in combination with Water Therapy, soon became subjects included in university curricula. Water Therapy was the domain of the Silesian healer Vincent Priessnitz, who in 1829 founded the present-day Jeseník (Gräfenburg) Spa, the first Water Therapy institute, where patients sought relief and where physicians would come to learn how to use the Priessnitz treatment, a method applied to this day.

The number of foreign visitors to Czech spas is rising from year to year, which testifies to the high quality of the medical care provided there and the beneficial

Spa Statistics There are 89 spa treatment providers in the Czech Republic, administering 230 spa facilities in 32 towns. The revenue of Czech registered spa facilities is estimated at CZK 11 billion.

Health insurance companies pay CZK 3.3 billion each year for spa treatment; in 2013, the sum was CZK 1.58 billion.

Fifty-three per cent of those seeking relief in spas are motoric system patients.

Out of the 839 000 guests who came to Czech spas for treatment in 2017, 385 000 were foreign patients.

Fifty per cent of the foreign guests coming to Czech spas are from Germany, followed

by Russians (17 per cent).

Sixty per cent of the total number of spa guests go to the Karlovy Vary Region; in the case of foreign guests, the percentage is 94.

Photo: CzechTourism archives, David Marvan

Since 2014, Czech spa tourism has been following a rising trend. This is partly due to the return of legislative terms and conditions regulating the financial coverage of spa treatment of Czech patients to the pre-2012 level, which led to an increase in their number and the prolongation of their curative sojourns. Another factor is the increase by 50 per cent, to more than CZK 3 billion, of the amount which health insurance companies pay out for the spa treatment of patients. The good condition of the Czech economy, growing wages and consequently greater interest in spa sojourns, also have a favourable effect. The growing interest in Czech spas as a safe and affordable way of spending holidays is partly linked with the worsened security situation worldwide. In addition, many Czech spas have chosen to focus more on relaxation and wellness stays, which guests pay for themselves, rather than caring exclusively for patients whose sojourns are covered by the health insurance system.

Bohemia-lázně a.s.

Spa Hotels Kriváň – Slovan | Sadová 5 | 360 01 Karlovy Vary | Czech Republic Phone: +420 352 511 111 | Fax: +420 353 228 220

accommodation@bohemia-lazne.cz

Discover the wonderful town of thermal mineral springs. Visit Karlovy Vary, a spa where natural wealth blends with the wealth of cultural sights. Visitors to Karlovy Vary can admire its Art-Nouveau architecture and historicising buildings from the turn of the 20th century, its town parks, unique colonnades and spa forests with 120 kilometres of forest paths suitable for Nordic walking.

There are some 60 thermal and cold springs gushing from the ground, with only 13 of them being used for drinking cures. The best known and most copious spring is Vřídlo with a temperature of 73 oC, the hottest spring in the Czech Republic. This is a typical geyser which, owing to its high carbon dioxide content, gushes up to a height of 12 metres. Due to their mineralisation properties, all the Karlovy Vary thermal springs are used for the treatment of gastrointestinal diseases and metabolic disorders, the treatment of post-injury conditions and the treatment of the locomotive system, especially the large joints, the spine, knees and hips, etc. Karlovy Vary mineral waters have a long-lasting effect

on the improvement of the condition of diabetic patients. Until the discovery of insulin, the Karlovy Vary mineral waters were practically the only prospect for diabetics.

The company is no newcomer to the market. Since 1992, it has been providing its services to clients from literally the whole world. The principle, which it strictly observes, is traditional balneology, which means that a stay in the spa is conceived individually for each client according to his or her health needs, supervised by an experienced spa physician and with the use of the natural mineral resources – thermal mineral springs for the drinking cure, bathing and washout, in addition to peat baths and compresses. Emphasis placed on the quality of spa treatment and rehabilitation is the greatest asset of the Bohemia-lázně company. Recently, the whole balneo procedural system has been completely reconstructed and a new rehabilitation swimming pool, which is part of the new Wellness & Spa section, has been built.

Bohemia-lázně a.s. offers: Spa Hotels – Kriváň, Slovan, Concordia – 3-star accommodation (117 single and 204 double rooms and 19 apartments) Ideal location in the centre of Karlovy Vary, just a few steps from the mineral spring colonnades Modern balneological centre, offering more than 45 different procedures based on thermal mineral water and peat 24-hour emergency service Spa, relaxation and wellness programmes, based on the treatment of gastrointestinal, metabolic and locomotive system disorders Preventive and curative stay for children aged from 7 years upwards

www.bohemia-lazne.cz

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SPA INDUSTRY

treatment and rehabilitation of the motoric system.

There are hundreds of natural curative springs and rich deposits of peloids (mud, bogs, and peat) and natural spring gas sources, some having a favourable climate, to be found in the Czech Republic.

The spas also offer curative sojourns covered by insurance companies and curative stays and wellness stays paid for by guests themselves.

Curative sojourns usually last for three or four weeks: on arrival, each patient is examined by a spa physician, who prescribes an individual plan of treatment.

Spa cures are used in the treatment of the motoric system, the circulatory and digestive systems, the nervous and respiratory systems, the urinary tract, and obesity, as well as in the treatment of skin diseases, gynaecological and endocrinological disorders and patients in post-oncological

Spas and Watering Places in the Czech Republic Spas: Aurora, Bechyně, Bílina, Bludov, Dubí, Františkovy Lázně (Franzensbad) Hodonín, Jáchymov, Janské Lázně, Jeseník, Karlova Studánka, Karlovy Vary (Karlsbad), Karviná, Klimkovice, Konstantinovy Lázně, Lázně Bělohrad, Lázně Bohdaneč, Lázně Kynžvart, Lázně Libverda, Lázně Toušeň, Lipová-lázně, Luhačovice, Mariánské Lázně (Marienbad), Lázně Mšené, Náchod, Osečná, Ostrožská Nová Ves, Poděbrady, Pozlovice, Skalka, Slatinice, Teplice, Teplice nad Bečvou, Třeboň, Velichovky, and Velké Losiny.

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conditions. The procedures can be divided into unique procedures using local natural sources (baths, packs, inhaling and drinking cures) and supplementary procedures provided in all spas (hydrotherapy, massages, electrotherapy, magnetotherapy, kinesiotherapy, etc.)

n STATISTICS OF GUESTS COMING

TO CZECH SPAS

The number of guests arriving at Czech spa facilities (either for treatment or wellness and relaxation) increased from 437 000 in 2000 to 839 000 in 2017 (385 000 were from foreign countries and 454 000 were domestic guests), according to the Czech Statistical Office (CSO). Following a decline in 2014 and 2015, the number of guests in 2016 and 2017 grew by approximately 7 per cent per year. Figures for the 1st quarter of 2018 indicate that the increase will be even more than 10 per cent year on year (the number of Czech guests accommodated in spa hotels rose by 8.2 per cent and the number of foreign guests by 12.4 per cent). It is to be expected that the figures for the whole year of 2018 will be very favourable. The number of domestic guests is higher than that of guests from other countries. The latter group, however, is showing higher growth rates, making good the fall in pre-

Photo: CzechTourism archives, Ladislav Renner

effects of the advanced treatment and rehabilitation methods used. Nowhere else in the world can such a concentration of curative springs be found as in the West Bohemian spa triangle, formed by three renowned spa resorts: Karlovy Vary, Mariánské Lázně, and Františkovy Lázně.

Another world famous spa not far away is Jáchymov Spa, the first watering place in the world to use radon water for treatment. Another primacy is held by Jeseník Spa, where the first Water Therapy institute was founded. Teplice Spa boasts the longest spa tradition in Bohemia, opening its 865th season this year. Darkov Spa situated in the north-east of the Czech Republic was founded 152 years ago. The top standards of care provided by physicians and physiotherapists, combined with the unique spring water, a remainder of the tertiary sea which once existed there, produce outstanding results in the

FOREVER YOUNG Situated in the picturesque spa town of Marianske Lazne Falkensteiner Grand MedSpa belongs to the best medical spa hotels in Western Bohemia. The guests enjoy cosy ambience of 19th century grand hotel and excellent gastronomy. The most important highlight is, however Aquapura SPA, where the guests can choose from among more than 60 treatments, performed by a highly skilled medical team. Medical and wellness product of the hotel unifies the best of traditional spa knowledge and

modern medical science. Beside the classical cure packages, the hotel proposes also metabolic balance weight control programme and destress programmes.

From May until October, the region is also highly desired destination for golf players. 6 golf courses, among which Royal Golf Club Marianske Lazne is the oldest in the Czech Republic, enable enough diversity even for the most persistent and passionate golfers.

HIGHLIGHTS · · · · ·

Licensed medical spa institute In-house mineral water springs All the treatments made directly on the spot Pool area with 5 pools, including the only outdoor pool in town (heated water) Possibility of organizing golf packages

Tel. +420/354/929 397 · reservations.marienbad@falkensteiner.com · falkensteiner.com/marienbad

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vious years. In 2017, Czech spas welcomed 454 000 domestic guests, the highest number for the past 15 years. The number of foreign tourists rose to 385 000, i.e. by 12.9 per cent in comparison with 2016.

Equally important as the number of guests is the length of their spa stays. Since 2013, the number of overnight stays in spa accommodation facilities has been growing (the falls caused by a decline in the number of foreign guests were offset by the higher number of overnight stays of Czech guests).

In 2017, guests (Czech and foreign taken together) spent 7.38 million nights in spas, a 4.8 per cent increase year on year (this growth was mainly due to the 12 per cent increase in the number of nights spent in spas by guests from other countries).

The most visited Czech spas are those in the Karlovy Vary region. More than half of the spa guests (60.3 per cent in 2017) visit this region, where they spend about half of the total number of nights spent in Czech spas. Karlovy Vary is also the most favoured spa among visitors from foreign countries. According to the Czech Statistical Office, 94 per cent of foreign guests visiting Czech spas choose Karlovy Vary for their stays. The increase or decrease in the number of guests staying in accommodation facilities in the Karlovy Vary | 36

region changes in practically the same way as the total number of visitors coming to the Czech Republic. Here, too, a decline could be observed in 2014 and 2015, followed by an approximately 10 per cent growth in subsequent years (in the 1st quarter of 2018, by as much as 13 per cent year on year).

Most foreign guests visiting Czech spas are from Germany, and their share of the total number of guests at Czech spas is growing slightly. In 2017, this share was 23.7 per cent (51.6 per cent of all foreign guests). Placed second are guests from Russia with 7.6 per cent of the total number (16.6 per cent of all guests from foreign countries). The third largest group of visitors is that coming from Taiwan, but in terms of the number of nights spent, third position is taken by guests from Israel.

n CURATIVE SOJOURNS Since 2008, the number of patients coming to Czech spas for treatment has been varying between 350 000 and 380 000 (half of the total number of guests coming to Czech spas), according to the Institute of Health Information and Statistics. Until 2011, this number also included 120 000 patients whose stay was covered by health insurance companies. In 2012, however,

due to cuts made by the Ministry of Health, this number began to decline. In 2013, it fell to a minimum, when only 73 000 patients came to spas for treatment covered by the health insurance system. This decline was partly set off by the arrival of a higher number of foreign guests and in particular patients who paid for their stays themselves (although they usually stayed for a shorter time). In 2016, altogether 365 000 patients arrived at Czech spas, 104 000 of whom had their stays and treatment paid for by the health insurance system; 111 000 were Czech paying guests and 149 000 were foreigners attending Czech spas for treatment.

The number of spa facilities differs from region to region. The Karlovy Vary region dominates, both as regards domestic patients (the region hosted 19 400 patients, the second highest number after the South Bohemia region with 28 400 domestic patients) and patients from other countries (141 000 out of the total 149 000 foreign patients).

This is because the Karlovy Vary region has the greatest concentration of spa facilities.

There are nearly 60 spa operators, most of them in the town of Karlovy Vary itself.

The large number of guests accommodated in hotels in the Karlovy Vary region naturally requires a corresponding number of

Photo: CzechTourism archives, Petr Toman

SPA INDUSTRY

CZECH BUSINESS AND TRADE

Janské Lázně: personnel. The number of physicians and nurses and non-medical personnel and the number of beds in the spa facilities are about half the number in the entire Czech Republic and correspond to the total number of spa patients coming to the Karlovy Vary region for treatment (nearly 50 per cent of the total number).

From the mountains right into thermal mineral water

n SURVEY OF SPA CARE PROVIDERS There are 89 therapeutic and rehabilitation spa care providers managing 231 spa facilities in 32 towns in the Czech Republic. These are companies of different sizes, from the smallest firms to companies with annual revenue amounting to hundreds of millions of crowns. Their most frequent legal form is the limited company (43), followed by joint stock companies (37), contributory organisations (2), two state enterprises and five companies owned by natural persons. The aggregate turnover of the 89 registered spa therapy providers is CZK 12 billion per year. Some of the companies also operate hotels in places other than the spas, or their revenue is generated by other activities, so that the aggregate revenue of the registered Czech spa facilities is estimated at CZK 10-11 billion.

There are two associations of companies in the Czech Republic providing services linked with spas. These are the Czech Spa Association, bringing together therapeutic spa operators in the Czech Czech Spa Towns Apply for their Joint Inclusion in the UNESCO World Heritage List At the beginning of 2019, European spa towns, including three in the Czech Republic, filed an application with the Czech Embassy in Paris for inclusion in the UNESCO World Heritage List. This is the climax of an eight-year process of preparations. The ceremony at which the relevant documents were passed over was attended by representatives of all 11 towns of the applicant countries, including those of Karlovy Vary, Mariánské Lázně, and Františkovy Lázně, and ambassadors of all 7 European countries concerned. The entry in the List under the common heading “The Great Spas of Europe” is sought by 11 European spa towns. The most strongly represented are the Czech Republic and Germany. Michal Urban, Chairman of the international working group which prepared the documents, is persuaded that the application has a good chance of success. However, the most important stage of the process, the actual assessment of the application by UNESCO and its expert organisation ICOMOS, is yet to come. By the end of April, the applicant countries must present more specific managerial plans and thereafter, in autumn this year, an expert and evaluation delegation of ICOMOS, UNESCO´s expert organisation, will visit the candidate spas. The vote on the actual entry will be made by the UNESCO World Heritage Committee at the turn of June and July next year. Ideally, “The Great Spas of Europe” will be entered in the UNESCO World Cultural and Natural Heritage List in mid-2020. According to the applicants, the Great Spas of Europe institute is evidence of the illustrious European spa phenomenon, which flourished from the early 18th century until the 1930s. As venues for people from all over Europe to meet, the spas played an important role in the democratisation of European society.

JANSKÉ LÁZNĚ – a picturesque mountain townlet at the base of Černá hora (Black Mt), which attracts tourists and cyclists in summer, skiers and winter sports lovers in winter, and spa guests all the year round.

Janské Lázně, the only spa resort on the Czech side of the Krkonoše (Giant Mts), won world renown already in the early 20th century for its successful rehabilitation of polio patients. Today, visitors are offered spa care focused on the treatment of motoric, nervous, and respiratory disorders in modern facilities for adult and child patients.

The spa treatments also include bed rehabilitation care for post-injury and post-surgery patients. All patients and visitors are offered the use of the spa aquacentre with thermal mineral water, fitness centre with professional therapists and a wide range of relaxation and treatment packages. Janské Lázně has the largest ski area in the Czech Republic – the Černá hora-Pec Ski Resort, where skiers have the use of up to 44 kilometres of ski slopes on a single ski pass.

Spa treatment in Janské Lázně is based on the use of thermal mineral water from local natural sources and the pure mountain climate.

For whatever reason you may decide to spend time in Janské Lázně – spa treatment, relaxation, mountaineering, or simply enjoying the countryside with local historical sites, you will not be disappointed.

Státní léčebné lázně Janské Lázně ✆ +420 499 860 303 | sales@janskelazne.com

www.janskelazne.com

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SPA INDUSTRY

n TRENDS AND OPPORTUNITIES

IN THE CZECH SPA INDUSTRY

Legislation and Expenses of the Health Insurance Companies Are Stabilised In 2015, the stricter regulation of the conditions qualifying patients to obtain spa treatment covered by the health insurance system were eased and the length of patient stay and the list of diseases qualifying patients for spa treatment were returned to the state before October 2012.

The Czechs´ Interest in Spa Treatment and Rehabilitation is Growing The number of Czech guests (patients and guests not undergoing spa therapy) visiting Czech spas is increasing. The reasons are the attractiveness of the spas themselves and the Spa Superlatives The newest spa – Lednice Spa Resort, Perla Spa House – the newest therapeutic spa in the Czech Republic proclaimed a therapeutic spa in 2009 – using iodine-bromine water for treatment.

The newest colonnade – Lednice Spa Resort is not only the newest therapeutic spa in the Czech Republic, but also one with the newest spa colonnade.

The most-visited cultural spa sight –

Lednice-Valtice Spa Resort is the only Czech spa on the territory of a UNESCO cultural sight (Lednice-Valtice cultural landscape). The State Chateau of Lednice is the most visited architectural sight in the Czech Republic.

The oldest spa – Teplice in Bohemia – The use of the Teplice hot spring for treatment goes back to the year 762.

The best-known spa – Karlovy vary; Karlovy Vary is a widely recognised spa resort not only in the Czech Republic, but also in other countries throughout the world. Karlovy Vary (Karlsbad) is, without exaggeration, an icon among global

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improved economic situation in the country.

In 2017, the number of guests accommodated in spa hotels rose to 839 000, a 7.6 per cent increase year on year. At the same time, the number of nights which Czech guests spent in the hotels rose by under 5 per cent.

Germans are Regular Guests and their Number is Growing, Russians are also Returning In 2017, the number of foreign guests coming to Czech spas and the number of nights they spent there reached a new record of 385 000, in comparison with 2013, with 374 000 arrivals, after which year the number of foreign visitors declined. There are efforts to attract guests from more countries, for example China and Israel. The interest of guests from Arab countries is increasing.

Emphasis on Investment To compensate for the decline in the number of clients and payments from the health insurance companies in 2013 and 2014, the spas focused on attracting paying guests, foreigners and people coming to the spas for relaxation. Today, the spas do not limit themselves to conventional spa sojourns, but also therapeutic and wellness resorts.

T he highest-lying spa – Jáchymov is not only the world´s oldest radon spa resort, but also the highest-lying spa resort in the Czech Republic. It lies at an altitude of 673 metres above sea level.

The lowest-lying spa – Hodonín; Ho donín is the lowest-lying spa resort in the Czech Republic, situated at an altitude of a mere 167 metres a.s.l.

The smallest spa – Karlova Studánka;

Karlova Studánka has only 250 permanent inhabitants.

The most original spa – Františkovy

Lázně spa – from the very beginning, the town of Františkovy Lázně (Franzensbad) was conceived as a spa resort. It was founded in 1793 by Emperor Francis I and is known as one of the first spas to use iron sulphate peat pulp in its therapeutic treatments.

The world´s oldest radon spa – Jáchymov – dates back to 1906. The use of radon in medicine was preceded by the research work and discoveries made there by Marie Sklodowska-Curie, twice

include popular wellness programmes (stays for managers, anti-stress, slimming, detoxification, wellness & beauty treatments). This is an offer for those who visit the Czech Republic for only a short time and for people wishing to spend a pleasant weekend.

High Quality is the Priority of Czech Spas Foreign clients come to Czech spas for quality. Czech spas have excellent experience in the use of natural resources; they have tradition and outstanding results in patient treatment. It is not a common practice in other countries for spas to have a permanent physician or experts studying on a long-term basis the effect of spa therapies on people´s health. If, some time in the future, a proposal is passed that patients could have their therapeutic stays in spas across the European Union covered by the health insurance system, Czech spas would be very well off. awarded the Nobel Prize.

T he warmest thermal spring – Karlovy Vary – The town of Karlovy Vary boasts the hottest mineral water spring in the Czech Republic The temperature of “Vřídlo” – Karlovy Vary’s mineral spring – is 73.4 oC. The coldest mineral spring – Mariánské Lázně – The temperature of the mineral springs in this spa is a mere 7 o–10 oC. The world´s oldest hydrotherapy spa – Jeseník Jeseník Spa was founded in 1822 by the local peasant healer, Vinzenz Priessnitz, whose curative method was hydrotherapy. His patients were distinguished people from Europe and abroad, kings and dukes. His nickname was “Water Doctor” or “Medical Columbus”.

The best-known “water garden” – Jeseník Unique “water garden” - an open-air balneo-park with a brook passing through it, where a system of stops is created for hydrotherapy and relaxation. It is conceived as a reminder of Priessnitz´s hydrotherapy method.

Photo: pixabay

Republic, and the Association of Spa Places in the CR, which is an organisation of spa towns and communities in the Czech Republic holding the spa statute. In addition to the two associations, another institution concerned with the propagation of Czech spas at home and abroad is the CzechTourism state-run tourism promotion agency.

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