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Results of the Health Care Survey 2011
       Health Care Marketing Congress
              September 2011




              #hcms11 #thom
– Draft –
       Survey participants

                                                           Sector


                                                   9%    15%                    OTC
                                                                                RX
                                            25%                                 Devices

                                                               29%              Biotech

                                              5%                                Hospital/Care

                                                   17%                          Other sectors




                      Scope of responsabilities                                           Job function

                                                                            Marketing Manager                   32%
                                       5%   15%                         Product/brand Manager             21%
          EMEA/Europe            22%                                     General Manager/CEO        13%
          BELUX
                                                                     Sales & Marketing Manager      13%
          Other
                                                                       Communication Manager        13%
          Worldwide
                                            58%                                 Sales Manager 5%
                                                                     Multichannel/CRM Manager      2%
                                                                              Online marketer      2%


Presentation1                                                   2
– Draft –
    Key concept: Net Average Index (NAI)




                             -60%         -20%               20%   60%




                The percentage reflects a balance between the positive, neutral and
                 negative views. It can vary from -100% to +100% depending on the
                                       amount of confidence.

                  A positive NAI indicates an increase of importance, the number
                        reveals how relevant or outspoken this increase is.




Presentation1
– Draft –

                    Chapter I


   How do Health Care Marketers feel about
               their FUTURE?

                 Confident

                 Hesitant

                 Pessimistic


Presentation1            4
– Draft –
           HC marketers are hesitatingly gaining confidence
                                                          General Confidence index in Health Care vs Other sectors

                30%                                   27%               28%                                                                      26%
                                                                                           25%
                25%
                                  23%
                                                                                           25%                                  18%
                20%
                15%                                                                                                                              20%
                                                                                                                  10%
                10%                                                                                                              6%
                     5%
                     0%
                -5%              2005                 2006              2007               2008                   2009          2010             2011
               -10%                                                                                               -6%
                                Confidence index of marketers from other industries                        Confidence index of Health Care marketers

                           Evolution in Projects                               Evolution in Team size                                  Evolution in Budget

     25%                        23%                               70%                                                     25%
                          20%                                           60%                                                                                        18%
     20%                               17%                        60%          55%                                        20%                    15%
                                                                                     52%                                                                     13%
                                                           14%                                 49%                48%     15%
                                                    13%
     15%                                                          50%                                                                       8%   8%
                                 13%                                                                                      10%          5%                                9%
     10%       8%                                            11% 40%                           47%                                                      4%
                                                                                                                           5%   0%                           1%
                                                                                                            28%
      5%                                                          30%                                25%          37%      0%
                                             -1%
      0%                                                          20%                                                     -5%   2005 2006 2007 2008 2009 2010 2011
             2005 2006 2007 2008 2009 2010 2011                                                             21%          -10%
     -5%                                                          10%                                16%
                                       -3%                                                                               -15%
    -10%                                                           0%                                                    -20%                    -21%
    -15%                                     -11%                       2005 2006 2007 2008 2009 2010 2011
                                                                                                                         -25%


NhealthCare = 83
NPresentation1
 OtherSectors= 577
                                                                                           5
– Draft –

      HC marketers estimate their budget based on the actual
      budget instead of the future strategy
                     Q: In 2011, how did the total marketing budget available within your marketing department change and what are the
                                                                   expectations for 2012?

                   30%

                   25%           23.0%

                   20%
                                                       15.2%
                   15%                                                                               13.0%
                                                                                                                            9.4%
                   10%

                    5%

                    0%
                                 2008                   2009                   2010                  2011                   2012
                    -5%

                   -10%                                                        -7.4%
                                                                                                    -15.3%
                   -15%

                   -20%
                                                       -20.0%                  -21.1%
                   -25%



                             Budget expectations of Health Care marketers               Actual budget of Health Care marketer




NPresentation1
 healthCare = 83
                                                                           6
– Draft –

                       Key takeaway n°1


“With budgets under
pressure, Health Care confidence
is being challenged”




Presentation1           7
– Draft –

                                Chapter II


                    Which sentence is TRUE?


                Patients will be more loyal towards a product

                Improving relationships with GP’s has become
                the nr 1 Health Care Challenge

                Patients’ influence is expected to increase
                the most

Presentation1                         8
– Draft –
    Top Health Care challenges are more administrative while
    relationship building is pushed down

                                        In your opinion, what will be the top 5 Health Care challenges?

                     4.00
   Rating (5 to 0)




                                                                                         1   Dealing with increasing
                                                         3                                   innovation costs and legal
                                                                                             requirements
                     3.50
                                                                                         3   Dealing with specific
                                                                                             stakeholders (social
                                                                                             security, other payers)
                                                  5 4                      1
                     3.00                                    2                           2   Dealing with increased pressure
                                                  6                                          from purchasing organizations

                                                                                         4   Dealing with the growth of
                     2.50                                                                    generic products and alternatives

                                                                                         5   Improving relationships with
                                        1
                     2.00                     2                                              specialist doctors
                                                         3

                                                                                         6   Improving relationships with
                                                                                             hospitals
                     1.50
                            20%   30%   40%        50%           60%      70%      80%
                                                                                             Last year’s position of top 3
                                                                       Respondents (%)
NhealthCare = 83
 Presentation1                                                             9
– Draft –
                       Dealing with new media enters the top 5 Marketing
                       challenges but remains very low rated

                                               In your opinion, what will be the top 5 Marketing challenges?

                       4.00
     Rating (5 to 0)




                                                                                           1   Building customer loyalty and
                                                                                               trust
                       3.50                                                                2   Differentiating from competitors
                                                        2   1
                                              5                                                on targeted segments

                                                                                           3   Dealing with new media
                                                    4
                       3.00                                                                    (online, social, mobile)
                                          6
                                      7
                                                                                           4   Increasing alliances with
                                                                                               strategic partners
                       2.50
                                                                   2                       5   Building a strong brand
                                                                                   1
                                                        3


                       2.00                                                                6   Increasing efficiency of
                                                                                               marketing and sales processes
                                 3
                                                                                           7   Dealing with empowered
                       1.50                                                                    patients
                          20%   30%           40%        50%           60%         70%
                                                                                               Last year’s position of top 3
                                                                       Respondents (%)
NhealthCare = 83
 Presentation1                                                             10
– Draft –
        While the number of influencers increases, a new decision
        maker holds the top: the patient

                                                How do you evaluate the influence of the following stakeholders ?
                                                                                                                                      Net Average Index (%)

                                    Patients                                                                                                 77%

      Legal and regulatory institutions                                                                                                      75%

                      Patients associations                                                                                                  71%

                             Social security                                                                                                 69%

                      Insurance companies                                                                                                    66%

                                   Hospitals                                                                                                 59%

                          Specialist doctors                                                                                                 36%

                                Pharmacists                                                                                                  27%

           Wholesalers and distributors                                                                                                      23%

                    Research organizations                                                                                                   21%

                     General practitioners                                                                                                   7%

                       Clinical laboratories                                                                                                 -4%

                                               0%     10%      20%     30%      40%      50%      60%     70%       80%     90%       100%

                   Substantial increase   Slight increase    Remain stable     Slight decrease   Substantial decrease     No answer
NhealthCare = 83
 Presentation1                                                                 11
– Draft –
         Delivering relevant services to both patients and physicians
         are expected to be key



                                        To what extent do you agree with the following statements?

                                                                                                                           Net Average
                                                                                                                            Index (%)


                   Patients will give more value to services                                                                    76%



               Physicians will expect more services from
                                                                                                                                71%
                        health care companies


                       Patients will be more loyal towards a                                                                    -29%
                                      product


                                                               0%        20%         40%        60%           80%      100%


                   Totally agree   Slightly agree    Neutral     Slightly disagree         Totally disagree         No answer



NhealthCare = 83
 Presentation1                                                      12
– Draft –
                Key takeaway n°2


                “Traditional Health Care
                challenges have a hard time to
                include new trends”




Presentation1
– Draft –

                                      Chapter III

             Major challenges and tight budgets
           ahead, how will Health Care marketers
                         handle it?
                They will use traditional tactics (sales reps,…) through
                traditional media channels (own
                brochures, magazines,…), leaving the ‘online’ matter for
                later
                They will need people with specific HC skills to handle
                these traditional challenges through traditional HC tactics

                They will use traditional tactics combining it mainly with the
                online media channel but keeping it conservative (mainly
                website building/optimization)

Presentation1                              14
– Draft –
     To build customer loyalty, HC marketers favor traditional
     ‘human interaction’ tactics

                                        Which are the top 5 marketing tactics for your brand ?

Rating 5.00
(5 to 0)                                                                                                    1 Sales reps visiting

            4.50                                                                                            2 Congresses and trainings
                                                                                         1
                                                                                                            3 Public relations
            4.00
                                                                                                            4 Brand activation

            3.50                                                        3                                   5 Advertising
                                                                    4
                                                                                     2                      6 Events
            3.00                    9                          6                                            7 Direct marketing

                                                           7                                                8 Sponsoring
            2.50              11
                                10                                                                          9 Point-of-sales material
                                                               5
                                                 8
            2.00                                                                                           10 Remote detailing

                                                                                                           11 Sampling
            1.50
                   0%   10%   20%          30%       40%            50%        60%        70%      80%
                                                                                         Respondents (%)




NhealthCare = 83
 Presentation1                                                          15
– Draft –

     While costs are clearly under pressure, detailing, congresses
     and trainings remain top marketing tactics

                   Which are the top 5 marketing tactics planned for your brand & how will your budget for these evolve?

                             Top marketing tactics planned                                      Expected budget evolution
                                                                                                                                                  NAI (%)
         Sales reps visiting                                       67%                                                                            -17%

Congresses and trainings                                          64%                                                                              -4%

            Public relations                                52%                                                                                   -10%
           Brand activation                                49%                                                                                     2%

                   Advertising                        47%                                                                                         -18%
                       Events                         46%                                                                                          5%

          Direct marketing                           43%                                                                                           4%

                    Sponsoring                 35%                                                                                                -25%

  Point-of-sales material               23%                                                                                                       -37%
          Remote detailing             22%                                                                                                        -25%
                     Sampling         19%         Responses(%)                                                                                    -47%

                                                                           0%          20%           40%          60%           80%         100%

                                                                            Increase substantially   Increase moderately      Remain the same
                                                                            Decrease moderately      Decrease substantially   No budget in 2012

NhealthCare = 83
 Presentation1                                                              16
– Draft –

         Online is the first planned media channel but with a very
         conservative and low structured approach

                   Which media channels have you planned to use?                      Which online channels have you planned to use?


                                                                                  Website building and
                             Online                            71%                                                                     66%
                                                                                     optimization

 Own Brochures and magazines                                                               Newsletters                            61%
                                                            65%

                                                                          Direct marketing e-mailings                             59%
                         Magazines                         63%
                                                                                          Social media                      50%
                        Newspapers                41%
                                                                                     Online advertising               36%
                       Door-to-door    16%
                                                                             Search engine optimization            30%
                         Television    16%
                                                                                              Webinars       18%

                             Mobile   13%                              Search engine advertising (e.g.
                                                                                                            16%
                                                                              google adwords)
                              Radio   12%                                                       Mobile    11%

                              Other   10%                                                      Blogging   8%

                           Outdoor       6%     Responses(%)                                     Other    3%                 Responses(%)



NhealthCare = 83
 Presentation1                                                          17
– Draft –




                                 Key takeaway n°3


“Traditional tactics will leverage online
resources to tackle challenges”

Presentation1
– Draft –


                                        Chapter IV


                How will the future of Health Care
                      marketing look like?   19




                Just like the present


                It will include responsibilities of sales management, market
                access and research

                It will require a significant amount of medical knowledge


Presentation1
– Draft –
         Marketers all expect changes in the future role of Marketing
         but their opinions lack realism

                                            How do you expect the role of Marketing to change in the future?
                                                                                                                                  Net Average
                                                                                                                                   Index (%)
              Further evolve from traditional marketing channels
                             towards E-marketing                                                                                    76%
                      More responsibilities in areas such as sales
                    management, market access & market research                                                                     65%

                                  More decisive role at board level                                                                 53%

                      More operational role by making sure costs &
                                                                                                                                    52%
                            processes are carefully managed

                                More supportive role towards Sales                                                                  35%

                   Purely focus on the marketing & promotional mix                                                                  -31%

                                          More administrative role                                                                  -41%

              I don’t expect any changes in the role of marketing                                                                   -74%

                                                                      0%        20%       40%        60%         80%        100%

                                   Totally agree      Slightly agree       Neutral     Slightly disagree       Totally disagree



NhealthCare = 83
 Presentation1                                                             20
– Draft –
     Top skills needed to take on these challenges are not health
     care related


                                              Top 5 skills/competences required to fulfill these challenges


  Rating 3.50                                                                                                 1 Creativity
  (5 to 1)
             3.30                                        3                                                    2 Communication
                                     6                                                   2
                                                                                                   1          3 Strategic
             3.10
                                                                                                              4 Analytical
             2.90          11
                                                                    4                                         5 Market access
                                          7                   5
             2.70                             8
                                                                                                              6 Negotiation
             2.50               12
                                                                                                              7 Ethics and Compliance
                                         10
             2.30                                                                                             8 Operational
                                         13
                                                    9                                                         9 Organizational
             2.10
                                                                                                              10   Coaching
             1.90
                                                                                                              11   Technology
             1.70              14
                                                                                                              12   Pricing
             1.50                                                                                             13   Medical knowledge
                    0%   10%         20%          30%        40%        50%        60%       70%       80%
                                                                                                              14   Regulatory
                                                                                         Respondents (%)
NhealthCare = 83
 Presentation1                                                                21
– Draft –




                  Key takeaway n°4



  “Marketers will need to step away from their
        traditional HC marketer's role”
Presentation1             22
– Draft –




           To wrap things up… 4 Key Takeaway’s




Presentation1                23
– Draft –

       Key takeaways



     1. With budgets under pressure, Health
       Care confidence is being challenged

     2. Traditional Health Care challenges have
       a hard time to include new trends
                                                   PATIENT
     3. Traditional tactics will leverage online
       resources to tackle challenges

     4. Marketers will need to step away from
       their traditional HC marketer's role


Presentation1                       24
– Draft –



                An initiative by




                                   http://www.thom.be/


                 In collaboration with




Presentation1                               25
– Draft –




      Back-up slides




Presentation1          26
– Draft –
    Key concept: Net Average Index (NAI)
    Quantifying Health Care Marketers’ beliefs


       How do you expect a certain parameter to evolve?
                 Options: Decrease, will stay the same, increase
                 Calculation of the index: a percentage between -100% and +100%




                               -60%       -20%               20%    60%




       The percentage reflects a balance between the positive, neutral and negative views.
       It can vary from -100% to +100% depending on the amount of confidence.

       A positive NAI indicates an increase of importance, the number reveals how relevant
       or outspoken this increase is.
Presentation1
– Draft –
  Top Health Care challenges this year will be more administrative
  while relationship building challenges are pushed down
  With a top challenge not marketing related, marketing budget might be negatively impacted
                                  In your opinion, what will be the top 5 Health Care challenges?

Rating 4.00
(5 to 0)                                                                                   1 Dealing with increasing innovation costs
                                                                                             and legal requirements
                                                            3

          3.50                                                                             3 Dealing with specific stakeholders
                                                                                             (social security, other payers)

                                                                                           2 Dealing with increased pressure from
                                                                                             purchasing organizations
                                                   7   54                   1
          3.00                                                  2
                                        8              6                                   4 Dealing with the growth of generic
                                       9                                                     products and alternatives

                                                                                           5 Improving relationships with specialist
          2.50                                                                               doctors

                                                                                           6 Improving relationships with hospitals

                                             1
          2.00               10                    2
                                                                                           7 Dealing with the extended time to
                                                           3                                 market products from R&D to
                                                                                             commercial launch
                                                                                           8 Improving relationships with general
          1.50                                                                               practitioners

                                                                                           9 Improving relationships with
                                                                                             pharmacists

          1.00                                                                             10 Improving relationships with
                 0%   10%   20%      30%     40%       50%       60%       70%      80%       wholesalers
                                                                         Respondents (%)      Last year’s position of the challenge

Presentation1                                                       28
– Draft –
        Compared to last year, health care challenges increased in
        importance, with a new top 2
        Improving relationship with Specialists disappeared of the top 5

                    Top 5 Health Care Challenges 2011                                          Top 5 Health Care Challenges 2010



Dealing with increasing innovation                                           Dealing with specific stakeholders
                                                               70%                                                                      52%
  costs and legal requirements                                                 (social security, other payers)


   Dealing with increased pressure                                                Improving relationships with
                                                         57%                                                                            52%
    from purchasing organizations                                                      specialist doctors


Dealing with specific stakeholders                                                Improving relationships with
                                                        53%                                                                 48%
  (social security, other payers)                                                          hospitals


   Dealing with the growth of                                                   Dealing with the growth of
                                                    49%                                                               46%
generic products and alternatives                                            generic products and alternatives


                                                                             Dealing with the extended time to
        Improving relationships with
                                                   48%                         market products from R&D to            46%
                 hospitals
                                                                                     commercial launch
                                                          Respondents (%)                                                         Respondents (%)




N2010= 56
N2011= 89

Presentation1                                                           29
– Draft –
   Each sector has its own top 1 Health Care Challenge
   While OTC faces increasing innovation costs/ legal requirements, RX will have to deal with
   specific stakeholders, ME more with purchasing organisations & Hospitals with specialists

                                                     Top 5 Health Care challenges per sector

                   OTC                                  RX                             Devices / ME                          Hosp/Care


     Innovation
                                                Specific                       Purchasing
     costs/legal               67%                                   67%                                    76%               SP                 53%
                                             stakeholders                     organizations
    requirements

TTM from R&D to                          Generic
                                                                                 Specific                            Specific
  commercial               52%       products/alterna          48%                                    52%                                        53%
                                                                              stakeholders                        stakeholders
     launch                               tives

                                          Innovation
        Specific
                         43%              costs/legal          45%                Hospitals      43%                    Hospitals          44%
     stakeholders
                                         requirements

    Generic                          TTM from R&D to                          Innovation                           Innovation
products/alterna     29%               commercial             38%             costs/legal     29%                  costs/legal             41%
     tives                                launch                             requirements                         requirements


      Pharmacists    24%                              SP     26%                        SP    29%                             GP     28%

                           Respondents (%)                          Respondents (%)                   Respondents (%)                    Respondents (%)


OTC= 21
RX= 42
Devices / ME= 21
Hosp/Care= 32
Presentation1                                                               30
– Draft –                                                                     title?
       Dealing with new media enters the top 5 Marketing
       challenges but remains very low rated
       HC marketers realize it is a challenge but don’t see it as a priority yet

                                  In your opinion, what will be the top 5 Marketing challenges?

Rating     4.00
(5 to 0)                                                                                  1 Building customer loyalty and trust

                                                                                          2 Differentiating from competitors on
                                                                                            targeted segments
           3.50                                                                           3 Dealing with new media
                             15                                        2 1                  (online, social, mobile)
                                         14            5
                                        13                                                4 Increasing alliances with strategic partners
                                              10
                                           12
           3.00                                               4                           5 Building a strong brand
                                               8
                                              9 76                                        6 Increasing efficiency of marketing and sales
                                                                                            processes
                                                                                          7 Dealing with empowered patients
           2.50                              11
                                                                              2           8 Improving patient experience with the
                                                                                            brand
                                                                   3
                                                                                   1      9 Optimizing the communication-mix (on-
                                                                                            line, off-line, detailing, events…)
           2.00                                                                          10 Segmenting the market and targeting
                                               3                                            customers in a more efficient way
                                                                                         11 Measuring return on marketing efforts

           1.50                                                                          12 Accelerating time to market

                                                                                         13 Optimizing pricing

                                                                                         14 Investing in relevant innovation, product
           1.00                                                                             development and R&D
                                                                                         15 Increasing sustainability
                  0%   10%        20%         30%      40%             50%        60%
                                                                       Respondents (%)


Presentation1                                                     31
– Draft –
    Although HC marketers expect patients influence to increase
    drastically, they do not yet perceive it as a top Marketing
    challenge

                                     To what extent do you agree with the following statements?


                                                                                                                  Net Average Index (%)


                Patients will increasingly search the                                                                     89%
                Internet for diagnostics and advices




           Patients will be more critical and will                                                                        85%
             proactively compare treatments


                                                        0%        20%         40%        60%            80%        100%



                Totally agree    Slightly agree    Neutral     Slightly disagree     Totally disagree         No answer




Presentation1                                                   32
– Draft –
        Two new marketing challenges entered the top 5: Dealing
        with new media & increasing alliances with strategic
        partners
        Top 3 marketing challenges decreased in importance compared to last year

                     Top 5 Marketing Challenges 2011                                             Top 5 Marketing Challenges 2010



     Building customer loyalty and                                               Building customer loyalty and
                                                               51%                                                                           65%
                  trust                                                                       trust


 Differentiating from competitors                                            Differentiating from competitors
                                                             48%                                                                       56%
       on targeted segments                                                        on targeted segments


            Dealing with new media
                                                             48%                       Building a strong brand                        54%
            (online, social, mobile)


Increasing alliances with strategic                                        Increasing efficiency of marketing
                                                         44%                                                                        50%
             partners                                                             and sales processes


            Building a strong brand                    39%                                  Optimizing pricing               41%

                                                         Respondents (%)                                                           Respondents (%)




N2010= 56
N2011= 89

Presentation1                                                           33
– Draft –
     Each Health Care sector has it’s own top 3, but with the same
     challenges ahead…

                                                Top 5 Health Care challenges per sector
Rating 4.50
(5 to 0)                                                                                      1 Building a strong brand
                                                                                              2 Differentiating from competitors
                                                                                          O
                                                                                          T   3 Innovation, product development, R&D
                                                                1                         C   4 Building customer loyalty & trust
        4.00
                                                           2                                  5 ROM efforts
                                                                                              1 Differentiating from competitors
                                                  3
                                                 4                                            2 Building customer loyalty & trust
                                                4         3                               R
        3.50                                                                    1             3 Alliances with strategic partners
                                5                         1                1              X
                                                          2     2                             4 Accelerating TTM
                                                                                              5 Efficient marketing/sales processes
                                        4
                                        4        3              2
                                                                                              1 Differentiating from competitors
        3.00
                                                                                              2 Segmenting & targeting customers/the market
                                    5                 3                                   M
                                                                                              3 Alliances with strategic partners
                                        5                                                 E
                                                                                              4 Optimizing pricing

        2.50                                5                                                 5 Efficient marketing/sales processes
                                                                                              1 Building customer loyalty & trust
                                                                                          C   2 Differentiating from competitors
                                                                                          A   3 Alliances with strategic partners
                                                                                          R
        2.00                                                                              E   4 Building a strong brand
               0%   10%   20%           30%               40%        50%            60%       5 New media (online, social, mobile)
 OTC= 21                                                              Respondents (%)
 RX= 42
 Devices / ME= 21
 Hosp/Care= 32
 Presentation1                                                         34
– Draft –
       Cheaper/generic products’ importance keep increasing

                                         To what extent do you agree with the following statements?

                                                                                                                                      Net Average
                                                                                                                                       Index (%)

                         Government will push cheaper alternatives                                                                        87%


                Physicians will change prescription behavior towards
                                  cheaper products
                                                                                                                                          62%



                 Patients will ask for generic / alternative products                                                                     51%



                          Patients will become more price sensitive                                                                       53%


                                                                        0%           20%            40%         60%        80%     100%


           Substantial increase      Slight increase     Remain stable            Slight decrease         Substantial decrease   No answer




Presentation1                                                                35
– Draft –
       Creating brand loyalty & awareness about product benefits
       as top communication objectives to answer the marketing
       challenges
       These objectives answer very well the top marketing challenges identified before:
       building loyalty/trust as well as differentiate from competition
                                  What are the top 3 communication objectives for your brand?

  Rating        2.50
  (3 to 0)
                                                                                            1 Creating brand loyalty


                                                                                            2 Creating awareness about your
                                                           2                                  product benefits
                                                       4
                                                                                            3 Engaging physicians in supporting
                                                           3                                  your brand

                2.00                                                                        4 Creating awareness about your
                                          6                                                   brand
                                                                      1                     5 Conversing with patients
                                                  5
                                          7                                                 6 Stimulating purchase of your brand


                                                                                            7 Conversing with physicians

                1.50
                       0%   10%   20%    30%     40%       50%        60%        70%
                                                                          Respondents (%)




Presentation1                                                    36
– Draft –
    Compared to 2010, GP’s , pharmacists, research organizations
    & wholesalers influence keep decreasing

                              Key Influencers 2011                                                       Key Influencers 2010


                            Patients                                 77%                       Social security                                     76%

Legal and regulatory institutions                                    75%     Legal and regulatory institutions                                    72%

                Patients associations                              71%                              Hospitals                                     72%

                      Social security                              69%                               Patients                                 70%

                Insurance companies                            66%                      Patients associations                                65%

                           Hospitals                         59%                        Insurance companies                                 59%

                   Specialist doctors                  36%                       Wholesalers and distributors                         42%

                        Pharmacists               27%                                            Pharmacists                        40%

     Wholesalers and distributors                23%                                  Research organizations                      31%

            Research organizations           21%                                            Specialist doctors                  30%

             General practitioners          7%                                          General practitioners               18%

                Clinical laboratories -4%                      NAI(%)                    Clinical laboratories       -23%                    NAI (%)




N2010= 56
N2011= 89

Presentation1                                                               37
– Draft –
       Compared to other industries, traditional media’s such as
       Magazines & Newspaper are still highly present in Health
       Care top 5 channels
                                          Which media channels have you planned to use?

                         Health Care Sector                                                Other industries


                     Online                            71%                             Online                            67%

Own Brochures and magazines                          65%          Own Brochures and magazines                 39%

                  Magazines                         63%                                Mobile                34%

                Newspapers                41%                                       Magazines          23%

                Door-to-door   16%                                                   Outdoor      17%

                  Television   16%                                                      Radio    13%

                     Mobile    13%                                                Newspapers     12%

                      Radio    12%                                                  Television   11%

                      Other    10%                                               Door-to-door    9%

                    Outdoor      6%                                                   Cinema      5%
                                                Responses(%)                                                        Responses(%)




Presentation1                                                     38
– Draft –
       Compared to other industries, Health Care marketers are
       still reluctant to use online channels, keeping it to the
       basics: website building, e-mails
                                                    Which online channels did you plan to use?

                             Health Care Sector                                                       Other industries

                Website building and
                                                                66%                             Social media                             70%
                   optimization

                        Newsletters                           61%         Website building and optimization                              70%

     Direct marketing e-mailings                              59%                 Search engine optimization                            68%

                       Social media                     50%                                      Newsletters                            66%

                  Online advertising              36%                             Direct marketing e-mailings                           66%

      Search engine optimization              30%                                          Online advertising                         61%

                           Webinars                                           Search engine advertising (e.g.
                                        18%                                                                                       53%
                                                                                     google adwords)
 Search engine advertising (e.g.
                                       16%                                                            Mobile             34%
        google adwords)

                             Mobile    11%                                                          Blogging             32%

                            Blogging   8%                                                              Other     20%

                              Other    3%                                                           Webinars    17%            Responses(%)
                                                    Responses(%)



Presentation1                                                            39

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The sentence that is true is:Patients’ influence is expected to increase the mostThis sentence is supported by the data shown, which indicates that "Patients' influence and empowerment" was rated as the top expected challenge, above improving relationships with GPs. The other two statements cannot be determined as true or false based on the information given

  • 1. Logo client Results of the Health Care Survey 2011 Health Care Marketing Congress September 2011 #hcms11 #thom
  • 2. – Draft – Survey participants Sector 9% 15% OTC RX 25% Devices 29% Biotech 5% Hospital/Care 17% Other sectors Scope of responsabilities Job function Marketing Manager 32% 5% 15% Product/brand Manager 21% EMEA/Europe 22% General Manager/CEO 13% BELUX Sales & Marketing Manager 13% Other Communication Manager 13% Worldwide 58% Sales Manager 5% Multichannel/CRM Manager 2% Online marketer 2% Presentation1 2
  • 3. – Draft – Key concept: Net Average Index (NAI) -60% -20% 20% 60% The percentage reflects a balance between the positive, neutral and negative views. It can vary from -100% to +100% depending on the amount of confidence. A positive NAI indicates an increase of importance, the number reveals how relevant or outspoken this increase is. Presentation1
  • 4. – Draft – Chapter I How do Health Care Marketers feel about their FUTURE? Confident Hesitant Pessimistic Presentation1 4
  • 5. – Draft – HC marketers are hesitatingly gaining confidence General Confidence index in Health Care vs Other sectors 30% 27% 28% 26% 25% 25% 23% 25% 18% 20% 15% 20% 10% 10% 6% 5% 0% -5% 2005 2006 2007 2008 2009 2010 2011 -10% -6% Confidence index of marketers from other industries Confidence index of Health Care marketers Evolution in Projects Evolution in Team size Evolution in Budget 25% 23% 70% 25% 20% 60% 18% 20% 17% 60% 55% 20% 15% 52% 13% 14% 49% 48% 15% 13% 15% 50% 8% 8% 13% 10% 5% 9% 10% 8% 11% 40% 47% 4% 5% 0% 1% 28% 5% 30% 25% 37% 0% -1% 0% 20% -5% 2005 2006 2007 2008 2009 2010 2011 2005 2006 2007 2008 2009 2010 2011 21% -10% -5% 10% 16% -3% -15% -10% 0% -20% -21% -15% -11% 2005 2006 2007 2008 2009 2010 2011 -25% NhealthCare = 83 NPresentation1 OtherSectors= 577 5
  • 6. – Draft – HC marketers estimate their budget based on the actual budget instead of the future strategy Q: In 2011, how did the total marketing budget available within your marketing department change and what are the expectations for 2012? 30% 25% 23.0% 20% 15.2% 15% 13.0% 9.4% 10% 5% 0% 2008 2009 2010 2011 2012 -5% -10% -7.4% -15.3% -15% -20% -20.0% -21.1% -25% Budget expectations of Health Care marketers Actual budget of Health Care marketer NPresentation1 healthCare = 83 6
  • 7. – Draft – Key takeaway n°1 “With budgets under pressure, Health Care confidence is being challenged” Presentation1 7
  • 8. – Draft – Chapter II Which sentence is TRUE? Patients will be more loyal towards a product Improving relationships with GP’s has become the nr 1 Health Care Challenge Patients’ influence is expected to increase the most Presentation1 8
  • 9. – Draft – Top Health Care challenges are more administrative while relationship building is pushed down In your opinion, what will be the top 5 Health Care challenges? 4.00 Rating (5 to 0) 1 Dealing with increasing 3 innovation costs and legal requirements 3.50 3 Dealing with specific stakeholders (social security, other payers) 5 4 1 3.00 2 2 Dealing with increased pressure 6 from purchasing organizations 4 Dealing with the growth of 2.50 generic products and alternatives 5 Improving relationships with 1 2.00 2 specialist doctors 3 6 Improving relationships with hospitals 1.50 20% 30% 40% 50% 60% 70% 80% Last year’s position of top 3 Respondents (%) NhealthCare = 83 Presentation1 9
  • 10. – Draft – Dealing with new media enters the top 5 Marketing challenges but remains very low rated In your opinion, what will be the top 5 Marketing challenges? 4.00 Rating (5 to 0) 1 Building customer loyalty and trust 3.50 2 Differentiating from competitors 2 1 5 on targeted segments 3 Dealing with new media 4 3.00 (online, social, mobile) 6 7 4 Increasing alliances with strategic partners 2.50 2 5 Building a strong brand 1 3 2.00 6 Increasing efficiency of marketing and sales processes 3 7 Dealing with empowered 1.50 patients 20% 30% 40% 50% 60% 70% Last year’s position of top 3 Respondents (%) NhealthCare = 83 Presentation1 10
  • 11. – Draft – While the number of influencers increases, a new decision maker holds the top: the patient How do you evaluate the influence of the following stakeholders ? Net Average Index (%) Patients 77% Legal and regulatory institutions 75% Patients associations 71% Social security 69% Insurance companies 66% Hospitals 59% Specialist doctors 36% Pharmacists 27% Wholesalers and distributors 23% Research organizations 21% General practitioners 7% Clinical laboratories -4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Substantial increase Slight increase Remain stable Slight decrease Substantial decrease No answer NhealthCare = 83 Presentation1 11
  • 12. – Draft – Delivering relevant services to both patients and physicians are expected to be key To what extent do you agree with the following statements? Net Average Index (%) Patients will give more value to services 76% Physicians will expect more services from 71% health care companies Patients will be more loyal towards a -29% product 0% 20% 40% 60% 80% 100% Totally agree Slightly agree Neutral Slightly disagree Totally disagree No answer NhealthCare = 83 Presentation1 12
  • 13. – Draft – Key takeaway n°2 “Traditional Health Care challenges have a hard time to include new trends” Presentation1
  • 14. – Draft – Chapter III Major challenges and tight budgets ahead, how will Health Care marketers handle it? They will use traditional tactics (sales reps,…) through traditional media channels (own brochures, magazines,…), leaving the ‘online’ matter for later They will need people with specific HC skills to handle these traditional challenges through traditional HC tactics They will use traditional tactics combining it mainly with the online media channel but keeping it conservative (mainly website building/optimization) Presentation1 14
  • 15. – Draft – To build customer loyalty, HC marketers favor traditional ‘human interaction’ tactics Which are the top 5 marketing tactics for your brand ? Rating 5.00 (5 to 0) 1 Sales reps visiting 4.50 2 Congresses and trainings 1 3 Public relations 4.00 4 Brand activation 3.50 3 5 Advertising 4 2 6 Events 3.00 9 6 7 Direct marketing 7 8 Sponsoring 2.50 11 10 9 Point-of-sales material 5 8 2.00 10 Remote detailing 11 Sampling 1.50 0% 10% 20% 30% 40% 50% 60% 70% 80% Respondents (%) NhealthCare = 83 Presentation1 15
  • 16. – Draft – While costs are clearly under pressure, detailing, congresses and trainings remain top marketing tactics Which are the top 5 marketing tactics planned for your brand & how will your budget for these evolve? Top marketing tactics planned Expected budget evolution NAI (%) Sales reps visiting 67% -17% Congresses and trainings 64% -4% Public relations 52% -10% Brand activation 49% 2% Advertising 47% -18% Events 46% 5% Direct marketing 43% 4% Sponsoring 35% -25% Point-of-sales material 23% -37% Remote detailing 22% -25% Sampling 19% Responses(%) -47% 0% 20% 40% 60% 80% 100% Increase substantially Increase moderately Remain the same Decrease moderately Decrease substantially No budget in 2012 NhealthCare = 83 Presentation1 16
  • 17. – Draft – Online is the first planned media channel but with a very conservative and low structured approach Which media channels have you planned to use? Which online channels have you planned to use? Website building and Online 71% 66% optimization Own Brochures and magazines Newsletters 61% 65% Direct marketing e-mailings 59% Magazines 63% Social media 50% Newspapers 41% Online advertising 36% Door-to-door 16% Search engine optimization 30% Television 16% Webinars 18% Mobile 13% Search engine advertising (e.g. 16% google adwords) Radio 12% Mobile 11% Other 10% Blogging 8% Outdoor 6% Responses(%) Other 3% Responses(%) NhealthCare = 83 Presentation1 17
  • 18. – Draft – Key takeaway n°3 “Traditional tactics will leverage online resources to tackle challenges” Presentation1
  • 19. – Draft – Chapter IV How will the future of Health Care marketing look like? 19 Just like the present It will include responsibilities of sales management, market access and research It will require a significant amount of medical knowledge Presentation1
  • 20. – Draft – Marketers all expect changes in the future role of Marketing but their opinions lack realism How do you expect the role of Marketing to change in the future? Net Average Index (%) Further evolve from traditional marketing channels towards E-marketing 76% More responsibilities in areas such as sales management, market access & market research 65% More decisive role at board level 53% More operational role by making sure costs & 52% processes are carefully managed More supportive role towards Sales 35% Purely focus on the marketing & promotional mix -31% More administrative role -41% I don’t expect any changes in the role of marketing -74% 0% 20% 40% 60% 80% 100% Totally agree Slightly agree Neutral Slightly disagree Totally disagree NhealthCare = 83 Presentation1 20
  • 21. – Draft – Top skills needed to take on these challenges are not health care related Top 5 skills/competences required to fulfill these challenges Rating 3.50 1 Creativity (5 to 1) 3.30 3 2 Communication 6 2 1 3 Strategic 3.10 4 Analytical 2.90 11 4 5 Market access 7 5 2.70 8 6 Negotiation 2.50 12 7 Ethics and Compliance 10 2.30 8 Operational 13 9 9 Organizational 2.10 10 Coaching 1.90 11 Technology 1.70 14 12 Pricing 1.50 13 Medical knowledge 0% 10% 20% 30% 40% 50% 60% 70% 80% 14 Regulatory Respondents (%) NhealthCare = 83 Presentation1 21
  • 22. – Draft – Key takeaway n°4 “Marketers will need to step away from their traditional HC marketer's role” Presentation1 22
  • 23. – Draft – To wrap things up… 4 Key Takeaway’s Presentation1 23
  • 24. – Draft – Key takeaways 1. With budgets under pressure, Health Care confidence is being challenged 2. Traditional Health Care challenges have a hard time to include new trends PATIENT 3. Traditional tactics will leverage online resources to tackle challenges 4. Marketers will need to step away from their traditional HC marketer's role Presentation1 24
  • 25. – Draft – An initiative by http://www.thom.be/ In collaboration with Presentation1 25
  • 26. – Draft – Back-up slides Presentation1 26
  • 27. – Draft – Key concept: Net Average Index (NAI) Quantifying Health Care Marketers’ beliefs How do you expect a certain parameter to evolve?  Options: Decrease, will stay the same, increase  Calculation of the index: a percentage between -100% and +100% -60% -20% 20% 60% The percentage reflects a balance between the positive, neutral and negative views. It can vary from -100% to +100% depending on the amount of confidence. A positive NAI indicates an increase of importance, the number reveals how relevant or outspoken this increase is. Presentation1
  • 28. – Draft – Top Health Care challenges this year will be more administrative while relationship building challenges are pushed down With a top challenge not marketing related, marketing budget might be negatively impacted In your opinion, what will be the top 5 Health Care challenges? Rating 4.00 (5 to 0) 1 Dealing with increasing innovation costs and legal requirements 3 3.50 3 Dealing with specific stakeholders (social security, other payers) 2 Dealing with increased pressure from purchasing organizations 7 54 1 3.00 2 8 6 4 Dealing with the growth of generic 9 products and alternatives 5 Improving relationships with specialist 2.50 doctors 6 Improving relationships with hospitals 1 2.00 10 2 7 Dealing with the extended time to 3 market products from R&D to commercial launch 8 Improving relationships with general 1.50 practitioners 9 Improving relationships with pharmacists 1.00 10 Improving relationships with 0% 10% 20% 30% 40% 50% 60% 70% 80% wholesalers Respondents (%) Last year’s position of the challenge Presentation1 28
  • 29. – Draft – Compared to last year, health care challenges increased in importance, with a new top 2 Improving relationship with Specialists disappeared of the top 5 Top 5 Health Care Challenges 2011 Top 5 Health Care Challenges 2010 Dealing with increasing innovation Dealing with specific stakeholders 70% 52% costs and legal requirements (social security, other payers) Dealing with increased pressure Improving relationships with 57% 52% from purchasing organizations specialist doctors Dealing with specific stakeholders Improving relationships with 53% 48% (social security, other payers) hospitals Dealing with the growth of Dealing with the growth of 49% 46% generic products and alternatives generic products and alternatives Dealing with the extended time to Improving relationships with 48% market products from R&D to 46% hospitals commercial launch Respondents (%) Respondents (%) N2010= 56 N2011= 89 Presentation1 29
  • 30. – Draft – Each sector has its own top 1 Health Care Challenge While OTC faces increasing innovation costs/ legal requirements, RX will have to deal with specific stakeholders, ME more with purchasing organisations & Hospitals with specialists Top 5 Health Care challenges per sector OTC RX Devices / ME Hosp/Care Innovation Specific Purchasing costs/legal 67% 67% 76% SP 53% stakeholders organizations requirements TTM from R&D to Generic Specific Specific commercial 52% products/alterna 48% 52% 53% stakeholders stakeholders launch tives Innovation Specific 43% costs/legal 45% Hospitals 43% Hospitals 44% stakeholders requirements Generic TTM from R&D to Innovation Innovation products/alterna 29% commercial 38% costs/legal 29% costs/legal 41% tives launch requirements requirements Pharmacists 24% SP 26% SP 29% GP 28% Respondents (%) Respondents (%) Respondents (%) Respondents (%) OTC= 21 RX= 42 Devices / ME= 21 Hosp/Care= 32 Presentation1 30
  • 31. – Draft – title? Dealing with new media enters the top 5 Marketing challenges but remains very low rated HC marketers realize it is a challenge but don’t see it as a priority yet In your opinion, what will be the top 5 Marketing challenges? Rating 4.00 (5 to 0) 1 Building customer loyalty and trust 2 Differentiating from competitors on targeted segments 3.50 3 Dealing with new media 15 2 1 (online, social, mobile) 14 5 13 4 Increasing alliances with strategic partners 10 12 3.00 4 5 Building a strong brand 8 9 76 6 Increasing efficiency of marketing and sales processes 7 Dealing with empowered patients 2.50 11 2 8 Improving patient experience with the brand 3 1 9 Optimizing the communication-mix (on- line, off-line, detailing, events…) 2.00 10 Segmenting the market and targeting 3 customers in a more efficient way 11 Measuring return on marketing efforts 1.50 12 Accelerating time to market 13 Optimizing pricing 14 Investing in relevant innovation, product 1.00 development and R&D 15 Increasing sustainability 0% 10% 20% 30% 40% 50% 60% Respondents (%) Presentation1 31
  • 32. – Draft – Although HC marketers expect patients influence to increase drastically, they do not yet perceive it as a top Marketing challenge To what extent do you agree with the following statements? Net Average Index (%) Patients will increasingly search the 89% Internet for diagnostics and advices Patients will be more critical and will 85% proactively compare treatments 0% 20% 40% 60% 80% 100% Totally agree Slightly agree Neutral Slightly disagree Totally disagree No answer Presentation1 32
  • 33. – Draft – Two new marketing challenges entered the top 5: Dealing with new media & increasing alliances with strategic partners Top 3 marketing challenges decreased in importance compared to last year Top 5 Marketing Challenges 2011 Top 5 Marketing Challenges 2010 Building customer loyalty and Building customer loyalty and 51% 65% trust trust Differentiating from competitors Differentiating from competitors 48% 56% on targeted segments on targeted segments Dealing with new media 48% Building a strong brand 54% (online, social, mobile) Increasing alliances with strategic Increasing efficiency of marketing 44% 50% partners and sales processes Building a strong brand 39% Optimizing pricing 41% Respondents (%) Respondents (%) N2010= 56 N2011= 89 Presentation1 33
  • 34. – Draft – Each Health Care sector has it’s own top 3, but with the same challenges ahead… Top 5 Health Care challenges per sector Rating 4.50 (5 to 0) 1 Building a strong brand 2 Differentiating from competitors O T 3 Innovation, product development, R&D 1 C 4 Building customer loyalty & trust 4.00 2 5 ROM efforts 1 Differentiating from competitors 3 4 2 Building customer loyalty & trust 4 3 R 3.50 1 3 Alliances with strategic partners 5 1 1 X 2 2 4 Accelerating TTM 5 Efficient marketing/sales processes 4 4 3 2 1 Differentiating from competitors 3.00 2 Segmenting & targeting customers/the market 5 3 M 3 Alliances with strategic partners 5 E 4 Optimizing pricing 2.50 5 5 Efficient marketing/sales processes 1 Building customer loyalty & trust C 2 Differentiating from competitors A 3 Alliances with strategic partners R 2.00 E 4 Building a strong brand 0% 10% 20% 30% 40% 50% 60% 5 New media (online, social, mobile) OTC= 21 Respondents (%) RX= 42 Devices / ME= 21 Hosp/Care= 32 Presentation1 34
  • 35. – Draft – Cheaper/generic products’ importance keep increasing To what extent do you agree with the following statements? Net Average Index (%) Government will push cheaper alternatives 87% Physicians will change prescription behavior towards cheaper products 62% Patients will ask for generic / alternative products 51% Patients will become more price sensitive 53% 0% 20% 40% 60% 80% 100% Substantial increase Slight increase Remain stable Slight decrease Substantial decrease No answer Presentation1 35
  • 36. – Draft – Creating brand loyalty & awareness about product benefits as top communication objectives to answer the marketing challenges These objectives answer very well the top marketing challenges identified before: building loyalty/trust as well as differentiate from competition What are the top 3 communication objectives for your brand? Rating 2.50 (3 to 0) 1 Creating brand loyalty 2 Creating awareness about your 2 product benefits 4 3 Engaging physicians in supporting 3 your brand 2.00 4 Creating awareness about your 6 brand 1 5 Conversing with patients 5 7 6 Stimulating purchase of your brand 7 Conversing with physicians 1.50 0% 10% 20% 30% 40% 50% 60% 70% Respondents (%) Presentation1 36
  • 37. – Draft – Compared to 2010, GP’s , pharmacists, research organizations & wholesalers influence keep decreasing Key Influencers 2011 Key Influencers 2010 Patients 77% Social security 76% Legal and regulatory institutions 75% Legal and regulatory institutions 72% Patients associations 71% Hospitals 72% Social security 69% Patients 70% Insurance companies 66% Patients associations 65% Hospitals 59% Insurance companies 59% Specialist doctors 36% Wholesalers and distributors 42% Pharmacists 27% Pharmacists 40% Wholesalers and distributors 23% Research organizations 31% Research organizations 21% Specialist doctors 30% General practitioners 7% General practitioners 18% Clinical laboratories -4% NAI(%) Clinical laboratories -23% NAI (%) N2010= 56 N2011= 89 Presentation1 37
  • 38. – Draft – Compared to other industries, traditional media’s such as Magazines & Newspaper are still highly present in Health Care top 5 channels Which media channels have you planned to use? Health Care Sector Other industries Online 71% Online 67% Own Brochures and magazines 65% Own Brochures and magazines 39% Magazines 63% Mobile 34% Newspapers 41% Magazines 23% Door-to-door 16% Outdoor 17% Television 16% Radio 13% Mobile 13% Newspapers 12% Radio 12% Television 11% Other 10% Door-to-door 9% Outdoor 6% Cinema 5% Responses(%) Responses(%) Presentation1 38
  • 39. – Draft – Compared to other industries, Health Care marketers are still reluctant to use online channels, keeping it to the basics: website building, e-mails Which online channels did you plan to use? Health Care Sector Other industries Website building and 66% Social media 70% optimization Newsletters 61% Website building and optimization 70% Direct marketing e-mailings 59% Search engine optimization 68% Social media 50% Newsletters 66% Online advertising 36% Direct marketing e-mailings 66% Search engine optimization 30% Online advertising 61% Webinars Search engine advertising (e.g. 18% 53% google adwords) Search engine advertising (e.g. 16% Mobile 34% google adwords) Mobile 11% Blogging 32% Blogging 8% Other 20% Other 3% Webinars 17% Responses(%) Responses(%) Presentation1 39

Notas del editor

  1. Quantifying Health Care Marketers’ beliefs
  2. Team increases much more than projects and budgetI still believe that there’s an insights related to the results: stable projects + decreasing budgets + increasing teams à the content of projects must have changed: more dependent on people than money. The reason why they’re hesitant might be the fact that they’re not used to that changePostiefvoor team size, wellichtnaperiode van under-staffingMaarprojectenblijvenstabiel, budget daaltiets.Du snietovertuigendpositief
  3. This generates a gap year after yearThe smart marketers amongst you could take the risk to swich toward a more positive expectation 
  4. With a top challenge not marketing related, marketing budget might be negatively impactedtop challenges do not add value to the health care chain. We are very far from the concept of Return on Health (and patients) – link to LievenAnnemans’ keynote?Relationship push down for specialists, hospitals, GP’s and pharmacists
  5. HC marketers realize it is a challenge but don’t see it as a priority yetpharma seems far from patients (because of constraints?). As innovation is getting difficult, they need to strengthen loyalty and trust, and differentiate (vs competitors) in another way. New media: either they don’t know how to handle it, or they don’t trust it, or they don’t think it’s possible, but that can have something to do with a lack of results assessment - maybe link to Dave Michels’ keynote
  6. Legal & regulatory institutions’ influence is also expected to increase severely while GP’s collect mix feelings
  7. to answer the challenge of building customer loyalty and trust This still will be very challenging as patients are increasingly empowered
  8. sales reps as well known nr 1Key Tactics planned are expensive although budget expectations are low
  9. Budget is mostly expected to remain the samelink to WimHamaekers’ keynote
  10. Responses for planned online channels remain low (under the 70%)marketers might not invest so much in online because they can’t track & measure success of some parts of this yet (same as other industries cf YMS?) - maybe link to Dave Michels’ keynote. Although online might be a good way to touch patients in a legal way (cf internet penetration). Knowing how limited strategies of social media and online advertising are, I think we can challenge their answers a bitWarning: this slide is biased by the 25% Hospital/Care respondents who don’t leverage reps, congresses, trainings, public relations so much66% of total survey respondents plan to build website (not 66% of the 71%)
  11. There is no real focus, all challenges being handled at once
  12. Regulatory & Medical knowledge are last in the top list