Reshaping pharmaceutical marketing: read Istat and Censis and get it over with

The periodic report of Istat, to which I subscribe as a journalist, has recently been published. You can either read it like a book and carry on unperturbed, or immediately change all the strategic dynamics of pharmaceutical marketing in Italy.

Of course, studying the Istat scenario and making pharmaceutical marketing strategic plans seems like a no-brainer, but I feel entitled to read this report with you and try to see what is being hypothesised and how we marketeers can respond.

Point one: the population is set to decline. In particular, together with ageing we will have by 2050 that the potentially active population 15-64 years old will undergo a sudden contraction from 63.8% to 53.3% with a very serious loss of 10 points in 30 years. In addition to the evolutionary effects of the labour market, the pressure that the country will have to face in trying to maintain the current level of welfare must also be strongly considered.

Point two: the population is ageing. The average age of the population in 2050 will be 50.7 years, even the Italian population will age by 5 years in just 30 years. The ratio of young people to the elderly will be 1 to 3 in 2050, while the working-age population will drop from 63.8% to 53.3% of the total in 30 years. The population aged 65 and over will account for 23.2% of the total, those up to 14 years of age for 13%, those in the 15-64 age bracket for 63.8%, while the average age has approached 46. Thus, it is certain that future prospects will be largely governed by the current age structure of the population and only to a lesser extent by the imagined changes in fertility, mortality and migration dynamics. By 2050, people aged 65 and over could account for 35% of the total in the median scenario. In any case, it will therefore be necessary to further adapt social protection policies to such an increasing share of the elderly population. Young people up to 14 years of age, although fertility is expected to recover in the median scenario, could represent 11.7% of the total by 2050, thus declining slightly. The question remains, however, that at that date the ratio of over-65s to young people will be 3:1.

Point three: increasing loneliness. As many as 10.3 million people will be living alone in 2040, some 2 million more than today, and only one in four families will be made up of a couple with children, while one in five will have no children. Small towns and villages will be emptied, and within 10 years 81% of Italy's municipalities will experience a decline in population, particularly in rural areas. By 2040 we will have more than 10 million single people.

Point four: increasing chronicity. The elderly with at least one chronic illness will increase by over 2 million by 2040, out of an increase in patients suffering from at least one pathology of over 3.5 million people in total. According to Osservasalute (Osservatorio sulla salute regionale dell'Università Cattolica) the number of chronically ill people will be 25 million by 2028, while the number of multi-chronically ill people will be 14 million. The most frequent chronic disease will be hypertension, with almost 12 million people affected, followed by arthrosis/arthritis. Within the same timeframe, 5.3 million people will suffer from osteoporosis, 3.6 million from diabetes and 2.7 million from heart disease in Italy. Chronic bronchitis, allergic diseases, nervous disorders and ulcers will increase at a similar rate. In addition to pathologies and therefore assuming drugs for specific therapies, in my view we need to start looking at the picture more from a distance.

Point five: the decline in primary care medicine. In the last ten years the absolute number of General Practitioners (GPs) has decreased by about 4,000, 78% of them have more than 23 years of seniority of degree and each GP assists on average 1,224 people. And the same dynamic is true for Pediatricians of Free Choice (PLS), who have decreased by 287 units in the same period of time.

Point six: greater patient autonomy and competence. It is not only the issue of the ability to question Dr. Google, but it is the increased willingness to be involved. I quote in full from a paper by Guendalina Graffigna et Al. for the first consensus conference on patient engagement:
"The last decades have seen a profound shift in care models towards an ever greater enhancement of the role of the person, seen as an active and "expert" subject within the clinical-assistance process. On the other hand, health care systems have to deal with people who express the wish to play a more active role in all the phases of the health care process and to know in depth all the possible treatment options, their advantages and risks".

These are a few simple aspects that in my opinion have an impact on Italian pharmaceutical marketing. Obviously others who are better at it will be able to grasp other more profound aspects, but these are already enough to give us a clear picture of the trends in pharmaceutical "consumption".
These demographic dynamics must be linked to how the economy will fare in Italy. If we are all richer, then we can imagine that the elderly, even if they are alone, will devote themselves to keeping healthy with fitness, spas, devoting their time to feeling good and enjoying old age. If, on the other hand, poverty should increase, then we could imagine that the elderly, alone, need assistance and this pressure will be borne by the state and local authorities. This pressure will be borne by the state and local authorities, which will need to have structures (including technology) and resources (not only financial) to cope with the increased demand for health care from needy and dependent people.

What are the megatrends? How should the new marketing structure be organised?         I will try to suggest the first ones that come to mind:
  • The state will want to save money (and it will have to);
  • Technology will be indispensable for care (and therapy);
  • The doctor's time will be more precious (availability and attention will decrease);
  • The patient at the centre is no longer a slogan (the patient puts himself at the centre).
  • We are on a path which, between now and the next few years, will lead us, apart from Covid or other disruptions (stagflation, wars, ...), to a world that is very different from the current one, in which pharmaceutical companies will have to:
  • Collaborate with the Payer to contain public spending;
  • Propose and promote technologies and not just drugs;
  • Enhance every moment of contact with the doctor, the other healthcare players and the patient.
The moment of contact with the doctor must absolutely take into account the fact that the combination of the above-mentioned dynamics is capable of permanently changing the doctor's attitude, and relationship marketing must take this into account. The pharmaceutical company's interaction with the doctor becomes more "valuable" for him and therefore for us. At the same time, the company cannot neglect the opportunity, always limited but very valuable, to offer information support directly to the patient. It must see its environment populated not only by informants and doctors, but by all the players in a giant network.
Do you feel involved in this model, or do you hope to retire sooner?
Salvatore Ruggiero

Salvatore Ruggiero

Salvatore Ruggiero nasce a Napoli nel 1964, si definisce un imprenditore seriale. Oggi a capo del gruppo Merqurio, di cui è stato anche fondatore. Sposato con Giuseppina, ha due figli e nel tempo libero, tra un'escursione e un'altra, tra un film ed un altro, è alla ricerca della ricetta dei biscotti perfetti.

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