Access to health care and medicine

Every year we assume responsibility for the well-being of millions of patients. We offer lifesaving and life-sustaining products and therapies in more than 90 countries. In developing and improving these products and therapies, we take into account different social and regulatory requirements and adapt them to different health care systems. This will enable us to meet the growing global demand for innovative, high-quality therapies.

Our products are often used to treat people who are suffering from serious or chronic diseases. Our task is to ensure the safety and quality of our products and services and to meet the highest safety and quality standards for all processes and therapies.

Our range of products and services includes a comprehensive network of hospitals, the availability of modern dialysis procedures and post-acute care – such as rehabilitation – and high-quality medical products. Our portfolio also includes digital health services, advanced therapies, and the expansion of primary care in emerging and developing countries. The main focus is on the quality of our products and of the medical care we provide our patients.

In 2020, access to health care and medicine was hampered by the COVID-19 pandemic. In these challenging times, we have taken on our special responsibility as part of the health care system with extensive measures. Further information can be found in the Group Management report and in Progress and measures of this report.

Our approach

Fresenius’ long-term goal is to further develop the company’s position as one of the leading international providers of health care products and services. In recent years, we have expanded our company along our value chain – increasing the global availability of our products and services.

The constant development of our products and services allows us to take advantage of growth opportunities. We guarantee our patients high-quality, comprehensive health care with our products and in our own facilities, allowing them to benefit from medical progress. Our core business focuses on ensuring that as many people as possible worldwide are able to participate in this progress. This ambition is also reflected in our commitment with regard to the society.

Fresenius Medical Care

Providing access to health care is an important topic and covers a broad range of activities. Fresenius Medical Care supports the development of infrastructure for renal care and cooperates with authorities to offer affordable care to a growing number of patients. Innovative digital services and products also help improve access to health care services and flexibility for patients. In crisis and emergency situations, the business segment benefits from its vertically integrated organization to provide access to health care to patients in need.

Fresenius Kabi

Fresenius Kabi is committed to improving the quality of life of patients. Fresenius Kabi’s product portfolio comprises a comprehensive range of I.V. generic drugs, infusion therapies and clinical nutrition products as well as the devices for administering these products. In the field of biosimilars, Fresenius Kabi focuses on autoimmune diseases and oncology. Within transfusion medicine and cell therapies, the company offers products for collection of blood components and extracorporeal therapies. These products and services are used to treat and care for critically and chronically ill patients.

With its comprehensive range of generics and its biosimilarsBiosimilarsA biosimilar is a drug that is “similar” to another biologic drug already approved. products, Fresenius Kabi offers affordable alternatives and contributes to provide access to modern, high-quality and affordable therapies for patients.

Fresenius Kabi is in regular exchange with the Access to Medicine Foundation, for example with regard to the Antimicrobial Resistance (AMR) Benchmark. In this Benchmark selected manufacturers of generic drugs are regularly evaluated in the categories Appropriate Access, Stewardship and Responsible Manufacturing. Fresenius Kabi scores consistently high and achieved third place in the latest AMR Benchmark 2020 among the companies evaluated in the category of generic drug manufacturers.1

1 Access to Medicine Foundation – Antimicrobial Resistance Benchmark

Fresenius Helios

Fresenius Helios’ acute care hospitals offer the full range of medical services throughout Germany and Spain. Most people can reach a Fresenius Helios hospital in Germany within an hour. The hospitals in Spain and South America acquired in recent years also aim to improve and further expand access to health care in their markets. This international network enables Fresenius Helios to transfer knowledge between two European health care systems: the German system provides health care at a high level that remains affordable. The Spanish health care sector offers more integrated outpatient and inpatient health care, with very high standards of service and patient experience. Particularly in 2020, this network enabled us to learn from each other. For example, an intensive exchange of knowledge took place in the treatment of COVID-19 patients in order to improve treatment outcomes in both countries for the benefit of patients.

Fresenius Vamed

Fresenius Vamed is active worldwide in the planning and construction of health care buildings with the aim of serving patient health and improving access to health care services. Fresenius Vamed also provides worldwide operational management services and technical services with a focus on building, construction, and medical technology, sterile goods supply, information and communication technology, and infrastructure and business services worldwide. This enables us to provide access to high-quality medical care for a growing number of people.

Patient safety is directly dependent on the quality of the treatments or products used and also indirectly on the provision of operational management services. Fresenius Vamed’s main goal which also represents an opportunity is to give people around the world access to health care services at all levels of care.

Progress and measures 2020

Product portfolio

Demand for affordable health care products is growing in emerging markets. To facilitate access to dialysis treatment, Fresenius Medical Care has developed the 4008A dialysis machine which meets high therapy standards while reducing costs for health care systems. At the same time, it is designed to be easy to handle even in challenging infrastructures and remote locations. In 2019, the 4008A dialysis machine was successfully launched in Asian emerging markets, including India, Pakistan, Nepal, and Bangladesh.

Fresenius Kabi is constantly expanding its product range to provide high-quality and affordable health care to more patients. The company continuously expands the availability of its products in established markets as well as in new markets including emerging markets and has launched new products in 2020. Fresenius Kabi, for example, launched the Exilia infusion pump system in 2020, a system in high demand during the COVID-19 pandemic.

In focus: Fresenius Helios strengthens through targeted acquisitions

In the year under review, Helios Germany strengthened its hospital network by acquiring four hospitals and six associated medical care centers in Bonn, Duisburg and Krefeld from the Malteser humanitarian aid group. The facilities have a total of 1,270 beds. Approximately 2,750 employees treat around 48,000 patients a year at the three locations. Together with the existing facilities, Helios Deutschland will in future be able to offer people in this region even better health care, tailored to their individual needs, with outpatient and inpatient treatment that go hand in hand.

Fresenius Helios acquires hospital in western Germany.

Fresenius acquires Malteser hospitals in German state of North-Rhine-Westphalia.

At the end of the year under review, Fresenius Helios acquired the Eugin Group. With about 1,300 employees, 31 clinics and 34 other sites in nine countries on three continents, the company offers a wide spectrum of state-of-the-art services in the field of fertility treatments. Fresenius Helios has already been offering fertility treatments in selected hospitals and outpatient centers in Germany, Spain and Latin America for many years. With the acquisition of the Eugin Group, the business segment becomes a leading international provider in this dynamically growing market and establishes a strong basis for further expansion.

Fresenius Helios acquires fertility services provider Eugin Group.

Helios Spain acquired hospitals in Colombia and in Spain the Hospital Nosa Señora dos Ollos Grandes in Lugo.

A comprehensive safety concept consisting of ten combined measures ensured that patients, visitors and employees in the clinics were protected against infection in 2020, which was significantly impacted by COVID-19. To ensure safe access to the clinics, mask scanners were introduced in the entrance areas of all Fresenius Helios hospitals and the outpatient centers, which provide feedback via a screen as to whether the mouth / nose protection is being worn correctly. Moreover, all Helios Spain Hospitals are ­certified as COVID-Safe by an outside certification entity.

Fresenius Vamed is one of the leading private providers of post-acute care in Central Europe, thus strengthening access to the relevant services, especially in the rehabilitation segment. In 2020, the expansion of outpatient rehabilitation services was driven forward. The new outpatient offerings are easy to access and enable in-service utilization of medically necessary rehabilitation services. In Germany, a total of 3 new outpatient rehabilitation clinics were opened in 2020, while in Austria the construction of 5 outpatient rehabilitation clinics continued despite the Corona crisis; these will open for patient operations in 2021. In Switzerland, the Zihlschlacht rehabilitation clinic was expanded with the commissioning of a 4-star superior private clinic for international patients and Swiss private patients.

Patient support in crisis and emergency situations

As a health care Group, we have to be crisis-proof and respond flexibly in all areas: it is our task to enable unrestricted access to our services and seamless care for patients even under difficult conditions. To ensure this, we have established high-performance as well as resilient emergency systems and programs in our business segments.

Fresenius Medical Care operates dialysis facilities in many regions of the world with diverse geographic, social and economic conditions. The business segment serves a vulnerable population of patients who need regular dialysis treatment multiple days a week. To ensure that patients receive their dialysis treatment, even in extreme conditions, Fresenius Medical Care has developed robust emergency response systems. For example, a system of regionally organized emergency response teams is in place to ensure business continuity. In addition to disaster response activities, Fresenius Medical Care repeatedly donates funds, dialysis machines and medical supplies to organizations that urgently require support.

Fresenius Kabi has a crisis team for emergency situations. The crisis team is set up at Management Board level immediately after an event that could lead to a crisis becomes known. The crisis team comprises members of the Management Board, key staff units, and other relevant functions of the business segment and initiates the necessary measures.

In the hospital sector, there are legal requirements for how care is to be organized in the event of an emergency. At Fresenius Helios, for example, emergency power generators ensure that operations or vital therapies, such as artificial respiration, can continue even in the event of a power failure. Fresenius Helios has developed contingency plans as part of its country-specific hospital infrastructure.

At Fresenius Vamed, a structured crisis management system takes immediate effect in crisis situations. It comprises the Management Board, key staff units and the management teams of the lead companies. The crisis team meets as soon as a crisis becomes known and initiates all necessary measures. Fresenius Vamed's facilities have emergency and outage concepts and crisis communication plans in place, which have been drawn up together with the local emergency units. These measures have increased the speed of response to individual COVID-19-related incidents and thus made it possible to provide facilities that were particularly affected with additional protective equipment.

Health care delivery during the COVID-19 pandemic

The COVID-19 pandemic posed major challenges to the global health care system in 2020. For Fresenius as a health care Group and as a company with a very large number of employees as well as patient contact, pandemic protection and prevention are essential. Emergency management plays a key role in this: it enables us to maintain the care of all patients in our health care facilities and ensure the supply of medicines. Based on the legal requirements and regulatory recommendations for the COVID-19 pandemic, our business units implemented numerous measures in response to the pandemic:
The COVID-19 pandemic presented Fresenius Medical Care with an extraordinary challenge in 2020. The business segment established strict safety protocols in its more than 4000 clinics to maintain the provision of essential treatments while reducing the risk of infection for patients and staff. Measures included screening all patients and staff entering the clinics and providing them with personal protective equipment. Fresenius Medical Care also set up isolation centers for infected patients. Under these circumstances, the business segment treated more than 29,000 patients with COVID-19 in North America and rolled out an expanded telehealth platform to support social distancing for both home and in-center patients. Acute kidney injury is common in critically ill COVID-19 patients. Fresenius Medical Care provided hundreds of acute dialysis devices and other supplies to hospitals for emergency treatment. Despite the increased safety measures, Fresenius Medical Care was able to continue producing and delivering life-saving products, even when operations and supply chains were hampered by global restrictions. Demand for some of Fresenius Kabi's drugs and medical devices has increased significantly due to the COVID-19 pandemic. Fresenius Kabi reacted to this demand early and switched production. This enabled the business segment to use all suitable capacities to expand production volume for these products. Despite the significantly higher production costs for essential drugs used to treat COVID-19 patients, Fresenius Kabi kept prices for these drugs stable during the pandemic. The measures taken at our Fresenius Helios' hospitals were always carried out in close, continuous consultation with the respective crisis team at Group level and the crisis teams or task forces of the clinics as well as the central and local hospital hygiene departments. In several Helios facilities in Germany, emergency departments had to be closed briefly in 2020. There were also temporary admission suspensions at entire clinics in the reporting year due to frequent coronavirus infections among employees or patients – for example at Helios Klinikum Bad Saarow in October 2020. Apart from these exceptions, health care services were maintained. Scheduled elective procedures were completely suspended in the first wave of the pandemic in spring 2020 due to political requirements on hospitals. In the second wave in fall / winter 2020, hospitals made their own decisions about whether to maintain elective procedures, depending on utilization. In Spain, the emergency rooms were never closed, but scheduled activities were reduced or even suspended as ordered by the authorities. The number of intensive care beds in Germany in spring 2020 was increased from 900 to 1,500; in the fall, the number was increased again to a total of 2,300 beds. During the first wave, the Spanish hospitals temporarily duplicated the number of intensive care beds, and incremented the conventional hospital beds to respond to the elevated number of COVID-19-patients. Fresenius Helios also launched a COVID-19-hotline in Germany in 2020, offering 24-hour telephone advice from 30 experts and receiving around 18,000 calls during the first peak phase of the pandemic alone. Helios Spain uses its corporate social media channel in Spanish language to provide written information or videos on most urgent questions, like hygiene, vaccines or even the impact on family life, as well as information on the impact of appointments in hospitals and the availability of COVID-19 tests in our centers. Further, two hotlines were created, one for general information and recommendations on COVID-19 and a second hotline to attend patients with suspected infection. In total, Helios Spain received around 13,000 calls. Among other things, Fresenius Vamed created catalogs of measures in which the pandemic experiences of all health care facilities in Austria, Germany, the Czech Republic, the UK, and Switzerland were collected; these catalogs are updated regularly. The experience gained will continue to be incorporated into risk management in the future; it will help Fresenius Vamed to continuously improve its processes and responsible action. Furthermore, a 24 / 7 information hotline as well as comprehensive and continuously updated information on the Fresenius Vamed intranet "Corona Infocenter" are available to Fresenius Vamed staff for current questions on the pandemic. Please refer to the Notes to the Consolidated Financial Statements for further information on assistance programs provided by various governments in the form of reimbursement payments and funding in connection with the COVID-19 pandemic.

Promotion of health awareness

The measures to promote health awareness in 2020 were dominated by COVID-19. During the coronavirus pandemic, our patients have been continuously informed about the observance of hygiene rules in our health care facilities. At Fresenius, mask scanners have been installed in the entrance areas of hospitals, and the range of video consultation hours has also been expanded. In addition, learning and information videos have been made available on our website. Fresenius Kabi promotes awareness and scientific exchange with health care professionals on clinical nutrition during patient treatment, for example through webinars or during congresses. In 2020, the business segment held a webinar series focusing on nutrition in the treatment of COVID-19 patients and on convalescent plasma as a potential treatment option for COVID-19 patients. At Helios Spain, webinars were held between hospitals to share best practices on the use of personal protective equipment. Further, a dedicated contact center supported the occupational safety department in tracking and tracing infected employees. About 3000 calls were made.

Fresenius Kabi supports health care professionals and patients by offering training and providing information materials. In the field of biosimilars, the business segment develops medical training including webinars that focus on the concept of biosimilars, the appropriate nutrition and autoimmune conditions, for example. Fresenius Kabi offers KabiCare, a comprehensive patient support program that supports health care professionals and patients cope and live with autoimmune conditions. KabiCare provides information about the disease and products, training including injection training, coaching tools, nutrition information, and other practical tips to help cope with the disease.

Social commitment

The ambition to provide access to health care for as many people as possible worldwide and to continuously improve it is also pursued by our business segments through their social commitment. Fresenius Medical Care's social commitment focuses on regional and local initiatives that support the interests of kidney patients. This includes emergency aid in crisis situations, e.g. through donations of dialysis machines and medical supplies, as well as long-term measures such as Kidney Kid, an initiative to educate children about kidney health at an early age. Fresenius Kabi and Fresenius Helios actively support social causes through donations or employee community engagement, among other things.

Our materiality analysis

Patient and product safety