The United States' southern neighbor and the East African nation of Kenya ranked as the most favorable markets for used equipment on a new U.S. Commercial Service reference guide on global prospects for American medical device exporters, while India was noted as a hotspot for the capital equipment industry.

The report, released a few weeks ago, was compiled over the summer based on findings by Commercial Service staff and local experts on opportunities for U.S. manufacturers and exporters in 49 countries.

A reference chart accompanying the guide gives countries rankings as prospects in a number of sectors, including health IT, surgical devices, capital equipment, orthopedic products and monitoring equipment, with 4 meaning U.S. exporters had the best shot at success and 1 the worst.

While Bulgaria, India, the Philippines and Serbia all got a 3 as markets for used equipment -- meaning they offered more opportunities than challenges for exporters -- Mexico and Kenya were the only nations to get a 4 as used equipment prospects.

The reason? For Mexico, it's possibly because of the proximity and the ease with which relationships are built between dealers in the United States and customers across the border, according to September Secrist, the global health care team leader with the U.S. Commercial Service, the division of the Commerce Department that produced the report.

"There's occasionally a sensitivity that Americans or wealthier countries (are) just shoving off our leftovers onto other countries," she told DOTmed News by phone, referring to the occasional reluctance of buyers to purchase used equipment. "When you have a country that is close enough like Mexico, it's easier to see the relationships that are built, see the sustainability of the used medical equipment."

Mexico does have some drawbacks for used sellers, though. Public hospitals are forbidden by law from buying used or refurbished products, the report said, and large private hospitals are eager to have the fanciest, most modern stuff. As a result, small and medium private hospitals are the main buyers for used equipment.

Still, Mexico is a huge market, with imports of all kinds of medical equipment totaling almost $3.9 billion last year, half of which were products of U.S. origin, according to the report.

"With Mexico it's just (about the) strongest relationships," Secrist observed. "That's how any agreements come to be, it's based on relationships."

Here's a snapshot of a couple of the other countries mentioned in the report:

Brazil

With $8 billion in predicted device sales next year, Brazil is the largest market for medical equipment in South America. It's effectively off-limits to most U.S. used equipment exports, as the country has tight controls on admitting used equipment. However, U.S. companies still carry on a brisk trade there, with U.S. goods accounting for almost a third of all medical device imports, according to the Commerce Department.

Nonetheless, it can be a tough business climate. "It's still a very protectionist market," Secrist said. "The biggest thing you're going to encounter are very high tariff rates, from 40 to 80 percent, especially if there is a local industry that is considered a competitor." Anvisa, the South American country's equivalent to our own Food and Drug Administration, also can be "difficult" to get through, she said. Exporters typically must also have a local partner presence, even if it's only a law firm acting on their behalf.

As a way around these challenges, some companies are looking to encourage local finishing --- building much of the equipment abroad but wrapping up the manufacture in-country, Secrist said. "Then they become a local manufacturer," she said. "It does avert the tax and tariff issues." (In the reference chart, Brazil gets a 1 for used equipment, a 3 for capital medical equipment and a 3 for health IT).

India

The second most populous country in the world, India teems with nearly 1.2 billion people -- almost one-third of whom have middle-incomes and thus the power to demand, and pay for, better treatment, according to the report.

Medical spending is, partly as a result, on the rise. The Indian medical equipment market stood at $2.7 billion last year, but is projected to hit $5 billion by the end of 2012. It's also a friendly market for U.S. companies: imports account for about half of this market, with the vast majority coming from the United States, the report said.

Also, the Indian national government is currently fairly permissive about medical devices, putting few restrictions on what comes in the country. True, that's changing. Draft regulations have been developed to put tighter control on the sector. For now, though, U.S. companies can benefit relatively freely from one source of India's equipment growth: the country's $1.5 billion medical tourism industry, as the country attempts to lure Europeans or Americans to have procedures done by U.S.-trained doctors in Indian hospitals for a fraction of what the treatments would cost in their home countries. This means Indian hospitals are often looking to buy equipment to "replicate the comfort and ease [of foreign hospitals] as much as they can," Secrist said. "Patients should feel they're getting the same equipment." (India gets a 4 for capital equipment, a 3 for used equipment and a 3 for health IT.)

Read the full report, 2012-2013 Healthcare Technologies Resource Guide: A Reference for U.S. Exporters, here: http://export.gov/static/2012%20Healthcare%20Resource%20Guide-17_eg_main_040182.pdf