Diabetic Retinopathy Market Size, Share, Growth Analysis, By Type(Proliferative Diabetic Retinopathy, and Non-proliferative diabetic retinopathy), By Management(Anti-VEGF, Intraocular Steroid Injection, Laser Surgery, and Vitrectomy), By Region - Industry Forecast 2025-2032


Report ID: SQMIG35A2516 | Region: Global | Published Date: March, 2024
Pages: 219 |Tables: 63 |Figures: 75

Diabetic Retinopathy Market Insights

Diabetic Retinopathy Market size was valued at USD 8.83 Billion in 2023 and is poised to grow from USD 9.4 Billion in 2024 to USD 15.44 Billion by 2032, growing at a CAGR of 6.4% during the forecast period (2025-2032).

The rising incidence of diabetes, the increasing number of seniors, and a growing number of diabetes-related blindness are among the primary drivers expected to drive market expansion throughout the forecast period. The market is also being spurred forward by rising diabetes awareness and new product introductions. Diabetes is a major and developing global condition in which the pancreas' inability to make insulin leads to a rise in blood sugar levels. Damage to blood capillaries in the retina causes diabetic retinopathy. 

High levels of sugar in the blood & poor monitoring of these constantly shifting BG levels are thought to be risk factors for diabetic retinal degeneration. Early detection of Type 2 diabetes in patients, medication correction, continuous self-monitoring by patients utilizing modern instruments, and adoption of a healthy lifestyle may prevent retinal blood vessel damage, lowering the incidence of diabetic retinopathy amongst patients. In spite of the diabetic population's efforts, diabetic retinopathy might result in irreversible blindness, depending on its current stage and severity. 

Market participants have focused on the early detection of diabetic retinopathy. Check Eye, a Ukraine-based healthtech business creating a powered by AI cloud-based platform to determine retinopathy due to diabetes, for example, introduced a mobile solution to organize screening for DR for people with diabetes and their families in January 2023. The screening was assisted and supported by the Ukrainian Diabetic Federation & the Filatov Centre for Eye Diseases. 

Furthermore, according to the Royal National Institution of Blind People (RNIB), diabetic retinal degeneration was one of the top causes of blindness in the United Kingdom. Rising consumer awareness levels and rising healthcare expenditure are two more aspects that are expected to drive market expansion. Furthermore, according to the WHO, the world's aging population is expected to triple by 2050, compared to 2020, making it critical to keep up a healthy lifestyle, reduce obesity, and regularly check BG levels in vulnerable groups.

Market snapshot - 2024-2031

Global Market Size

USD 8.30 billion

Largest Segment

Proliferative

Fastest Growth

Proliferative

Growth Rate

6.4% CAGR

Global Diabetic Retinopathy Market 2023-2031 ($ Bn)
Country Share for North America Region- 2023 (%)

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Diabetic Retinopathy Market Segmental Analysis

Global Diabetic Retinopathy Market is segmented based Type, Management and region. Based On Type the market is segmented into Proliferative Diabetic Retinopathy and Non-proliferative diabetic retinopathy. Based On Management the market is segmented into Anti-VEGF, Intraocular Steroid Injection, Laser Surgery, Vitrectomy. Based on region the global Diabetic Retinopathy Market is segmented into North America, Europe, Asia-Pacific, South America, and MEA. 

Analysis by Management 

Anti-VEGF medications accounted for the greatest percentage of revenue of 92.8% in 2023 because to their effectiveness and efficacy in the management of diabetic retinopathy. Anti-VEGF medications are commonly used to treat Proliferative Diabetes Retinopathy (PDR). Anti-VEGF drugs have been shown to be more effective in PDR, particularly in situations of vitreous hemorrhage, neovascular a condition called and prior to vitrectomy. 

In contrast to anti-VEGF drugs, intraocular steroids injection is a new method of treating diabetic retinopathy (DR) & diabetic macular edema (DME) that is progressively gaining traction. Corticosteroid-based medicines are used in the injections to inhibit cellular growth. Triamcinolone (Durezol) has the best therapeutic efficacy and a large market presence among all corticosteroids studied. As retinopathy care tools, other components include surgery with lasers and vitrectomy. 

Analysis by Type 

Non-proliferative diabetic retinopathy dominated the diabetes-related retinopathy market in 2023, accounting for 70.5% of total revenue. The growing senior population and increased occurrences of diabetes-related blindness are the main reasons for its high share. Additionally, rising demand for routine retinal screening for long-term diabetes patients is likely to drive category growth. The proliferating diabetic retinopathy segment, on the other hand, is predicted to grow at a 6.8% CAGR from 2023 to 2030. 

The Proliferative Diabetic Retinopathy (PDR) sector is predicted to grow at a faster rate of 5.6% during the forecast period. It is a severe stage of retinopathy in which weak blood vessels form within the layers of the retina and vitreous humor, resulting in vision impairment & blindness. It can cause macular edema, which has no signs in the beginning. Thorough eye exams, which include tonometry, vision tests, and others, are used to diagnose it. It is managed with laser surgery, which causes blood vessels to shrink.

Global Diabetic Retinopathy Market By Type 2023 (%)

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Diabetic Retinopathy Market Regional Insights

North America dominated the market, accounting for 37.8% of total revenue in 2023. Some of the market's drivers include the presence of modern healthcare infrastructure, favorable government activities pertaining to medication research, and the presence of substantial patient & practitioner awareness levels. One of the primary factors contributing to this region's huge share is the high market penetration of new goods such as anti-VEGF medications such as Lucentis, Avastin, and Eylea. High healthcare expenditure, increased patient knowledge of diabetes, the availability of well-established medical facilities, and a favorable reimbursement environment are some of the primary causes. 

The Asia Pacific market is expected to grow at a 7.1% CAGR from 2023 to 2030, owing to the presence of high unmet medical requirements, as well as rapidly rising patient awareness about effective diabetes diagnostic procedures and rising medical costs in the developing nations of India and China. Latin America and the Middle East are also expected to experience profitable growth during the predicted period.

Global Diabetic Retinopathy Market By Geography, 2023-2031
  • Largest
  • Fastest

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Diabetic Retinopathy Market Dynamics

Drivers

Rising Prevalence of Diabetes

  • The increasing global prevalence of diabetes is a significant driver for the diabetic retinopathy market. Diabetic retinopathy is a common complication of diabetes and affects many diabetic patients. The growing diabetic population contributes to the demand for diagnostic and treatment options for diabetic retinopathy. 

Investing more in the infrastructure of healthcare 

  • Better facilities and equipment are made possible by more funding. Among those with the necessary tools to identify and manage diabetic retinopathy are ophthalmology departments. A larger market for diabetic retinopathy may result from increased screening and treatment of more patients with stronger infrastructure.

Restraints 

Lack of Awareness and Access to Eye Care 

  • Despite the growing prevalence of diabetic retinopathy, there is a lack of awareness about the condition and the importance of regular eye examinations among diabetic patients. Limited access to eye care facilities, particularly in remote or underserved areas, hampers early detection and timely treatment.

Hurdles in the Developing World: Lack of Professionals and Infrastructure Hinder Diabetic Retinopathy Market Growth 

  • Developing economies face a double challenge in addressing diabetic retinopathy. Firstly, a scarcity of skilled professionals like ophthalmologists exists. This limits the capacity to diagnose and treat the condition effectively. Secondly, weak healthcare infrastructure translates to a lack of specialized equipment and facilities needed for proper diabetic retinopathy care. These factors combine to restrict the growth of the diabetic retinopathy market in these regions.

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Diabetic Retinopathy Market Competitive Landscape

To increase their market position, major players are focused on collaborations, partnerships, acquisitions, and other strategic operations. Industry leaders face growing competition with novel medication launches and regulatory approval of innovative management treatments, making it challenging for them to remain competitive in an ever-changing industry. However, market leaders' large investments in R&D are predicted to enhance market growth.

Eyenuk, a worldwide artificial intelligence (AI) healthcare company as well as the market leader in practical applications for AI Eye Evaluation and AI Predictive Biomarkers, will be able to market its EyeArt AI retinal screening device throughout the European Union in January 2023 for new uses such as identifying AMD (age-related macular degeneration) and glaucomatous damage to the optic nerve (a sign of glaucoma).

Top Player’s Company Profiles in Diabetic Retinopathy Market

  • Novartis AG
  • Roche Holding AG
  • Bayer AG
  • Regeneron Pharmaceuticals, Inc.
  • Allergan plc (AbbVie Inc.)
  • Carl Zeiss Meditec AG
  • Topcon Corporation
  • Nidek Co., Ltd.
  • Optos plc (Nikon Corporation)
  • Bausch Health Companies Inc.
  • Alcon Inc.
  • Santen Pharmaceutical Co., Ltd.
  • Lumenis Ltd. (XIO Group)
  • Iridex Corporation
  • Leica Microsystems (Danaher Corporation)
  • StemCells Inc. (Microbot Medical Inc.)
  • Bioptigen, Inc. (Metabolic Technologies Inc.)
  • CenterVue SpA
  • Visunex Medical Systems, Inc.
  • Clarity Medical Systems, Inc.

Diabetic Retinopathy Market Recent Developments

  • In June 2023 Eyenuk received FDA clearance for its Topcon NW400 retinal camera with its EyeArt AI system for the autonomous AI detection of diabetic retinopathy. 

  • In January 2023, Eyenuk received European Union Medical Device Regulation (MDR) certification for its EyeArt AI eye screening system. This certification covers the detection of diabetic retinopathy, age-related macular degeneration, and glaucoma. 

  • In June 2022, Regeneron Pharmaceuticals, Inc. announced that the US Food and Drug Administration (FDA) has accepted for update the EYLEA (aflibercept) The injection supplemental Biologics License Use (sBLA) for every 16-week 2 mg dosage regimen (after initial every month doses) in patients in diabetic retinopathy (DR).

Diabetic Retinopathy Key Market Trends

  • Increasing Emphasis on Early Detection and Intervention: There is a growing recognition of the importance of early detection and intervention in diabetic retinopathy. The focus is shifting towards regular screening programs, awareness campaigns, and advanced imaging technologies for early diagnosis, enabling timely treatment and better management of the condition. 

  • Advancements in Imaging Technologies: Imaging technologies, such as optical coherence tomography (OCT) and fundus photography, continue to advance, providing detailed visualization of retinal structures and abnormalities. These advancements enhance the accuracy of diagnosis, monitoring, and treatment planning in diabetic retinopathy, driving market growth. 

  • Rise in Minimally Invasive Treatment Options: Minimally invasive treatment options, such as intravitreal injections of anti-VEGF (vascular endothelial growth factor) drugs and laser photocoagulation, are gaining prominence in the management of diabetic retinopathy. These treatments offer improved outcomes, reduced complications, and faster recovery, leading to increased adoption and market growth. 

  • Integration of Artificial Intelligence (AI) in Diabetic Retinopathy Diagnosis: AI-based algorithms and machine learning are being integrated into diagnostic systems for diabetic retinopathy. These AI solutions aid in the automated analysis and interpretation of retinal images, assisting healthcare professionals in detecting and grading diabetic retinopathy accurately and efficiently.

Diabetic Retinopathy Market SkyQuest Analysis

SkyQuest’s ABIRAW (Advanced Business Intelligence, Research & Analysis Wing) is our Business Information Services team that Collects, Collates, Co-relates and Analyses the Data collected by means of Primary Exploratory Research backed by the robust Secondary Desk research.

Our analysis reveals that the Diabetic Retinopathy Market is poised for significant growth, driven by several key factors. Firstly, the escalating prevalence of diabetes worldwide, coupled with the increasing aging population, contributes to a higher incidence of diabetes-related complications, including diabetic retinopathy. As diabetes continues to be a prevalent global health concern, the incidence of diabetes-related blindness is expected to rise, fueling demand for diagnostics and treatments for diabetic retinopathy. Additionally, heightened awareness about diabetes and its associated complications among healthcare professionals and patients alike is driving early detection and intervention efforts, further propelling market growth.

Furthermore, the introduction of innovative products and advancements in diagnostic and treatment technologies is expanding the scope of diabetic retinopathy management. These developments offer improved outcomes and enhanced patient care, fostering market expansion. Diabetes, a chronic condition characterized by the pancreas' inability to produce insulin, results in elevated blood sugar levels. Diabetic retinopathy, a complication of diabetes, occurs due to damage to the blood capillaries in the retina, highlighting the critical need for effective diagnostic and therapeutic solutions in the diabetic retinopathy market.

Report Metric Details
Market size value in 2022 USD 8.30 billion
Market size value in 2031 USD 14.51 billion
Growth Rate 6.4%
Base year 2023
Forecast period 2024-2031
Forecast Unit (Value) USD Billion
Segments covered
  • Type
    • Proliferative Diabetic Retinopathy, and Non-proliferative diabetic retinopathy
  • Management
    • Anti-VEGF, Intraocular Steroid Injection, Laser Surgery, and Vitrectomy
Regions covered North America (US, Canada), Europe (Germany, France, United Kingdom, Italy, Spain, Rest of Europe), Asia Pacific (China, India, Japan, Rest of Asia-Pacific), Latin America (Brazil, Rest of Latin America), Middle East & Africa (South Africa, GCC Countries, Rest of MEA)
Companies covered
  • Novartis AG
  • Roche Holding AG
  • Bayer AG
  • Regeneron Pharmaceuticals, Inc.
  • Allergan plc (AbbVie Inc.)
  • Carl Zeiss Meditec AG
  • Topcon Corporation
  • Nidek Co., Ltd.
  • Optos plc (Nikon Corporation)
  • Bausch Health Companies Inc.
  • Alcon Inc.
  • Santen Pharmaceutical Co., Ltd.
  • Lumenis Ltd. (XIO Group)
  • Iridex Corporation
  • Leica Microsystems (Danaher Corporation)
  • StemCells Inc. (Microbot Medical Inc.)
  • Bioptigen, Inc. (Metabolic Technologies Inc.)
  • CenterVue SpA
  • Visunex Medical Systems, Inc.
  • Clarity Medical Systems, Inc.
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Table Of Content

Executive Summary

Market overview

  • Exhibit: Executive Summary – Chart on Market Overview
  • Exhibit: Executive Summary – Data Table on Market Overview
  • Exhibit: Executive Summary – Chart on Diabetic Retinopathy Market Characteristics
  • Exhibit: Executive Summary – Chart on Market by Geography
  • Exhibit: Executive Summary – Chart on Market Segmentation
  • Exhibit: Executive Summary – Chart on Incremental Growth
  • Exhibit: Executive Summary – Data Table on Incremental Growth
  • Exhibit: Executive Summary – Chart on Vendor Market Positioning

Parent Market Analysis

Market overview

Market size

  • Market Dynamics
    • Exhibit: Impact analysis of DROC, 2021
      • Drivers
      • Opportunities
      • Restraints
      • Challenges
  • SWOT Analysis

KEY MARKET INSIGHTS

  • Technology Analysis
    • (Exhibit: Data Table: Name of technology and details)
  • Pricing Analysis
    • (Exhibit: Data Table: Name of technology and pricing details)
  • Supply Chain Analysis
    • (Exhibit: Detailed Supply Chain Presentation)
  • Value Chain Analysis
    • (Exhibit: Detailed Value Chain Presentation)
  • Ecosystem Of the Market
    • Exhibit: Parent Market Ecosystem Market Analysis
    • Exhibit: Market Characteristics of Parent Market
  • IP Analysis
    • (Exhibit: Data Table: Name of product/technology, patents filed, inventor/company name, acquiring firm)
  • Trade Analysis
    • (Exhibit: Data Table: Import and Export data details)
  • Startup Analysis
    • (Exhibit: Data Table: Emerging startups details)
  • Raw Material Analysis
    • (Exhibit: Data Table: Mapping of key raw materials)
  • Innovation Matrix
    • (Exhibit: Positioning Matrix: Mapping of new and existing technologies)
  • Pipeline product Analysis
    • (Exhibit: Data Table: Name of companies and pipeline products, regional mapping)
  • Macroeconomic Indicators

COVID IMPACT

  • Introduction
  • Impact On Economy—scenario Assessment
    • Exhibit: Data on GDP - Year-over-year growth 2016-2022 (%)
  • Revised Market Size
    • Exhibit: Data Table on Diabetic Retinopathy Market size and forecast 2021-2027 ($ million)
  • Impact Of COVID On Key Segments
    • Exhibit: Data Table on Segment Market size and forecast 2021-2027 ($ million)
  • COVID Strategies By Company
    • Exhibit: Analysis on key strategies adopted by companies

MARKET DYNAMICS & OUTLOOK

  • Market Dynamics
    • Exhibit: Impact analysis of DROC, 2021
      • Drivers
      • Opportunities
      • Restraints
      • Challenges
  • Regulatory Landscape
    • Exhibit: Data Table on regulation from different region
  • SWOT Analysis
  • Porters Analysis
    • Competitive rivalry
      • Exhibit: Competitive rivalry Impact of key factors, 2021
    • Threat of substitute products
      • Exhibit: Threat of Substitute Products Impact of key factors, 2021
    • Bargaining power of buyers
      • Exhibit: buyers bargaining power Impact of key factors, 2021
    • Threat of new entrants
      • Exhibit: Threat of new entrants Impact of key factors, 2021
    • Bargaining power of suppliers
      • Exhibit: Threat of suppliers bargaining power Impact of key factors, 2021
  • Skyquest special insights on future disruptions
    • Political Impact
    • Economic impact
    • Social Impact
    • Technical Impact
    • Environmental Impact
    • Legal Impact

Market Size by Region

  • Chart on Market share by geography 2021-2027 (%)
  • Data Table on Market share by geography 2021-2027(%)
  • North America
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • USA
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Canada
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Europe
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • Germany
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Spain
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • France
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • UK
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of Europe
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Asia Pacific
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • China
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • India
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Japan
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • South Korea
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of Asia Pacific
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Latin America
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • Brazil
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of South America
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Middle East & Africa (MEA)
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • GCC Countries
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • South Africa
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of MEA
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)

KEY COMPANY PROFILES

  • Competitive Landscape
    • Total number of companies covered
      • Exhibit: companies covered in the report, 2021
    • Top companies market positioning
      • Exhibit: company positioning matrix, 2021
    • Top companies market Share
      • Exhibit: Pie chart analysis on company market share, 2021(%)

Methodology

For the Diabetic Retinopathy Market, our research methodology involved a mixture of primary and secondary data sources. Key steps involved in the research process are listed below:

1. Information Procurement: This stage involved the procurement of Market data or related information via primary and secondary sources. The various secondary sources used included various company websites, annual reports, trade databases, and paid databases such as Hoover's, Bloomberg Business, Factiva, and Avention. Our team did 45 primary interactions Globally which included several stakeholders such as manufacturers, customers, key opinion leaders, etc. Overall, information procurement was one of the most extensive stages in our research process.

2. Information Analysis: This step involved triangulation of data through bottom-up and top-down approaches to estimate and validate the total size and future estimate of the Diabetic Retinopathy Market.

3. Report Formulation: The final step entailed the placement of data points in appropriate Market spaces in an attempt to deduce viable conclusions.

4. Validation & Publishing: Validation is the most important step in the process. Validation & re-validation via an intricately designed process helped us finalize data points to be used for final calculations. The final Market estimates and forecasts were then aligned and sent to our panel of industry experts for validation of data. Once the validation was done the report was sent to our Quality Assurance team to ensure adherence to style guides, consistency & design.

Analyst Support

Customization Options

With the given market data, our dedicated team of analysts can offer you the following customization options are available for the Diabetic Retinopathy Market:

Product Analysis: Product matrix, which offers a detailed comparison of the product portfolio of companies.

Regional Analysis: Further analysis of the Diabetic Retinopathy Market for additional countries.

Competitive Analysis: Detailed analysis and profiling of additional Market players & comparative analysis of competitive products.

Go to Market Strategy: Find the high-growth channels to invest your marketing efforts and increase your customer base.

Innovation Mapping: Identify racial solutions and innovation, connected to deep ecosystems of innovators, start-ups, academics, and strategic partners.

Category Intelligence: Customized intelligence that is relevant to their supply Markets will enable them to make smarter sourcing decisions and improve their category management.

Public Company Transcript Analysis: To improve the investment performance by generating new alpha and making better-informed decisions.

Social Media Listening: To analyze the conversations and trends happening not just around your brand, but around your industry as a whole, and use those insights to make better Marketing decisions.

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FAQs

Global Diabetic Retinopathy Market size was valued at USD 8.30 billion in 2022 and is poised to grow from USD 8.83 billion in 2023 to USD 14.51 billion by 2031, growing at a CAGR of 6.4% during the forecast period (2024-2031). 

To increase their market position, major players are focused on collaborations, partnerships, acquisitions, and other strategic operations. Industry leaders face growing competition with novel medication launches and regulatory approval of innovative management treatments, making it challenging for them to remain competitive in an ever-changing industry. However, market leaders' large investments in R&D are predicted to enhance market growth. 'Novartis AG', 'Roche Holding AG', 'Bayer AG', 'Regeneron Pharmaceuticals, Inc.', 'Allergan plc (AbbVie Inc.)', 'Carl Zeiss Meditec AG', 'Topcon Corporation', 'Nidek Co., Ltd.', 'Optos plc (Nikon Corporation)', 'Bausch Health Companies Inc.', 'Alcon Inc.', 'Santen Pharmaceutical Co., Ltd.', 'Lumenis Ltd. (XIO Group)', 'Iridex Corporation', 'Leica Microsystems (Danaher Corporation)', 'StemCells Inc. (Microbot Medical Inc.)', 'Bioptigen, Inc. (Metabolic Technologies Inc.)', 'CenterVue SpA', 'Visunex Medical Systems, Inc.', 'Clarity Medical Systems, Inc.'

North America dominated the market, accounting for 37.8% of total revenue in 2023. Some of the market's drivers include the presence of modern healthcare infrastructure, favorable government activities pertaining to medication research, and the presence of substantial patient & practitioner awareness levels. One of the primary factors contributing to this region's huge share is the high market penetration of new goods such as anti-VEGF medications such as Lucentis, Avastin, and Eylea. High healthcare expenditure, increased patient knowledge of diabetes, the availability of well-established medical facilities, and a favorable reimbursement environment are some of the primary causes. 

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