In the developed world in private healthcare every country is different. Oddly enough, that may be less so in the developing world – just look at laboratories.

Put brutally, diagnostic labs are simply factories harnessed to logistic networks.

If you run a European lab group, the main stress in your life comes from the payors. Are the Germans about to impose yet another budget ceiling? Will the Swiss continue to allow doctors to process their own tests? What will be the result of the latest cut-throat winner-takes-all five year contract in Sweden? Can we inveigle the English NHS into allowing us to run a lab without meeting NHS employment conditions?

Then there are the problems of having to work with the world’s most powerful profession. The medical profession is entrenched in positions of power in Western Europe – ask any French lab chief who has to work with biologistes.

These fears and concerns are what keeps the CEOs of the big groups awake at night.

I’ve recently talked to African and CIS based lab groups. And life is much simpler for them because the consumer pays for the test. And that is true whether you are in Egypt, Russia or Kazakhstan.

That makes life much easier. All you have to do is organise the sales force and run the labs.

OK, that may be a gross oversimplification, but the truth is that the business model is a hell of a lot simpler in the developing world. I am sure there are other things to keep you awake, but the idea that the developing world is fiendishly difficult is one that needs to be re-examined by healthcare service companies.