Healthcare in South East Asia
Excellent healthcare outcomes
Immense developmental challenges
Considerable challenges such as infrastructure and human capital issues
605 million people
Average age < 27yo
Vietnam spends the most, while Myanmar spends the least. Looking at public and private spending, private spending is higher, with the exception of Thailand and Brunei, where public spending is higher.
Data from World Bank 2011 (latest available)
(Total health expenditure is the sum of public and private health expenditure)
Government expenditure on health shows a different – but equally revealing – picture of healthcare provision. Thailand spends the most, Myanmar spends the least. Indonesia again is low down on health spending, coming in second last. The top three – Thailand, Vietnam, Brunei – all have well developed public healthcare systems. As a comparative, the US and UK are spending around 19-16%, against the ASEAN average of 6.7%.
ASEAN Average 6.7%
OECD Average 17.2%
ASEAN Average $422.4
OECD Average $4593
We made this graph to give you an indication of just how far behind ASEAN is in terms of real healthcare spending. As you can see, the comparison between the US and UK is extreme. Singapore is the only ASEAN country that comes anywhere close on comparable terms. This does not mean that healthcare in ASEAN is ‘small beer’; on the contrary, it just goes to show the huge growth potential there is! All ASEAN countries - with the exception of Myanmar, Cambodia and Laos - are opportunity markets for healthcare and demand is rising rapidly.
Singapore is rightly proud of the efficiency of its healthcare sector: excellent outcomes achieved at a closely managed cost
POINTS OF INTEREST FOR HEALTHCARE INVESTORS LOOKING AT ASEAN
POINTS OF INTEREST FOR HEALTHCARE INVESTORS LOOKING AT ASEAN
THAILAND
Thailand has a well-developed healthcare sector.
Private investment is increasing rapidly as demand for good quality provision grows as government provision falls behind in quality.
Bangkok Dusit Medical Services, the largest private hospital operator in Thailand, has invested in highly profitable non-core medical businesses…
POINTS OF INTEREST FOR HEALTHCARE INVESTORS LOOKING AT ASEAN
VIETNAM
An increase in demand for private healthcare in Vietnam is boosting investments. The government is offering generous incentives to foreign investors in the health sector: foreign healthcare backers enjoy a corporate income tax rate of 10%, tax exemption over the first four years of a project and a 50% subsequent tax break in the following years.
Last year, VinMec, the country’s largest and first hotel-like hospital was built, featuring five-star hotel standards, 25 VIP rooms, and two presidential suites.
The Triple Eye Infrastructure Corporation is awaiting government permissions to invest over $160 million in building a 200-bed international hospital.
The Chandler Corporation, has also made a move on Vietnam's largest private hospital group, Hoan My Medical Corporation, putting in $99 million to acquire an 80% stake…
POINTS OF INTEREST FOR HEALTHCARE INVESTORS LOOKING AT ASEAN
BRUNEI
Brunei is small but rich! Investment remains high in its well funded healthcare sector.
Parkway Pantai, one of Asia's largest private healthcare providers, is in a joint venture with the Brunei Investment Agency to manage a 21-bed specialty cardiac center…
A combined GDP of around $17 trillion.
Makes up about 40% of world trade.
16 countries
3 billion people
Image by garryknight
Singapore is also a globally renowned medical tourism hub and also a center of excellence in oncology (which accounts for high revenue spend per patient): health tourism patients were worth over $800m in 2011 and nearly half from Indonesia.
Heath tourism is set to grow further still within the region, as better of patients from ASEAN travel to different countries for treatment, and the region’s growing medical prominence attracts more foreigners from developed markets.
Key Facts
1,800 total hospitals
Only 5 hospitals internationally accredited; all 5 are private
0.3 doctors and 0.6 beds per 1,000 compared to neighbouring Malaysia 0.8 and 1.8 respectively. As a comparative, the OECD Average is 4.8 beds per 1,000 population and 3.2 doctors per 1,000 population
Major Hospital Groups
Lippo Group – Siloam Hospitals
Kalbe Group – RSMK Hospitals
Premier Group – RS Premier Hospitals
Health Issues
Increase in non-communicable diseases ((especially cardiovascular diseases)
Growing elderly population
Malaria and Dengue fever
Tuberculosis
Growing HIV/AIDs problem
Smoking related diseases
Indonesia currently has a basic level of healthcare provision, with half the population – i.e. 125m+ - lacking state health coverage or state or private health insurance.
The government is set to introduce basic health health Insurance coverage called SJSN (Sistem Jaminan Sosial Nasional), where from 1st January 2014, it will provide 140 million Indonesians with health coverage implemented by the BPJS (Badan Penyelenggara Jaminan Sosial) state social security provider. Further, it aims to have truly universal coverage by 2019.
It will mainly provide for the poor and vulnerable, who are currently catered for under a number of other social protection programs.
SJSN is a move towards a more comprehensive and joined up approach to state cover and provision.
It is worth noting that with the 2014 elections fast approaching and a 2nd term ‘lame duck’ presidency, the government is content for high public spend levels, such as implementing the health scheme, without tackling politically sensitive and economically costly subsidies. The question remains: will the next government have the political will?
Key Facts
1,200 total hospitals
2/3rd of hospitals in public sector
Average of 2.1 beds per 1,000 people
Major Hospital Groups
Bangkok Dusit Medical Services (BGH) – Thailand’s largest private hospital chain
Bumrungrad Hospital Plc - Thailand’s second-biggest listed hospital operator and a leading hospital chain
Health Issues
HIV/AIDS, which in the early 2000s emerged as the country’s leading cause of death
Key Facts
1,921 total hospitals
Private sector hospitals 1,202
State hospitals are much larger than private and account fro 51% of the country’s 93,180 hospital beds
Health Issues
Heart disease
PRIVATE HEALTH IN THE PHILIPPINES
Key Facts
358 total hospitals
138 public hospitals
38,394 public hospital beds
2,880 public health clinics
220 private hospitals
6,589 private medical clinics
Major Hospital Groups
KPJ Healthcare Berhad
IHH Healthcare Berhad
Columbia Asia
Ramsey Sime Darby Health Care
Health Issues
Non-communicable diseases such as heart disease and type-2 diabetes
Dengue fever
Key Facts
1,063 total hospitals
137 private hospitals
152,000 hospital beds
State hospitals are much larger than private and account fro 51% of the country’s 93,180 hospital beds
Health Issues
Developing country ailments including rabies, malaria, dengue fever
Tuberculosis
Key Facts
25 total hospitals
10,756 hospital beds
15 public hospitals
10 private hospitals
Health Issues
‘Developed country’ ailments such as cancer, cardiovascular diseases and strokes; these account for 60% of all deaths
Key Facts
6 total hospitals
4 public hospitals
2 private hospitals
17 heath centers
Health Issues
Ageing population
Lifestyle related health problems such as inactivity and smoking
GDP per capita
(current US$) - 2011
Data from World Bank
(Myanmar data not available)
Health expenditure per capita
(current US$) 2011
THE APPLICATION OF DIGITAL HEALTH
SOME EXAMPLES
Dokter Gratis (Free Doctor)
An App for consultation (iOS, Android)
Developed by Warung Kreasi and handled by Medika Consulting group
At the moment there are 12 general practitioners to respond to all the chats every day. Working in shifts, it’s claimed that a doctor has the capacity to handle about 1,000 chats per day. The app has so far been downloaded 130,000 times with around 500 chats happening each day
SOCIAL AND DIGITAL
Some widely used digital apps…
Dokita (Dokter Kita – ‘Our Doctor’)
An (Android) app service of Dokita.co, one of the products/ideas by Aibilities;
Patients are able to:
Consult
Submit prescriptions
Purchase medicine & medical items
Aibilities is a startup company focusing on health issues
DIGITAL HOSPITAL TAKEUP
Our preliminary research shows that digital hospital and healthcare system take up is low. According to our contacts in the Ministry of Heath, patient-centric e-records have been implemented in a limited number of cases. In the small number of hospitals that they have, such as Cipto Mangunkusumo Hospital (RSCM), there is still limited awareness and understanding. The Ministry says there is plenty of scope for improvement.
Most hospitals are still using internal based information systems (HIS), and there are no major digital providers. The only major firm is AdMedika, who provide a Hospital Information System (Hisys); the firm is a subsidiary from Telkom Indonesia.
DIGITAL HOSPITAL TAKEUP
Government and Private Sector Initiatives
Digital Healthcare Week 2013 Conference and Exhibition is a one-stop-shop where policy-makers, senior executives from healthcare providers, care providers, clinicians, nurses, healthcare IT professionals and technologies companies can come together for a week of collaboration, sharing and learning for improving the quality of care and accessibility to healthcare for patients.
Full Information: PHIE Workshop
Private Sector Partnerships
Last July 2013, Smart Communications, Inc. subsidiary Voyager Innovations, Inc. collaborated with Asian Hospital and Medical Center to develop a digital health system that will improve coordination between patients and their healthcare providers.
Full Information: Smart subsidiary partners with Asian Hospital for mobile health project
DIGITAL HOSPITAL TAKEUP
There is one example of digital and IT systems beginning to be integrated into healthcare. A Thai IT company has developed its own innovative application, Tele Diang, which could ease problems associated with the country’s shortage of radiologists by offering a pioneering tele-radiologist service.
The solution allows radiologists to access the system from other hospitals or even from home via the internet and view the images and send back their interpretations.
This has so far been adopted by at least 20 hospitals nationwide, including Praram 9 Hospital and Vejthani Hospital in Bangkok, Srisawan Hospital in Nakhon Sawan province and other provincial hospitals.
DIGITAL HOSPITAL TAKEUP
With the slow nation-wide take up of digital healthcare, hospitals in both the public and private sector have been installing their own system networks – on a case by case, individual hospital by individual hospital basis.
There is definitely demand for technology and integrated systems, but no grand joined up strategy at present, such as in the UK.
DIGITAL HOSPITAL TAKEUP
In hospitals, the term e-health is understood so far as a software system for the purpose of public health, mainly free software, provided by the state.
Current examples include
Medisoft (by MOH): the standard software for all hospital statistic medical reports
Healthnet
Goodsoft
E-Health (by IBOSS Vietnam)
The introduction of ‘Telemedicine’ has recently been picked up, and some systems are used in tele-consultation, tele-surgery assistance, tele-imaging, and tele-cardiology. This has proved very popular with medical professionals and patients.
DIGITAL HOSPITAL TAKEUP
Brunei was the first country in the region to have telemedical facilities that allow patients to access stroke specialists in Germany without stepping out of Southeast Asia.
Telemedicine has helped connect Jerudong Park Medical Centre (JPMC) doctors and patients with specialists from overseas through satellite technology, video conferencing and data transfer through phones and the Internet, a strategy that will put it closer to its bid to lure medical tourists.
Telemedicine has also helped connect doctors and nurses of Neuroscience Stroke Rehabilitation Centre (NRSC) with Krakenhaus Nordwest Hospital in Frankfurt, Germany through a protected data line to allow for assessment, interpretation, and reporting of MR-I and CT imaging.
Source: an MNC client’s market assessment
Of this our client reckons MNCs have just 20% Rx & 11% OTC market share in Indonesia – but Rx growth c. 16%
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