An introductory overview of healthcare across South East Asia and a look at the growing healthcare trends across the region. Download the presentation by clicking the "Save this presentation" icon above.

2. CONTENTS
1.
A Snapshot of Healthcare in the Region
2.
The Big Healthcare Themes for 2014
3.
Healthcare Across ASEAN: Country
Overviews
4.
Appendix: Digital Healthcare Across ASEAN
5.
Appendix: Thoughts for Pharma

3. Healthcare
in South
East Asia
Healthcare in South East Asia is going through a period of
unprecedented change…

Rapid economic growth

Rapid population growth

Increasing affluence and demand for better, and in some
cases, private healthcare

Public healthcare sector reform and broadening

The introduction of „new‟ growing healthcare challenges…

4. A SNAPSHOT
OF THE
REGION
Excellent healthcare
outcomes
•
•
•
The WHO says health expenditure
per capita in ASEAN is around 4%
of GDP: that’s low. The OECD
average, as a comparative, is
around 9.5%.
However health expenditure has
increased two and half-times
between 1998 and 2010, reaching
over $68 billion.
Nonetheless, healthcare quality
and provision varies widely across
SE Asia…
Singapore - Advanced healthcare, high
spend, promotes private contributions
Thailand, Brunei, Malaysia - Good to
high standard of healthcare with focus
on higher quality
Indonesia, Vietnam, Philippines Basic healthcare provision
Cambodia, Laos, Myanmar - Poor and
low level healthcare provision
Immense developmental
challenges
Considerable
challenges such as
infrastructure and
human capital
issues

5. ASEAN TOTAL HEALTHCARE SPEND
– OVER $68 BILLION
605 million people
Average age < 27yo
Data from World Bank 2011 (latest available)

6. ASEAN TOTAL HEALTHCARE SPEND
AS % GDP = Public + Private
20
18
16
14
12
10
8
6
4
2
0
Public
Private
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)

7. ASEAN GOVERNMENT HEALTHCARE SPEND
% OF TOTAL GOVERNMENT 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%.
25
20
ASEAN Average 6.7%
OECD Average 17.2%
15
10
5
0
USA OECD Average
UK
Thailand
Vietnam
Data from World Bank 2011 (latest available)
Health expenditure, public (% of government expenditure)
(Philippines data not available)
Brunei
Singapore
ASEAN Average
Cambodia Malaysia
Laos
Indonesia Myanmar Philippines

8. ASEAN SPEND PER CAPITA
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.
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
Singapore is rightly proud of the efficiency of
its healthcare sector: excellent outcomes
achieved at a closely managed cost
Data from World Bank 2011 (latest available)
Health expenditure per capita (current US$)
ASEAN Average $422.4
OECD Average $4593

9. POINTS OF
INTEREST FOR
HEALTHCARE
INVESTORS
LOOKING AT
ASEAN
INDONESIA

There has been considerable investor interest in Indonesia‟s healthcare
space, including private hospital groups.

The Indonesian government has tried to encourage more private sector
involvement in the health sector. The Negative Investment List currently stipulates
that foreign investors may now own up to 67% (65% previously) in healthcare
related businesses. Ownership in the pharmaceutical sector is capped at 75%. It
should be noted however that Indonesia still places limits of foreign ownership
and rights.

Private investors are taking more interest in Indonesian healthcare.
Blackstone, Bain Capital, and Dubai's Abraaj Capital, among others, have all been
looking to break into the Indonesian healthcare sector by acquiring a percentage
of private Indonesian healthcare operator Siloam, according to Reuters.

Siloam is the major hospital chain in Indonesia, but there are also a number of
other private providers

10. 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.

PHILIPPINES
 Investments, especially in public-private
partnerships (PPPs), are big in the
Philippines
 The government opened for bidding the
construction of a 700-bed capacity
specialty tertiary hospital earlier this year.
The project is estimated to cost US$ 135
million.
Bangkok Dusit Medical
Services, the largest private hospital
operator in Thailand, has invested in
 Large private healthcare investments are
highly profitable non-core medical
also taking place; Makati Medical
businesses…
Centre, one of the leading hospitals in the
Philippines, is investing heavily in new
laboratories for the diagnosis and
treatment of diseases…

11. POINTS OF
INTEREST FOR
HEALTHCARE
INVESTORS
LOOKING AT
ASEAN
VIETNAM
MALAYSIA
 An increase in demand for private healthcare in
 Malaysia has increased its 2013
Vietnam is boosting investments. The
budget by 15% for healthcare to US$
government is offering generous incentives to
6.36 billion, as increased demand, plus
foreign investors in the health sector: foreign
the government‟s desire to reach
healthcare backers enjoy a corporate income
developed
country
status
by
tax rate of 10%, tax exemption over the first
2020, drives healthcare growth.
four years of a project and a 50% subsequent
tax break in the following years.
 For digital healthcare providers, big
opportunities; from 2010-2014 the
 Last year, VinMec, the country‟s largest and
government is making a push to
first hotel-like hospital was built, featuring fiveexpand the use of IT in medical
star hotel standards, 25 VIP rooms, and two
care, health education and health
presidential suites.
services system management. It is
pushing “telemedicine” which allows
 The Triple Eye Infrastructure Corporation is
for virtual medical consultation and
awaiting government permissions to invest over
training.
$160 million in building a 200-bed international
hospital.
 There has been an issue with
telemedicine
„take-up‟
however;
despite this private sector demand is
 The Chandler Corporation, has also made a
strong…
move on Vietnam's largest private hospital
group, Hoan My Medical Corporation, putting in
$99 million to acquire an 80% stake…

12. POINTS OF
INTEREST FOR
HEALTHCARE
INVESTORS
LOOKING AT
ASEAN
SINGAPORE
BRUNEI
 An aging population and a focus on
improving healthcare is driving investment in
Singapore.
 Brunei is small but rich! Investment
remains high in its well funded
healthcare sector.
 The country‟s recent health policy was laid
out in the „Healthcare 2020 Masterplan‟…
 Parkway Pantai, one of Asia's largest
private healthcare providers, is in a
joint venture with the Brunei
Investment Agency to manage a 21bed specialty cardiac center…
 Changes starting in 2014 include a new
payment scheme introduced by the
government that will cover more
patients, more conditions and more
treatments. In particular, there will be more
support for the elderly and for low income
families.
 Singapore plans to add 3,700 hospital beds
and recruit 20,000 more healthcare workers.
Two more general hospitals, four community
hospitals, and six polyclinics will open by
2020.

13. The Big Healthcare Themes
for 2014

14. The Big
Healthcare
Themes for
2014
The year 2014 will be an exciting milestone for
healthcare across the region; big changes and
challenges await…
Some of the main issues will be:

The continued opening up of the private healthcare
market and the embrace of the Public-Private
Partnership (PPP) mechanism

The increasing relevance of ASEAN

A greater demand for better and wider provision
from the public sector

More focus on growing but largely ignored health
problems

15. Private
Healthcare
Growth
Private healthcare growth is continuing to grow at a rapid rate – this trend will
continue in 2014…




In Indonesia, the government has moved in recent years to encourage more private
sector involvement and revised the Negative Investment List to allow for more
private sector investment.
In the Philippines too, investments in PPPs are big. The government needs private
sector cash to sustain state provision.
In Thailand, private investment is growing at breakneck speed as demand for good
quality provision grows and government provision falls behind.
In Vietnam, private healthcare is also on the march. The government is even
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.
South East Asia truly is going private and there are big opportunities for private
healthcare providers and health firms. People with more money are prepared to
spend more money on their health.

16. The
Increasing
Relevance of
ASEAN
• ASEAN is becoming more important and
relevant for countries in the region. The
ASEAN Economic Community 2015 and
the ASEAN led Regional Comprehensive
Economic Partnership (RCEP)
demonstrate this.

17. The ASEAN
Economic
Community
(AEC)
•
The ASEAN Economic Community (AEC) is the goal of
regional economic integration by 2015.
•
The AEC aims at: (a) a single market and production base, (b)
a highly competitive economic region, (c) a region of equitable
economic development, and (d) a region fully integrated into
the global economy.

18. THE REGIONAL
COMPREHENSIVE
ECONOMIC
PARTNERSHIP
(RCEP)
•
The Regional Comprehensive
Economic Partnership (RCEP)
is a proposed free trade
agreement between 16 AsiaPacific nations.
•
The 10 ASEAN states plus its
FTA partners Australia, China, India, Japan, S
outh Korea and New Zealand.
16 countries
3 billion people
A combined GDP of around $17 trillion.
Makes up about 40% of world trade.

19. The
Increasing
Relevance
of ASEAN
•
As ASEAN becomes more and
more relevant, so to does ASEAN
and its influence on healthcare.
ASEAN leaders have committed to
healthcare as one of the priority
areas for region-wide integration.
•
Through mechanisms such as the
Healthcare Services Sectoral
Working Group (HSSWG), ASEAN
is attempting harmonize health
regulations, and regulations
regarding some medical products
and devices. This has important
ramifications for the healthcare
industry; understanding and working
through ASEAN is increasingly
important, as it takes on a larger
regional healthcare remit.

20. The
Increasing
Relevance
of ASEAN
•
The HSSWG is an important part of the ongoing liberalization process of the
ASEAN Framework Agreement on Services (AFAS).
•
In the future, Mutual Recognition Arrangements (MRAs) on Medical
Practioners, Nursing and Dental Practioners could reshape regional
healthcare expertise and allow for much more mobility and skill transfers
between ASEAN states; likewise with the development of greater
equivalences and regional policy streamlining. Many MRAs have already
been signed – for example in dentistry and nursing – the issue is
streamlining and follow-through at the national legal level on country by
country regulations.
•
ASEAN is and will play a much greater role in shaping regional healthcare in
the future.
•
This is also an important issue to consider in terms of equity. Although
opening up of markets could be a boost for the healthcare sector across the
region, it also risks exacerbating divides; it is possible that the better-off will
be better off still and that less developed systems may fall further behind.
Greater mobility may also lead to „brain drains‟ where highly qualified
practioners move to ASEAN countries where higher remuneration is
available, increasing capacity and skill gaps.

21. The
Increasing
Relevance
of ASEAN
•
As ASEAN pushes forward with regional integration, there is also a
concern over the greater pressure and demand that will be put on
some of the regions „healthcare hubs‟ - the leading ASEAN countries
with good but affordable healthcare systems - specifically Thailand
and Malaysia.
•
This is because ASEAN is aiming to implement a regional system
where ASEAN member citizens will be able to receive health services
in any country in the region with a similar standard. Medical workers
will also eventually be allowed to work in any ASEAN country via the
full implementation of MRAs. This means that the demand for doctors
and hospital services will increase in countries with good, but
affordable healthcare systems.
•
All these issues will become increasingly important points of focus for
the future and in the run-up to 2015.

22. Bigger
and Better
Public
Health
Provision
•
Across the region, there is a greater push for universal healthcare provision and
better provision where it is currently insufficient.
•
From the Philippines to Thailand where public „universal‟ system are already in
place, governments are under pressure to provide better health services to those in
harder to reach regions – mostly in rural areas.
•
Indonesia is about to embark on a hugely ambitious program of „universal‟ healthcare
provision via the introduction of basic health insurance coverage through SJSN.
•
Even in wealthy Singapore, the government is reforming its healthcare insurance
policies to focus on increasing affordability, through a reformed MediShield and greater
provision for the elderly – with more elderly focused community hospitals planned.
•
It is not just the private health sector which is growing, but an increasingly
growing public sector.
•
Looking across the other side of the world to Brazil this year, mass protests took
place among Brazil’s middle classes at poor public services and
provision, including healthcare. What this lesson tells us is that tax-paying
middle classes soon demand better services for their hard earned tax payments.

23. A focus on
growing „new‟
health threats
•
As ASEAN nations get richer they become more prone to
‘rich country diseases’ – type-2 diabetes, obesity and
„sedentary lifestyle‟ related diseases are all on the rise
across the region.
•
Over 191 million people are now living with diabetes in
the Asia-Pacific according to the International Diabetes
Federation (IDF).
•
Issues such as mental healthcare also need to be
addressed.
So
far
the
problem
is
mainly
ignored, marginalized - or even worse - stigmatized. As
work and lifestyles become more urban and „busy‟, stress
and mental illness is likely to become a growing health
problem.

24. A focus on
growing „new‟
health threats
The other change is that rapid population growth is overshadowing
another important trend; Asia is on track to become the „oldest
region in the world‟ by 2050 according to the ADB. Asia‟s elderly
population is growing rapidly; it is projected to hit 922.7 million by
the middle of this century.
•
Despite this shocking statistic, it should be noted that Asia and South
East Asia is very diverse in demographic trends - Japan
, China, Singapore and Malaysia face an increasingly elderly
population, however much of South East Asia still has very young
demographics. There are therefore competing wellness challenges
across the region and priorities vary from country to country.
•
This means more age related diseases and healthcare needs;
needs which are currently largely ignored and in short supply.
•
Asia is focusing on its young, but it is the elderly which may prove to
be a ticking time-bomb for the region. Healthcare companies have a
potentially large role to play in providing for this growing need.
•
Image by garryknight
•
There is a huge lack of capacity in South East Asia for countries to
treat and elderly health conditions such as dementia. This is
combined with a lack of palliative care and suitable health support
systems.

25. HIV/AIDS
•
According to the UNDP, Indonesia faces a threat of a major HIV epidemic. UNAIDS
states that HIV/AIDS in Indonesia is one of the fastest growing epidemics in Asia
and that the incidence of HIV is a “concentrated” epidemic, indicating high risk
populations where infection rates are over five percent.
•
HIV/AIDS has high prevalence levels in Jakarta and Bali (populous regions), but also
serious concentrations in rural areas, usually in close proximity to mining areas. This
is especially true of Papua.
•
According to a report by UNAIDS, the cumulative number of reported HIV infections
in Indonesia has risen sharply from 7,195 in 2006 to 76,879 in 2011.
•
Some of the major issues include a lack of education and public awareness, and
access and use of safe sex precautions (this is complicated by societal taboos and
some conservative religious attitudes).
•
The Indonesian government is aware of the issue and has set up a National Strategy
to combat the problem, with the goal that by 2014 eighty percent of key populations
will be reached through effective preventive reduction programs.

26. HIV/AIDS
•
Although HIV/AIDS is a growing concern, countries
such as Thailand – which once had serious
HIV/AIDS epidemics – have made huge progress
in tackling the issue according to the
UNDP, through education, public awareness and
safe sex promotion.
•
Infection rates have been cut dramatically since
1991 and Thailand is one of the very first countries
to have achieved the sixth Millennium
Development goal, to begin to reverse the spread
of HIV/AIDS by 2015, in advance of the target
date.

27. Medical
Tourism
• Medical tourism is Big Business in
Southeast
Asia,
especially
for
Thailand, Malaysia and Singapore.
• Thailand has perhaps the most advanced
medical tourism sector (with end-to-end
solutions fully integrated with air travel; hotel
accommodation for traveling families and
airport greeting).
• It is estimated Thai medical tourism
increased from nearly 400,000 foreign
patients, in 2007, to nearly 700,000 in 2012
worth a staggering $3.8 billion. That‟s $3.8
billion in direct healthcare spending: the total
economic impact may be three times that
amount.
• Another point of interest about the Thai
health tourism sector is the wide range of
countries from which it takes patients –
Japan, Middle East, UK, USA and Australia
are the big five – not just from its ASEAN
neighbors.
• 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.

28. Healthcare Across
ASEAN

29. INDONESIA












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
Health expenditure, total (% of GDP)
Health expenditure, public (% of government expenditure)
Health expenditure, private (% of GDP)
Health expenditure, public (% of GDP)
Health expenditure per capita (current US$)
2.72
5.32
1.79
0.93
95.00
• Small budgets and underinvestment have led to basic indeed poor provision
compared to other ASEAN states.
• Basic primary healthcare provision is provided through an array of government social
protection schemes. This does not cover the total population. This will change from
2014 with the introduction of a universal coverage scheme (discussed on next slide);
this, however, will still only be basic cover.
• Indonesia‟s healthcare system is also decentralized (since 2001), which has led to
varying degrees of quality and provision from region to region – Java has relatively
good access to healthcare, but across the 17,000 islands, availability is patchy.
„Puskesmas‟ public health centers are the only available health services available in
rural areas (if at all).
• Healthcare spending is set to rise, due to an increase in state spending, and by
encouraging the private sector to boost investments in health infrastructure via PPPs
(Public-Private Partnerships). There has been a recent law change, increasing the
allowed foreign ownership percentage of hospitals from 65% to 67%, also from Tier 1
major cities to across the country.

30. SJSN AND THE
INTRODUCTION
OF BPJS (A SEA
CHANGE IN
INDONESIAN
HEALTHCARE
PROVISION)
•
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?

31. Health expenditure, total (% of GDP)
Health expenditure, public (% of government expenditure)
Health expenditure, private (% of GDP)
Health expenditure, public (% of GDP)
Health expenditure per capita (current US$)
THAILAND
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
4.06
14.49
1.00
3.06
201.84
•
Healthcare in Thailand can generally be categorized as high – especially in
relation the rest of SE Asia. The public system covers everything from basic
health needs up to operations and access to antiretroviral treatment for HIV.
•
Thailand has had a universal healthcare program in place since October 2001, although
it is underfunded and puts a serious demand on public resources. This is one of the
reasons why there is growing demand for higher quality private healthcare – the
emergence of a dual-track system, a growing policy sticking point in Thailand.
•
Thailand has four main health security systems; The Civil Servant Medical Benefit
Scheme (CSMBS) for civil servants and their families, the Social Security Scheme
(SSS) for employees of private companies, the Universal Health Coverage scheme
(UHC), also widely known as the 30 baht scheme, for low income earners.
•
It also has a highly-developed medical tourism sector, as previously discussed.
Health Issues
 HIV/AIDS, which in the early 2000s
emerged as the country‟s leading
cause of death

32. THAILAND
2014 AND
BEYOND
•
Despite its healthcare strength, Thailand's national health system is in need of
improvement, as high-quality medical professionals are in short supply. Thailand is
facing a shortage of doctors, especially at public hospitals in rural areas. According to
the Private Hospital Association, it is estimated that 40,000 more doctors are needed
to ensure quality healthcare, but there are only 2,500 graduates every year.
•
The „2011 World Health Statistics‟ report by the World Health Organization stated that
in Thailand there are just three physicians for every 10,000 patients, compared to
18.3 in Singapore, 9.4 in Malaysia, 11.5 in the Philippines and 12.2 in Vietnam. This
may be exacerbated as the ASEAN Economic Community takes effect.
•
Ageing is also an issue. The population of Thailand is getting old. According to Viroj
Tangcharoensathien, senior adviser of Thailand's International Health Policy
Program, 11% of the Thai population is over 60 years of age and the trend is rising –
more elderly healthcare provision is therefore needed. The proportion of older citizens
in the total population is expected to reach 14% in 2015, 19.8% in 2025 and nearly
30% by 2050.

33. Health expenditure, total (% of GDP)
Health expenditure, public (% of government expenditure)
Health expenditure, private (% of GDP)
Health expenditure, public (% of GDP)
Health expenditure per capita (current US$)
PHILIPPINES
4.073
(no data available)
2.72
1.36
96.51
•




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
The Filipino healthcare system can generally be considered to be of a good
standard. Healthcare is provided by the Philippine Health Insurance Corp
(PhilHealth), which has existed since 1995, and operates the National Health
Insurance Program. It is estimated that the program covers around eight out of ten
Filipinos. State spending on healthcare is limited due to constraints on the state
budget.
•
In 2010, a major reform effort was made to achieve universal coverage, reduce payments
and provide more comprehensive cover. Some still remain uncovered however; some rural
areas only have basic primary healthcare.
•
The Philippines has a decentralized hospital system setting, wherein the Department of
Health (DOH) serves as the governing agency for both local government units (LGUs) and
the private sector providing services to communities and individuals.
•
The Philippines has a large private healthcare sector in which most expenditure is out-ofpocket, with the remainder being funded through insurance schemes.
•
Medical professionals are of a very high standard, training at the top universities in the
country or outside, usually in the US. This has led to a number of Filipino health
professionals being „poached‟ by western countries – such as the UK – who have recruited
Filipino nurses to fill shortfalls. Some areas in the Philippines are still understaffed.

34. PRIVATE
HEALTH IN THE
PHILIPPINES
•
The private sector, which is much larger than the public sector in terms of human, financial
and technological resources, is composed of for-profit and non-profit providers that cater to
30% of the population.
•
Although the private health sector is regulated by the DOH and the Philippine Health
Insurance Corporation, health information generated by private providers is generally
absent in the information system of the DOH.
•
Regulation of health science schools and universities is under the Commission on Higher
Education, while the regulation of health professionals is carried out by the Professional
Regulation Commission.
•
Some of the top private hospitals in the Philippines:
•
St. Luke's Medical Center
•
Makati Medical Center
•
Asian Hospital and Medical Center
•
University of Santo Tomas Hospital
•
The Medical City

35. Health expenditure, total (% of GDP)
Health expenditure, public (% of government expenditure)
Health expenditure, private (% of GDP)
Health expenditure, public (% of GDP)
Health expenditure per capita (current US$)
MALAYSIA






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


3.58
6.12
1.95
1.64
346.01
•
Malaysia has a very high level of healthcare, from basic needs to advanced treatment
– GPs to advanced invasive surgery. It may have a low ratio of GDP spend, but its
public healthcare system is one of the best in Asia. This is primarily due to a welldeveloped co-existing government and private healthcare system. A significant
amount of coverage and provision is facilitated by private healthcare providers.
•
The government is committed to universal coverage and public medical services are heavily
subsidized. For the poor, healthcare is free. A majority of Malaysians have private insurance
policies or pay out-of-pocket for private healthcare expenses. Through this „two-tier‟ system
the population has easy access to primary- and secondary-care facilities.
•
The government accounts for around 60% of total healthcare spending in Malaysia, but it is
trying to reduce costs by advancing the private sector as an ever greater healthcare
provider. Malaysia‟s healthcare industry is valued at around US$8.4 billion. The government
is pushing for spending on both public and private healthcare to rise to around 7% of GDP
by 2020 in order for Malaysia to reach developed-country standards. This may be difficult to
meet however, due to Malaysia‟s fiscal consolidation and current budgetary constraints.
•
Private and public healthcare demand is set to grow due to an aging population, increased
prosperity and greater consumer awareness of private healthcare services.
Health Issues
Non-communicable diseases such
as heart disease and type-2
diabetes
Dengue fever

36. VIETNAM






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
Health expenditure, total (% of GDP)
Health expenditure, public (% of government expenditure)
Health expenditure, private (% of GDP)
Health expenditure, public (% of GDP)
Health expenditure per capita (current US$)
6.81
9.43
4.06
2.75
94.81
• Healthcare in Vietnam can generally be described as good to basic cover, but suffers from poor
provision in rural areas. Public healthcare provision is also limited. Private healthcare expenditure
is rising rapidly owing to increasing prosperity coupled with low level state provision. Vietnam –
along with Korea – is reckoned by Big Pharma to have the most corrupt drug purchasing system in
the region.
• In 2010, 60% total coverage was achieved. Vietnam covers its population via a number of programs. One is
the Vietnam Social Insurance Agency, for employees of state-owned enterprises and private companies.
This is employee and employer contribution based – around 5% of salary. Vietnam also runs a Healthcare
Fund for the Poor, with the aim of achieving universal coverage by 2014. Universal coverage, however, is
unlikely due to poor health infrastructure, especially in rural areas, and complications involved in covering
the informal sector.
• The government carries around 30% of total expenditure on healthcare, with households making up the
rest, increasingly via buying their own health insurance packages.
• Most healthcare expenditure is now in the private sector, accounting for over 60% out of an expected total
healthcare spend in Vietnam in 2014 of $6 billion, up from $3.5 billion in 2009.
• There is a big push for private health sector involvement; this is driven by the need to upgrade services, lack
of state finance, and a growing middle class. The Vietnamese government has implemented a number of
laws from 2008 to 2011 to encourage growth and investment in the health sector. The government has
encouraged private investment in the health sector, mostly due to Vietnam‟s broader social mobilization
policy in health; this has been backed by foreign investor tax breaks. The framework for private healthcare
providers is therefore relatively good.

37. Health expenditure, total (% of GDP)
Health expenditure, public (% of government expenditure)
Health expenditure, private (% of GDP)
Health expenditure, public (% of GDP)
Health expenditure per capita (current US$)
SINGAPORE





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
4.56
8.82
3.15
1.42
2286.38
•
Despite the relatively low level of spending on healthcare in Singapore, it has one of the best
healthcare systems not only in SE Asia, but also in the world. Economically, Singapore may have the
world’s most efficient healthcare system. Its facilities are world class and cater from basic services to
highly advanced transplant surgery; many people travel to Singapore for ‘medical tourism’.
•
Singapore operates a universal healthcare system through compulsory insurance, subsidies and price
limitations. No medical service is free, despite public insurance schemes and subsides. This is designed to
ration the use of services. Around 70-80% of Singaporeans obtain their medical care within the public health
system via the three major public healthcare finance schemes; Medisave, Medishield and Medifund. Private
healthcare demand is still high however, via private insurance schemes.
•
Overall, the „Healthcare 2020 Masterplan‟ aims to add 4,100 hospital beds by 2020, including 1,900
community hospital beds, mainly to cater to the aging population. The government also plans to build four
new acute hospitals between 2020 and 2030.
•
In 2014, MediShield will be renamed MediShield Life, the age ceiling (previously 90 years) will be removed
and the compulsory fund will cover all Singaporeans, including those with pre-existing illnesses. The
government has also introduced the Pioneer Generation Package, which will pay for healthcare bills for those
in the late 60s and older. For low-income families, the qualifying age floor of 40 years will be removed from
the Community Health Assist Scheme (CHAS) so that children in these families can also receive subsidized
outpatient medical treatments. Subsidies for lower and middle-income patients at specialist outpatient clinics
will also be increased.

38. Health expenditure, total (% of GDP)
Health expenditure, public (% of government expenditure)
Health expenditure, private (% of GDP)
Health expenditure, public (% of GDP)
Health expenditure per capita (current US$)
BRUNEI
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
2.46
8.85
0.37
2.10
993.42
•
Brunei has a very good public health care system, in which all citizens are entitled to
free medical care; this is paid for by the state’s rich oil and gas resources. Brunei is
also a very small country at the tip of Malaysia, with a population of around 408,000;
this makes the system more manageable.
•
A handful of hospitals are supported by health clinics around the country. These facilities
are of a high level and provide good treatment for all standard medical needs. Health
facilities are very good and a large number of health professionals and doctors receive their
training in the UK, North America, New Zealand and Australia; until recently all medical
training took place overseas as there were no medical training establishments in the
country.
•
The government also funds overseas specialist treatment, usually in Singapore and
Malaysia, as part of the paternalist, absolute monarchy „social compact with the people‟.

39. MYANMAR,
CAMBODIA,
LAOS
400
Health expenditure per capita
(current US$) 2011
12000
GDP per capita
(current US$) - 2011
10000
300
8000
6000
200
4000
100
2000
0
0
Malaysia
Cambodia
Laos
Myanmar
Malaysia
Lao PDR
Cambodia
Myanmar
• Healthcare in these three countries can generally be characterized as poor and underdeveloped; the
countries themselves could also be categorized the same way.
• Myanmar’s recent political and economic opening has revealed an extremely impoverished and
underfunded healthcare system, which will require substantial investment and time to build up;
international donor agencies have recently started working on Myanmar’s numerous public policy
predicaments.
Data from World Bank
(Myanmar data not available)
• Cambodia and Laos are increasingly being left behind by their SE Asian peers. Rural agriculturally based
economies characterize the current landscape. Government care is therefore very basic, although better in
urban areas. For the private healthcare sector, there is little demand due to small income levels (see graph
to the left on per capita GDP compared to Malaysia). ‘Subsistence incomes’ do not include allocations for
private healthcare.

40. Appendix: Digital Healthcare
Across ASEAN

41. ACROSS ASIA
Urban
3,784,644,400
Total Asian
43%
Rural
Population
1,033,688,491
Internet Users
27%
Internet Penetration
Mobile Subscribers
3,110,235,171
82%
Mobile Penetration
57%

42. THE
APPLICATION
OF DIGITAL
Digital health is growing
HEALTH
in South East Asia – like the rest of the world
eHealth, telehealth, mHealth, social health

43. SOME
EXAMPLES
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Telehealth Systems
Therapeutic & Diagnostic Medical Devices
Remote Monitoring Devices
Mobile Health Applications
Secured Wireless Communication Medical Devices
Medication Monitoring Equipment
Mobile Health Devices
Medical Robotics
Personal Health Records
Communications Networks
Gaming for Health
ePrescriptions
Patient communities
Information websites

44. INDONESIA
SOCIAL AND DIGITAL
• IT and digital technologies are already
being used widely in Indonesia – although
there is a huge need for a joined up
approach to IT systems integration.
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
Some widely used digital apps…
DIGITAL HOSPITAL TAKEUP

• So far in terms of IT integrated
systems, these are limited, usually to one
hospital or one hospital unit, if at all. They
are also all found in high-end private
hospitals. Potential is ripe!
• Digital technologies though are widely
used; according to Edelman Indonesia‟s
„Healthcare Professionals Survey 2013
‟, 4 out of 5 physicians in Jakarta trawl the
internet for work-related information.
Digital is already used in helping doctors
with limited means and services to make
diagnoses.

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.
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

45. PHILIPPINES
•
•
The digital landscape in the
Philippines is changing fast. At
present, the Philippines is the
networking capital of the world
and growing as time goes by.
Seeing the necessity of digital
health
strategy,
Philippine
healthcare initiatives are now
finding its rightful place in the
digital space. The government
together with the private sector is
pushing forward the digitalization
of Healthcare information and
accessibility for the benefit of the
Filipinos.
DIGITAL HOSPITAL TAKEUP
Government and Private Sector Initiatives
•
Digital Healthcare Week 2013 Conference and Exhibition is a one-stop-shop where policymakers,
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

46. THAILAND
DIGITAL HOSPITAL TAKEUP
•
Successive Thai governments have aimed
to turn the country into a healthcare hub in
South East Asia; however, the country has
never had a strategy or a policy for
establishing a digital electronic healthcare
system.
•
Patient e-records and integrated IT
systems are currently not widely
used, with traditional administration
remaining the primary system for keeping
patient records.
•
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.

47. MALAYSIA
For digital healthcare providers, big opportunities; from
2010-2014 the government is making a push to expand
the use of IT in medical care, health education and
health services system management. It is pushing
“telemedicine” which allows for virtual medical
consultation and training.
However…
This is a very ambitious national initiative and has failed
to get large-scale traction due to a lack of knowledge and
execution capabilities.
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.

48. VIETNAM
• In Vietnam, digital healthcare is
so far mainly convened to
administrative systems, although
„telemedicine‟ is also beginning
to be taken up. Digital healthcare
growth potential is therefore
strong.
• Predominantly, e-health
applications are so far used to
support the management and
administration of health
services, reduce arbitrary work
pressure for staff of health
facilities, and improve the quality
of Information.
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 telecardiology. This has proved very popular
with medical professionals and patients.

49. BRUNEI
DIGITAL HOSPITAL TAKEUP
•
The Government of Brunei aims to have a single electronic
health record that is accessible from any government
hospital, clinic or healthcare centre.
• 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.
•
It has signed an agreement to develop the Brunei
Healthcare Information System (Bru-HIMS), a nationwide
project to digitise patient care documents and provide
electronic medical records.
• 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.
•
iSoft and Ishajaya Technology have been commissioned
to build the framework of the digital healthcare system that
will
provide
access
to
patient
data,
identity
management, process automation for administrative and
clinical
departments,
workflow
design
and
resource scheduling.
• 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.

50. Appendix: Thoughts for Pharma

51. Pharma Market – South Asia Region
US$ 40.5bn, YoY +5.5%
ASEAN is
thus about
$15.4$16.5bn
+6.2%
+5.7%
+20.6%
-1.6%
+3.6%
+8.7%
Of this our client reckons
MNCs have just 20% Rx
& 11% OTC market share
in Indonesia – but Rx
growth c. 16%
+12%
+9.7%
Source: an MNC client’s market assessment

52. Drugs Spend And Market Size
Source: World Health Organization

Thailand is key for regional pharma –large predominantly public spend. Thailand also has the second biggest market size.

Malaysia is also big spending– mostly private, despite its small market size.

Vietnam is mostly private spend, despite large state healthcare provision.

The Philippines is almost entirely private spend.

Indonesia’s market potential is huge – biggest economy and population in the region with solid growth rates – but from a low
base.

53. THANK YOU
Stephen Lock
Edelman Indonesia
Stephen.Lock@edelman.com