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Ipsos Business Consulting
Build · Compete · Grow
IDENTIFYING
OPPORTUNITIES
WITHIN ASEAN’S
UNIVERSAL
HEALTHCARE
PROGRAMMES
June 2017
The information contained herein is of a general nature and is not intended to address the circumstances of any particular
individual or entity. Although we endeavour to provide accurate and timely information, there can be no guarantee that
such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should
act upon such information without appropriate professional advice after a thorough examination of the particular situation.
© 2017 Ipsos. All rights reserved. Contains Ipsos’ Confidential and Proprietary information and may not be disclosed or
reproduced without the prior written consent of Ipsos.
INTRODUCTION
The strong growth potential of emerging economies, such
as those within the Association of Southeast Asian
Nations (ASEAN), continues to attract attention from
global businesses. Combined, the 10 member states —
Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the
Philippines, Singapore, Thailand and Vietnam — account
for almost 9% of the global population with the grouping’s
annual economic growth expected to remain relatively
high, at about 7%, by 2020, outpacing many other countries
and regions.
Indonesia, the region’s largest economy and most populous
nation, accounts for 38% of Asean’s economy and 40% of
its population. It is among the world’s 15 most populous
countries, along with the Philippines and Vietnam, which
are respectively expecting to achieve economic growth of
7.6% and 11.1% a year until 2020. Singapore, Thailand and
Malaysia posted a combined gross domestic product (GDP)
of about US$980.97bn in 2015 with expected annual
growth ranging from 5.0–11.7% by 2020. Annual economic
growth looks positive in other Asean economies and is
expected to exceed 8% a year in Brunei, Laos, Cambodia
and Myanmar within the same period.
The Philippines and Vietnam are among the fastest-growing
Asean economies. The Philippines government has spurred
economic growth through infrastructure development
which has improved job opportunities and increased
household spending. Vietnam has signed trade agreements
with EU countries, which are expected to fuel further
growth.
Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 3
7,204.96
7,630.98
CAGR:
1.2%
CAGR:
1.0%8.7%
ASEAN
91.3% 91.3%
8.7%
Non-ASEAN
World population (millions), 2015–20
Source: IMF World Economic Outlook Database
Global and Asean gross domestic product (USD, billions)
2015–20
73,192.5
95,332.4
CAGR:
7.8%
CAGR:
5.3%
96.6%
2015 2020f
ASEAN
3.4%
3.7%
96.3%
Non-ASEAN
Source: IMF World Economic Outlook Database
2015 2020f
HEALTHCARE IN ASEAN’S EMERGING
COUNTRIES
Improving economic development across Asean is driving
the healthcare industry’s development. Singapore,
Thailand and Malaysia have benefited from the rise of
global medical tourism which supports quality healthcare
facilities, medical professionals, hospitality and related
services. Other Asean countries have started implementing
universal healthcare policies to support local demand for
higher quality affordable treatment, as well as to fulfil UN
Sustainable Development Goals by 2030. Laos and Cambodia
have partially implemented universal healthcare covering
about 12% and 17% of their populations respectively.
Myanmar is also making steps towards universal coverage
with its Myanmar Health Vision 2030.
Indonesia, Vietnam and the Philippines, which have led
regional growth in healthcare over the past three years
due to their on-going universal healthcare programs,
exhibit some of the sector’s strongest near-term potential
within the region
Analysis of key market and healthcare indicators among
Asean countries
Source: Ipsos Business Consulting Analysis
Healthcare Service
MakretPotential
Low
Cambodia
Myanmar
Philippines Vietnam
Indonesia
Malaysia
Thailand
Singapore
Brunei Darussalam
Laos
Low
Med High
High
Key comparative indicators for healthcare market potential
within Asean
Sources: IMF World Economic Outlook Database, World Bank, UN
GDP per
Capita, 2015
% of Aged
Population, 2015
Population Size,
2015 In mn
Expected
GDP Growth,
2015-2020f
Expected Ageing
Population Growth,
2015-2020f
$3,416
$2,951
6.5%
11.1%
255.5
101.4
6.7%
5.6%
4.6%
3.4%
5.2%
4.6%91.6
7.6%
$2,171
Indonesia PhilippinesVietnam
Key comparative indicators for healthcare development
Sources: BMI Report on Pharmaceutical and Healthcare Report, government health data for
each country, World Bank
Healthcare
Expenditure
per Capita 2015
Hospital Bed per
1000 Population,
2015
Expected
THE Growth,
2015-2020f
Total Healthcare
Expenditure
(THE) in 2015, in
USD bn
Doctors / Physicians
per 1,000 population,
2015
$95.9
$137.0
$24.5
$13.9
10.2%
9.3% 2.5
0.3
0.7
0.81.2
0.8
8.4%
$12.0
$131.0
Indonesia PhilippinesVietnam
Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 4
The three countries are also expected to see growth in
their elderly populations at about the same annual rate as
the general population, which is forecast to rise by 3-5%
a year until 2020. The incidence of chronic diseases and
healthcare expenditure will also increase as these societies
continue to age. These trends, supported by the gradual
implementation of universal healthcare policies and the
development of healthcare infrastructure, are forecast to
see Indonesia, the Philippines and Vietnam post the
strongest growth in total healthcare expenditure, ranging
from 8–10% a year by 2020.
Theshortageandunevendistributionofmedicalprofessionals,
a low per-capita ratio of hospital beds, and relatively high
out-of-pocket healthcare expenses are key challenges for
the industry across the three countries. National health
insurance will play a critical role in facilitating access to
healthcare and reducing out-of-pocket expenses.
Thailand provides a strong regional example of these
benefits. Within a year of implementing its universal
healthcare programme in 2002 it reduced out-of-pocket
expensesfrom21.5%toabout8%oftotalhealthexpenditure.
Current out-of-pocket expenses in Indonesia, the Philippines
and Vietnam provide a stark contrast, accounting for 36%
to 54% of total healthcare expenditure in 2014 despite the
gradual rolling out of universal health coverage.
Percentage of out-of-pocket expenses from total healthcare expenditure, 2004–14
Source: World Bank
10
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
0
20
30
40
50
60
70
VNM THA IDN PHL
Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 5
Target of Coverage • Full population coverage by 2017• Full population coverage by 2019 • 80% of population covered by 2020
Benefits and
Services Package
• Benefits are classified into four
types:
o Inpatient benefits – including 11
medical and 12 surgical cases
o Outpatient benefits – including
day surgery, radiotherapy,
haemodialysis, outpatient blood
transfusion, MDG related, and
primary care
o Z Benefits – for chronic cases,
such as cancer, acute leukaemia,
orthopaedic implants
• Same benefits package across all SHI
members:
o Inpatient / outpatient care and
medical rehabilitation (including
antenatal care and birth)
o Disease screening
o Drug reimbursement for
medicines listed by Ministry of
Health
o Travel expenses from district to
higher-level hospitals (for
particular groups)
Schemes &
premiums
• Six membership categories:
o Formal economy (private,
government, household help,
enterprise owners) Premium
based on earnings, totalling 2.5%
of income split equally between
employer and employee
o Informal economy (migrant
workers, informal sector, self
employed individual, organised
groups) – premium for monthly
income <P25,000 at P600/quarter
and >P25,000 at P900/quarter
o Indigents (insufficient income for
family subsistence) – government
fully subsidises premiums.
o Sponsored – premium is
subsidised from sponsoring
individual/local government/
organization
o Senior citizens – premium free as
it is paid from Sin Tax Law as per
Republic Act No. 10351
o Lifetime – Non-paying after 120
monthly contributions aged >56
years old
• Five membership groups:
o Employers and employees:
(> 3 months’ work contract) –
4.5% of income, split by 3%
employer and employee 1.5%
o Social Insurance Authority
recipients – including pensioners,
injured workers, unemployed
o People paid from the state
budget: including civil servants,
soldiers, war veterans, ethnic
minorities, low-income earners,
and children under six years
o People supported by the state
budget: Households living just
above the poverty line and
students – Premium subsidy of
70% to the near poor and 30% to
students
o SHI household members
(including family members, not
classified under another group)
Inception
• The National Health Insurance Act
in 1995 or Republic Act 7875,
established PhilHealth to
implement the NHIP with a
mandate to provide full coverage
within 15 years of its inception
• Healthcare coverage went through
many transformations from 1960
to 2014
• From 1st January 2014, JKN is
operated though a single provider,
BPJS. Previously health insurance
wasmanaged under PT. ASKES
• Introduced in 1992 under Decree
No. 299/1992/HDBT
• The separate Health Care Fund for
the Poor (HCFP) was introduced in
2003 and merged with the national
insurance programme in 2009
• The law was revised in 2015 to
make the enrolment of all
households compulsory
Provider
• Philippines Health Insurance
Corporation (PhilHealth)
• Social Security Agency for Health or
Badan Penyelenggara Jaminan
Sosial - Kesehatan (BPJS Kesehatan)
• Vietnam Social Security Agency
(VSS)
Policy
Indonesia The Philippines Vietnam
• Philippines’ National Health
Insurance Programme (NHIP)
• Jaminan Kesehatan Nasional (JKN),
or Indonesia’s National Health
Insurance
• Bao Hiem Y Te (BHYT), or Vietnam’s
Social Health Insurance (SHI)
Source: Ipsos Business Consulting Analysis
NATIONAL INSURANCE IN INDONESIA, THE PHILIPPINES AND VIETNAM
Overview of universal healthcare schemes1
• BPJS covers 155 types of disease at
the primary healthcare level
• Around 700+ cases are code listed
in the Indonesia Case Based Group
depending on region, hospital class,
and type of treatment (inpatient/
outpatient)
• BPJS covers some 574 types of drugs
through the 2016 National
Formulary for 29 therapeutic classes
and 90 sub-therapeutic classes
• Two categories, including foreign
workers who stay a minimum six
months:
o Low-income members (PBI) – IDR
23,000 a month, paid by the
government
o Non-PBI member:
Salaried workers & families
(PPU) – premium at 4.5% from
income, split 4% byemployer
and 0.5% by employee.
• Civil servants, soldiers, police,
government officials and staff
• Labour (state-owned and
private)
Non-salaried workers & families
(PBPU), including self-employed,
non-contracted workers –
premium at IDR 25,500 for class
III, IDR 51,000 for class II, and IDR
80,000 for class I per member/
month
Non-workers & families (BP),
including veterans, investors, etc)
– 5% from 45% of civil servant’s
basic
Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 6
CURRENT PROGRESS
The Philippines and Vietnam have already covered more
than 70% of their populations with their respective
programmes. Vietnam began compulsory registration of
households in 2015 in line with its revised Health Insurance
Law. A healthcare data portal and information system for
verifying eligibility for health insurance was introduced in
its hospitals the following year to reduce the cost and time
of servicing socially insured patients.
Indonesia has made good progress with its universal
health insurance, launched after the Philippines and
Vietnam, with coverage rising from 46.7% of the population
in 2013 to 65.4% in 2016. The country passed the Indonesian
Constitutional Law No.24 in 2011 making it compulsory
for all Indonesian citizens to enrol with the national
healthcare scheme which became operational on 1
January 2014. Efficient application procedures, including
an online portal and more than 120 BPJS branches, helped
facilitate Indonesia’s faster enrolment rate compared with
the Philippines and Vietnam.
A prime objective of social health insurance is to ensure
low-income families have access to affordable healthcare.
This is especially important in countries, such as Indonesia
and the Philippines, where a significant proportion of the
population is poor.
Population (%) covered by universal health insurance 2013–161
Sources: Ipsos Business Consulting Analysis, IMF Data, PhilHealth, BPJS
Indonesia
46.7%
49.4%
60.6%
65.4%CAGR = 13.4%
2013 2014 2015 2016
Philippines
78.9%
86.7% 88.2%
89.5%
CAGR = 6.4%
2013 2014 2015 2016
Vietnam
68.9%
71.0%
75.3%
77.0%CAGR = 4.9%
2013 2014 2015 2016
Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 7
Indonesia launched its programme with a focus on low-
income families (PBI), private large, small, and medium
enterprises, state-owned enterprises, micro businesses,
and non-salaried workers (PBPU and BP). The government
did not achieve its target of covering self-employed,
unemployed and retiree (PBPU and BO) members by the
end of 2015. Enrolling salary earners (PBI and PPU) has
become more efficient as the government imposes strict
penalties on employers who do not enrol employees in
the scheme. PBPU and BP members currently account for
14% of current membership.
Expanding coverage has taken longer in the Philippines,
where PhilHealth was launched in 1995 with coverage
reaching 50–60% between 2001–05. The country’s
informal economy has proven a particularly challenging
segment as self-employed people account for more than
40% of the total workforce. Many employed people do not
have spending priorities.
Before Vietnam made its national health insurance universal
and compulsory in 2015, it had started smaller-scale initiatives
with civil servant and state enterprises in 1992. These
were expanded from 2005 to include non-state enterprises,
poor people and war veterans. Children under six years
old, those living just above the poverty line, and students
and farmers were bought into the scheme from 2009. By
2011, the near poor and poor accounted for 27% of the
membership, followed by students (20%), children under
six years old (15%) and others (38%), health ministry
figures show. Vietnam expanded coverage to 70% of the
population within 2014 after dependents of labourers and
cooperative members were included. Certain sectors, such
as the informal sector and the remaining 40% of private
companies who have yet to enrol their staff, will impede
achieving targeted total coverage due to competing cost
priorities and weaker benefits from coverage for those
people compared with other beneficiaries.
To improve implementation, each country has strived to
build partnerships with private hospitals as inadequate
supply and infrastructure meant government hospitals
were unable to satisfy demand for universal healthcare.
Indonesia’s BPJS formed partnerships with 1,866 hospitals
(about half of which were private) and 25,828 doctors and
healthcare professionals by October 2016. However, the
ratio of health insurance members per hospital remains
very high. In Indonesia, primary healthcare providers refer
patients to higher-level facilities. Stricter referral
mechanisms from primary healthcare providers are
therefore required to prevent overcrowding at the
secondary and tertiary levels. Furthermore, only 64% of
hospitals with the potential to join the universal healthcare
programme have become official partners due to the strict
accreditation policy.
Partner hospitals (as % of total hospitals) and members
served in 2016
Sources: Ipsos Business Consulting Analysis, PhilHealth, BPJS, Desk research
% of hospitals already
partnered
Philippines
Vietnam
Indonesia
Covered Members per
Partnered Hospitals
73% 93,723
64%
87% 60,130
77,316
Indonesia
Philippines
National health insurance membership by group
(2014 and 2015)
Sources: Ipsos Business Consulting Analysis, PhilHealth, BPJS, Desk research
64.8%
18.2%
6.8%
3.7%
ASKES(Transition)
6.6%
24.2%
9.4%
3.2%
2014 2015
63.2%
Formal
Economy
Informal
Economy
Indigents
Sponsored
Senior Citizen
Lifetime
2014 2015
30%
9%
49%
2%
8%
2%
36%
9%
40%
2%
10%
3%
PBI
PPU
PBPU
BP
Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 8
PhilHealth has also continued to increase its accredited
hospitals from 1,061 at the beginning of 2015 to 1,198 within
the first-half of 2016. By mid-2015, PhilHealth had contracted
17 facilities to deliver its so-called “Z packages” for severe
diseases. However, despite increasing the number of
healthcare facilities within the scheme, the Philippines faced
similar challenges to Indonesia with regards to the number
of national insurance members per participating hospital.
Vietnam, on the other hand, demonstrates much higher
levels of government cooperation with hospitals than
Indonesia or the Philippines. This has resulted in a better
ratio of covered members per hospital. The Vietnamese
government also plans to build more facilities outside of the
Ho Chi Minh and Hanoi regions, as well as increasing the
numberofmedicalpractitionerswithintheprogramme.The
country still needs to be more vigilant in two areas, however:
First, implementing stricter referral mechanisms to enforce
the requirement for members to first contact community
health centres for assessment, these centres will refer them
tohigherlevelfacilitiesifneeded.Currently,manypeoplego
directly to the higher healthcare facilities which means they
are not entitled to full benefits. Second, the Social Security
Agency should control the current fee-for-service payment
systemtoensurequalityofserviceisnotsacrificedforquantity.
Vietnam has generated a significant surplus in terms of the
volumeofpremiumscollectedcomparedwithhealthcare
expenditure even as the country has made great steps in
expanding its coverage. The government plans to provide
healthcare services and high-quality medicine to all
beneficiaries as part of its efforts to promote social equality.
To prevent future problems regarding reimbursement for
fee-for-service payments, Vietnam has established “diagnostic
relatedgroup”(DRG)benchmarksforreimbursementtariffs,
which make it difficult for hospitals to increase patient costs
by adding unnecessary treatments.
The Philippines has also created a slight premium surplus,
despite having the lowest premiums as a percentage of
healthcare expenditure of the three countries. PhilHealth
claims to have a robust financial position for funding its
expanding coverage and payments as fund reserves grow
steadily, despite critics doubting the programme’s
sustainability. Indonesia is in a much weaker position as
benefit payments have exceeded revenues for the past two
years. BPJS relies on investment funds and support from
central government to mitigate premium deficits. However,
the significant rise in benefit payments is positive for the
healthcare industry as they benefit pharmacies, hospitals
andtheirrelatedsupplychains.TheIndonesiangovernment
in early 2016 increased premiums to reduce the scheme’s
rising cost burden.
Comparison between collected premiums and benefit payments
in Indonesia, the Philippines and Vietnam, 2014–15
Premium
Collected
IDR 51.4tn
Benefit
Payment
IDR 56.3tn
Premium
Collected
IDR 39.6tn
Benefit
Payment
IDR 41.3tn
20152014
Premium
Collected
P103 bn
Benefit
Payment
P97 bn
Premium
Collected
P81.4 bn
Benefit
Payment
P78.2 bn
20152014
PHILIPPINES
Sources: PhilHealth, BPJS, Vietnam Ministry of Finance, Vietnam Social Security
Premium
Collected
VND145.9 bn
Benefit
Payment
VND101.2 bn
Premium
Collected
VND130.5 bn
Benefit
Payment
VND 86.3 bn
20152014
VIETNAM
Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 9
Indonesia’s government launched a new policy in 2016
through Ministry of Health Decree 64/2016 enabling JKN
inpatients to improve their treatment class by paying the
difference in costs for a better room while the treatment,
drugsandequipmenttariffsremainthesame.Thismechanism
negatively affects hospitals, especially private facilities, as
they have to adjust internal calculations where the level
of inpatient class previously referred to different levels of
equipment, medical practitioner fees, and sometimes
drugs. Some of hospitals are now reluctant to continuing
partnering BPJS as a result. This policy could threaten the
relationship between BPJS and facilities, ultimately lowering
levels of access and treatment for patients and members.
Despite the challenges and current issues, national
healthcare insurance programmes present an opportunity
to sustainably deliver affordable healthcare services. The
keytosuccessiscollaborationandsynergyamongstakeholders
while creating the mechanisms to address the needs and
interests of each player. For businesses looking to expand
within the region, it is worth noting that while Indonesia
JKN programme offers strong opportunities due to its
relatively low level of development, significant risks could
emerge as the programme’s mechanisms and regulations
change.
Indonesian BPJS patient visits to healthcare facilities
surged by almost 70% in 2015, driven mostly by outpatient
visits which increased most significantly at secondary and
tertiary healthcare facilities. These figures show how the
programme’s benefits are amplified when access to primary
healthcare facilities rises. Despite the lower proportion of
inpatient cases at secondary and tertiary facilities, these
centres accounted for 55% of total benefit payments in
2014. Attempts to control costs by imposing set fees per
patient (‘capitation’) have not been entirely successful,
and further changes in this area might be expected. With
regards to the payment methods in secondary and tertiary
facilities, the government needs to continue performing
periodic reviews to ensure treatment costs are sustainable
at public and private hospitals while ensuring new diseases
are covered.
BPJS benefit payments by healthcare facilities, 2014
BPJS patient visits to healthcare facilities, 2014-15
Source: BPJS Kesehatan
Source: BPJS Kesehatan
Promotive & Preventive
Non-capitation/CBG Services
Inpatient - Secondary / Tertiary HC
Outpatient - Secondary / Tertiary HC
Outpatient - Primary HC (Capitation)
Inpatient cases - Seondary
/ Tertiary HC
Outpatient - Secondary
/ Tertiary HC
Outpatient - Primary HC
19.6%
2014
2014 2015
16.2%
55.2%
8.7%
0.3%
70.8%
24.4%
68.6%
27.1%
63%
4.3%
87.2 mn 146.7 mn
4.8% 87%
50%
Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 10
KEY TAKEAWAYS WHAT IPSOS BUSINESS CONSULTING
CAN DO?
1. Clear market segmentation is crucial
With the ongoing implementation of national schemes,
market players need to accurately determine the most
favourable target segments. National programmes boost
access to healthcare especially for the middle-low patient
segment. Additionally, increasing income and improving
health awareness will drive demand in the private sector.
However, the nature of the opportunity for each segment
varies greatly by country.
2. Regional disparity affects patient outcomes
Indonesia, Vietnam, and Philippines face similar problems
from shortages of healthcare practitioners. The level of
healthcare facilities and medical practitioners, not to mention
the type of diseases, also determines the types of medical
devices or equipment needed. These factors vary within
each country’s region, affecting patient needs, treatment
programmes and opportunities for healthcare businesses.
3. Partnership with industry stakeholders is critical for
understanding the evolving market landscape
Government and related bodies must continually evaluate
how well they are implementing their respective national
healthcare programmes, all of which are still in fairly early
stages of development. Such evaluations will inevitably
affect procurement mechanisms. Building and maintaining
strong relationships throughout the stakeholder chain will
improve the flow of reliable information regarding market
dynamics which will be critical in enabling market players
to develop effective strategies.
4. Expanding healthcare market will increase competition
Direct and indirect factors will continue to grow the
region’s healthcare industry and attract new market
entrants. Identifying unmet needs, including technical
factors such as product distribution and after-sales service,
will help market players compete and expand their target
segments.
• We can help you analyse the market, competitive landscape
and customer behaviour to deliver insights into which
market you should target and how you should target it.
• We can also assist you in predicting future developments,
as well as likely business impacts, so you can determine
favourable growth strategies
We are the market intelligence and strategy division of
Ipsos. Your growth is our goal as we provide fact-based
analysis to assist you to enter, evolve, and expand in
emerginganddevelopedmarkets.Withourdiversebackground
covering research marketing, strategic planning and
management consulting, our role is reducing complexity
to help you maximise growth opportunities. We customise
each project to focus on your individual business objectives.
1Abbreviations
ASKES: Asuransi Kesehatan (previous health insurance
programe)
BP: Bukan Pekerja (informal sector, such as investors,
employers, retirees, etc)
PBPU: Pekerja Bukan Penerima Upah (informal sector who
are not paid by another party, such as entrepreneurs)
PPU: Pekerja Penerima Upah (formal sector paid by other
party, such as employees, civil servants, etc)
PBI: Penerima Bantuan Iuran (informal sector with low
ability to pay premiums who are supported by government
funds)
Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 11
GO-TO-MARKET
Preparing for market entry has never been so complex.
The rise of global connectivity, both online and in terms
of real-world trade infrastructure, means that businesses
need to adapt to rapid changes throughout the world of
commerce. New trade partnerships allow competition to
come from all sides, e-commerce requires a revolution in
logistics, and the rise of internet advertising demands
mastery of this new media platform.
These new market realities affect consumer preferences
intermsofproductsandtheirmethodofpurchase,advertising
models, logistics in an e-commerce world, legal requirements
at every step of the way, and competitors both local and
overseas. Companies must remain ready to respond to
real-time evaluations of sales performance, while continuing
to monitor progress toward long-term goals.
Now more than ever, a detailed understanding of the market
is an essential element of a winning business model. The
Ipsos Business Consulting proprietary model for Go-to-Market
strategy, combined with our world-class marketing research
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of the global marketplace.
Ipsos begins its Go-to-Market process with a detailed
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strategy based on our clients’ products and their unique
selling points, identifying reliable local partners to assist
in market entry.
By determining market growth potential through a realistic
analysis of its drivers and barriers, Ipsos clearly maps the
businesslandscapetoshowthewayforward.Precisecustomer
demographic profiles identify your target market, while
a breakdown of your product value chain allows you to
optimise the logistics network from end to end.
This framework allows us to identify your company’s inherent
strengths, match each product to its ideal marketplace,
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you set realistic goals, whether your KPIs focus on growing
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deciding on strategy a straightforward process.
With the right plan in place, we map out a realistic timeline
for short, medium and long-term goals, as well as the means
to measure progress towards them. Ipsos continually does
duediligenceon potentialpartnershipswith otherbusinesses,
compiling easy-to-read comparative summaries that examine
severalkeyparametersinordertoidentifythemostpromising
among them.
Along the way, we continually seek out strategic levers your
company can use to gain a market advantage, and then we
convert them into clear initiatives for fast implementation.
Our Project Management Office provides you with status
reports and simple dashboards so that a current evaluation
of your progress is always at your fingertips.
Well-researched, comprehensive and easy to use: Our
dedicated multi-level approach makes Ipsos an ideal partner
for Go-to-Market in both emerging and developed markets.
For more information on how you can get started on the
path to market success, go to www.ipsosconsulting.com
to find your nearest office.
www.ipsosconsulting.com/go-to-market
EXPERIENCE OF GO-TO-MARKET
strategy in emerging and
developed markets
OVER
1
Market
Dynamics
2
Market
Diagnostics
3
Market
Assessment
4
Internal
Diagnostics
5
Market
Entry
6
Partner
Evaluation
7
Implementation
Our 7-stage
Go-to-Market
SOLUTION
20YEARS
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Ipsos Business Consulting is the specialist consulting
division of Ipsos, which is ranked third in the global research
industry. With a strong presence in 88 countries, Ipsos
employs more than 16,000 people.
We have the ability to conduct consulting engagements
in more than 100 countries. Our team of consultants has
been serving clients worldwide through our 21 consulting
"hubs" since 1994. Our suite of solutions has been developed
using over 20 years experience of working on winning sales
andmarketingstrategiesfordevelopedandemergingmarkets.
There is no substitute for first-hand knowledge when it
comes to understanding an industry. We draw on the detailed
industry expertise of our consultants, which has been
accumulated through practical project execution.
Founded in France in 1975, Ipsos is controlled and
managed by research and consulting professionals. They
have built a solid Group around a multi-specialist positioning.
Ipsos is listed on Eurolist - NYSE-Euronext. The company
is part of the SBF 120 and the Mid-60 index and is eligible
for the Deferred Settlement Service (SRD).ISIN code
FR0000073298, Reuters ISOS.PA, Bloomberg IPS:FP
Build · Compete · Grow
At Ipsos Business Consulting we focus on maintaining our
position as a leading provider of high quality consulting
solutions for sales and marketing professionals. We deliver
information, analysis and recommendations that allow our
clients to make smarter decisions and to develop and
implement winning market strategies.
We believe that our work is important. Security, simplicity,
speed and substance applies to everything we do.
Through specialisation, we offer our clients a unique depth
of knowledge and expertise. Learning from different
experiences gives us perspective and inspires us to boldly
call things into question, to be creative.
By nurturing a culture of collaboration and curiosity, we
attract the highest calibre of people who have the ability
and desire to influence and shape the future.
Our Solutions
· Go-to-Market · Market Sizing
· Business Unit Strategy · Pricing
· Competitive Intelligence · Forecasting
· Partner Evaluation · Brand Strategy & Value
· Innovation Scouting · Sales Detector
· Optimal Channel Strategy · B2B Customer
Segmentation
AUTHORS
Stevens Hendrajaya
Senior Consultant, Indonesia
E. Stevens.Hendrajaya@ipsos.com
T. +62 21 527 7701
Douglas Cassidy
Head of Consulting, Indonesia
E. Douglas.Cassidy@ipsos.com
T. +62 21 527 7701
Xiaobo Cui
Global Healthcare Sector Lead
E. Xiaobo.Cui@ipsos.com
T. +86 10 52193224
CONTACT US
healthcare.bc@ipsos.com www.ipsosconsulting.com Ipsos Business Consulting
AUSTRALIA
Level 13, 168 Walker Street
North Sydney 2060
NSW, Australia
E. australia.bc@ipsos.com
T. 61 (2) 9900 5100
GREATER CHINA
BEIJING
12th Floor, Union Plaza
No. 20 Chao Wai Avenue
Chaoyang District, 100020
Beijing, China
E. china.bc@ipsos.com
T. 86 (10) 5219 8899
SHANGHAI
31/F Westgate Mall
1038 West Nanjing Road 200041
Shanghai, China
E. china.bc@ipsos.com
T. 86 (21) 2231 9988
WUHAN
10F HongKong & Macao Center
118JiangHan Road
HanKou Wuhan, 430014
Wuhan, China
E. china.bc@ipsos.com
T. 86 (27) 5988 5888
HONG KONG
22/F Leighton Centre
No 77 Leighton Road
Causeway Bay
Hong Kong
E. hongkong.bc@ipsos.com
T. 852 3766 2288
INDIA
MUMBAI
Lotus Corporate Park
1701, 17th Floor, F Wing
Off Western Express Highway
Goregoan (E),
Mumbai – 400063, India
E. india.bc@ipsos.com
T. 91 (22) 6620 8000
GURGAON
801, 8th Floor, Vipul Square
B-Block, Sushant Lok, Part-1
Gurgaon – 122016, Haryana,
India
E. india.bc@ipsos.com
T. 91 (12) 4469 2400
INDONESIA
Graha Arda, 3rd Floor
Jl. H.R. Rasuna Said Kav B-6, 12910
Kuningan
Jakarta, Indonesia
E. indonesia.bc@ipsos.com
T. 62 (21) 527 7701
JAPAN
Hulic Kamiyacho Building
4-3-13, Toranomon
Minato-ku, 105-0001
Tokyo, Japan
E. japan.bc@ipsos.com
T. 81 (3) 6867 8001
KENYA
Acorn House
97 James Gichuru Road Lavington
P.O. Box 68230
00200 City Square
Nairobi, Kenya
E. africa.bc@ipsos.com
T. 254 (20) 386 2721-33
MALAYSIA
18th Floor, Menara IGB
No. 2 The Boulevard
Mid Valley City
Lingkaran Syed Putra, 59200
Kuala Lumpur, Malaysia
E. malaysia.bc@ipsos.com
T. 6 (03) 2282 2244
NIGERIA
Block A, Obi Village
Opposite Forte Oil
MM2 Airport Road, Ikeja
Lagos, Nigeria
E. africa.bc@ipsos.com
T. 234 (806) 629 9805
PHILIPPINES
1401-B, One Corporate Centre
Julia Vargas cor. Meralco Ave
Ortigas Center, Pasig City, 1605
Metro Manila, Philippines
E. philippines.bc@ipsos.com
T. 63 (2) 633 3997
SINGAPORE
3 Killiney Road #05-01
Winsland House I, S239519
Singapore
E. singapore.bc@ipsos.com
T. 65 6333 1511
SOUTH AFRICA
Wrigley Field The Campus
57 Sloane Street Bryanston
Johannesburg, South Africa
E. africa.bc@ipsos.com
T. 27 (11) 709 7800
SOUTH KOREA
12th Floor, Korea Economic
Daily Building, 463 Cheongpa-Ro
Jung-Gu 100-791
Seoul, South Korea
E. korea.bc@ipsos.com
T. 82 (2) 6464 5100
THAILAND
21st and 22nd Floor, Asia Centre Building
173 Sathorn Road South
Khwaeng Tungmahamek
Khet Sathorn 10120
Bangkok, Thailand
E. thailand.bc@ipsos.com
T. 66 (2) 697 0100
UAE
4th Floor, Office No 403
Al Thuraya Tower 1
P.O. Box 500611
Dubai Media City, UAE
E. uae.bc@ipsos.com
T. 971 (4) 4408 980
UK
3 Thomas More Square
London E1 1YW
United Kingdom
E. europe.bc@ipsos.com
T. 44 (20) 3059 5000
USA
Time & Life Building
1271 Avenue of the Americas
15th Floor
New York, NY10020
United States of America
E. us.bc@ipsos.com
T. 1 (212) 265 3200
VIETNAM
Level 9A, Nam A Bank Tower
201-203 CMT8 Street, Ward 4
District 3
HCMC, Vietnam
E. vietnam.bc@ipsos.com
T. 84 12646 84 714

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Identifying Opportunities Within ASEAN’s Universal Healthcare Programmes

  • 1. Ipsos Business Consulting Build · Compete · Grow IDENTIFYING OPPORTUNITIES WITHIN ASEAN’S UNIVERSAL HEALTHCARE PROGRAMMES
  • 2. June 2017 The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavour to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act upon such information without appropriate professional advice after a thorough examination of the particular situation. © 2017 Ipsos. All rights reserved. Contains Ipsos’ Confidential and Proprietary information and may not be disclosed or reproduced without the prior written consent of Ipsos.
  • 3. INTRODUCTION The strong growth potential of emerging economies, such as those within the Association of Southeast Asian Nations (ASEAN), continues to attract attention from global businesses. Combined, the 10 member states — Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam — account for almost 9% of the global population with the grouping’s annual economic growth expected to remain relatively high, at about 7%, by 2020, outpacing many other countries and regions. Indonesia, the region’s largest economy and most populous nation, accounts for 38% of Asean’s economy and 40% of its population. It is among the world’s 15 most populous countries, along with the Philippines and Vietnam, which are respectively expecting to achieve economic growth of 7.6% and 11.1% a year until 2020. Singapore, Thailand and Malaysia posted a combined gross domestic product (GDP) of about US$980.97bn in 2015 with expected annual growth ranging from 5.0–11.7% by 2020. Annual economic growth looks positive in other Asean economies and is expected to exceed 8% a year in Brunei, Laos, Cambodia and Myanmar within the same period. The Philippines and Vietnam are among the fastest-growing Asean economies. The Philippines government has spurred economic growth through infrastructure development which has improved job opportunities and increased household spending. Vietnam has signed trade agreements with EU countries, which are expected to fuel further growth. Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 3 7,204.96 7,630.98 CAGR: 1.2% CAGR: 1.0%8.7% ASEAN 91.3% 91.3% 8.7% Non-ASEAN World population (millions), 2015–20 Source: IMF World Economic Outlook Database Global and Asean gross domestic product (USD, billions) 2015–20 73,192.5 95,332.4 CAGR: 7.8% CAGR: 5.3% 96.6% 2015 2020f ASEAN 3.4% 3.7% 96.3% Non-ASEAN Source: IMF World Economic Outlook Database 2015 2020f
  • 4. HEALTHCARE IN ASEAN’S EMERGING COUNTRIES Improving economic development across Asean is driving the healthcare industry’s development. Singapore, Thailand and Malaysia have benefited from the rise of global medical tourism which supports quality healthcare facilities, medical professionals, hospitality and related services. Other Asean countries have started implementing universal healthcare policies to support local demand for higher quality affordable treatment, as well as to fulfil UN Sustainable Development Goals by 2030. Laos and Cambodia have partially implemented universal healthcare covering about 12% and 17% of their populations respectively. Myanmar is also making steps towards universal coverage with its Myanmar Health Vision 2030. Indonesia, Vietnam and the Philippines, which have led regional growth in healthcare over the past three years due to their on-going universal healthcare programs, exhibit some of the sector’s strongest near-term potential within the region Analysis of key market and healthcare indicators among Asean countries Source: Ipsos Business Consulting Analysis Healthcare Service MakretPotential Low Cambodia Myanmar Philippines Vietnam Indonesia Malaysia Thailand Singapore Brunei Darussalam Laos Low Med High High Key comparative indicators for healthcare market potential within Asean Sources: IMF World Economic Outlook Database, World Bank, UN GDP per Capita, 2015 % of Aged Population, 2015 Population Size, 2015 In mn Expected GDP Growth, 2015-2020f Expected Ageing Population Growth, 2015-2020f $3,416 $2,951 6.5% 11.1% 255.5 101.4 6.7% 5.6% 4.6% 3.4% 5.2% 4.6%91.6 7.6% $2,171 Indonesia PhilippinesVietnam Key comparative indicators for healthcare development Sources: BMI Report on Pharmaceutical and Healthcare Report, government health data for each country, World Bank Healthcare Expenditure per Capita 2015 Hospital Bed per 1000 Population, 2015 Expected THE Growth, 2015-2020f Total Healthcare Expenditure (THE) in 2015, in USD bn Doctors / Physicians per 1,000 population, 2015 $95.9 $137.0 $24.5 $13.9 10.2% 9.3% 2.5 0.3 0.7 0.81.2 0.8 8.4% $12.0 $131.0 Indonesia PhilippinesVietnam Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 4
  • 5. The three countries are also expected to see growth in their elderly populations at about the same annual rate as the general population, which is forecast to rise by 3-5% a year until 2020. The incidence of chronic diseases and healthcare expenditure will also increase as these societies continue to age. These trends, supported by the gradual implementation of universal healthcare policies and the development of healthcare infrastructure, are forecast to see Indonesia, the Philippines and Vietnam post the strongest growth in total healthcare expenditure, ranging from 8–10% a year by 2020. Theshortageandunevendistributionofmedicalprofessionals, a low per-capita ratio of hospital beds, and relatively high out-of-pocket healthcare expenses are key challenges for the industry across the three countries. National health insurance will play a critical role in facilitating access to healthcare and reducing out-of-pocket expenses. Thailand provides a strong regional example of these benefits. Within a year of implementing its universal healthcare programme in 2002 it reduced out-of-pocket expensesfrom21.5%toabout8%oftotalhealthexpenditure. Current out-of-pocket expenses in Indonesia, the Philippines and Vietnam provide a stark contrast, accounting for 36% to 54% of total healthcare expenditure in 2014 despite the gradual rolling out of universal health coverage. Percentage of out-of-pocket expenses from total healthcare expenditure, 2004–14 Source: World Bank 10 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 0 20 30 40 50 60 70 VNM THA IDN PHL Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 5
  • 6. Target of Coverage • Full population coverage by 2017• Full population coverage by 2019 • 80% of population covered by 2020 Benefits and Services Package • Benefits are classified into four types: o Inpatient benefits – including 11 medical and 12 surgical cases o Outpatient benefits – including day surgery, radiotherapy, haemodialysis, outpatient blood transfusion, MDG related, and primary care o Z Benefits – for chronic cases, such as cancer, acute leukaemia, orthopaedic implants • Same benefits package across all SHI members: o Inpatient / outpatient care and medical rehabilitation (including antenatal care and birth) o Disease screening o Drug reimbursement for medicines listed by Ministry of Health o Travel expenses from district to higher-level hospitals (for particular groups) Schemes & premiums • Six membership categories: o Formal economy (private, government, household help, enterprise owners) Premium based on earnings, totalling 2.5% of income split equally between employer and employee o Informal economy (migrant workers, informal sector, self employed individual, organised groups) – premium for monthly income <P25,000 at P600/quarter and >P25,000 at P900/quarter o Indigents (insufficient income for family subsistence) – government fully subsidises premiums. o Sponsored – premium is subsidised from sponsoring individual/local government/ organization o Senior citizens – premium free as it is paid from Sin Tax Law as per Republic Act No. 10351 o Lifetime – Non-paying after 120 monthly contributions aged >56 years old • Five membership groups: o Employers and employees: (> 3 months’ work contract) – 4.5% of income, split by 3% employer and employee 1.5% o Social Insurance Authority recipients – including pensioners, injured workers, unemployed o People paid from the state budget: including civil servants, soldiers, war veterans, ethnic minorities, low-income earners, and children under six years o People supported by the state budget: Households living just above the poverty line and students – Premium subsidy of 70% to the near poor and 30% to students o SHI household members (including family members, not classified under another group) Inception • The National Health Insurance Act in 1995 or Republic Act 7875, established PhilHealth to implement the NHIP with a mandate to provide full coverage within 15 years of its inception • Healthcare coverage went through many transformations from 1960 to 2014 • From 1st January 2014, JKN is operated though a single provider, BPJS. Previously health insurance wasmanaged under PT. ASKES • Introduced in 1992 under Decree No. 299/1992/HDBT • The separate Health Care Fund for the Poor (HCFP) was introduced in 2003 and merged with the national insurance programme in 2009 • The law was revised in 2015 to make the enrolment of all households compulsory Provider • Philippines Health Insurance Corporation (PhilHealth) • Social Security Agency for Health or Badan Penyelenggara Jaminan Sosial - Kesehatan (BPJS Kesehatan) • Vietnam Social Security Agency (VSS) Policy Indonesia The Philippines Vietnam • Philippines’ National Health Insurance Programme (NHIP) • Jaminan Kesehatan Nasional (JKN), or Indonesia’s National Health Insurance • Bao Hiem Y Te (BHYT), or Vietnam’s Social Health Insurance (SHI) Source: Ipsos Business Consulting Analysis NATIONAL INSURANCE IN INDONESIA, THE PHILIPPINES AND VIETNAM Overview of universal healthcare schemes1 • BPJS covers 155 types of disease at the primary healthcare level • Around 700+ cases are code listed in the Indonesia Case Based Group depending on region, hospital class, and type of treatment (inpatient/ outpatient) • BPJS covers some 574 types of drugs through the 2016 National Formulary for 29 therapeutic classes and 90 sub-therapeutic classes • Two categories, including foreign workers who stay a minimum six months: o Low-income members (PBI) – IDR 23,000 a month, paid by the government o Non-PBI member: Salaried workers & families (PPU) – premium at 4.5% from income, split 4% byemployer and 0.5% by employee. • Civil servants, soldiers, police, government officials and staff • Labour (state-owned and private) Non-salaried workers & families (PBPU), including self-employed, non-contracted workers – premium at IDR 25,500 for class III, IDR 51,000 for class II, and IDR 80,000 for class I per member/ month Non-workers & families (BP), including veterans, investors, etc) – 5% from 45% of civil servant’s basic Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 6
  • 7. CURRENT PROGRESS The Philippines and Vietnam have already covered more than 70% of their populations with their respective programmes. Vietnam began compulsory registration of households in 2015 in line with its revised Health Insurance Law. A healthcare data portal and information system for verifying eligibility for health insurance was introduced in its hospitals the following year to reduce the cost and time of servicing socially insured patients. Indonesia has made good progress with its universal health insurance, launched after the Philippines and Vietnam, with coverage rising from 46.7% of the population in 2013 to 65.4% in 2016. The country passed the Indonesian Constitutional Law No.24 in 2011 making it compulsory for all Indonesian citizens to enrol with the national healthcare scheme which became operational on 1 January 2014. Efficient application procedures, including an online portal and more than 120 BPJS branches, helped facilitate Indonesia’s faster enrolment rate compared with the Philippines and Vietnam. A prime objective of social health insurance is to ensure low-income families have access to affordable healthcare. This is especially important in countries, such as Indonesia and the Philippines, where a significant proportion of the population is poor. Population (%) covered by universal health insurance 2013–161 Sources: Ipsos Business Consulting Analysis, IMF Data, PhilHealth, BPJS Indonesia 46.7% 49.4% 60.6% 65.4%CAGR = 13.4% 2013 2014 2015 2016 Philippines 78.9% 86.7% 88.2% 89.5% CAGR = 6.4% 2013 2014 2015 2016 Vietnam 68.9% 71.0% 75.3% 77.0%CAGR = 4.9% 2013 2014 2015 2016 Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 7
  • 8. Indonesia launched its programme with a focus on low- income families (PBI), private large, small, and medium enterprises, state-owned enterprises, micro businesses, and non-salaried workers (PBPU and BP). The government did not achieve its target of covering self-employed, unemployed and retiree (PBPU and BO) members by the end of 2015. Enrolling salary earners (PBI and PPU) has become more efficient as the government imposes strict penalties on employers who do not enrol employees in the scheme. PBPU and BP members currently account for 14% of current membership. Expanding coverage has taken longer in the Philippines, where PhilHealth was launched in 1995 with coverage reaching 50–60% between 2001–05. The country’s informal economy has proven a particularly challenging segment as self-employed people account for more than 40% of the total workforce. Many employed people do not have spending priorities. Before Vietnam made its national health insurance universal and compulsory in 2015, it had started smaller-scale initiatives with civil servant and state enterprises in 1992. These were expanded from 2005 to include non-state enterprises, poor people and war veterans. Children under six years old, those living just above the poverty line, and students and farmers were bought into the scheme from 2009. By 2011, the near poor and poor accounted for 27% of the membership, followed by students (20%), children under six years old (15%) and others (38%), health ministry figures show. Vietnam expanded coverage to 70% of the population within 2014 after dependents of labourers and cooperative members were included. Certain sectors, such as the informal sector and the remaining 40% of private companies who have yet to enrol their staff, will impede achieving targeted total coverage due to competing cost priorities and weaker benefits from coverage for those people compared with other beneficiaries. To improve implementation, each country has strived to build partnerships with private hospitals as inadequate supply and infrastructure meant government hospitals were unable to satisfy demand for universal healthcare. Indonesia’s BPJS formed partnerships with 1,866 hospitals (about half of which were private) and 25,828 doctors and healthcare professionals by October 2016. However, the ratio of health insurance members per hospital remains very high. In Indonesia, primary healthcare providers refer patients to higher-level facilities. Stricter referral mechanisms from primary healthcare providers are therefore required to prevent overcrowding at the secondary and tertiary levels. Furthermore, only 64% of hospitals with the potential to join the universal healthcare programme have become official partners due to the strict accreditation policy. Partner hospitals (as % of total hospitals) and members served in 2016 Sources: Ipsos Business Consulting Analysis, PhilHealth, BPJS, Desk research % of hospitals already partnered Philippines Vietnam Indonesia Covered Members per Partnered Hospitals 73% 93,723 64% 87% 60,130 77,316 Indonesia Philippines National health insurance membership by group (2014 and 2015) Sources: Ipsos Business Consulting Analysis, PhilHealth, BPJS, Desk research 64.8% 18.2% 6.8% 3.7% ASKES(Transition) 6.6% 24.2% 9.4% 3.2% 2014 2015 63.2% Formal Economy Informal Economy Indigents Sponsored Senior Citizen Lifetime 2014 2015 30% 9% 49% 2% 8% 2% 36% 9% 40% 2% 10% 3% PBI PPU PBPU BP Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 8
  • 9. PhilHealth has also continued to increase its accredited hospitals from 1,061 at the beginning of 2015 to 1,198 within the first-half of 2016. By mid-2015, PhilHealth had contracted 17 facilities to deliver its so-called “Z packages” for severe diseases. However, despite increasing the number of healthcare facilities within the scheme, the Philippines faced similar challenges to Indonesia with regards to the number of national insurance members per participating hospital. Vietnam, on the other hand, demonstrates much higher levels of government cooperation with hospitals than Indonesia or the Philippines. This has resulted in a better ratio of covered members per hospital. The Vietnamese government also plans to build more facilities outside of the Ho Chi Minh and Hanoi regions, as well as increasing the numberofmedicalpractitionerswithintheprogramme.The country still needs to be more vigilant in two areas, however: First, implementing stricter referral mechanisms to enforce the requirement for members to first contact community health centres for assessment, these centres will refer them tohigherlevelfacilitiesifneeded.Currently,manypeoplego directly to the higher healthcare facilities which means they are not entitled to full benefits. Second, the Social Security Agency should control the current fee-for-service payment systemtoensurequalityofserviceisnotsacrificedforquantity. Vietnam has generated a significant surplus in terms of the volumeofpremiumscollectedcomparedwithhealthcare expenditure even as the country has made great steps in expanding its coverage. The government plans to provide healthcare services and high-quality medicine to all beneficiaries as part of its efforts to promote social equality. To prevent future problems regarding reimbursement for fee-for-service payments, Vietnam has established “diagnostic relatedgroup”(DRG)benchmarksforreimbursementtariffs, which make it difficult for hospitals to increase patient costs by adding unnecessary treatments. The Philippines has also created a slight premium surplus, despite having the lowest premiums as a percentage of healthcare expenditure of the three countries. PhilHealth claims to have a robust financial position for funding its expanding coverage and payments as fund reserves grow steadily, despite critics doubting the programme’s sustainability. Indonesia is in a much weaker position as benefit payments have exceeded revenues for the past two years. BPJS relies on investment funds and support from central government to mitigate premium deficits. However, the significant rise in benefit payments is positive for the healthcare industry as they benefit pharmacies, hospitals andtheirrelatedsupplychains.TheIndonesiangovernment in early 2016 increased premiums to reduce the scheme’s rising cost burden. Comparison between collected premiums and benefit payments in Indonesia, the Philippines and Vietnam, 2014–15 Premium Collected IDR 51.4tn Benefit Payment IDR 56.3tn Premium Collected IDR 39.6tn Benefit Payment IDR 41.3tn 20152014 Premium Collected P103 bn Benefit Payment P97 bn Premium Collected P81.4 bn Benefit Payment P78.2 bn 20152014 PHILIPPINES Sources: PhilHealth, BPJS, Vietnam Ministry of Finance, Vietnam Social Security Premium Collected VND145.9 bn Benefit Payment VND101.2 bn Premium Collected VND130.5 bn Benefit Payment VND 86.3 bn 20152014 VIETNAM Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 9
  • 10. Indonesia’s government launched a new policy in 2016 through Ministry of Health Decree 64/2016 enabling JKN inpatients to improve their treatment class by paying the difference in costs for a better room while the treatment, drugsandequipmenttariffsremainthesame.Thismechanism negatively affects hospitals, especially private facilities, as they have to adjust internal calculations where the level of inpatient class previously referred to different levels of equipment, medical practitioner fees, and sometimes drugs. Some of hospitals are now reluctant to continuing partnering BPJS as a result. This policy could threaten the relationship between BPJS and facilities, ultimately lowering levels of access and treatment for patients and members. Despite the challenges and current issues, national healthcare insurance programmes present an opportunity to sustainably deliver affordable healthcare services. The keytosuccessiscollaborationandsynergyamongstakeholders while creating the mechanisms to address the needs and interests of each player. For businesses looking to expand within the region, it is worth noting that while Indonesia JKN programme offers strong opportunities due to its relatively low level of development, significant risks could emerge as the programme’s mechanisms and regulations change. Indonesian BPJS patient visits to healthcare facilities surged by almost 70% in 2015, driven mostly by outpatient visits which increased most significantly at secondary and tertiary healthcare facilities. These figures show how the programme’s benefits are amplified when access to primary healthcare facilities rises. Despite the lower proportion of inpatient cases at secondary and tertiary facilities, these centres accounted for 55% of total benefit payments in 2014. Attempts to control costs by imposing set fees per patient (‘capitation’) have not been entirely successful, and further changes in this area might be expected. With regards to the payment methods in secondary and tertiary facilities, the government needs to continue performing periodic reviews to ensure treatment costs are sustainable at public and private hospitals while ensuring new diseases are covered. BPJS benefit payments by healthcare facilities, 2014 BPJS patient visits to healthcare facilities, 2014-15 Source: BPJS Kesehatan Source: BPJS Kesehatan Promotive & Preventive Non-capitation/CBG Services Inpatient - Secondary / Tertiary HC Outpatient - Secondary / Tertiary HC Outpatient - Primary HC (Capitation) Inpatient cases - Seondary / Tertiary HC Outpatient - Secondary / Tertiary HC Outpatient - Primary HC 19.6% 2014 2014 2015 16.2% 55.2% 8.7% 0.3% 70.8% 24.4% 68.6% 27.1% 63% 4.3% 87.2 mn 146.7 mn 4.8% 87% 50% Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 10
  • 11. KEY TAKEAWAYS WHAT IPSOS BUSINESS CONSULTING CAN DO? 1. Clear market segmentation is crucial With the ongoing implementation of national schemes, market players need to accurately determine the most favourable target segments. National programmes boost access to healthcare especially for the middle-low patient segment. Additionally, increasing income and improving health awareness will drive demand in the private sector. However, the nature of the opportunity for each segment varies greatly by country. 2. Regional disparity affects patient outcomes Indonesia, Vietnam, and Philippines face similar problems from shortages of healthcare practitioners. The level of healthcare facilities and medical practitioners, not to mention the type of diseases, also determines the types of medical devices or equipment needed. These factors vary within each country’s region, affecting patient needs, treatment programmes and opportunities for healthcare businesses. 3. Partnership with industry stakeholders is critical for understanding the evolving market landscape Government and related bodies must continually evaluate how well they are implementing their respective national healthcare programmes, all of which are still in fairly early stages of development. Such evaluations will inevitably affect procurement mechanisms. Building and maintaining strong relationships throughout the stakeholder chain will improve the flow of reliable information regarding market dynamics which will be critical in enabling market players to develop effective strategies. 4. Expanding healthcare market will increase competition Direct and indirect factors will continue to grow the region’s healthcare industry and attract new market entrants. Identifying unmet needs, including technical factors such as product distribution and after-sales service, will help market players compete and expand their target segments. • We can help you analyse the market, competitive landscape and customer behaviour to deliver insights into which market you should target and how you should target it. • We can also assist you in predicting future developments, as well as likely business impacts, so you can determine favourable growth strategies We are the market intelligence and strategy division of Ipsos. Your growth is our goal as we provide fact-based analysis to assist you to enter, evolve, and expand in emerginganddevelopedmarkets.Withourdiversebackground covering research marketing, strategic planning and management consulting, our role is reducing complexity to help you maximise growth opportunities. We customise each project to focus on your individual business objectives. 1Abbreviations ASKES: Asuransi Kesehatan (previous health insurance programe) BP: Bukan Pekerja (informal sector, such as investors, employers, retirees, etc) PBPU: Pekerja Bukan Penerima Upah (informal sector who are not paid by another party, such as entrepreneurs) PPU: Pekerja Penerima Upah (formal sector paid by other party, such as employees, civil servants, etc) PBI: Penerima Bantuan Iuran (informal sector with low ability to pay premiums who are supported by government funds) Ipsos Business Consulting Identifying Opportunities Within Asean’s Universal Healthcare Programmes | 11
  • 12. GO-TO-MARKET Preparing for market entry has never been so complex. The rise of global connectivity, both online and in terms of real-world trade infrastructure, means that businesses need to adapt to rapid changes throughout the world of commerce. New trade partnerships allow competition to come from all sides, e-commerce requires a revolution in logistics, and the rise of internet advertising demands mastery of this new media platform. These new market realities affect consumer preferences intermsofproductsandtheirmethodofpurchase,advertising models, logistics in an e-commerce world, legal requirements at every step of the way, and competitors both local and overseas. Companies must remain ready to respond to real-time evaluations of sales performance, while continuing to monitor progress toward long-term goals. Now more than ever, a detailed understanding of the market is an essential element of a winning business model. The Ipsos Business Consulting proprietary model for Go-to-Market strategy, combined with our world-class marketing research service in 88 countries around the world, puts us ahead of the pack in preparing our clients for the new realities of the global marketplace. Ipsos begins its Go-to-Market process with a detailed assessment of the existing marketplace to identify its needs, opportunities and limitations as well as the strengths and weaknesses of competitors. We then provide a clear entry strategy based on our clients’ products and their unique selling points, identifying reliable local partners to assist in market entry. By determining market growth potential through a realistic analysis of its drivers and barriers, Ipsos clearly maps the businesslandscapetoshowthewayforward.Precisecustomer demographic profiles identify your target market, while a breakdown of your product value chain allows you to optimise the logistics network from end to end. This framework allows us to identify your company’s inherent strengths, match each product to its ideal marketplace, and position your brand for maximum impact. We help you set realistic goals, whether your KPIs focus on growing your market share, increasing penetration or finding a new niche for your products. Ipsos’s own visual model to compare pilot projects in terms of cost, timescale, ease of implementation, and potential performance level, makes deciding on strategy a straightforward process. With the right plan in place, we map out a realistic timeline for short, medium and long-term goals, as well as the means to measure progress towards them. Ipsos continually does duediligenceon potentialpartnershipswith otherbusinesses, compiling easy-to-read comparative summaries that examine severalkeyparametersinordertoidentifythemostpromising among them. Along the way, we continually seek out strategic levers your company can use to gain a market advantage, and then we convert them into clear initiatives for fast implementation. Our Project Management Office provides you with status reports and simple dashboards so that a current evaluation of your progress is always at your fingertips. Well-researched, comprehensive and easy to use: Our dedicated multi-level approach makes Ipsos an ideal partner for Go-to-Market in both emerging and developed markets. For more information on how you can get started on the path to market success, go to www.ipsosconsulting.com to find your nearest office. www.ipsosconsulting.com/go-to-market EXPERIENCE OF GO-TO-MARKET strategy in emerging and developed markets OVER 1 Market Dynamics 2 Market Diagnostics 3 Market Assessment 4 Internal Diagnostics 5 Market Entry 6 Partner Evaluation 7 Implementation Our 7-stage Go-to-Market SOLUTION 20YEARS
  • 13. ABOUT IPSOS BUSINESS CONSULTING Ipsos Business Consulting is the specialist consulting division of Ipsos, which is ranked third in the global research industry. With a strong presence in 88 countries, Ipsos employs more than 16,000 people. We have the ability to conduct consulting engagements in more than 100 countries. Our team of consultants has been serving clients worldwide through our 21 consulting "hubs" since 1994. Our suite of solutions has been developed using over 20 years experience of working on winning sales andmarketingstrategiesfordevelopedandemergingmarkets. There is no substitute for first-hand knowledge when it comes to understanding an industry. We draw on the detailed industry expertise of our consultants, which has been accumulated through practical project execution. Founded in France in 1975, Ipsos is controlled and managed by research and consulting professionals. They have built a solid Group around a multi-specialist positioning. Ipsos is listed on Eurolist - NYSE-Euronext. The company is part of the SBF 120 and the Mid-60 index and is eligible for the Deferred Settlement Service (SRD).ISIN code FR0000073298, Reuters ISOS.PA, Bloomberg IPS:FP Build · Compete · Grow At Ipsos Business Consulting we focus on maintaining our position as a leading provider of high quality consulting solutions for sales and marketing professionals. We deliver information, analysis and recommendations that allow our clients to make smarter decisions and to develop and implement winning market strategies. We believe that our work is important. Security, simplicity, speed and substance applies to everything we do. Through specialisation, we offer our clients a unique depth of knowledge and expertise. Learning from different experiences gives us perspective and inspires us to boldly call things into question, to be creative. By nurturing a culture of collaboration and curiosity, we attract the highest calibre of people who have the ability and desire to influence and shape the future. Our Solutions · Go-to-Market · Market Sizing · Business Unit Strategy · Pricing · Competitive Intelligence · Forecasting · Partner Evaluation · Brand Strategy & Value · Innovation Scouting · Sales Detector · Optimal Channel Strategy · B2B Customer Segmentation AUTHORS Stevens Hendrajaya Senior Consultant, Indonesia E. Stevens.Hendrajaya@ipsos.com T. +62 21 527 7701 Douglas Cassidy Head of Consulting, Indonesia E. Douglas.Cassidy@ipsos.com T. +62 21 527 7701 Xiaobo Cui Global Healthcare Sector Lead E. Xiaobo.Cui@ipsos.com T. +86 10 52193224
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