Healthcare Asia (February 2020)

ISSUE NO. 14

The magazine for healthcare administrators and policy makers

|

www.healthcareasiamagazine.com

THE PERFECT HEALTH APP HONG KONG HOSPITAL AUTHORITY HAS STREAMLINED A FRAMEWORK FOR A MOBILE APP THAT IT EYES LAUNCHING IN 2019

Healthcare Asia

WHY THE UHC RISKS ERASING PHILIPPINES’ MOM AND POP HOSPITALS TELEMEDICINE ON THE CARDS FOR THAILAND’S HOSPITALS HOW RISING COSTS ARE HEATING UP MEDICAL TOURISM WARS HOW TAIWAN ORCHESTRATES DIGITAL HEALTHCARE WITH PORTABLE MACHINES

Display to 29 February 2020

SERENA WEE CEO, GLENEAGLES HOSPITAL CEO, ICON SOC p10

FROM THE EDITOR This year has been off the charts for the Healthcare Asia team. The second year of our awards programme yielded nearly 200 nominations and 50 awards from the region’s most outstanding hospitals. Flip the pages and check out the big winners.

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The team also successfully gathered experts and decision makers from hospitals in the cities of Manila, Jakarta, and Bangkok for the annual Healthcare Asia Forum. Panelists from the first stop, Manila, pressed on the need for a universal healthcare programme in the Philippines as out-of-pocket expenses now account for 54.2% of patients’ funding sources. Read more about this discussion on page 22.

Over to Bangkok, hospitals are now gearing up for telemedicine to upgrade their universal healthcare services to its 69.81 million-strong population.

Learn more about hospitals’ initiatives on page 26.

This issue also features an exclusive interview with the CEO of Singapore’s Icon SOC, Serena Wee, who talked about the expansion of their oncology services into haematology and radiation and their innovative medical concierge service that caters to medical tourists that now comprise 50% of their patients. Check out the interview on page 10.

As always, we wish you the very best of health.

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Distributed to all CxO, board levels, doctors, and healthcare professionals of major private/public hospitals and health ministries in ASEAN and Hong Kong.

2019

Healthcare Asia Forum

CONTENTS

14

10

CEO INTERVIEW ICON SOC STRENGTHENS CANCER CARE AMIDST SINGAPORE’S MEDICAL TOURISM BID

24 COUNTRY REPORT

FIRST 04 Massive healthcare deals take off

16 Taiwan’s medical device manufac-

06 Medical tourism wars heat up as

turers squeeze big data into portable machines

costs skyrocket

08 Can the new Universal Healthcare Bill save dying smaller private hospitals?

08 Australia’s BlueChilli launches healthtech accelerator programme in Singapore

EVENT COVERAGE 18 What steps should Philippine hospitals take to reach universal healthcare?

20 Is Thailand, the poster child

FEATURE PROFILE HONG KONG HOSPITAL AUTHORITY’S BIG DATA PUSH

EVENT COVERAGE HEALTHCARE ASIA AWARDS 2019

OPINION 28 Making healthcare more affordable and accessible

30 Protected data sharing and Life Sciences in the Asia Pacific: From treatment to prevention

32 Keeping up with healthcare: How Singapore can remain an attractive expat destination

for universal healthcare, ready for telemedicine?

22 Indonesia’s hospitals brace for healthtech disruption

Published Bi-annually Bi-monthly on the Second week of the Month by Charlton Media Group 101 Cecil St. #17-09 Tong Eng Building 2 HEALTHCARE ASIA Singapore 069533

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FIRST MASSIVE HEALTHCARE DEALS TAKE OFF ASIA

Takeda Pharmaceutical

Megadeals such as Japanese pharmaceutical firm Takeda’s $58b acquisition of Irish drug company Shire and Bristol-Myers Squibb’s $74b acquisition of biopharmaceutical firm Celgene will continue to dominate Asia’s healthcare landscape in 2019, as local companies race to attract new technology investments, according to Baker McKenzie’s Global Transactions Forecast 2019 report.

Despite a lacklustre performance in 2018 with dealmaking in the healthcare sector dropping 5% to $308b, pharmaceutical companies are forecasted to continue shedding non-core assets in a bid to specialise and gain access to new technology as competition for the next innovative drug heats up.

New business models “A lot of the medical device companies are shifting their business models so that they don’t just offer a medical device,” Baker McKenzie’s healthcare mergers & acquisitions (M&A) partner Jan Hobson said.

“Instead, they offer a solution or patient support around it, or they offer to run a service for a hospital.

Many manufacturers are having to buy in that expertise.”

Moreover, IPO activity has been boosted by new rules from the Hong Kong bourse which have made it easier for biotech firms to list. “The HKSE now allows biotechs that aren’t yet profitable or without revenue to list, provided their expected market capitalisation is more than $190m,” Ashok Lalwani, Baker McKenzie’s healthcare initial public offering (IPO) partner, said in the report. “The new rules mean in Hong Kong, the number of biotech companies coming to the market in the early stages of research and development and with no profit or turnover is expected to grow.”

In comparison, biotech firms listed on bourses in Shanghai and Shenzhen must prove three consecutive years of profit and revenue before listing.

4

HEALTHCARE ASIA

Hong Kong is creating a $10b public healthcare stabilisation fund.

Rising drug costs push up healthcare spending HONG KONG

W

hen it comes to buying medicines and securing healthcare services, Hong Kong’s residents can expect to shell out more in the near future as experts predict that healthcare spending will double from $175b at present to $315b by 2033.

According to Asia Care Group’s (ACG) 2019 Hong Kong Healthcare market report, proprietary medicines and supplies presented the most significant change in the past 15 years, with extraordinary increases between 79-134% in expenditure on this category of commodity per month, depending on the type of housing individuals reside in.

“Over a ten-year period, spending increased across all categories of healthcare delivery,” the report noted.

“However, growth in spending on preventative care saw the lowest increases of just 4.8% in public and 4.3% in private settings. This is problematic given the rise in noncommunicable diseases (NCDs) that necessitate sustainable systems to place greater focus on primary care and prevention.

In the past 15 years, proprietary medicines and supplies saw extraordinary increases between 79-134%in expenditure.

Public hospital capacity ACG estimates that the total number of hospital beds for both public and private facilities is projected to reach nearly 40,000 by year 2026. In the same period, the bed to elderly patient ratio is expected to drop in the coming decade, experiencing a compound annual growth rate of -2.67% between 2019 and 2026.

“This reflects that the planned increase in bed numbers will be insufficient to cope with the demands of an ageing population unless a new model of care evolves,” the report warned.

“There is an urgent need to evolve new models of care, principally focused on better primary care. We must also find better ways of bridging the public/ private divide, either through public-private partnership (PPP) or, perhaps, through independent price regulation to cool the overheated private sector market,” Thalia Georgiou, managing partner for ACG, said in a statement.

In 2019, the Hong Kong government will create a $10b public healthcare stabilisation fund, which aims to cover additional expenditure which may be incurred by the Hospital Authority (HA) in case of unexpected circumstances. The government has also earmarked $1.2b in establishing Hong Kong Genome Institute which aims to promote the clinical application and scientific research on genomic medicine.

ACG estimated that the corporate primary healthcare market in Hong Kong reached $500m (HK$3.9b) in 2017, with the top five clinic chains accounting for 80% of market share by total revenue.

xxx capita total expenditure Per Pharmaceutical market growth on forecast health

Source: Fitch Solutions

FIRST Bumrungrad has also earmarked funds for projects such as IBM Watson for Genomics, nextgeneration sequencing (NGS), noninvasive prenatal testing (NIPT), Biotia Systems pathogen detection, BC platforms, and robotic-assisted spine surgery.

The hospital is earmarking funds for projects such as IBM Watson for Genomics.

Bumrungrad splurges on tech

T

THAILAND

hailand’s Bumrungrad International Hospital is utilising artificial intelligence for pathogen and drug resistance detection to acquiring proprietary genomic technology as part of its efforts to offer treatment options that are unavailable elsewhere in Asia.

Apart from its high-profile investment in IBM Watson for Oncology, Bumrungrad has also earmarked funds for projects such as IBM Watson for Genomics, next-generation sequencing (NGS),

non-invasive prenatal testing (NIPT), Biotia Systems pathogen detection, BC platforms, and robotic-assisted spine surgery.

Genomic precision “With Watson FG, we can dig deep into the gene to see what is the cause of the cancer, as opposed to just diagnosing and treating it. This is a whole different level of genomic precision medicine that no one else is offering. We will be doing our own production of genomic

sequencing here on site,” noted Aniello Sorrentino, chief strategist of Bumrungrad.

The hospital will also soon roll out robotic-assisted spine surgery, which will use robots to more precisely perform surgeries, make smaller incisions that reduce recovery time required and blood loss, and minimise complications.

Bumrungrad has also teamed up with New York-based Biotia for a pioneering pathogen detection technology where it will implement real-time, portable sequencers on-site and use Biotia AI pathogen identification software to reduce detection time from weeks to hours.

“By utilising this technology, Bumrungrad will confidently be able to offer the most appropriate treatment for any infectious diseases detected; improving patient outcomes and minimising the risk of antimicrobial resistance development,” said Somsak Chaovisitsaree, Bumrungrad’s former CEO. The hospital will also focus on a three-year renovation programme for patients’ rooms and shared spaces.

“On the issue of renovation, our tenth floor will be completely redesigned and we are going to have the first in the world production of an outpatient robotic pharmacy. Right now our outpatients need to go up and down the building to get their drugs. This is a highly complex project that will begin in 2020,” Sorrentino added.

THE CHARTIST: RECORD GROWTH FOR MALAYSIA’S PRIVATE HOSPITAL OPERATORS IN 2018

P

rivate healthcare operators in Malaysia are set to enjoy another strong earnings year amidst robust medical tourism figures and the abolishment of the GST. This builds on the positive performance by IHH Healthcare Berhad and KPJ Healthcare Berhad which saw record revenue growth per inpatient in Q3 2018.

“The Malaysian healthcare sector will experience robust growth driven by the country’s concerted effort to improve the health and well-being of its population. In 2017, healthcare expenditure in Malaysia was valued at $13.10b (MYR56.33b) and is expected to experience a five-year compound annual growth rate (CAGR) of 9.0% in local currency terms and 10.6% in US dollar terms, reaching $21.66b (MYR87.17b) by 2022,” Fitch Solutions said in a report.

Private healthcare growth forecasts

Sources: Fitch Solutions

Revenue per inpatient at IHH In 2018

Source: Fitch Solutions

HEALTHCARE ASIA

5

FIRST HOW MUCH ARE YOU WORTH IN SINGAPORE? SINGAPORE

Medical tourism wars heat up as costs skyrocket

Per capita xxx Steady growth total in expenditure Thailand medical on health tourism arrivals

ASIA

Salaries may rise by up to 10%.

Singapore’s healthcare industry can expect to see between 5-10% increases in salary with highperforming candidates within the biomedical sector receiving a possible 15% hike when they change employers, according to a report by HR services provider Randstad. The firm added how the highest pay rise can be expected from the diagnostic and devices sectors, whilst salary spikes in the pharmaceutical industry only occur when there is a new entrant to the market.

“We foresee that salaries could rise for experienced staff once the Chinese pharmaceutical companies enter Singapore and start competing with local firms for top talent,” it added.

Role of manufacturing Singapore’s biomedical industry is set to be a major contributor to the country’s manufacturing scene, with big pharma and global biologics companies setting up shop in the Lion City to manufacture high-quality medicines that cater to the needs of the global patient population.

Randstad noted how eight of the top 10 pharmaceutical companies have a presence in Singapore, therefore boosting the country’s growth in manufacturing and commercial activities. Moreover, the biomanufacturing sector employs an estimated 6,000 highly skilled workers.

“They are responsible for the increase in biomedical manufacturing output by 11.5% in October 2018 compared to a year ago,” Randstad said. “This accounted for the 15.8% expansion from higher production of pharmaceuticals and biologics, as well as a 2.9% growth in the medical technology segment to meet export demand from the US.” The industry is looking to hire PhDs and Master’s degree holders to work as medical science liaison (MSL) officers to better facilitate the industry’s transition to a more highskill job market in Singapore. Starting salaries for MSLs sit at $5,000.

6

HEALTHCARE ASIA

T

he rising cost of healthcare in Singapore is increasingly diminishing the city’s attractiveness as a medical tourism hub with patients opting to turn to neighbouring countries for their medical needs, according to RHB Research.

“As healthcare costs in neighbouring countries like Malaysia and Thailand are much lower, they have been attracting medical tourists from the region – thereby eating into Singapore’s market share,” Juliana Cai, analyst at RHB. “Although there is no official data on the number of medical tourists, our channel checks with the companies under our coverage suggest that these numbers have been declining YoY. We believe this is a structural problem, and will continue to impact the Singapore players in the near term.”

The strengthening of the Singapore dollar against regional currencies also adds to the already expensive cost burden plaguing healthcare providers which have been investing in the quality of their services and keeping costs down.

The rising cost of healthcare is also hitting close to home as a growing number of Singaporeans lament the

Source: Fitch Solutions

Healthcare costs in Malaysia and Thailand are much lower and have been attracting medical tourists from the region - thereby eating into Singapore’s market share.

staggering cost burden.

With healthcare insurance providers no longer offering integrated shield policies with 100% medical cost coverage, Cai expects the likelihood of softening demand for private healthcare which will consequently impact hospital bottomline. “We think that some of the private healthcare providers margins will be negatively impacted, with the local government keeping tabs on rising healthcare costs, due to public discontent,” she said.

A separate report by insurer Aon notes that medical inflation in Singapore is expected to hit 10% in 2019. The headline figure is above the global average of 8% as cancer and cardiovascular diseases continue to drive the cost of medical plans up.

Private hospitals like Raffles Medical, IHH Healthcare and Health Management International are also in a capex-intensive expansion phase which will weigh in on margins in FY19.

HEALTHTECH MOST FUNDED CATEGORIES BY VALUE

Source: 2019 by Galen Growth Asia

FIRST

Can the new Universal Healthcare Bill save dying smaller private hospitals?

PHILIPPINES

I

n February 2019, Philippine president Rodrigo Duterte signed the Universal Health Care (UHC) Act into law, allowing all Filipinos to be enrolled to the National Health Insurance Program of the Philippine Health Insurance Corporation (PhilHealth) and giving citizens access to a full range of health care services, from preventive to promotive, curative, rehabilitative, and palliative.

By law, UHC will ensure that there is no balance billing for the non-contributory group members or ward admissions and and that fixed co-payment will be set for contributory group members. Amongst the reforms that will be implemented over time include designating PhilHealth as the national purchaser for health goods and services, improvement of health facilities and responding to the gap in health workers throughout the country, and strategic engagement of the private sector.

Healthcare Asia sat down with Dr. Teodoro Herbosa, MD FPCS, executive vice president at the University of the Philippines and chief for the division of trauma surgery at Philippine General Hospital as he discusses how the bill can affect the operations of smaller private hospital players.

HCA: How does the UHC Bill affect the operations of private hospitals in the Philippines, especially the smaller players?

The UHC bill strengthens the single payer health insurance by the government through PhilHealth. This will have repercussions with the private hospitals depending on early release of reimbursement claims or number of denials of payments. We will have to await the implementing rules and regulations or IRR to fully understand any changes in coverage of illnesses and payment schemes.

The implementation of the Case Payment System has also benefitted public hospitals through added revenue but disadvantaged private hospitals. The PhilHealth also passed on doctors’ payments to the administration, which led to friction between the two when the payment system is inefficient.

HCA: What are the challenges that you see in its rollout and implementation?

The biggest challenges include the infrastructure gap in the health system which requires the increase in the capacity or numbers of public hospitals. Together with this is the human health resources gap and the concomitant brain drain of health professionals to other countries with higher

Dr. Teodoro Herbosa

paying jobs in the health sector. The biggest threat we see is the question whether access to health and services will be adequate amidst higher population base covered by UHC. HCA: During the 2018 Healthcare Asia Forum, you predicted the demise of ‘mom and pop’ hospitals. Will the UHC Bill be able to provide a solution to this dilemma?

This threat continues. This threat is cash liquidity of the small hospital operations.

They will have to partner with banks for loans for their cash flow. Delayed reimbursement has become more common with UHC. Some solutions by mom and pop hospitals have been to sell to the consolidators or capitalistbuying hospitals so that they can remain in operation.

HEALTHCARE WATCH OFFICE WATCH

VC Deal Flow in Singapore in 2018

Australia’s BlueChilli launches healthtech xxxx accelerator programme in Singapore Australian venture studio and innovation group BlueChilli has tied up with Enterprise Singapore to launch a Singapore-based healthtech accelerator. The programme will scout for ideas from domain experts across Southeast Asia, and founders who will be selected to build or advance their startup through the programme will get access to tech development services, startup training, seed funding and a global network of advisors and mentors.

The Asia Pacific’s healthtech sector is the second largest in the world for investment funds raised, after only the US. In 2018, $8.59b (US$6.3b) was deployed into healthtech startups in the region, which significantly exceeded 2017 and doubled that of 2016. Southeast

8

HEALTHCARE ASIA

Asia’s healthtech ecosystem is still emerging within the region and poised for growth, with Singapore and Indonesia contributing to most of its notable deals in 2018.

“New ideas, innovative business models and emerging technologies Common coming out of thearea accelerator have immense potential to disrupt and transform the health industry and improve quality of life across the globe,” according to BlueChilli’s CEO Sebastien Eckersley-Maslin.

Building up its activities in the region, BlueChilli also launched an innovation centre in partnership with Coca-Cola Amatil in Indonesia in April 2019. Meanwhile, BlueChilli has also joined Enterprise Singapore’s Startup SG Accelerator initiative with its healthtech accelerator Community bar programme.

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BlueChilli team

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Making Healthcare Software Human 1

Statistics shown based on internal company data of a Philippine multi-clinic chain.

Estimated costs based on market-available information.

2

At Icon SOC we have employed a unique sharedcare model that connects patients to cancer treatments and clinicians in Singapore, whilst enabling them to access local medical relationships to manage ongoing health, side effects and follow-up appointments throughout their treatment and beyond.

Predee Daochai President Serena Wee Kasikornbank CEO Icon SOC ASIA 10 HEALTHCARE

CEO INTERVIEW

Icon SOC strengthens cancer care services amidst Singapore’s medical tourism bid Icon SOC CEO Serena Wee expands their oncology services and employs a concierge for foreign patients.

O

ne of the hospitals working to boost Singapore’s leadership status in the Southeast Asian cancer care industry is Icon SOC, which is a result of Singapore Oncology Consultants’ (SOC) incorporation into Australian cancer care giant Icon Group in 2016.

In an interview with Healthcare Asia, Icon SOC CEO Serena Wee talks about the expansion of the company’s oncology services into haematology and radiation and their innovative medical concierge service that caters to medical tourists that comprise 50% of their patients.

What are the healthcare needs that Icon SOC addresses?

Icon SOC is made up of a prominent and experienced team of cancer specialists, including medical oncologists, haematologists, and radiation oncologists who have trained and worked at cancer centres both in Singapore and abroad. As of September 2018, Icon SOC has seven cancer centres, with outreach clinics in Vietnam and Cambodia.

We provide chemotherapy, haematology (including the treatment of both malignant and non-malignant blood conditions), immunotherapy, radiation oncology services, and pharmacy; as well as clinicians who work with patients to provide a personalised treatment plan based on their individual disease and cultural background.

How do you overcome your challenges as a CEO? I started with Icon SOC in 2018 as Chief Operating Officer managing the regional portfolio for Icon. During this time, I was able to grow our reach across the ASEAN region and work with teams across Icon SOC in the continual improvement of cancer care.

Having over 25 years’ experience in healthcare management, strategic planning and business development within the region, I am familiar with Singapore’s healthcare landscape, but there are always challenges. Ensuring you are leading by example for your teams and keeping a positive working environment is a constant part of my job but a rewarding one. As CEO, I want to maintain a balance between being there for my staff and ensuring I am leading the business for growth and meeting goals.

model that connects patients to cancer treatments and clinicians in Singapore, whilst enabling them to access local medical relationships to manage ongoing health, side effects and follow-up appointments throughout their treatment and beyond.

Most recently, we announced the further expansion of Icon SOC’s oncology service into the field of haematology and radiation oncology. The integrated model will ensure a close working relationship and collaborative decision making between the different specialists involved in a patient’s treatment and provide seamless care throughout the patient journey.

What is Singapore’s status in the cancer care industry?

In Singapore alone, 15 people die from cancer every day.

There is also an acute need for cancer care in Singapore. With our ageing population, the cancer burden will significantly increase over the coming years.

Cancer is currently the leading cause of death in Singapore, accounting for 29.1% of deaths in 2017. As the risk of cancer increases with age, the number of people being diagnosed and living with cancer is likely to continue to rise.

Singapore is growing as a regional leader in cancer care with patients from Indonesia, Vietnam, Myanmar and Malaysia frequently seeking services. 50% of patients treated at Icon SOC clinics come from across Asia and the Middle East via medical tourism. We have a dedicated medical concierge service that supports patients seeking to travel for treatment and care in a culturally sensitive and personal manner.

Patients are supported by a companion who will assist from the initial point of contact up to treatment and followups. We provide assistance with accommodation and medical appointments and employ a shared-care model that connects patients to cancer treatments and clinicians, whilst enabling them to access local medical relationships to manage ongoing health and follow-up appointments.

Any new initiatives that other hospitals can emulate?

We provide patients with evidence-based cancer treatments, give them access to clinical trials, whilst What are the key business milestones for Icon SOC? supporting and caring for patients and their families.

In March 2018, Icon Group signed an agreement with Continued investment in treatment techniques and Vietnam’s National Cancer Hospital (K Hospital) in technology and involvement in clinical trials for new drug Hanoi and Military Hospital 175 in Ho Chi Minh City, to treatments allow people to have a greater choice when We installed develop large-scale cancer care infrastructure, implement more “cold cap” planning and accessing the care they need. an international standard in medical excellence across We also recently installed more “cold cap” technology as technology as hospital management, and leverage innovative technologies an option for an option for combatting chemotherapy-induced hair loss. to deliver remote care. We are currently in the process This technology aims to help patients retain more of their combatting of finalising these projects, which will see the company’s chemotherapy- hair during chemotherapy treatment. All Icon SOC clinics footprint expand beyond Singapore. are equipped with this technology and it is available to induced hair At Icon SOC, we have employed a unique shared-care patients as clinically appropriate. loss.

HEALTHCARE ASIA

11

CASE STUDY

Better ways to better health: MyHealth Clinic cuts turnaround times in half through digital solutions With the LifeSys RIS PACS platform, 90% of MyHealth Clinic’s cases were read within a day, from the previous turnaround time of 2-3 days, with 30% of cases turned around in less than an hour.

W

orld Bank data show that the Philippines is an archipelagic country with a 106.7 million population, growing 1.7% on average per year. With a labor force growing at 1.8% annually, more and more people are being able to afford healthcare but are not able to get the service they need due to lack of physicians and limited accessibility especially for rural areas. CNN shared that with a ratio of one doctor for every 33,000 persons, there’s colossal need for accessible healthcare that is being unmet.

“We simply do not have enough doctors, nurses, clinics and hospitals to adequately meet the healthcare needs of our various populations, and the infrastructure that does exist, tends to be concentrated in major cities, leaving those in Tier 3/4 cities and villages, with few options other than travel or ignore treatment. This is costly to the individual, their families, and societies at large,” said Joseph Mocanu, Managing Director at Verge Capital Management at the Healthcare Asia Forum last April 2019.

He stressed that decentralising healthcare is one of the key initiatives that will help provide quality healthcare to the more than 5 billion people globally who currently do not have access.

“Decentralisation can allow for the separation of data collection and diagnosis, so you can retain much of the specialised talent in the major urban centres, while being able to meaningfully diagnose, triage, and treat those who otherwise would have had to leave their homes,” he added.

MyHealth Clinic, a network of multispecialty medical clinics based in the Philippines, is among the first to respond to the ever-growing healthcare demand. From launching the Philippine’s first 24/7 Urgent Care Clinic and Telemedicine services, to becoming the country’s largest network of full-service ambulatory clinics offering the most extensive healthcare services, MyHealth Clinic has been on the rise to be among the country’s leading providers for outpatient healthcare.

MyHealth Clinic’s vision is to provide the best customer experience in the healthcare industry by delivering affordable 12

HEALTHCARE ASIA

Radiologist using the LifeSys RIS PACS platform

“The faster it takes for a radiologist to complete a report, the shorter patients have to wait for proper diagnosis and treatment.” and accessible healthcare. In pursuit of these goals, they’ve opened operating clinics situated in accessible locations and lengthened their clinic hours to cater to their patients’ varied schedules and lifestyles.

Their partnership with DoubleDragon Properties’ subsidiary, CityMall Commercial Centers Inc., would allow them to provide ambulatory services in CityMalls all over the country. They’ve also partnered with Maxicare, Insular Health Care, and many more to allow their patients to benefit from their HMO’s and insurance partners.

They administer patient surveys as a feedback mechanism for improvements in their healthcare delivery services. MyHealth Clinic is also a firm believer that technology and digitisation of healthcare can further improve patient experience and at the same time make its services more affordable.

Without a doubt, technological advancement over the last decade or so has significantly transformed industries.

The technological revolution has enabled industries to serve market segments they were previously unable to reach through innovative go-to-market models and the development of more affordable product/ service offerings. But adoption of digital

innovations in healthcare has not been quite as fast.

“It’s true there are many challenges in adopting new technologies in healthcare,” said Dr. Francis Mangonon, MyHealth Clinic’s head of operations. “But it is also true that we should be giving attention to it. With the way the healthcare landscape is evolving, there is likely to be no other way forward but to find the sweet spot between digital and personal in healthcare.”

Electronic health records (EHR) continues to be a big trend in health technology.

There has also been a lot of news around Artificial Intelligence (AI) and Deep Learning (DL) and a recent surge in the number of patient-directed applications from online pharmacies, adherence programs, remote or on-demand primary care consultation and services, wearables, among others. One area MyHealth Clinic saw could benefit from new technologies was their imaging operations.

MyHealth Clinic conducts hundreds of thousands of medical imaging services in a year across its network. It usually took around 2 to 3 days to provide the final report to patients. As they expanded sites and the traffic situation worsened, they also realised their specialists wasted a lot of time moving

CASE STUDY

MyHealth Clinic Branches in accessible locations

from one site to another. Not only were they unable to optimise their resources, they also kept the patients waiting.

Dr. Steven Pua, chief medical officer of MyHealth Clinic, said “As a radiologist myself, I was looking for solutions that can reduce turnaround times and is easy to learn and use. But as an administrator, I was looking for solutions that can enable more efficient operations and is simple and cost-effective to setup and maintain. As MyHealth Clinic grows, we would also need a system that scales easily to support our expansion plans.

When I came across LifeSys, it seemed like they were going to be able to solve these concerns, not just on the radiology side but also on the administrative side.”

In February 2019, MyHealth Clinic began the roll out of the LifeSys RIS PACS platform across its various sites. As of the end of June, 90% of cases are read within a day - an almost 50% reduction, given their previous turnaround time of 2-3 days. Around 30% of their cases were actually turned around in less than an hour.

“We think patient waiting time is one of the key drivers for customer experience. To fulfill our vision of providing the best customer experience, reducing turnaround time in our radiology operations was one of the best places to start,” said MyHealth Clinic’s Dr. Rafael Dy Tiapco.

With legacy radiology systems, doctors would need to be on-site to be able to access the images and write reports. When Dr. Eric Schulze, founder and CEO of Lifetrack Medical Systems, began developing LifeSys, he previously had extensive experience with RIS PACS systems in both developed and developing markets, both as a practicing radiologist and a teleradiology pioneer. He had witnessed the evolution and limitations of PACS systems since his residency at Massachusetts General Hospital, so he went on to build LifeSys from the ground up to have all the functionalities and benefits the legacy systems did not offer.

With LifeSys, radiologists are now able to access patient images and records on and off site, at any time of the day. This enhanced capability for radiologists has allowed them to read more studies, boosting their productivity, and virtually eliminating the clinic backlog.

“Having a lot of clinic locations is good for patient accessibility but also poses as an operational challenge. With the increasing traffic situation, radiologists lose a lot of time on the road moving from one clinic to another. With LifeSys being both on cloud and onsite, we are able to improve patient experience without compromising operational efficiency. It’s a win-win situation for our patients and for MyHealth Clinic. The faster it takes for a radiologist to complete a report, the shorter our patients have to wait and the more patients we can accommodate,” said Dr. Pua

Dr. Mangonon added. “We have also been able to collaborate with Lifetrack so that we can provide our patients digital access to their images and reports. We reduce the need for CDs and film printing which saves costs but at the same time makes it easier for patients to always have their records readily accessible.”

Dr. Pua continued, “We continue to realise the benefits that a system like LifeSys or any other digital solution can provide for us. Our radiologists continue to learn and maximise the system. It’s easy to use - the results in turnaround time in a couple of months speak for this. There are other functionalities that we have yet to take advantage of, like the built in analytics to inform our operational decisions. I’m sure that this positive trend will continue.

We continue to watch out for other ways, digital or non-digital, that could further improve patient experience, affordability and accessibility of our services without compromising quality. There are more patients out there waiting to be served.”

CONTACT Company Name: Lifetrack Medical Systems Pte Ltd Address: 100 Amoy St., Found8 Amoy Singapore 069920 Email: inquiries@lifetrackmed.com Phone Number: +65 9226 0118 Website: https://lifetrackmed.com/

“With LifeSys, radiologists can report on patient images and records on and off site anytime, boosting their productivity, and virtually eliminating backlog. It’s a win-win situation for patients and MyHealth Clinic.”

Turnaround approximates time between when images are ready for reading by a radiologist and time when reading report is finalized.

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FEATURE PROFILE

The Hong Kong Hospital Authority is developing apps to improve the patient experience.

Here’s a behind-the-scenes look at Hong Kong Hospital Authority’s big data push Driven by the government’s growing investment in healthcare technology and big data, the hospital authority has streamlined a health app framework for a mobile app that will soon be launched.

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he Hong Kong Hospital Authority is crafting a centralised mobile app which will give patients and doctors a single framework to access disease information and treatment options, Healthcare Asia has learned.

“What we have done over the last few years is to develop a series of apps for various things. What we’re doing now is that we’re putting it all together into one common framework so that it becomes an extensible framework for all interactions with the Hospital Authority and with their own healthcare providers. This is what we are building and it’s going to be called HA Go,” said Dr. NT Cheung, head and chief medical informatics officer of the Hong Kong Hospital Authority.

The app, which is slated to be launched in 2019, will be designed to address the inherent limitations that current healthrelated mobile applications face.

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The HA first started its big data push by developing simpler healthcare apps to improve patient experience, such as an app to reduce pharmacy queuing, and another to automate bookings.

“There’s a big limitation when you do clinical apps because you have to be very careful about the security of the data. The idea here is when we say framework, part of it so that we have a consistent way of registering patients and their carers. Within this framework we can then allow our clinicians to communicate with the patient with the assurance that we know who they are,” Dr. Cheung explained.

Continuous innovation The HA first started its big data push by developing simpler healthcare apps to improve patient experience, such as an app to reduce pharmacy queuing, and another to automate bookings for specialty outpatient clinics.

“And then we started building more disease-specific apps. We found that we are starting to build more and more of these apps. There are hundreds of thousands of different

diseases, and in theory you can make an app for each of them. But for a patient that will be unworkable. So the idea here is that all they need to download is HA Go, and if they need the diabetes app, the doctor will press a button on his system and the diabetes app will get pushed to their machine and they wouldn’t be bothered with the apps that they don’t need,” Dr. Cheung said.

HA Go is part of Hong Kong’s effort to better engage patients in their own care. “A more involved and more educated patient is a healthier patient. We have a comprehensive medical record system within the Hospital Authority already. It’s called the Clinical Management System and the doctors use that for all of their care and orders and things. But the thing is that when patients go home, their behaviour doesn’t make

FEATUREPROFILE PROFILE FEATURE SINGAPORE VIEW

Healthcare boosts capital markets Singapore’s capital markets were significantly lifted up by the Lion City’s reputation as a medical hub and its relatively high price-earnings ratios which attracted healthcare players to list on the Singapore Exchange (SGX), according to PwC’s latest Equity Capitals Market Watch report.

Four healthcare companies made their trading debut on SGX’s Catalist board in 2018, including Asian Health Specialists, Hyphens Pharma International, Medinex and Biolidics, and witnessed strong debut gains. Private healthcare provider Asian Healthcare Specialists, which offers highly subspecialised orthopaedic services, also performed strongly in 2018 with a 13% growth in its share price since its April 2018 IPO. Dr. NT Cheung, Hong Kong Hospital Authority

it to the system—whether they are exercising or eating well or anything.

They might be keeping a paper diary or this and that. The idea here is that the information about what the patient is doing outside the hospital also gets recorded, and when the doctor sees them again they will know exactly what the patient has been doing,” he added.

With HA Go, patients have become a contributor to their own record as the app reminds patients of things when they need to do them, and all under a single framework which allows doctors to prescribe apps as needed to patients.

“And then the app will be able to take relevant patient data from the system and customise the experience for the patient. And the patient data will also then flow back into the medical record for the doctor’s review. It’s a complete picture endto-end involving the patient and tying in with the workflow of the doctor who is already electronically enabled, but at the moment the last mile of the patient is not available,” Dr. Cheung noted.

Government support The HA receives the lion share of government healthcare allocations which have been steadily growing by an average of 7% over the past decade, data from BMI Research show.

Finance secretary Paul Chan boosted the recurrent financial provision to the HA by $6b to $61.5b in his latest budget address, representing a year-on-year increase of 11%.

Thanks to the budget boost, the HA has been able to tap on emerging technologies such as big data to improve clinical outcomes. “We’ve had access to standardised, high quality data for many years. But now we’re talking about big data. And there are a lot of unstructured data that we can also get value from. But now with the tools that we have, we believe that this data is ripe for extraction,” he explained.

For instance, the HA is building a collaborative data lab to support machine learning in Hong Kong.

“What we’re going to do is that we will take this data and scrub it so it doesn’t have any identifiers, and then it can be offered to researchers who have machine learning projects who think that this data is workable. We hope to take advantage of all this data to drive machine learning projects in Hong Kong around healthcare,” Dr. Cheung said.

The data lab is still being set up, but it is due to launch this year and run for 12 months on a pilot basis. The pilot will be conducted in collaboration with local researchers and universities.

Despite this, there are many other issues which need to be addressed when it comes to building healthcare apps. “We need to figure out how to use these algorithms— whether there will be possible downsides and mistakes and so on.

We’re still at the phase where we’re learning to build the algorithms and the machine learning engines,” he noted.

Outperforming indexes Singapore’s listed healthcare sector was also observed to have fared better than the benchmark Straits Times Index (STI) performance by recording a smaller -6% decline for the start of Q1. Despite strong share price gains, PwC warned that heightened competition from neighbouring countries like Malaysia and Thailand could heap pressure on the local healthcare market in the coming years.

The Malaysian government allocated $6.93b for healthcare in its 2019 budget, which is 7.8% higher compared to its previous budget, in a bid to develop its medical tourism industry. Likewise, Thailand’s largest private hospital operator Dusit Medical Group has grown its revenue from foreign patients 10% YoY in the first six months of 2018. “The strong Singapore dollar against these regional currencies could make medical tourism in Singapore more costly, thus reducing demand from foreign patients,” PwC Singapore added.

Nonetheless, the report highlighted how some Singapore-brand hospital groups have taken their operations overseas to counter the migration of medical tourists. Singapore-listed Health Medical International for example established its Mahkota Medical Centre in Malacca and the Regency Specialist Hospital in Johor, whilst Raffles Medical Group took its brand to China. “Despite the competition from our ASEAN counterparts, we expect continued growth in Singapore’s healthcare sector given the reputation of the Republic’s healthcare system, increasing demand led by its aging population, as well as the growing affluence in the region,” PwC Singapore commented.

Healthcare sector raised 5.7% of IPO funds

Sources BMI Research Source: SGX, December 2018

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COUNTRY REPORT: TAIWAN

Taiwanese firms at MEDICA, the world’s largest trade fair for the medical device industry in Germany 2018

Taiwan’s medical device manufacturers squeeze big data into portable machines Predictive and personalised patient monitoring systems can cut down mortality rates by close to 25%.

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aiwan-based healthcare manufacturing firms are rolling out portable advanced patient monitoring systems amidst the country’s efforts to amp up its hospital facilities and services to meet the digitalisation needs of their patients and mitigate the shortage of medical professionals.

From the minute patients walk into hospitals and clinics for consultations to after-patient care, hospitals in Taiwan’s major cities are cutting down waiting times and the need for manpower to orchestrate mundane tasks, such as checking in patients, through the use of artificial intelligence (AI) and automation. For instance, to request a primary checkup at Taiwan’s largescale hospitals like Taipei Medical University Hospital, patients only have to insert their National Health Insurance (NHI) ID cards at selfservice kiosks which immediately 16

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uploads their information to the hospital information system.

In some of its intensive care units and haemodialysis centres, hand-held monitoring systems that can integrate big data and provide AI-assisted realtime data are becoming increasingly popular.

According to Dr. Ray Jade Chen, superintendent for the Taipei Medical University Hospital (TMUH), such systems can cut down mortality rates by close to 25% as human error is decreased. Chen, who presented at the Medical Taiwan International Medical, Health & Care Expo last June, explained that such systems can enable medical practitioners to prioritise intensive care unit (ICU) patients, particularly in the evening.

“Monitoring systems that include and record all of the patients data real-time, such as their heart rates and blood pressure, decreases the need for nurses to manually monitor patients’

Patients at Taipei Medical University Hospital need only insert their National Health Insurance ID cards to upload their information into the hospital information system.

vital statistics, and therefore we won’t miss anything important,” Chen highlighted.

With its efforts in developing and utilising predictive AI technology, the Taipei Medical University Hospital employs the TED ICU, which integrates clinical data from its patients across its eight ICU departments to enhance efficiency and better allocate resources to patients. The platform provides doctors with ‘dashboard’ information on their patients, including X-ray photos, medical reports and progress notes all in one digital space.

The system, which was rolled out almost two years ago, has reportedly reduced staff response times by 6.4 minutes, and drastically shortened time spent in routine paper work by 9,600 hours per year. Expenditure in paper copies of reports have also been reduced by $1,620.06 (NT$50,000) annually.

COUNTRY REPORT: TAIWAN “Also, it allows us to analyse the data quickly since it’s all there and predict any potential risks such as delirium and sepsis hours before they happen, so we can make the necessary adjustments to patient care to further avoid any more complications,” Chen added. According to the hospital’s data, the length of ICU stays have also dropped from seven to five days on the back of better monitoring through its predictive patient monitoring system.

This sentiment was echoed by Brian Chong, vice president for ICT manufacturing firm Wistron Medical Technology Corporation, who added that the reliance on automation for menial and repetitive tasks, such as health insurance verification and checking vital signs, not only cuts down on labour costs, but also lessens the burden on the country’s available medical practitioners. Chong was also present at the Medical Taiwan International Medical, Health & Care Expo in June.

“The shortage of medical professionals is a trend we’ve been seeing in Taiwan for some time now, and it’s troubling because the country’s ageing population continues to grow as well,” Chong explained.

Labour crunch According to a 2014 report by Taiwan’s National Health Research Institutes, hospitals are forecasted to face a shortage of 7,762 doctors across the general, surgical, gynecological, pediatrics and emergency departments by 2022. The report also noted that doctors in service would be at least 40 to 59 years old, meaning that in less than three years, patients may further struggle to find doctors to treat them.

The country’s elderly population accounted for 3.43 million of its 23.59 million population, and is projected to rise to 3.78 million by 2020, data from Taiwan’s National Development Council (NDC) showed. Meanwhile, medical care costs for Taiwan’s population aged 65 and over accounted for 37.6% of total NHI expenditure in 2014, when the elderly share of the population was 12%, according to PwC Taiwan’s 2018 market overview. These costs are

projected to grow with the forecasted rapid rise in seniors, with Taiwan formally becoming an ‘aged society’ in 2018.

Telehealth gains traction Meanwhile, medical manufacturing firms are also making strides in developing portable monitoring devices to provide a similar, if not the same, level of care to patients living in rural areas and to the elderly who prefer receiving care at home, as telehealth gains traction across the country.

Although telemedicine has been promoted in Taiwan for more than 10 years, previous plans have either been shut down or were economically ineffective, whilst other plans relied on government funds.

“Because of the culture and past perceptions, the past government’s efforts to promote telehealth were not that successful,” said Kelly Wang, senior marketing manager for medical device manufacturer BriteMED Technology Inc. “But this time, president Tsai Ing-Wen has a different policy. And both doctors and other care service providers have recently joined together with the aim of integrating their services to make it more communicable and accessible.

So probably this time, because of this integration, it will be more successful.”

Additionally, the shifting focus on a more aggressive policy in developing Taiwan’s telehealth service were attributed to a low fertility rate, younger people remaining single, long life expectancy and advanced medical technology in better economic conditions in Taiwan, according to a report by Huang and colleagues.

“Elderly people in Taiwan prefer to age at home and to live in the community rather than stay in institutions, as staying in the institution means isolation from their family members and close friends and requires leaving their familiar living environment,” the report’s authors noted.

In response, point-of-care devices such as BriteMED’s 12-Lead Portable Electrocardiogram (ECG) and Wistron’s Spartan Cube have been

A governmentbacked industry plan aims to increase the value of Taiwan’s medical device sector to $6.5b by 2020.

gaining popularity across medical professionals providing home and rural area medical services. Such devices, which record patient statistics accurately amidst their size and location-usage, also cuts down the costs for patients’ health expenditures.

“In some cases, such devices can be more accurate in recording information,” Dr. Wei-Fong Kao, deputy director for the International Healthcare Centre at TMUH, noted.

“Wearable ECG recorders are usually 90% more accurate in screening arrhythmia, compared to the 50% and 10% reported by Holter and traditional ECGs, respectively.”

Taiwan’s biomedical industry, which includes the applied biotechnology, pharmaceutical and medical device sectors, is a major priority focus for the country, with combined domestic market sales totalling $13b in 2016, according to PwC Taiwan’s report.

The firm also noted of a government-backed industry investment plan, which was announced in April 2017, that aims to move Taiwan’s medical device sector up the value-added chain, as well as increase its value to $6.5b (NT$200b) by 2020.

“It’s a costly undertaking of course, but the long-term preventive benefits on the country’s healthcare industry, especially for the ageing population, far outweigh the short-term expenses,” Chong highlighted. “We can expect a lot more predictive and personalised healthcare to rise in the coming years given the digital age and emerging economies’ needs.”

Taiwan medical market size

Sources: Export.gov

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HEALTHCARE ASIA FORUM: MANILA

Healthcare leaders discuss the future of Philippine healthcare at Makati Shangri-La

What steps should Philippine hospitals take to reach universal healthcare?

A severe labour and funding crunch are holding back ill-prepared healthcare providers in the country.

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ospitals in the Philippines are looking to streamline their organisational structures and improve employee engagement in anticipation of the government’s bid to roll out its Universal Health Care (UHC) into law, which will see all Filipinos enrolled in the National Health Insurance Program of the Philippine Health Insurance Corporation (PhilHealth).

At the Manila Leg of the 2019 Healthcare Asia Forum, around 70 attendees from 33 hospitals, which include practitioners from Singapore and Malaysia, exchanged ideas on how hospitals could best enhance their services and staff retention practices whilst adapting to changes brought about by UHC. According to Dr. Mar Wynn Bello, OIC-director IV for the Bureau of International Health Cooperation (BIHC) at the Department of Health (DOH), the government needs to 18

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seek the help of the private sector to reduce Filipino patients’ out-ofpocket expenditures which now account for 54.2% of their funding sources.

“Out-of-pocket expenses, or what patients themselves are spending, are not decreasing. If you compare it with Vietnam and Indonesia, the Philippines is witnessing a trend of increasing out-of-pocket funding, despite the fact that we are providing more budget now for public health,” he said, noting that the budget of the DOH is at $3.27b-$3.47b (PHP170b180b) which is roughly 18 times higher than the budget in 1991.

Dr. Bello added that under the UHC, coverage of social health insurance will expand into the provision or expenditure in terms of healthcare, which is where the private sector will come into play.

Chris Hardesty, director of life sciences at KPMG, expressed

The Philippines is witnessing a trend of increasing out-of-pocket funding despite the fact that we are providing more budget now for public health.

skepticism over the government’s capability to achieve its goals by 2030 on its own. “If you think about how a government can expand access and coverage to its people, you can increase taxes, or you could reduce the layer of covers that you’re promising to people. Neither one of those is a really good, viable option,” he said. “We need to figure out a way to not only help the population’s health and help save costs but to also have sustainable business models.”

KPMG’s statistics showed that for every additional year of life expectancy that is added to a country’s population, there will be a consequent 4% increase in GDP. The Philippines’ life expectancy stood at 72.5, DOH noted.

“From an economic perspective, there’s a lot of incentives to achieve this vision. That’s why we need novel business models from the private sector to come in and help achieve this vision,” Hardesty added.

HEALTHCARE ASIA FORUM: MANILA Whilst the UHC may see the consolidation of hospitals and health facilities at the provincial level, measures are being taken to ensure that healthcare practitioners stay both at their respective hospitals and in the country. A study conducted in 2002 found personnel shortages ranked as the top issue for hospitals, and whilst it no longer places as the number one concern after being overtaken by financial challenges, it still remains a pressing problem for hospital management, according to Dr. Marcellus Ramirez, assistant medical director at the University of Santo Thomas (UST).

According to Dr. Arturo De La Peña, president and CEO of St. Luke’s Medical Center, retention programmes pose a big challenge, especially for underpaid nurses.

“Right now, radiation technologists, medical technologists and physical therapists are being targeted. They’re receiving way about four or five times the salary we can offer,” he said.

He added that when looking at the salary scale of nurses in the private sector, it is almost comparable with government hospitals. “But we’re not trying to improve it because millennials are not very particular about the non-monetary benefits.

They don’t care about health insurance, they don’t care about the medical benefits. So what we do is convert the non-monetary benefits to monetise them.”

Maria Martina Geraldine Dimalibot, senior vice president and chief medical officer at St. Luke’s Medical Center, highlighted that 17.5% of new nurses leave their first job in their first year, whilst 14% leave in their second year due to burnout and dissatisfaction. Dimalibot shared that they formed a ‘Pathway to Excellence’ (PTE) programme and various committees to encourage nurse participation in improving outcomes, as well as monitoring of the hospital’s systems to address performance gaps.

Dr. Benjamin Campomanes, senior vice president and chief medical officer at St. Luke’s Medical Centre, also shared how they introduced a one-health care system organisational structure to streamline practices in their two hospitals at Bonifacio Global City and Quezon City, which marks a shift from its pre-one-health care system processes where forms from one hospital were not accepted in the other.

Rafael Solis, executive vice president and head of hospital

Radiation technologists, medical technologis and physical therapists are receiving about four or five times the salary we can offer.

operations at St. Luke’s Medical Center, cited a 2017 study that showed that a 5% increase in employee engagement could lead to a 3% boost in earnings, as well as a drop in the number of employees looking to leave, which stood at 51%.

“Staff turnover is the biggest challenge for hospitals, although we have seen a decrease in turnover. That said, we need to capitalise on this high global engagement. This is the best time to transform and reform organisations, as employees are more likely to back them up,” he noted.

Joseph Mocanu, managing partner for Verge HealthTech Fund and advisor for Lifetrack Medical Systems Inc., also stressed the need for a national health record with a standard and open infrastructure, highlighting that until one is set in place, Philippine hospitals and medical practitioners are running blind. “You don’t need someone who has studied for 25 years taking your pulse. That is inefficient, and wasteful. They should be using their 25 years of training to make decisions and nothing else. No writing, no administration, no running around. Just using their brain for what it’s trying to do.”

Arianna Danganan

MEMBERSHIP PROGRAMMES

How to implement universal healthcare with national membership programmes

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s the Philippines mulls the ways it can implement universal healthcare, Dr. Arturo S. De La Peña, president & CEO of St. Luke’s Medical Center, discusses the role of the private sector in turning the systematic change into reality and the possible membership models for the country’s national healthcare programmes.

How can the Philippines implement universal healthcare?

Universal healthcare law is a good law because it provides access for every Filipino. But the implementation of rules and regulations should be well-crafted. Based on the universal healthcare law, there would be two types of members to healthcare programmes, the non-contributing members and the contributing members. Basically, the non-contributing members should have no balance billing. Most of them will go to government hospitals.

But the contributing members can go anywhere else, but they should have balance billing. Meaning to say, the government will shoulder a certain amount and the rest will either be out-of-pocket, supported by private insurance, supported by whatever they can arrange. Moreover, there’s a shift towards more out-patient procedures.

The very big question is: Is the national health organisation, the Department of Health, ready to handle the influx of a lot of patients to the hospitals because as of now, the ratio for patient beds is about one or little less than 2 beds per 100 patient population. There should be a lot of investment in the infrastructure, especially from the government’s

side, to be able to handle these large influx of patients who would go to the hospital seeking healthcare.

What are your thoughts on the issue that was raised that the government can’t do it alone?

Certainly, as a general rule in life, nobody can stand alone and this is very true whether in governance, in government, or in private sector.

You see, in terms of specialties in terms of so many other things, the government does not have all of the expertise needed.

They can tap into the expertise of the private sector to be able to deliver high quality of care to the patients.

Dr. Arturo S. De La Peña

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HEALTHCARE ASIA FORUM: BANGKOK

Industry leaders gather to discuss the future of Thailand healthcare at Doubletree by Hilton

Is Thailand, the poster child for universal healthcare, ready for telemedicine?

Heavy traffic is one of the factors pressuring healthcare providers to implement on-demand digital care.

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hailand is gearing up for on-demand digital care to the next phase of its universal healthcare (UHC) programme as part of its efforts to expand the healthcare net to a rapidly growing mobile-first population. At the Bangkok Leg of the 2019 Healthcare Asia Forum, more than 40 attendees from 20 hospitals and industry players, with a speaker flying in from Singapore and an attendee from The Netherlands, exchanged ideas on how Thailand can step up its healthcare game by embracing telemedicine.

David Thomas Boucher, chief business transformation officer at Bumrungrad International Hospital, defined ‘on-demand care’ as disrupting the medical services market via mobile technology where services are offered on demand, resulting in an easier, more affordable and satisfying patient experience.

“By adopting on demand care, 20

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we are essentially adopting retail approaches by bringing patients and providers together via technology,” he explained, highlighting how Bangkok’s growing traffic problem signals a greater need for telemedicine.

Apart from needing better physician directories or implementing patient satisfaction online reviews similar to how riders would rate their Grab drivers, hospitals also need to adopt patientfriendly environments resembling a Starbucks cafe or hotel lobby to change the ‘scary and professional’ image of hospitals, he added.

“There are a lot of positions hospitals can take, but we should ultimately be part of the solution to not just stay competitive, but also to enhance the medical industry as a whole.”

Michael David Mitchell, hospital director for Bangkok International

Hospitals also need to adopt patient-friendly environments resembling a Starbucks cafe or hotel lobby to change the ‘scary and professional’ image of hospitals.

Hospital, echoed the sentiment and highlighted how private hospitals in Thailand are becoming internationally competitive by digitising healthcare services.

Digitising healthcare He added how private hospitals in Thailand have a wider range of choices compared to those in Australia, from the number of rooms patients can choose from, to the network sharing systems present in hospital operations, down to the large amount of parking spaces available at local hospitals.

“We must obviously be smart in managing costs but still get good patient outcomes, so it is vital we understand the clinic and nonclinical manpower cost structure,” Mitchell said. “Telehealth is the next step, and it is also really useful for remote areas where primary care general practitioners (GPs)

HEALTHCARE ASIA FORUM: BANGKOK MEDICAL TOURISM

Smart visa-driven medical tourism boom threatens to overwhelm Thai public hospitals

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hailand is seeing a surge in medical tourists since introducing its new smart visas in 2018 which allow visitors from several Asian countries to stay for 90 days rather than 30.

Dr. Phusit Prakongsai, acting senior advisor on health promotion at Thailand’s Ministry of Health, highlighted that the number of medical tourists is expected to surge to roughly 40 million in 2019, and as a result has pressured the government to find ways in which it can control costs at both the public and private health sector fronts and still ensure quality healthcare delivery to all patients.

“We have a lot of debate on medical tourism, especially on medical government policy. From the Ministry of Finance standpoint, they will try to establish benchmark prices and stabilise costs, but from Ministry of Public Health perspective, we have the problem of limited human and infrastructure resources,” Dr. Prakongsai noted. “Public hospitals such as Bangkok’s King Chulalongkorn Memorial Hospital are very crowded with patients.”

Part of the government’s strategic plan to become a global medical hub involved loosening visa restrictions and the creation of smart visas.

Extending visas from 30 days to 90 days for citizens of China along with those of Cambodia, Laos, Myanmar and Vietnam (CLMV) increased the number of treatment options given the longer duration, whilst the smart visas allowed foreign professionals within 12 categories, including one for ‘affluent, medical and wellness tourism’, to stay in the country for up to four years without a need for a work permit.

are able to provide care from their offices without having to travel hours to reach patients in rural areas.

Telehealth has worked in Australia, and there is potential in Thailand.”

Dr. Tullawat Pacharapha, COO of Vejthani Hospital, shared this view, adding that geographical fragmentation will be less and less significant as Thailand pushes with digitisation, especially if it takes on telemedicine.

The journey to UHC Thailand has come a long way to get to where it is today to provide UHC to its 69.81 million population and a reputation as one of the region’s leading medical tourism centres, according to Dr. Phusit Prakongsai, acting senior advisor on health promotion at Thailand’s Ministry of Health.

From fragmented public health insurance schemes and a large uninsured population back in 1963, Thailand implemented UHC in 2002, when the country’s gross domestic product (GDP) per capita stood at a mere $1,870.

“Thailand was not, and is not, a rich country. We fall under the lower middle income country but we still managed to achieve UHC. There are a lot of predictions that the country will

A report noted that in 2011, 500,000 of the 19 million visitors that came to Thailand travelled specifically for medical treatment, whereas of the 10.2 million tourists that visit Singapore each year, only 200,000 go to receive medical care. About 1.4 million international patients received medical treatment in 2012 and the number is increasing annually. A separate 2016 Medical Tourism Index noted that annually, the number of medical tourists visiting Thailand had jumped to 25 million.

Dr. Prakongsai further highlighted how keeping costs down is vital.

“Our role is to try to communicate and control, from some distance, the quality and price of the services, but we are not trying to be competitive with the private sector because our roles and our responsibilities are somewhat different - we are mainly responsible for the Thai citizen.”

Dr. Phusit Prakongsai, Thailand Ministry of Health

not survive with its UHC programme given the rising medical costs, but we are positive that we will be able to continue this with more government initiatives, such as telemedicine.”

Whilst telemedicine policies have yet to be implemented on the national level, Dr. Prakongsai said that the government is looking into more investments and getting the timing right to provide on-demand digital care to locals, expats and tourists.

He further added that as Thailand’s medical tourism grows, talks are underway as to how both the public and private sector can work together to maintain costs but still assure high quality care.

Private sector’s role Although Thailand has already achieved universal healthcare, there is still a big role the private sector can play to keep the country moving forward with its telehealth ambitions and overall UHC vision, according to Chris Hardesty, director of life sciences at KPMG. “UHC creates a virtuous cycle in that it can provide more jobs, which leads to improved economic performance, which in turn leads to higher productivity, and so on,” he explained, highlighting that

Thailand has come a long way to get to where it is today to provide UHC to its 69.81 million population and reputation as one of the region’s leading medical tourism centres.

diagnostics, which is perceived as a service that the private sector is best at providing, could be the most important part of the whole package.

“Getting diagnostics right in the first instance could save a lot of costs down the road, so companies and the public sector have to work together to understand how that can help the overall system.”

Upskilling and upgrading Whilst some say that the medical industry is seeing a shortage in staff, Major General Niwat Boonyuen, deputy CEO of Group 4 Bangkok Dusit Medical Services (BDMS) and director of Bangkok Hospital Chiang Mai, argued that upskilling staff and providing technologies that help them work better are two of the main priorities hospitals should focus on, especially if the country is looking to embrace telemedicine.

“Number of staff is not the problem.

Hospitals need to prioritise training for their professionals, as well as finding ways to get patients involved in their treatments. Communication, especially with international patients, is important as more and more patients want to understand what is happening, and why,” he explained.

Arianna Danganan HEALTHCARE ASIA

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HEALTHCARE ASIA FORUM: JAKARTA

Industry leaders discuss the future of Indonesia’s healthcare at Fairmont Jakarta.

Indonesia’s hospitals brace for healthtech disruption

Disruptors come in the form of personalised medicine and healthtech.

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t the Jakarta Leg of the 2019 Healthcare Asia Forum, over 40 attendees from 28 hospitals, including practitioners from Singapore, exchanged case studies and strategies on how to best deal with disruptive elements that comprise not only the growth and failure of healthtech but also generational changes and the optimisation of a universal healthcare policy.

Siloam Hospitals Group commercial group head Amelia Hendra shared how the firm is marketing healthcare services to the millennial generation — which is expected to comprise 44% of Indonesia by 2030 — by dropping traditional marketing techniques and integrating values of transparency and innovation. According to her, the hospital is also providing consumer education through their app, which is being continuously developed to be a platform for their services.

Meanwhile, Awal Bros Hospital Group hospital director Dr. Aditya Nugraha, M. Biomed, discussed how a “disruption wave will eat an organisation” if it does not defend itself from five disrupters, namely, personalised medicine, the Amazon effect, the digital revolution, regulatory changes, and changing 22

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Siloam Hospitals Group is providing healthcare consumer education on their app in response to the digital threats.

consumerism patterns. One of the potentially disruptive healthtech in Indonesia is the machine learningdriven app Alodokter, founded by CEO Nathanael Faibis, who shared that 80% of the 300,000 monthly teleconsultations can already make the “right recommendation.”

Moreover, it removes the need for patients and doctors to communicate using other unsafe messaging apps by having them interact with each other through the app.

Digital disruptions However, Omni Hospitals Group deputy group CEO Dr. Num Tanthuwanit warned that a lot of healthtech could fail due to the mismatch of the

Healthcare Asia Forum panel discussion

provider’s readiness and technology, actual bad technology, the ignorance of the last mile, the lack of optimisation, and “short-term thinking.”

Tanthuwanit cited his administrative experience in Bumrungrad International Hospital, which involved utilising IBM’s Watson technology that was supposed to deliver AI-driven recommendations for cancer treatment but failed to use actual patient data and instead fed on hypothetical data.

“It’s easy to get caught up when big names and big brands are involved,” he said.

Healthtech is not the only disruptive force that Indonesian hospitals should look out for. According to Chris Hardesty, KPMG life sciences director, universal healthcare is a $2t opportunity and that healthcare stakeholders can create a UHC environment through a political process model, which includes reframing debate, tapping into political opportunities, and mobilising resources.

In order to synthesise the healthcare industry into pushing for a UHC environment, the Indonesian government however still has a lot to deal with. Of the 2,831 hospitals in Indonesia, only 2,004 are accredited, according to Dr. Andi Saguniz, director of health service facilities for Indonesia’s Ministry of Health.

Saguniz also shared that the new minimum services standard that aims to impose the treatment of health as a basic service at the regional level will be piloted in 2019 and must be enforced by 2020. The government is also looking to increase the number of modern health centres from 264 in 2018 to 300 in 2019 as well as build three new hospitals in East Indonesia.

Recognising

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Deadline for submissions is on 20 december 2019

AW RDS 2020

2020

For inquiries, contact Julie Anne Nunez

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HEALTHCARE ASIA

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EVENT COVERAGE

Healthcare Asia Awards 2019 honours Asia’s best hospitals

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ver 140 prime industry figures from Asia’s prestigious hospitals and healthcare firms flocked to the Conrad Centennial Singapore on 23 May 2019 for the second Healthcare Asia Awards night.

The gala night featured 50 awards and nominations hit nearly 200.

The event was attended by representatives from The Medical City, Femto Research Group Co., Ltd, Fullerton Healthcare Group, Bangkok Hospital, Gleneagles Hong Kong Hospital, Omni Hospitals, Pun Hlaing Siloam Hospitals, St. Luke’s Medical Center Global City, Thonburi Healthcare Group, Union Hospital, and other hospitals in Asia.

The awards were expertly judged by Abhay Bangi, Partner, Life Sciences & Healthcare Lead, Ernst & Young; Dr Loke Wai Chiong, Executive Director, Healthcare Sector Leader, Deloitte; Dr Zubin Daruwalla, Director, SEAC Health Industries Leader, PwC; Chin Chee Choon, Advisory Leader, Nexia TS; and Willy Leow, Partner, Risk Advisory Services, BDO LLP.

HEALTHCARE ASIA AWARDS 2019 WINNERS Amiri Medical Complex Clinical Service Initiative of the Year - Afghanistan Customer Service Initiative of the Year - Afghanistan Asian Hospital and Medical Center Hospital of the Year - Philippines ICT Initiative of the Year - Philippines Management Innovation of the Year - Philippines Patient Care Initiative of the Year - Philippines Service Delivery Innovation Initiative of the Year - Philippines Aster Aadhar Hospital Corporate Social Responsibility of the Year - India Bangkok Hospital Chiang Mai Patient Safety Initiative of the Year - Thailand Bangkok Hospital Pattaya Corporate Social Responsibility of the Year - Thailand Management Innovation of the Year - Thailand ICT Initiative of the Year - Thailand Femto Research Group Co.,Ltd Service Innovation of the Year - Thailand FE “VITAMED MEDICAL” LLC Diagnostics Provider of the Year - Uzbekistan French Medical Institute for Mothers and Children Patient Safety Initiative of the Year - Afghanistan Management Innovation of the Year - Afghanistan

Kan Thar Yar International Specialist Hospital Hospital of the Year - Myanmar KPJ Damansara Specialist Hospital Employee Engagement of the Year - Malaysia Life Care Diagnostic Medical Centre Diagnostics Provider of the Year - Malaysia Primary Care Provider of the Year - Malaysia ManilaMed - Medical Center Manila Emilio Aguinaldo College - School of Medicine Clinical Service Initiative of the Year - Philippines Manipal Hospital Klang Clinical Service Initiative of the Year - Malaysia Patient Care Initiative of the Year - Malaysia Patient Safety Initiative of the Year - Malaysia Mariano Marcos Memorial Hospital and Medical Center Health Promotion Initiative of the Year - Philippines MAXCURE HOSPITALS Marketing Initiative of the Year - India Primary Care Provider of the Year - India Muscat Private Hospital ICT Initiative of the Year - Oman Patient Safety Initiative of the Year - Oman National Hospital ICT Initiative of the Year - Indonesia National Kidney and Transplant Institute Facilities Improvement Initiative of the Year - Philippines Service Innovation of the Year - Philippines Neo-Health Informatics Service Delivery Innovation Initiative of the Year - Hong Kong Oasis Centre for Reproductive Medicine Health Promotion Initiative of the Year - India Service Innovation of the Year - India Omni Hospitals Clinical Service Initiative of the Year - Indonesia Diagnostics Provider of the Year - Indonesia Service Innovation of the Year - Indonesia Health Promotion Initiative of the Year - Indonesia RadLink Asia Pte Ltd Diagnostics Provider of the Year - Singapore Philips Corporate Social Responsibility of the Year - Malaysia Health Promotion Initiative of the Year - Malaysia Marketing Initiative of the Year - Malaysia Pun Hlaing Siloam Hospitals Employee Engagement of the Year - Myanmar Health Promotion Initiative of the Year - Myanmar ICT Initiative of the Year - Myanmar Patient Safety Initiative of the Year - Myanmar Sri Kota Specialist Medical Centre Facilities Improvement Initiative of the Year - Malaysia

Fullerton Healthcare Group Primary Care Provider of the Year - Singapore

St. Luke’s Medical Center Global City Patient Safety Initiative of the Year - Philippines

Gleneagles Hong Kong Hospital Management Innovation of the Year - Hong Kong

St. Luke’s Medical Center Quezon City Customer Service Initiative of the Year - Philippines

Ispahani Islamia Eye Institute & Hospital Hospital of the Year - Bangladesh

Union Hospital Patient Care Initiative of the Year - Hong Kong

Hemas Hospitals (Pvt) Ltd Patient Care Initiative of the Year - Sri Lanka Service Delivery Innovation Initiative of the Year - Sri Lanka Health Promotion Initiative of the Year - Sri Lanka

Tawam Hospital Patient Care Initiative of the Year - UAE Patient Safety Initiative of the Year - UAE

Jupiter Lifeline Hospitals Ltd Hospital of the Year - India 24

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The Aga Khan University Management Innovation of the Year - Pakistan Service Delivery Innovation Initiative of the Year - Pakistan

The Medical City Clark, Inc. Marketing Initiative of the Year - Philippines Primary Care Provider of the Year - Philippines Thonburi Healthcare Group Clinical Service Initiative of the Year - Thailand Hospital of the Year - Thailand University of Santo Tomas Hospital Corporate Social Responsibility of the Year - Philippines VitalLife Scientific Wellness Center Service Delivery Innovation Initiative of the Year - Thailand Patient Care Initiative of the Year - Thailand Dr. Eugenio Jose F. Ramos, The Medical City CEO of the Year

Philips

KPJ Damansara Specialist Hospital

Bangkok Hospital Chiang Mai

Amiri Medical Complex

Tawam Hospital

OMNI Hospitals

VitalLife Scientific Wellness Center

Gleneagles Hong Kong Hospital

Pun Hlaing Siloam Hospitals HEALTHCARE ASIA

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EVENT COVERAGE

Life Care Diagnostic Medical Centre

Hemas Hospitals Pvt Ltd

The Medical City

Thonburi Healthcare Group

The Medical City Clark 26

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Ispahani Islamia Eye Institute & Hospital

Fullerton Healthcare Group

University of Santo Tomas Hospital

Union Hospital

Kan Thar Yar International Specialist Hospital

ManilaMed Medical Center Manila Emilio Aguinaldo College School of Medicine

National Kidney and Transplant Institute

National Hospital

RadLink Asia Pte Ltd

Femto Research Group

Jupiter Lifeline Hospitals Ltd

Bangkok Hospital Pattaya

Sri Kota Specialist Medical Centre

St. Luke’s Medical Center Global City and St. Luke’s Medical Center Quezon City

OPINION

ABHIJIT GHOSH AND ZUBIN J DARUWALLA Making healthcare more affordable and accessible

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ingapore remains a leader in making healthcare more accessible for its growing pioneer generation. The focus now is likely to shift towards taking the digital route to making healthcare more affordable and accessible.

Consider this: An integrated app that connects your health records to monitor and prompt re-order of your medicine and grocery stock. It also suggests what to eat for the week supported by quick nutritional recipe videos with the option of ordering the necessary ingredients with one click.

With Internet of Things (IoT) enabled healthcare solutions supported by integrated medical records running on unique patient identifiers, they can connect residential homes, nursing homes and senior-friendly communities to grocery shops. The Health Promotion Board can drive this rollout by pairing with pharmacies to provide seniors with subsidies.

More incentives driven by smart devices should be introduced to promote healthy behaviours too. Geolocation trackers and nail ID patches can be adopted by Dementia-Friendly Communities for better safety and identification of dementia patients. A physical login tracker can prevent a widespread of illnesses such as dengue and HFMD by location/vicinity.

In a data-driven world, Singapore must work towards a secure centralised or de-centralised data exchange that holds data for all stakeholders (patients, provides, regulators, etc.) that the entire population can interact with, interlinking their day to day activities from healthcare to nutrition to social living.

Enhancing data and analytics capabilities to mine this data, such as managing a data-driven population health platform will provide insights into citizen behaviours and assist in evidence-based policies and decision making for ageing populations.

This has the potential to be a goldmine of learning for Singapore.

Running these platforms on forward-looking technological platforms with enhanced cybersecurity capabilities will also be key to ensure protection from data threats.

A holistic approach to healthcare Our population is ageing rapidly, with a growing chronic disease burden. We must therefore create a stronger social network propelled by elderly-centred design. Our programmes have to be developed around education, environment, and nutrition, most suited to further empowering the elderly.

In particular, we could explore the following: • With Singapore’s familial culture, we can expand senior living communities to accommodate more initiatives. Engaging the elderly with enriching activities such as caring for plants, or combining Singapore’s several nursing homes with daycare to create intergenerational centres where the elderly can frequently 28

HEALTHCARE ASIA

ABHIJIT GHOSH Singapore Healthcare & Pharmaceutical Leader and Tax Partner, PwC

ZUBIN J DARUWALLA Southeast Asia Healthcare Consulting Director, PwC

Singapore Budget Breakdown

Source: Fitch Solutions

interact with young children, will instil a sense of responsibility and empowerment in the elderly.

Schools can also organise community days where school children are buddied up with elderly residents for routine visits. These initiatives could also help the elderly tackle depression and loneliness through increased social interaction.

• Cooperate with and incentivise the private sector to operate means-tested healthcare at home programmes with mobile clinics, or regular but affordable home visits by nurses and doctors.

Subsidising renting of hospital beds and equipment for use at home will complement this.

• Providing subsidies and free distribution of simple, humancentric innovative gadgets and assistive utensils for elderly patients with chronic diseases such as stroke, arthritis and Parkinson’s to improve quality of life.

Affordable healthcare for all As healthcare expenditure and cost of living increases, planning for financial inclusion will be key. Our healthcare system has undergone significant financing reform to move towards universal health coverage, to expand financial protection to the elderly, cancer patients and those suffering from chronic diseases such as diabetes.

However, in light of rapidly inflating healthcare costs, it may be worthwhile to allow tax deductions (not tied to CPF contributions) for medical related insurance premiums. This will encourage more taxpayers to take up health insurance policies for themselves and their families and offer them greater access to healthcare.

To further encourage preventive healthcare, tax relief for medical costs incurred by those over 50 years old for annual health screening may also be considered. What is imperative will be to ensure adequate and appropriate medical screening rather than unnecessary medical tests.

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OPINION

CHRIS HARDESTY

Protected data sharing and Life Sciences in the Asia Pacific: From treatment to prevention

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study conducted by Forbes Insights and KPMG on cyber security in life sciences indicate that whilst life sciences organisations are elevating cyber security as a strategic imperative, it is at a pace that lags behind the desired adoption of broader digital technologies. Further, according to the International Association of Privacy Professionals, life sciences firms spend about US$8m on privacy compliance programmes annually though it is expected to be more like US$15m for digitalty transformed companies, and upwards of US$2m for fast-growing biotechs.

The lack of proper cyber security programmes at the organisational level is hurting business and consumers in numerous ways. These range from the halting of clinical trials due to poor technology infrastructure and fear of intellectual property (IP) theft, to valuation concerns during mergers & acquisitions when one of the companies reveals data privacy violations, and the removal or recall of medical devices from data streaming services because of tampering concerns.

Data sharing for the win Forward-looking life sciences companies are betting their future on being integrated, data-driven service organisations rather than as mere product sellers. Many are looking for new sources of data, even direct from consumers through wearables and social media.

Unfortunately, as breaches have shown, whilst data is valuable and available, ineffective governance will prevent open sharing.

The damage arising from data loss include reputational, regulatory and eventually, the removal of social license to hold such information. However, laws governing data localisation threaten to undo much of the progress made in areas like telemedicine and remote servicing of medical devices.

Progress in innovation for life sciences companies will see them mature from data analysis to data sharing across borders, with competitors, on the cloud and in real-time. Whilst this may sound daunting for some, 76% of the participants in the Forbes insightsKPMG study believe moving to the cloud actually improves their security profile. However, nearly half of these same executives have not increased cyber security budgets despite their knowledge of high-profile breaches.

B&D’s portfolio, which includes over 200 products with software embedded, is trending toward IoT-enabled technologies, hence the laser focus on cyber security initiatives and emphasis on medical device security and transparency. The company regularly publishes results from cyber security vulnerability assessments (CVAs), and outlines the procedures on their website. loT: Interest of Thieves?

Hospital and care provision infrastructure is increasingly reliant on medical device integration and vice versa. Thus, putting in place a 30

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CHRIS HARDESTY Director for Life Sciences KPMG

secure network is in the best interest of all parties as cyber attacks can take many forms. It can be through a medical device connected to the hospital’s IT system, through inappropriate access to sensitive information or device tampering.

Taking a collaborative approach to cyber security and privacy is ideal and starts with the design phase. Of the companies that participated in the Forbes Insights - KPMG study, whilst 92% indicated they are integrating privacy principles during product development, only 15% conduct regular software engineer training on secure development and programming.

Don’t overlook the people factor Companies are continuing to invest in cyber security, focusing on software/technology and improved governance and polices.

And interestingly, of all the efforts associated with improved cyber protection for life sciences companies, only 9% of respondents in the Forbes Insights-KPMG study cited greater staffing as a priority.

Additionally, just 38% conduct cyber training for leadership, 34% carry out employee response drills, and 28% host desktop drills for the IT department.

Whilst IP loss/leakage remains foremost on the minds of executives, most life sciences organisations are only able to monitor a small percentage of their employee and third-party bases. Not many are directing efforts at insider detection which is much more difficult than tracing external threats.

As such, one of the most immediate challenges is getting relevant parts of the organisation to work under a unified approach.

Two-thirds of employee-based security threats are actually accidental rather than activities with malicious intent. In this regard, organisations must help employees understand that cyber security programmes are designed to protect them and their patients and should not be perceived as initiatives driven by mistrust of employees.

Programmes that fail to create this positive position may give rise to disgruntled employees and become part of the problem it is attempting to solve.

What’s your game plan?

Life sciences companies must evolve their cyber security programmes from “treatment” (reactive) to “prevention” (proactive).

This entails integrating data security principles into the broader organisation growth strategy and in some cases, even as-a-service itself to customers.

Ultimately, when it comes to cyber security, there is no substitute for good planning and management. It requires a holistic view of people, processes and technology, and cyber teams must continuously monitor and allow their programme to evolve as new cyber threats emerge.

OPINION LORI STETZ, STELLA GEORGE, MITESH PATEL

Keeping up with healthcare: How Singapore can remain an attractive expat destination

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n 2018, Singapore emerged as the best place for expats to live and work in for the fourth year in a row — no mean feat considering it is also one of the world’s most expensive cities to reside in. A 2018 survey conducted by ECA International also found the city-state to be the most liveable city for Asian expats for the 14th year in a row. Healthcare is a key determinant of quality of life and we look at some expat healthcare trends that will shape this in 2019: 1. Increasing awareness of the importance of workplace mental health Employers and governments are becoming increasingly aware of how anxiety and depression affects an individual’s wellbeing. Dr Stetz explains that, “with mental health being taken more seriously in the workplace, many corporations, government bodies and policy makers are taking meaningful steps towards providing a more holistic wellness approach.” One good case study is Xero and the changes they made to their global well-being leave policy: employees are entitled to 14 days paid leave in addition to annual leave for personal wellbeing.

Come 2024, the APAC region can expect a corporate wellness market worth US$7.4b.

Separately, studies have shown that companies across Singapore, Malaysia, Indonesia, and the Philippines that neglect corporate wellness had productivity losses totalling US$44.6b within a fiscal year.

Corporate wellbeing is increasingly entrenched in workplace cultures and strategies. A happier and healthier workforce enables higher productivity, job satisfaction and also helps to attract and retain talent.

“Quite often, employees on assignment face intense pressures of a work promotion on top of managing their family life and health in an overseas context. Unfortunately, when it comes to prioritising these challenges, health and family usually take back seat,” says Dr George. Other factors like frequent travel, always being available and ‘’switched-on’’ via technology; stressors of living abroad and absence of social support structures also have an impact.

2. Growing influence of social health determinants It is crucial that employers take into consideration factors that have a 90% influence people’s health: the conditions in which they live and work, including their behaviours and socio-economic circumstances.

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Known as the social determinants of health, these factors also include economic stability, education, community and family.

Expat assignments fail for many reasons, but most often it’s when the expectations of their new life doesn’t quite match up to the reality. For individuals, moving internationally can be relatively straightforward. But when expats are relocating with family, considerations expand to include spouses leaving their homes, children moving schools, leaving behind family and friends, language barriers and culture shock on arrival — and it becomes easy to see why it may not work out for everyone.

Companies with low rates of failure in relocating staff put in place comprehensive support, before, during, and after their employees’ assignments. They recognise that for employees moving with families, they want the peace of mind IPMI affords them by ensuring their families have access to the best possible care — wherever they are in the world.

3. The 4P health care model: personalisation, prevention, prediction and participation Individuals increasingly consider themselves active participants in their health, rather than passive patients. Technology has transformed shopping and banking to become highly tailored experiences, and consumers expect a similar experience from their health care services. They are demanding greater personalisation and are increasingly willing to share data about themselves to support that outcome.

Healthcare companies can use this influx of information to tailor treatment plans for their patients, help them to better manage health conditions and encourage healthy behaviours. “The evolution of data storage and use will also mean advancements in electronic health records that accompany the expatriate from their home country, enabling consistent and personalised treatment plans wherever in the world they go,” adds Dr Patel.

Singapore constantly tops the rankings as one of the most liveable cities in the world for expats, with the provision of first-class healthcare being one of the factors for this distinction. Even then, we expect to see employers and health care providers partnering more with their globally mobile employees in the coming years — to offer all-round support for their health and wellbeing.

LORI STETZ Senior Medical Director Aetna International

STELLA GEORGE Senior Medical Director Aetna International

MITESH PATEL Medical Director Aetna International

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Medical services • • • • • • •

Thonburi Hospital Thonburi 2 Hospital Thonburi Bamrungmuang Hospital Rajyindee Hospital Ubonrak Thonburi Hospital Sirivej Chanthaburi Hospital Thonburi Thungsong Hospital

• • • • •

Welly Hospital, China Ar Yu International Hospital, Myanmar Thonburi Burana Hospital Pattaya City Hospital Phuket Provincial Administrative Organization Hospital • Koh Lan International Medical Center

• Clinic Heart Center at Thonburi 2, Phatra Thonburi Hospital and Phathalung Hospital

Lifetime Health Guardian For All

Thonburi Healthcare Group, We have been providing integrated healthcare services with continuously quality development Healthcare Solutions Provider • Premiere Home Health Care : Providing medical solutions at patients’ home • Jin Wellbeing County Development of Healthcare mixed-use projects combining accommodation designed for elderly.

• Thonburi Health Village Pracha Uthit : Live healthy with happiness

Other Business • Dental Siam and Apex Healthcare : One stop service including distribution of dental equipment and after sale services • Modular Software Expertise Co.,Ltd Development of software for hospital management

• Thonburi Realty Development Co.,Ltd. • Rajthanee Realty Co.,Ltd

PRIMARY CARE PROVIDER OF THE YEAR - PHILIPPINES

The Medical City: Leading healthcare with innovation and expert care

The Philippines’ largest healthcare network invests in new technology and cancer care for the future. modern PET-CT imaging system features advanced capabilities used for assessment of cancer – such as staging of cancer to help doctors determine the most appropriate treatment option and re-staging to evaluate patient’s response to cancer treatment.

The Medical City

F

or premier health institution The Medical City (TMC), the future of healthcare does not merely rely on cutting-edge technology and innovations.

Technology at TMC is being efficiently applied to deliver better care, with investments ranging from the latest and most modern PET-CT imaging system for the assessment of cancer at TMC Main to pioneering thoracic endovascular aortic aneurysm repair for patients in Central Luzon, courtesy of TMC Clark.

TMC is the country’s largest healthcare network in the Philippines with its main facility located along Ortigas Avenue in Pasig City, Metro Manila, whilst the provincial hospitals are situated in Clark, Iloilo, Laguna, and Pangasinan. This is supplemented by a network of 50 clinics in strategic locations scattered all over the Metro and in select provinces. TMC has also taken its brand into the global arena through the ownership and operation of Guam Regional Medical City (GRMC), the first and only private hospital in Guam.

TMC is a top-tier hospital network distinguished for providing innovative and comprehensive care in cardiology, oncology, neuroscience, orthopedics, pediatrics and women’s health, and regenerative medicine among others.

In October 2018, TMC Main, under the leadership of its new President and CEO Dr. Eugenio Jose F. Ramos, earned its fifth Joint Commission International’s Gold Seal of Approval® for Hospital Accreditation by 36

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demonstrating continuous compliance with its internationally-recognized standards.

No excuse for delays TMC’s Acute Myocardial Infarction (AMI) Program also retained its status as the only program of its kind with a Gold Seal of Approval in the Philippines, and one of only 16 around the world. AMI is the medical term for heart attack, and TMC’s program targets a 60 minute Door-to-Balloon time.

This means that a heart attack patient who walks through the doors of the hospital’s Emergency Department should have the blocked coronary artery opened in the Catheterization Laboratory within 60 minutes. TMC received its first certification from JCI for its AMI program in 2015.

What difference does complete cancer care make? Complete cancer care means comprehensive, personalized care delivered by a multidisciplinary team of expert physicians and healthcare staff with access to the most advanced technology all under one roof.

This is what TMC Main’s Augusto P. Sarmiento Cancer Institute (APSCI) offers − complete and world-class cancer care with the acquisition of advanced technologies aimed at providing targeted treatments and accurate diagnosis to help plan cancer care that is tailor-fit to the patient.

The TMC-APSCI’s latest offerings include the PET-CT scan, MRI Fusion Prostate Biopsy, and Intra Operative Radiation Therapy (IORT). TMC’s latest and most

Complete cancer care TMC also now offers MRI Fusion Prostate Biopsy, a fully integrated fusion biopsy system specifically created for personalized prostate care. With this technology, “targeted” biopsies are made possible by the fusion of ultrasound images of the prostate with MRI scans, in real time during the procedures. Not only does it confirm if the target was hit, as even small lesions can be biopsied.

Intra Operative Radiation Therapy or IORT is a new technique that allows patients to safely receive their radiation treatment at the same time as their surgery for breast cancer. With IORT, patients receive breast cancer radiation therapy in minutes instead of weeks. Radiation is given directly to the area where the cancer was, and for some patients with early stage breast cancer, this may be the only radiation treatment they will need. Instead of receiving 33 sessions of radiation, women undergoing breast conserving surgery get the intra operative dose and only 15 sessions after.

Pink Walk: #BreastWalkEver One in every 13 Filipino women is at risk of getting breast cancer, the highest incidence in Asia, according to the Philippine Breast Cancer Society. The TMC network hospitals rounded up a series of activities to mark their Breast Cancer Awareness campaign last October.

TMC Clark, which is located at the Clark Global City, in cooperation with the Philippine Society of General Surgery and the Philippine College of Surgeons, organized a walkathon for the benefit of breast cancer patients aimed at creating awareness and encouraging annual screening for early detection and prevention of breast cancer. The event dubbed TMC Clark’s Pink Walk: #BreastWalkEver bagged the Marketing Initiative at the 2019 Healthcare Asia Awards.

PARALYSIS

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State-of-the-art inpatient facility for coordinated and comprehensive interdisciplinary neuro rehab

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PRIMARY CARE PROVIDER OF THE YEAR - SINGAPORE

Fullerton Healthcare Group wins Primary Care Provider of the Year for the second time The healthcare group continues to grow, serving over 17,000 companies and 13 million patient visits.

Ho Kuen Loon, Group Chief Operating Officer and Country Managing Director, Singapore

F

ullerton Health is a leading vertically integrated healthcare platform in the Asia Pacific region with a proven track record of providing clients with seamless service offerings through customized healthcare management and administration.

In the Asia Pacific, where two-thirds of the world’s population lives, many face unmet health needs due to access and affordability. Through the company’s more than 500 owned medical facilities and a global network of more than 10,000 healthcare providers, Fullerton Health offers accessible and affordable care in the eight markets they service and beyond, as it continues to expand through careful planning and strategic acquisitions in Asia Pacific, to develop a strong presence and footprint in markets across the region and broaden its service offerings.

Fullerton Health serves over 17,000 esteemed companies, counting over 13 million patient encounters per annum from blue-chip MNCs to small-to-mid sized corporates throughout Asia Pacific.

As a healthcare innovation pioneer, Fullerton Health believes in harnessing technology and data to enable on-demand aggregation, providing cost-effective management of healthcare services while meeting patients’ needs. It partnered with a leading provider of data and analytics technology and services to healthcare organizations to develop a strategic plan 38

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that leverages greater use of data through healthcare analytics, which is a key business driver to enable them to leverage their data to deepen their understanding of the diverse needs across the Asia Pacific.

Its technology enables them to improve business performance and efficiency, which in turn creates cost-savings for patients and clients.

A strong believer in doing well and doing good, Fullerton Heath also gives back to the communities in which they were nurtured

in and operate. The Fullerton Health Foundation was incorporated in 2015 with the mission to improve the lives of the underprivileged, through campaigning for change and collaborating with charities, the private sector, and government entities, to build capacity in healthcare and education in Asia Pacific by grant giving to non-profit organizations and committing in-kind resources.

A multi-award winning healthcare provider, Fullerton Health won the Primary Care Provider of the Year in 2018 and 2019 at the Healthcare Asia Awards, as well as Patient Care Initiative of the Year and Facilities Improvement Initiative of the Year in 2018 for its revolutionary Executive Health Screening pod design in Singapore.

CONTACT Company name: Fullerton Healthcare Group Address: 108 Robinson Road, 09-00, Singapore 068900 Phone number: (65) 6333 3636 Email: corporateservices@fullertonhealth.com Website: www.fullertonhealth.com

“Fullerton Health believes in harnessing technology and data to enable on-demand aggregation.”

Fullerton team

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Connecting the dots of patient care Philips Tasy EMR connects all the dots across clinical and non-clinical aspects of the healthcare organization. It provides: - Integrated solution through a single interface with data access across multiple sites, leading to less duplicate effort - Advanced clinical analytics that streamline workflows - Clinical decision support with real-time data access as needed - Flexible, dynamic solution to cater to your needs, while remaining agile and adaptive to changing requirements Explore more at: www.philips.com.au/tasy

Portfolio may vary according to geography. Contact your local Philips representative for more information.

Tawam Hospital is affiliated with Johns Hopkins Medicine, USA, and operated by Abu Dhabi based Abu Dhabi Health Services (SEHA), Tawam Hospital has been providing health services to the residents of Al ain and referral services for the Emirates and the GCC States for the last 30 Years. In addi�on to ambulatory and dental services , the hospital provides a wide spectrum of services including Emergency, Cri�cal care, Medical, Surgical, Oncology, Maternal and Child Health Services.

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Tawam Hospital has strengthened its posi�on as a leading UAE medical ins�tu�on and na�onal referral center having made significant service enhancement over the past years. Our goal at Tawam hospital is to offer the best medical care to our pa�ents in the most efficient way possible. That means we consistently evaluate our processes, facili�es and general opera�ons so we can make improvements and learn how we can provide even be�er services and care for our pa�ents, visitors, and staffs. In line with its efforts to improve services , Tawam hospital has received a number of quality awards in recogni�on of its commitment to excellence.

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The Emergency Department (ED) at Tawam is a 52 beds capacity unit that provides emergency pa�ent care 24 hours a day, 7 days a week. The pa�ent popula�on served by Emergency Department consists of New born, pediatric , adolescent, adult and geriatric pa�ents requiring or seeking emergency care including oncology. A team of renowned doctors, highly skilled nurses, healthcare professionals, pa�ent rela�on officers and medical residents lead the department. Tawam hospital aims to improve every aspect of emergency care we provide in the department. We are an�cipa�ng to developing more as we con�nuously aspire to be the best. Tawam Hospital offers services in all special�es, however; the Emergency department (ED) treats over 110,000 pa�ents per year is popular amongst the local community.

The Emergency Department bagged two pres�gious Interna�onal Healthcare Asia Awards on May 2019 at the award ceremony held at the Conrad Centennial Hotel, Singapore. · Pa�ent Care Ini�a�ve of the Year- ”Improving Pain Management in ED." · Pa�ent Safety Ini�a�ve of the Year- ”Educa�on Changes Culture: Reducing blood culture contamina�on rates in the ED.” Dr. Thiagarajan Jaiganesh (chairman-ED) & Mr. Moawia Jaber (Nurse Manager) take this opportunity to thank Tawam Hospital Management, ED Physicians, Residents, ED Nurses & Support Staffs for their unwavering effort in making these two projects successful.

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