Healthcare Asia (March-June 2016)

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EXCLUSIVE

Indonesia’s difficult UHC plan Dr. Nila Moeloek, Indonesia’s minister of health, speaks about the progress of the country’s universal healthcare plan

+

HOW WILL the AEC boost asean healthcare?

Hong Kong revamps elder care

Case Study: Philippine heart center’s expansion

Interview with

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Institut Jantung negara’s

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FROM THE EDITOR Welcome to the sixth issue of Healthcare Asia!

As the Southeast Asian region gears up for the ASEAN Economic Community, Healthcare Asia keeps track of whether this new system can provide the much needed boost to healthcare in Southeast Asia.

Publisher & EDITOR-IN-CHIEF Tim Charlton PRODUCTION Editor Roxanne Primo Uy art director Bryan Barrameda Editorial Assistant Ephraim Bie

ADVERTISING CONTACT Rochelle Romero rochelle@charltonmediamail.com Trishia Garduño trishia@charltonmediamail.com

ADMINISTRATION Lovelyn Labrador lovelyn@charltonmediamail.com Advertising advertising@charltonmediamail.com Editorial editorial@charltonmediamail.com

SINGAPORE Charlton Media Group 101 Cecil St. #17-09 Tong Eng Building Singapore 069533 +65 6223 7660

HONG KONG Charlton Media Group 19/F, Yat Chau Building, 262 Des Voeux Road Central Hong Kong. +852 3972 7166 www.charltonmedia.com

We also have a comprehensive feature on Indonesia’s five-year universal healthcare scheme, which was pegged as both momentous and ambitious. Currently in the midpoint of the universal healthcare plan, we interviewed Indonesia’s minister of health Nila Moeloek, as she talks about the diverse challenges the scheme is facing.

We also interviewed Institut Jantung Negara’s CEO Datuk Dr Mohd Azhari Yakub, where he discusses how Malaysia’s premier heart centre maintains its competitive edge and strengthens its differentiating characteristics.

This issue of Healthcare Asia also features two interesting case studies from the Philippine Heart Centre and the Makati Medical Centre. Learn about PHC’s groundbreaking deployment of multiple regional heart centres to broaden the access to cardiovascular care in the Philippines. MakatiMed also details its breakthrough cellular therapeutic centre, which has just recently received government accreditation.

Asia is an exciting region for healthcare developments, innovations, and trends, and we hope this issue gives you a glimpse of what’s happening and what’s yet to come.

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

Enjoy!

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Tim Charlton

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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.

HEALTHCARE ASIA 1

CONTENTS

coverage: Apac 26 post-event medtech forum 2015

Asia-Pacific Med Tech Forum spearheads a healthy future

profile 18 feature How is Indonesia’s difficult scheme

INTERVIEW 16 cEO IJN opens Malaysia’s sole heart

halfway through implementation?

FIRST 06 Thai hospitals stalled with

failure ward this year

HEALTHCARE INSIGHT 14 How will the much-awaited

5000-doctor deficit

07 Foreign patients shun Singapore

08 Healthcare firms zero in on

AEC boost ASEAN healthcare?

COUNTRY REPORT 22 Hong Kong scrambles to

expansion plans

OPINION 30 A new service delivery model for the elderly

32 Reaching the promise of UHC: Healthcare without fear

overhaul elder care

10 Hong Kong’s ageing doctors hinder private hospital operations

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

2 HEALTHCARE ASIA

To access the stories online, visit the website

www.healthcareasiamagazine.com

Our immuno-oncology development program is one of the fastest growing in the industry.

— Reshma Rangwala, MD, PhD Senior Principal Scientist, MSD Oncology Clinical Research

visionary science

in iMMUno-oncoLoGy:

TURNING IDEAS INTO RESULTS

MSD Pharma (Singapore) Pte Ltd 150 Beach Road #31-00 Gateway West Singapore 189720 Tel: (65) 6508 8400 Fax: (65) 6296 0005 http://www.msd-singapore.com Copyright © 2015 MSD Pharma (Singapore) Pte. Ltd., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. All rights reserved. ONCO-1157244-0000 10/15

HEALTHCARE ASIA 3

CO-PUBLISHED CORPORATE PROFILE

MSD and the journey to address cancer

MSD, also known as Merck in the US and Canada, is celebrating 125 sterling years of saving lives through breakthroughs, innovative drugs, and therapies.

European Society of Oncology (ESMO) Asia Congress in Singapore, December 2015 : MSD was a platinum sponsor

A

Pacific headquarters of Singapore work s MSD, also known as Merck in in various fields including research and the United States and Canada, development, manufacturing, commercial celebrates its 125th anniversary operations, and global support functions this 2016, the pharmaceutical giant has to deliver medical therapies to patients in made and is making great strides in the Asia Pacific and around the world. healthcare industry since it was founded in 1891. MSD is currently ranked Dedication to excellence fifth among the top pharmaceutical “Through our prescription medicines, companies in Asia Pacific, according vaccines, biologic therapies and animal to IMS Health, with its operations health products, we work with customers headquartered in Singapore spanning and operate in more than 140 countries twelve countries: Australia, Hong Kong to deliver and Macau, India, “We demonstrate innovative health Indonesia, South our commitment to solutions. We also Korea, Malaysia increasing access to demonstrate our and Brunei, New Zealand, healthcare through commitment to Philippines, far-reaching policies, increasing access to healthcare Taiwan, Thailand, programs and through farand Vietnam. partnerships.” reaching policies, After merging programs and partnerships,” says Jannie with Schering-Plough in 2009, MSD’s Oosthuizen of MSD. Currently, MSD’s manufacturing presence in Singapore core businesses lie in oncology, vaccines, doubled, with MSD’s presence in diabetes, and hospital and specialty care.

Singapore extending into research and As a company dedicated to excellence development through the Translational in healthcare innovation, research and Medicine Research Centre which development as well as commercial supports MSD’s global research and innovation are two important aspects development efforts via a range of through which MSD seeks to address the pre-clinical and clinical development unmet medical needs of today. programs.

In 2015, the company invested US$6.5 MSD’s 1,200 employees in the Asia 4 HEALTHCARE ASIA

billion on research and development, with 19 compounds in the late stage development.

Recent developments The company’s recent developments include their latest antibiotic for use in hospitals to treat adults with complicated intra-abdominal infections, as well as complicated urinary tract infections, and their newest drug for hepatitis C which received U.S. FDA approval.

MSD also developed and launched the world’s first diabetes DPP-IV inhibitor which won the prestigious Prix Galien Award for Best Pharmaceutical Agent of the Year in 2007, a particularly relevant drug in the Asia Pacific where diabetes is all too common.

“Our breakthrough anti-PD-1 immunotherapy drug for advanced melanoma has been approved in the U.S., Europe, and in Asia Pacific (Australia, New Zealand, Hong Kong & Macau, Korea, Taiwan and Singapore),” says Oosthuizen, adding that the drug received the Prix Galien U.S.A. Award for Best Biotechnology Product in October 2015 and the Breakthrough Therapy Designation from the U.S. Food Drug Administration in two tumor types: advanced melanoma and advanced non-small cell lung cancer

CO-PUBLISHED CORPORATE PROFILE

Jannie Oosthuizen VP, President International Oncology MSD

(NSCLC).

“It combats cancer by harnessing the power of the body’s own immune system. It is a humanized monoclonal antibody that works by increasing the ability of the body’s immune system to help detect and fight tumor cells.” The drug has been approved now in the U.S. for NSCLC. Easing the burden Asia Pacific and Latin America cumulatively account for 64 per cent of the world’s population, about 4.6 billion people in total, and the burden of cancer in both regions results in about 4.6 million cancer-related deaths annually.

MSD aims to revolutionize cancer treatment in Asia Pacific.

“Our goal is to translate breakthrough science into innovative oncology medicines to help people with cancer, worldwide. Helping patients fight cancer is our passion and supporting accessibility to our breakthrough medicine, such as anti-PD-1 immunotherapy, is our commitment. Our focus is on pursuing research in immunooncology, and we are accelerating every step in the journey – from lab to clinic – to potentially bring new hope to people with cancer,” says Oosthuizen.

A leading healthcare provider Clinical trials are currently ongoing in over 10 countries for more than 30 tumor types including lung, breast,

GSK’s investigational immunotherapy as and gastric, to name a few of the more monotherapy, as well as in combination common cancers afflicting people in the with anti- PD-1 therapy in patients with Asia Pacific region. locally advanced, recurrent or metastatic “We’re exploring different tumor solid tumor(s) that have progressed after characteristics (such as PD-L1 expression) standard treatment. as biomarker predictors of patient A collaboration with Amgen has responsiveness. Such predictors are launched tests to evaluate the efficacy important to the success of targeted and safety of Amgen’s investigational oncology therapy, which can be oncolytic immunotherapy in combination customized for patients who present with MSD’s anti-PD-1 therapy in a Phase themselves as more responsive to certain 1, open-label treatment “Our goal is to translate trial of patients approaches. breakthrough science with recurrent In other words: how into innovative oncology or metastatic to identify the medicines to help people squamous cell right medicine with cancer, worldwide. carcinoma of the head and neck for the right Helping patients fight (SCCHN). patient,” says cancer is our passion.”

“In line with Oosthuizen. our mission As a of helping save lives, we plan to work leading healthcare provider, MSD is closely with the medical fraternity to fully committed to engagement with identify patients early through screening the medical and scientific communities. programs as well as general practitioner This includes launching a series of education. Early detection and diagnosis symposiums called “Current Trends in are key to increased survival rates,” says Immuno-Oncology” as part of their Oosthuizen.“Our mission is to help save efforts in the area of scientific education, as many cancer patients’ lives as we to update scientific leaders on the latest can – and we are best positioned to do developments in oncology in countries this through innovation and increasing such as Australia, Korea, Taiwan and patient access. Together with scientists Hong Kong. and physicians around the world, we endeavor to improve the lives of patients Strategic collaborations suffering from these illnesses.”

MSD has also collaborated with several partners in the healthcare industry.

Disclaimer: This is a MSD-sponsored article. Registration status and With GlaxoSmithKline (GSK) MSD has availability of products mentioned in the article may differ among initiated Phase 1 clinical trials to evaluate countries.

Current Trends in Immuno-Oncology, March 2015, Hong Kong, one of a series of oncology symposiums organized by MSD in Asia Pacific

HEALTHCARE ASIA 5

FIRST in areas such as cardiovascular or orthopedics,” Bhuller recommends.

To increase the efficiency and effectiveness of medical specialists, Feige also urges the hiring of 5,600 family physicians for Thailand.

ageing woes haunt hospitals

Constant pressure remains on both doctors and healthcare providers to hold off the overload brought about by the rapidly ageing population. According to a survey by Polycom, healthcare players from the Asia-Pacific believe a ballooning and ageing population are the most pressing causes for concern for healthcare in the coming years.

When asked about what they believe are the largest inhibitors to achieving a better healthcare future, respondents are split between three factors: funding, access to healthcare, and the lack of government support.

“These findings are unsurprising considering that the inhibitors identified for the future were similar to the inhibitors currently plaguing the healthcare sector.

Varying concerns Interestingly, when segmented by occupation, those working on the ground level and those in management were split in terms of what they project as the most pressing future healthcare concerns. “For instance in APAC, those working in executive, finance and innovation and planning roles believe the largest inhibitor is access to healthcare.

Comparatively, those in nursing, administration and patient services think it is funding,” the report said.

Meanwhile, when asked about what they foresee as the greatest barriers to healthcare, respondents from Southeast Asia believe that healthcare accessibility across all regions and demographics will be a cause for concern in the coming years in their respective markets. “This trend continues with the majority feeling that policy will likely be an obstacle,” the report added.

6 HEALTHCARE ASIA

Bangkok Hospital

Thai hospitals stalled with 5000-doctor deficit

T

THAILAND

hailand expects to see more private hospitals moving forward, but this can only happen if it cracks its medical specialist shortage dilemma first.

According to Mickael Feige, partner at corporate strategy consulting firm Solidiance, Thailand is facing a shortage and imbalance in the number of its medical specialists not only in its tier-2 cities, but also in the capital cities. “The shortage directly impacts the demand for sophisticated medical devices as there are no sufficient resources to operate them,” Feige warns. For instance, come 2019, the deficit of physicians, is expected to balloon to 4,044, according to data from the Thailand Information Center for Civil Rights and Investigative Journalism.

Meanwhile, Rhenu Bhuller, senior vice president for transformational health at Frost & Sullivan Asia-Pacific, says Thailand still has a lot of hurdles to go through before it can reach its full potential, especially in medical tourism. “To take the industry to the next level, Thailand still needs to be able to grow the more specialized elective surgery sector

Mickael Feige

Rhenu Bhuller

Brimming with potential However, despite challenges in terms of human resources, the Thai medical industry is still expected to grow in the near term on the back of equally robust demand from the local economy and Asian tourists seeking medical treatment in the country.

“Thailand’s history in medical tourism and its strong base in the services industry has brought it to the stage it is at. With approximately 40 JCI (Junior Chamber International)-accredited hospitals, it has the largest number of hospitals that are providing services in this area compared to other South East Asian nations,” says Bhuller. Feige agrees, citing data from the Tourism Authority of Thailand that points to about 2.89 million medical tourists in 2013, a jump from only 1.2 million medical tourists in 2009. As a result, he says, more private hospitals have begun opening in order to meet demand.

According to Feige, rapid economic development in tier-2 cities, coupled with the influx of patients from bordering countries such as Laos and Cambodia, is fueling the growth of Thai private hospitals. “The current number of hospitals is increasing in the private sector. Over the past three years, we have seen an interest from private hospitals to open satellite hospitals in tier-2 cities,” he observes.

Future medical specialist shortage, 2019

Source: Thailand Information Center for Civil Rights And Investigative Journalism

FIRST

Yong Chern Chet

Raffles Hospital

Foreign patients shun Singapore SINGAPORE

A

slowdown in foreign patients is driving Singapore to refocus its medical tourism industry. Singapore’s medical tourism industry is now undergoing radical change as foreign patients, long seen as a reliable revenue source, are now slowing to a trickle as the country battles external economic headwinds.“Besides local patient demand, at least one third of certain private hospitals’ revenue comes from medical tourists. However, the persistent depreciation of various currencies against the SGD

(Singapore Dollar) has led to lower foreign patient volume, especially from Indonesia,” says Jodie Foo, lead analyst at OCBC Investment Research.

Industry forecasts paint a sobering picture for the next four years. According to Frost & Sullivan, by 2019, the growth rate of Singapore’s medical tourists and the revenues they bring are expected to slow to 9.0% and 7.5%, respectively, from 9.8% each in 2015.

Dr Yong Chern Chet, healthcare sector leader at Deloitte Southeast Asia, agrees with this analysis.

“Medical tourism markets generally

go through an evolution of maturity stages and depending on the stage a particular market is at in relation to its neighboring geography, it influences the specific activity of medical tourism in-situ,” Yong says.

Cost has been a leading factor in the slow exodus of medical tourists to Singapore’s next door neighbours. “With concerns over the risk of flagging medical tourism in Singapore, attention has also been turned to consider whether we are losing patients to other neighboring countries like Thailand, Malaysia and Indonesia, where costs of treatments are more affordable,” Foo says.

As a result, Singapore’s medical tourism industry is expected to resemble a premium healthcare market in the next two to three years. “There will be reduced value proposition for patients seeking bread-and-butter treatments at value-for-money rates,” warns Yong.

Number of medical tourists in Singapore

Source: OCBC

The Chartist: Can telecare heal Indonesia’s lacklustre healthcare?

If the world’s largest archipelago’s underdeveloped medical system is to grow in leaps and bounds to hit its healthcare objectives, then it must first bridge the geographic distance between its citizens and quality healthcare access.

This is easier said than done, though, according to BMI, as Indonesia’s 17,508 rural islands pose a challenge unlike any other. However, telecare may be what the doctor ordered for its ailing medical system, as BMI said telecare will be particularly apposite given the skewed distribution of healthcare personnel and infrastructure.

“In 2015, East Java had 4 hospital beds per 10,000 people, a ratio far less than Yogyakarta which had 13 hospital beds /10,000 citizens,” BMI Research says.

Skewed geographic distribution of health resources

Source: BMI

Telecare still out of reach for many

e/f =BMI estimates/forecasts.

Source: National sources, BMI

HEALTHCARE ASIA 7

FIRST

Healthcare firms zero in on expansion plans

Decentralisation dilemmas

C

ountries in Asia-Pacific are in a race to meet the demands of a burgeoning medical tourism industry, with Southeast Asian players positioning themselves as industry hubs of the region. With the medical tourism industry expected to breach the $20-billion mark by 2019 according to Frost and Sullivan, Dr Yong Chern Chet, healthcare sector leader for Deloitte Southeast Asia, said numerous industry players are currently focusing on capacity and market expansion.

According to Sanpichit Songpaisan, senior manager for Ipsos, Thailand, Singapore and Malaysia are positioning themselves as medical tourism hubs and each enjoys a reputation for providing world-class treatments at internationally accredited hospitals — Thailand and Singapore respectively have 30 and 15 private hospitals accredited by Joint Commission International.

“What we would like to see more are efforts to generate new value creation with business model innovation and better leverage of current assets and resources which would more effectively address inherent growth challenges of the healthcare industry such as manpower shortages and high allocation of capex for physical infrastructure development,” Yong said.

Gleneagles Hospital, Malaysia

Ashwin Moduga, research manager at IDC, adds that patient retention will become a challenge to these hospitals, along with the possibility of a slowdown due to more developed regions like the US and Europe reducing health costs.

Meanwhile, other issues also abound.

From a governmental perspective, a robust medical tourism industry might influence a rise in the general cost of healthcare locally and increase competition for scarce medical talent between the public and private sector, Yong says. “Also from a public health perspective, permeability of medical travel might bring with it the risk of spreading disease pandemics like MERS Virus outbreaks,” he adds.

A robust medical tourism industry might influence a rise in the general cost of healthcare locally and increase competition.

Why healthcare data systems direly need cybersecurity While the digitisation of healthcare data and advancements in healthcare technologies have had boundless benefits, the breakneck speed of innovation is not without its pitfalls. According to the Deloitte 2016 Global Healthcare outlook report, these improvements are being accompanied by pervasive and persistent cyber risks that can leave businesses and organisations vulnerable to debilitating losses and reputational damage.

“Provider and payer organisations handling personally identifiable information (PII) and protected health information (PHI) must continually guard against malicious cyber events which are increasing in frequency and severity,” the report said. According to the report, among the emerging threats are cloudbased computing attacks, medical device security concerns, and privileged access.

8 HEALTHCARE ASIA

When University of Malaya academic consultant, Dr. Chan Chee Khoon evaluated Malaysia’s public sector healthcare system, he proposed a decentralised approach, but other analysts do not seem to share his enthusiasm.

While a more decentralised Malaysian healthcare system may close the current gap in service delivery between wealthy and poor Malaysians by freeing the government from conflicts of interest, decentralisation brings its own set of headaches.

“One of the major issues with decentralised health delivery systems, based on experiences in other countries, is that of the lack of an integrated health system,” Ashwin Moduga, research manager at IDC. Potential roadblocks Moduga reckons chronic disease management for conditions like diabetes, cardiovascular disorders and respiratory disease needs to be monitored at a central level. “Decentralised health systems have had problems with communicating disease statistics, disparate population level disease management programs and have often led to huge pockets of underserved populations,” says Moduga.

Meanwhile, Dr. Yong Chern Chet, healthcare sector leader at Deloitte Southeast Asia reckons that instead of moving towards decentralisation, the more urgent issue lies in boosting the overall capacity and capability of the public healthcare sector. “There is a risk that the private sector, it will not keep up with the demand,” says Yong.

A HIMSS AND MINISTRY OF PUBLIC HEALTH THAILAND COLLABORATION

22 - 25 August 2016 Queen Sirikit National Convention Center, Bangkok, Thailand www.HIMSSAsiaPacConference.org (English Version) http://ehealth.moph.go.th/himss (Thai Version)

Brought to you by:

Many healthcare systems are rapidly transforming to adopt a more patient-centered approach to care. Complimenting this effort is the increased involvement from tech-savvy and betterinformed patients with their caregivers.

In Collaboration with:

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However, achieving digital and patient-centered care is a complex process that requires clear definitions, methods of measurement, adoption of technologies and cultural changes.

Attend HIMSS AsiaPac16 to achieve patient-centered care.

Applying Better Data for Better Health

HIMSS AsiaPac16 Organizing Committee

►Clinical and Business Intelligence ►Genomic Medicine ►Data Governance ►Population Health ►Preventive Care Moving Closer to Your Patient ►Internet of Things ►Interactive Healthcare ►Telemedicine ►Patient Engagement ►Smart Healthcare

Director of Information Technology & Communication, Ministry of Public Health Thailand

Creating Smart Hospital Flows ►Intelligent Hospital Technologies ►IT Governance ►Physician Connectivity ►Nursing Informatics ►Medical Tourism

Vice Chair: Assoc. Prof. Wansa Paoin Secretary General, Thai Medical Informatics Association

Committee Advisor: Dr. Choosna Makarasarn President, Thai Medical Informatics Association

Thai Committee Members: Thai Committee Secretariat: Dr. Nawanan Theera-Ampornpunt, Director of Information Technology & Communication, Ministry of Public Health Thailand

Dr. Boonchai Kijsanayotin, Health Systems Research Institute, Ministry of Public Health Thailand Dr. Visit Vamvanij, Hospital Director, Faculty of Medicine Siriraj Hospital, Mahidol University

Transforming Care Models ►Caring for an Ageing Population ►Care Models ►Universal Healthcare ►Interoperability ►Rural Healthcare

Chair: Dr. Polawat Witoolkollachit

International Committee Members: Dr. Byoung-Kee Yi, Principal Research Scientist, Medical Informatics Department, Samsung Medical Center, South Korea Dr. Chong Yoke Sin, Chief Executive Officer, Integrated Health Information Systems, Singapore Dr. James Miser, Chief Medical Information Officer, Bumrungrad International, Thailand Dr. Monica Trujillo, Chief Medical Information Officer, UnitingCare Health, Australia

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HEALTHCARE ASIA 9

FIRST

Hong Kong’s ageing doctors hinder private hospital operations HONG KONG

A

s Hong Kong’s ageing population increases in proportion to the working age, with the median age rising in tandem from 42 in 2014 to 51 years old by 2040, its medical system has been operating with raised sense of urgency.

Public hospital fees are currently under review for the first time in ten years, with the government outlining plans to incentivise patients to enroll in the special administrative region’s voluntary health insurance scheme as the population’s dependency ratio is expected to rise from 35% in 2014 to 76% by 2040.

However, one of the main issues at hand with Hong Kong hospitals is that of overcrowding and wait times. “Hospitals in the US have been able to reduce overcrowding in Emergency Rooms using triage nurses who set a prioritisation process in place.

Virtual care and telehealth have also shown positive results in helping reduce overcrowding and wait times,” says Ashwin Moduga, Research Manager, IDC. According to the Hong Kong Cancer Registry, those aged 65 years and older accounted for 50% of the total number of new cancer cases in 2013.

Hong Kong hospitals will also have to deal with a shortage in human resources as the

demand for medical treatment increases with age.

“According to local news sources, the public sector treats 90% of the region’s yearly cases despite employing only 40% of the industry’s doctors,” says Ang Wei Zheng of BMI Research.

Wei Zheng adds that not only the population is aging, but also its medical profession, noting the the median age of doctors is 47 years old. ‘This creates the risk that a retirement of a sizeable proportion of the physicians in Hong Kong will exacerbate the shortfall of physicians in the administrative region. To address this, the Hong Kong authorities initiated a new scheme costing HKD570mn (USD73mn),” Wei Zheng. Reforms in healthcare expenditure are to be expected, and are forecast to grow from HKD141bn (USD18bn) in 2015 to HKD256bn (USD33bn) by 2025.

Medical consultations in a few taps on your phone

10 HEALTHCARE ASIA

Ang Wei Zheng

118% on January 3 2015. While the rising demand of healthcare services due to the ageing population is a factor, there are also systematic drivers as well,” Wei Zheng said.

Citing a study by the journal of Health Economics, Policy and Law, Wei Zheng said A strategic shift 8.6% of admissions were due to avoidable Meanwhile, according to Wei Zheng, Hong hospital conditions (AHC) - deemed as cases Kong will also require a strategic shift in where hospital admission can be avoided if the delivery of healthcare services in the the patient receives more appropriate and region due to overcrowding challenges, timely healthcare. with the average bed occupancy rate “Critically, the researchers note that the risk from 30 December 2015 to January 2015 averaging 103%. “This is more acute in public of an admission for AHC increases by 40% for every 10-year increase in the age of the hospitals such as Caritas Medical Centre, Hong Kong patient,” he added. where the bed occupancy rate hit a high of

healthcare Watch

The ease brought about by connected devices has reached the healthcare landscape, which means tedious trips to the hospital will soon be a thing of the past.

This is what RingMD brings to the table—a platform allowing patients globally to search and seek for online consultations with doctors through a phone or video call.

RingMD’s web and mobile-based application is also designed as an allin-one platform that permits medical professionals to do online consultations and enter notes/diagnoses securely. During consultations, RingMD also makes the user’s medical history and other related files readily available, allowing for efficient and cost effective practice for doctors around the world. Initially, RingMD launched exclusively as a web app, but has recently launched its mobile app which can be downloaded for both Android and iOS.

Ashwin Moduga

RingMD interface

Available on various devices

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HEALTHCARE ASIA 11

co-published Corporate profile

Medtronic harnesses technology and infrastructure to improve medical efficiency

A global healthcare solutions provider is changing the way Asian healthcare is delivered.

W

hile several countries in the Asia Pacific (APAC) region have managed to buck the economic downturn in the West, their respective healthcare systems seemingly have not kept pace with the vast economic growth currently being enjoyed in the region. In the state of Maharashtra, India, for instance, access to quality healthcare is challenged by infrastructure concerns—there are simply not enough facilities to cater to patient demand.

Medtronic commits itself to forging new, different, and stronger partnerships

“At Medtronic, our Integrated Health Solutions team is systematically diagnosing inefficiencies in the local market context and developing solutions to address them.”

12 HEALTHCARE ASIA

Infrastructure deficit This situation mirrors the infrastructure deficit seen elsewhere in India and in the region: in India, the ratio of cath (catheterization) labs to the country’s population is one to two cath labs per million population. In Indonesia, Vietnam, and the Philippines, the ratio is just as dire, with barely one cath lab for every 1 million population. This compares to 4-6 cath labs per million population in developed markets.

“A vast majority of patients requiring tertiary care are going to cities like Pune and Mumbai for treatment at present,” explains Dr. Paresh Doshi, chief executive officer and owner of Orchid Hospital, one of the many new facilities in the province supported by Medtronic Integrated Heatlh Solutions, which is dedicated to creating more access, lowering costs of care and improving quality by addressing market inefficiencies.

For physicians such as Dr. Doshi, the opening of Orchid Hospital and the support of Medtronic could not have come at a more opportune time.

“Before we opened our facility,

there was no large private sector hospital anywhere in North Maharashtra,” Dr. Doshi adds. Medtronic Integrated Health Solutions has been working with mid-size and entrepreneur-led private, multispecialty hospitals to facilitate access to capital, build new care infrastructure, and support hospital expansion plans. In fact, hospitals in India have aggressive expansion plans to respond to the gap in access with 50% – 60% planning to increase bed-strength and add cath labs.

Market inefficiencies Five types of market inefficiencies limit the growth of APAC’s healthcare systems at present: 1) Patient flow - low diagnosis and treatments rates are further compromised by the inadequate number of trained medical staff and localized care pathways, 2) Material flow - high channel margins and channel costs result in markups, 3) Capital flow - high cost of capital for healthcare infrastructure limits expansion in developing markets, 4) Operational flow - lean and best-in-class practices for nonclinical operations management through operational excellence are lacking, and 5) Data flow - linking of patient data to individual patients for better risk assessment and patient management are needed.

“At Medtronic, our Integrated Health Solutions team is systematically diagnosing inefficiencies in the local market context and developing solutions to address them in order to better align value, increase access to care and improve clinical outcomes,” says Dr. Sundeep Lal, Medtronic Vice President, Integrated Health

Solutions, APAC. Aside from hospital partnerships, Medtronic is also targeting specific diseases such as HF (heart failure), a leading cause of death and re-hospitalization with half of HF-afflicted patients dying within five years of diagnosis.

However, it is difficult to accurately estimate the incidence, prevalence, outcomes and key causes of heart failure, particularly in developing markets.

To address these challenges, CARE Hospitals, a multispecialty large healthcare chain of hospitals in India, and Medtronic entered into a strategic partnership to set-up specialized HF Clinics.

“With our combined clinical and technical expertise, we intend to optimize care and outcomes for HF patients across the care continuum. This enhanced therapy delivery and management of HF will improve patient outcomes,” says Dr. N. Krishna Reddy, CARE hospitals co-founder.

Improved patient care Building on Medtronic‘s unique combination of resources, process optimization expertise and therapy knowledge, cost and efficiency concerns can be addressed for improved patient care.

Medtronic is in the process of implementing similar partnerships across APAC to address the unique needs of healthcare systems and to improve access, quality, cost and efficiency. They are committed to forging new and stronger partnerships with those who are equally committed to delivering seamless, integrated care and taking healthcare Further, Together.

IMAGINE QUALITY HEALTHCARE NO MATTER WHERE YOU LIVE

Getting good, affordable care shouldn’t depend on your address. That’s why we’re working with healthcare systems around the world to make our technologies and services available to more people in more places — removing barriers to affordable care.

Let’s take healthcare Further, Together.

Learn more at medtronic.com/furthertogether.

UC201602657a EN © 2015 Medtronic. All Rights Reserved. Printed in USA 09/2015

HEALTHCARE ASIA 13

healthcare INSIGHT: AEC

The demand for quality healthcare has never been more robust

How will the much-awaited AEC boost ASEAN healthcare?

The regional health care sector is seeing growth as progressive changes set by the Asean Economic Community are propelled into motion.

W

hen the Asean Economic Community (AEC) was set to be launched in December 2015, it was seen as a benefit to the growing healthcare industry, particularly in the medical devices sector. Due to increased governmental focus on healthcare and medical equipment across a number of member states, the demographic shift of the increase of middle-income earners across the Asean is driving demand for better healthcare and medical devices which facilitate more efficient treatment.

Ageing populations and the implementation of new public health policies in several member states are also important factors in forecasting the growth of the health sector.

As a result, the ASEAN region is beginning to see remarkable positive changes in healthcare. Thailand, Singapore, and Malaysia in particular 14 HEALTHCARE ASIA

The demographic shift of the increase of middle-income earners across the Asean region is driving demand for better healthcare.

are positioning themselves as medical tourism hubs in the region, with each country enjoying a reputation for world class centres of excellence in specific fields of medical treatments.

Sweeping changes Singapore, which was once a top player in the healthcare industry for medical tourism, is facing increased pressure from its neighbouring countries, who have begun investing further in their own respective offerings. Additionally, affordability is a key driver in medical tourism, as rates are at least seven times lower than those charged to patients seeking medical treatment in the U.S. The demand for medical devices increases proportionally to the strength of the country’s medical tourism sector. Asean countries currently import most of their medical equipment from the US,

Japan, Germany and the Netherlands because the region’s manufacturers are not yet technologically advanced enough to produce complex machinery such as ultrasound, x-ray machines and MRI scanners.

However, the rapid growth in Asean populations has also accelerated the growth of the medical device market across the region, especially in Malaysia, where this market was valued at USD 1 billion in 2013. This is roughly the equivalent of Thailand and Indonesia, where populations are much larger.

“Thailand has Asean’s largest diagnostic imaging market with a market share of about 27%.

Diagnostic imaging is the largest single medical device category both globally and within Asean. However, it achieved a CAGR of 10.85% from 2008–12 which is slower than the next largest category, consumables, which had a CAGR of 17.13%,” according to Sanpichit Songpaisan, senior manager for Ipsos Business Consulting.

“The size of Asean’s dental product market is about half the global average, 3.9 per cent of the medical equipment market compared with

healthcare INSIGHT: AEC 6.9 per cent. This category also has the lowest regional growth rate for medical equipment, just 8.1 per cent per year. It is even contracting in Indonesia where dental care is one of the lowest health priorities,” Songpaisan adds.

In most Southeast Asian countries, cancer, diabetes, tuberculosis and cerebrovascular conditions are the most significant health risks.

Increasing healthcare expenditures in developing countries, where millions of rural dwellers face major financial difficulties in seeking medical treatment, has prompted the government to develop universal healthcare policies.

For instance, in the Philippines, the PhilHealth national health scheme allows the low income population, comprising about 25 million people or 26% of the population, access to free medical treatment when admitted to government hospitals.

These programs across the Asean region provide medical device companies with a relatively untapped market with a high growth potential.

Key success factors Medical device companies which aim to become market leaders in the ASEAN region must take into consideration key success factors such as providing effective cost management and introducing cutting edge technologies that are suitable for the needs of the market. Companies which manufacture products locally will gain an advantage as the lower labour and logistics costs will allow them to set price points lower than other suppliers. Competitive pricing will be a major incentive for public hospitals, while new technology appropriate to the market will allow these companies to gain greater market share by transforming the market completely.

Another key challenge faced by the ASEAN region is the significant shortage of nurses and physicians, a particularly important concern for countries such as Singapore, where there is also a current shortage of beds in hospitals. “Currently, the ratio of physicians to population in Asean stands at less than 2.0 per 1,000 people, compared to 3.3 per

1,000 people in OECD countries.

The shortage of skilled medical professionals is a stumbling block for health care providers in the region which is looking to address the shortage of beds,” says Abhay Bangi, Partner at Transaction Advisory Services at EY. Promoting the best standards As a result, the Mutual Recognition Arrangements (MRA) program is being developed by the AEC for medical professionals and nurses, facilitating their mobility within the Asean region, promotes the adoption of the best standards and qualifications, and provides them with opportunities for capacity building and training.

For instance, a foreign medical professional may apply locally to be registered if he or she has been licensed by the country of origin’s Professional Medical Regulatory Authority (PMRA) to practice medicine. Medical qualifications, if recognised by the host country and the country of origin as actively practicing as a general practitioner or specialist for a minimum of five years are recognised under the arrangement.

“Even for those that fulfil these criteria, the challenge remains regarding their mobility within Asean nations, as unlike other professions, ASEAN member states have maintained their national authority in deciding which medical and dental professionals practice in their countries,” adds Bangi.

“This means that some national authorities can be susceptible to lobbying and pressure from the local medical professional community to continue a ‘closed door’ policy,” Bangi says. However, it is believed that several Asean member states will adopt the MRA policy over the next three to five years to ease the shortage of medical professionals in their respective countries.

Learning from history Additionally, according to Paul Barach, clinical professor at Wayne State University, the Southeast Asian region could also take a page out of Europe’s book, where critical and

Abhay Bangi

Paul Barach

Ashwin Moduga

nationalistic questions are being raised and where there is a renewed focus on local context dependent requirements.

“Increased migration forces are making it more and more difficult for skilled workers to get jobs in new countries and I imagine this will happen in ASEAN areas as well,” Barach said.

Barach also concedes that the path to a better healthcare future through the ASEAN Economic Community isn’t that clear yet, and that there is a more pressing need for better certification, credentialling, use of simulations, and better monitoring of providers and closer long-term alliances.

Barach also sees more centralised requirements with detailed requirements for all medical professionals and specialists as the AEC develops in the coming years.

“Large groups like Apollo system in India are moving ahead with more stringent CME and CPD programs, more rigorous credentialling, more oversight and using HIT to better oversee provider outcomes while providing more transparent information to the public,” Barach says. Meanwhile, according to Ashwin Moduga, research manager at IDC, the biggest challenge for healthcare providers in the region will be attracting health professionals and care givers to the rural areas of Southeast Asia.

The healthcare industry’s long term prospects in the ASEAN region are positive overall. It is to be hoped that the challenges being faced by the industry can be addressed by the member states in order for the rate of progress to continue.

Breakdown of ASEAN Medical Device market

Source: Espicom Business Intelligence, Ipsos Business Consulting

HEALTHCARE ASIA 15

Dr Mohd Azhari Yakub CEO Institut Jantung Negara 16 HEALTHCARE ASIA

CEO INTERVIEW

Institut Jantung Negara opens Malaysia’s sole heart failure ward this year Datuk Dr Mohd Azhari Yakub is planning the subspecialisation of heart-related treatments.

T

he 432-bed Institut Jantung Negara (IJN) is Malaysia’s premier heart centre and one of the largest heart centres in the region. IJN has also unveiled the countries sole heart failure ward this year, staffed with a specially trained medical team. Healthcare Asia interviewed IJN’s CEO Datuk Dr Mohd Azhari Yakub, to get a glimpse of what it’s like leading Malaysia’s national referral centre for cardiovascular disease.

of the private wards to reduce, if not eliminate, the waiting time for private patients. Now, an angiogram or cardiology intervention can be done within a week or even days. The institute has also been actively reaching out to the public through the setting up of screening test booths and road shows in shopping malls around Klang Valley.

How do you plan to increase your growth and success in Malaysia?

We believe in providing high quality care with competitive pricing. We are not selling our services based on prices. Quality comes first, while cost is secondary.

Recently, we had doctors coming from Australia who dubbed IJN the ‘Cleveland Clinic of Asia’ because of the excellent quality of work we do here and our well-trained staff.

What issues do you foresee IJN facing this year and how do you plan to solve them?

2015 was a tough year for Institut Jantung Negara as expected, due to the implementation of the goods and services tax. However, we are also bracing for another difficult year in 2016 as the problem is compounded by the economic slowdown and weak Ringgit.

We are well aware that the public is cost-sensitive because of the current economic climate and high cost of living. The main issue in 2016 will be containing costs so that we can pass on any cost savings to our patients.

Nevertheless, we see these challenges as an opportunity to position IJN as a quality alternative to private hospitals through our competitive prices.

We keep the prices competitive by establishing a mechanism that reviews processes in a methodical manner in order to identify areas in which to reduce operating costs and increase efficiency, translating to lower costs.

This mechanism has already yielded good results.

Since late 2013, IJN has been investing about RM44m in upgrading its information system so it can move forward in its customer experience.

Another challenge that we see IJN having to overcome is the perception that it is a public hospital with a long waiting list, and we hope to correct this misconception and position ourselves as a quality alternative for patients seeking heart-related treatments as private patients.

In truth, IJN has a private clinic and private ward to cater for private patients. We’ve doubled the capacity

We believe in providing high quality care with competitive pricing. We are not selling our services based on prices.

Quality comes first, while cost is secondary.

What are your current initiatives as well as future plans for Institut Jantung Negara?

Despite the tough times ahead, we will be pushing forward with expansion plans focussing mainly on increasing our local market share. Presently, we are collaborating with BP Healthcare Group to run a cardiology clinic in their Taman Megah facility.

We are also hoping to expand this through collaborations with other partners for better reach and access to patients. Additionally, we are complementing our overseas initiatives with a collaboration with the Malaysia Healthcare Travel Council (MHTC), an initiative started by the government to promote medical tourism.

We also narrowing our focus in our promotional activities to certain services such as our screening tests, as well as a 24-hour emergency service for priority angioplasty, which is the recommended treatment for heart attacks, where doctors have a window of between four and six hours from the time of a heart attack to rescue heart muscles.

Furthermore, we are also planning the subspecialisation of heart-related treatments, a strategy that we believe is our differentiating factor. In this day and age, there can’t be a cardiologist who does everything so we have employed cardiologists who are experienced in many different facets of cardiology.

We have doctors who specialise in valve problems and other minimally invasive treatments so patients can be assured that they will get the best. In line with this, we have opened up Malaysia’s sole heart failure ward this year.

Due to the special care and closer monitoring that heart failure patients require, the ward is staffed with a medical team that is specially trained and offers services of monitoring patients in their homes and who performs regular checks.

We want to be known as the centre to go to for heart-related health problems. We can afford to be oncall around-the-clock because we have the resources and expertise. The main thing is the care.

We are aware of patients’ expectations in terms of price so we strive to make it comfortable for them as well, which is in line with our efforts to provide a holistic customer experience.

HEALTHCARE ASIA 17

feature profile

Dr Nila Moeloek, Indonesia’s Health Minister leads citizens in a walk

How is Indonesia’s difficult scheme halfway through implementation?

It has been two years since Indonesia started Jaminan Kesehatan Nasional, the country’s universal healthcare plan, and while it has delivered benefits, the difficult road towards the second half remains.

S

etting up a universal healthcare system for a country with a population of over 250 million people seems like a herculean task, but the Indonesian government is keen on achieving that goal with Jaminan Kesehatan Nasional (JKN). Launched in 2014, JKN is a single national health insurance scheme in Indonesia, established as part of the National Social Security System which is administered through the mechanisms of social health insurance pursuant to Act No. 40 of 2004.

Dubbed by former President Susilo Bambang Yudhoyono as a milestone in the history of Indonesia, the ambitious plan to provide all Indonesians with quality healthcare was greeted with enthusiasm in the country characterised by diversity.

In November 2005, the national government, under the auspices of the coordinating Ministry for People’s Welfare, held a national health conference to raise awareness among high-level political leaders and health authorities at all levels, highlighting the priority attached to health by the government. The Ministry of Health in 2006 has also issued a new strategic plan emphasising the new vision “self reliant communities to pursue healthy living” and its mission “to make people healthy.” The values underlying the vision and mission include: being people-oriented, 18 HEALTHCARE ASIA

Launched in 2014, JKN is a single national health insurance scheme in Indonesia, established as part of the National Social Security System.

rapid and appropriate response, teamwork, high integrity, and transparency and accountability.

With JKN, the goal is to meet the basic health needs of every Indonesian, from those who can pay premiums to those whose contributions are paid for by the government. “The goal of JKN is to provide access for Indonesian people to quality health care without any financial hardship. Through JKN, Indonesia is moving toward achieving Universal Health Coverage. JKN is implemented under social health insurance principles and the membership is mandatory. The target of total coverage is in 2019,” says Indonesian Health Minister Nila Djuwita Anfasa Moeloek.

Increasing coverage Moeloek says that as of January 16, the coverage of JKN is 158,669,787 people - more than 60% of the entire Indonesian population. The structure of membership is comprised of contributory members (formal and informal workers) and non-contributory (poor people). The premiums of poor people are shouldered by the central government and a few funded by the local government.

“On the other hand, contributory people should pay their premium monthly. The premium for informal

feature feature profile profile The coverage of JKN is 158,669,787 people - more than 60% of the entire Indonesian population.

Dr Nila Moeloek Indonesia’s Health Minister

workers is a nominal rate, meanwhile the premium for formal workers is a percentage of wages and it will be paid by both employers and employees,” she says. JKN is administered by the social security agency, Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan. The scheme provides for a broad benefit package delivered by primary-to-tertiary health care facilities, the health minister says.

During the first stage of the national healthcare program, 86.4 million poor people were covered by the Jamkesmas program, 11 million poor people covered by the Jamkesda program, 16 million civil servants covered

by PT Askes, 7 million workers covered by PT Jamsostek and 1.2 million TNI/National Police members covered by Asabri.

The provider payment system implemented in JKN is capitation for primary healthcare facilities and diagnosisrelated group payment known as INA CBG for secondary and tertiary healthcare facilities. “Premium pooling is the main source of financing in JKN. The program is utilised by people across the provinces; however, the utilisation rate on catastrophic cases, for instance, cancer, hemodialysis and coronary heart disease was high.

This condition pushed for higher spending in claims reimbursement for BPJS Kesehatan. The claim ratio is now more than 100%,” she says. She adds, however, that based on the regulation, the deficit problem has been handled by central government.

Improving the system Moeloek says that implementation of JKN involves two aspects: health financing (premium pooling and provider payment) and healthcare delivery (supply side).

“These two aspects should be improved together. From the financing aspect, the growth of membership should be watched and keep increasing as targeted and premium collection should be completed as well. The level of premium should be reviewed and updated accurately,” she says. She adds that under the umbrella of Health System Strengthening, health care delivery should be

strengthened, and the supply side should be improved, both in quality and quantity, to solve the mis-distribution problem and achieve equity of health access. This involves having enough human resources, health facilities, medical equipment, supplies and drugs.

“Based on its 2015-2019 Strategic Framework, the Ministry of Health is focussing on strengthening health care delivery and enhancing promotive and preventive health services. In order to provide better quality of health services, it is important to develop and implement the standard medical and non-medical services and also fulfill health human resources and medical supplies. And it must be available in all areas in Indonesia to solve inequity problems,” Moeloek says.

Focussing on prevention Currently, however, she says they are focussed on improving promotive and preventive programs, considering the increasing spending on noncommunicable diseases such as heart disease, chronic kidney disease and cancer. “The Ministry of Health will intensify promotive and preventive programs in respect to reducing the morbidity rate, detecting and finding cases in their early stages and to induce people in a healthy life manner,” Moeloek says.

In order to keep up with the demands of an ambitious universal healthcare project, some hospitals in Indonesia are being used by educational institutions to provide training in clinical education for medical doctors, dentists, and other qualified health care professionals. Act No. 44 of 2009 stipulated that teaching hospitals should integrate education, research and health services in medical or dentistry education, continuing education, and other healthcare professions.

Currently, there are 300 hospitals functioning as medical education centres; 68 hospitals have met the qualified standards and have been assigned as teaching hospitals by the Ministry of Health and the Ministry of Research and Technology and Higher Education.

Today, a teaching hospital is a tertiary level referral

Dr Nila Moeloek answers questions in a conference

HEALTHCARE ASIA 19

feature profile community development. The acknowledgement comes especially in the form of political support. The SDGs cover 17 goals and 169 targets, considerably larger in scale and wider in outreach to resolve the interlinkages and intrications of development,” Moeloek says.

Dr Moeloek attends a presentation

hospital, so this situation makes it hard for the students to find cases related to their competencies, Moeloek says.

“It is necessary to establish Government Regulation No. 93 of 2015 concerning teaching hospitals, which is that teaching hospitals should provide primary, secondary and tertiary health services so that students can fulfil their competencies. The efforts to meet more competencies are done through building a teaching hospital network (Afiliasi and Satelit teaching hospitals),” she says.

Challenges abound Indonesia is not without its own achievements in the health sector. The country was declared polio-free by the WHO in 2014, and was the first country in SoutheastAsia to reach global targets on tuberculosis in 2006.

Since its preparation, however, the international body says many changes have taken place in the country. These include reporting of cases of avian influenza in poultry and subsequently in humans. Prior to its eradication in 2014, there was a polio outbreak in the country, and the 2004 tsunami killed thousands of individuals, raising a medical emergency of massive proportions.

Despite this, however, the country is still confronted with numerous challenges. Moeloek says the challenges in the country’s health sector are threefold. On the national level, the disparity of health status remains high among different socioeconomic levels and between residents from urban and rural areas. Implementation of the National Social Security System is also a big task. Regionally, the country is looking at positioning itself within the ASEAN Economic Community, and globally, it is tasked towards the achievement of sustainable development goals (SDG).

“Millennium Development Goals (MDGs) ended 2015 and were replaced with the SDGs starting from 2016. There are many countries that acknowledged the MDGs as the driver for reducing poverty and advancing 20 HEALTHCARE ASIA

The country is looking at positioning itself within the ASEAN Economic Community and globally.

Near-term outlook In the national development framework of 2015-2019, the government will pursue the actualisation of the TRISAKTI pledge of the President which has been translated into nine agenda of priorities known as NAWA CITA, Moeloek says. “The fifth agenda priority of NAWA CITA will be achieved through the implementation of the Smart Indonesia Program, Healthy Indonesia Program and Family Welfare Program,” she adds.

The Healthy Indonesia Program is an effort to achieve the highest health status for all Indonesians - having healthy behavior, living in healthy sanitation and having access to quality healthcare provisions. It consists of three main pillars: a healthy paradigm; strengthening healthcare provision by applying the strategy of improving the access to healthcare and optimising the referral system; and the National Health Insurance. With regard to strengthening the healthcare provision in remote areas and border territories, the Ministry of Health recruits and deploys ‘team based’ early-career health professionals in a program called “Healthy Archipelago” (Nusantara Sehat).

“This government-led movement and innovation in health deployed its first batch in May 2015 and will continue to send teams to remote health posts in Indonesia up to 2019,” Moeloek says. In the implementation of health development program and activities, the health minister says there is a need for program and activities integration targeted to four main prioritised programs. “The prioritisation will embrace some promotive activities, including an activity that aims at primary healthcare provision,” Moeloek says.

Indonesia’s UHC looks good at a distance

HEALTHCARE ASIA 21

cOUNTRY report: hong kong

Princess Margaret Hospital has advanced facilities for geriatric care

Hong Kong scrambles to overhaul elder care

Government officials are racing to strengthen the healthcare sector as the number of elderly Hong Kong residents overwhelms the system.

I

f analyst’s predictions turn out to be accurate, by 2040, nearly one-third of all Hong Kong residents will be aged 65 years and older, a seismic demographic shift that will present as one of the toughest policy challenges for the government. Already, officials have been proposing and implementing measures meant to accommodate the influx of elderly Hong Kong residents and their medical needs, but with the health sector requiring too many improvements at once, there is a question on which initiatives should be given priority.

The number of people aged 65 years and above is expected to balloon from 14% of the total population in 2014 to 31% by 2040, a sharp rise that will put the territory ahead of Singapore (30%) and Thailand (26%) in its share of population at the aforementioned 22 HEALTHCARE ASIA

Government expenditure for elderly care services nearly doubled from HK$3.3 billion in 2007 to HK$6.2 billion in 2015.

demographic, says Ang Wei Zheng, pharmaceuticals & healthcare analyst at BMI Research.

Government preparations The government is preparing for this ageing population trend by addressing the shortage of doctors and other medical professionals, and strengthening the elderly care system.

But among Hong Kong healthcare reform measures, BMI Research declared that the top of the agenda for authorities will be to develop a new health care financing model that will be sustainable in the face of a shrinking tax base.

Ang says in the current model, public hospitals provide heavily subsidised medical services, which results in government health expenditure accounting for 46% of total healthcare spending in 2015. But the government will not be able to

afford to spend this much any more as the ageing population leads to a higher dependency ratio and lower available tax base. It also becomes clear that the subsidy-heavy model will be very difficult to sustain when factoring in the surge in medical and drug spending for the elderly.

“The aging population is a key driver to increasing demand for medical services and the growth of healthcare spending,” says Karon Wan, managing partner at Deloitte China Public Sector.

Wan cites data that government expenditure for elderly care services nearly doubled from HK$3.3 billion in 2007 to HK$6.2 billion in 2015, and in 2015 that expenditure is equally divided between public and private spending.

The Hong Kong Cancer Registry reveals those aged 65 years and older accounted for 50% of new cancer cases in 2013. Authorities look to solve the dilemma of financially supporting elderly health care programs through incentive schemes that encourage patients to enroll in the special administrative region’s voluntary health insurance scheme.

Still, it could take some time before this voluntary health insurance scheme is ironed out and implemented, with authorities suggesting late last year that the scheme is unlikely to be launched during the final stretch of Chief Executive Leung Chun-ying’s term, says BMI Research in a separate report in January 2016.

Healthcare workforce shortage Aside from creating a more financially sound healthcare system, Hong Kong is facing an uphill battle in staffing its public hospitals and elderly care facilities with doctors, caregivers and other medical professionals.

Many factors contribute to this shortage, but a key reason is the decrease of medical student intake and the competitive need stimulated by private sector growth, says Karon Wan, managing partner at Deloitte China Public Sector.

Wan notes that the government has placed some short-term bandaids such as setting up a time-limited

cOUNTRY report: hong kong fund to re-employ the retiring medical staff, increasing medical student intake in 2015, and allocating HK$300 million to enhance staff training through scholarships.

But Ang reckons that even though authorities have sought to attract workers to the elder care industry through courses such as the Foundation Certificate in Care Worker Training and the Certificate in Health Worker Training, these have not been able to adequately address the manpower challenge. He points to the number of graduates falling to 1,220 in 2014/15 from 2,470 in 2010/2011.

Likely recognising the gravity of the workforce shortage at hand, the government in 2012 began a strategic review on healthcare manpower planning and professional development in Hong Kong. The review covers 13 healthcare professions, including doctors, dentists, Chinese medicine practitioners, nurses, midwives, pharmacists, chiropractors, and medical laboratory technologists, among others.

The Hong Kong Food and Health Bureau expects the review will be completed in mid-2016, after which recommendations will be made to “better enable us to meet the projected demand for healthcare professionals as well as foster professional development of our healthcare system and the continued provision of quality healthcare services to the public.”

Even though the review has not been completed, the Food and Health Bureau says preliminary findings have led authorities to bump up the number of publicly-funded degree places in medicine, dentistry and other healthcare disciplines by 50, 20 and 68 respectively in the 2016/17 to 2018/19 triennium.

Moreover, the Medical Council of Hong Kong has introduced more flexibility in the relevant internship requirement for non-locally trained doctors to practise in Hong Kong, making it easier to attract talent.

Overburdened hospital system Critics of the Hong Kong healthcare system point out that it

Karon Wan

Ang Wei Zheng

has a lacklustre primary care system where residents put off visiting local community clinics for primary care until their conditions worsen, which then leads to overcrowding in hospitals.

A worsening problem The problem may worsen as more elderly people represent the population because under the current set-up, many will not be able to afford primary care since the majority of the providers are privatised. Wan reckons 70% of primary care is privatised making it a difficult option for the elderly who generally have multiple chronic diseases with costly treatments, and the elderly prefer the public healthcare system which is 90% subsidised by the government.

“This financially friendly option has become the main avenue through which to receive primary care instead of local community doctors or facilities. This results in an overburdened public hospital system,” says Wan. Given the projected revenue challenges of the government, Wan reckons there will be large efforts to encourage availability and improve the delivery of primary care in the next few years. Already, there has been some initial progress in this regard through the setup of the Primary Care Office in 2010 and the development of stronger clinical protocols, but ultimately

success in this area will hinge on strong cooperation between the government, health and hospital departments, the welfare sector and non-public organisations.

Analysts agree that despite the challenges ahead, the government goal is clear: Provide quality elderly care while restricting costs from spiralling out of control.

Wan says hope lies in developing new delivery models and forging effective public-private partnerships.

Ang echoes the importance of the private sector, viewing them as a key partner in creating more residential care homes for the elderly, staffed with excellent nurses and care workers that can address their patients’ special needs.

The government may also find promise in promoting disease prevention initiatives, launching community-based elderly support programs and expanding technologybased disease management models.

The potential for technology adoption is particularly exciting, says Wan, envisioning a future when there is real-time interaction to monitor and maintain elderly health through data retrieval and analysis.

In order to encourage a more open attitude towards medical technology among the elderly, the Smart Elderly IT Star Awards were established in 2012 to reward strong adoption among the cohort. “Technological advancements provide tangible and immediate solutions to providing elderly independence and improving their safety, health, and wellbeing,” says Wan.

Overcrowding a persistent challenge

70% of primary care is privatised making it a difficult option for the elderly who generally have multiple chronic diseases.

Source: Hong Kong Hospital Authority

HEALTHCARE ASIA 23

Case Study 1: Makati Medical Center

MakatiMed’s CTC is only one of four of its kind in the country

MakatiMed’s rare stem cell therapy tech Makati Medical Center features its cellular therapeutics centre, allowing it to provide cutting-edge stem cell therapies in the Southeast Asian nation.

W

hen Makati Medical Center’s Cellular Therapeutics Center (CTC) earned Department of Health and Food and Drug Administration accreditation for cellular therapy in the Philippines – one of only four health facilities in the country to receive the accreditation to date – it became clear that its relentless pursuit of world-class standards was paying off.

CTC has spent the last few years hiring highly trained scientists and specialists and procuring top-tier equipment from all over the world in order to provide a viable alternative or adjunct cutting-edge therapy for chronic, autoimmune, and degenerative diseases such as cancer, multiple sclerosis and ischemic cardiomyopathy.

Still seeking leaps in improvement, CTC plans to collaborate with local universities and foreign-based scientists, and share its recent findings in international conferences.

“We are constantly keeping abreast with the latest developments in 24 HEALTHCARE ASIA

CTC is currently one of only four health facilities with DOH accreditation and is, in effect, allowed to offer stem cell therapies in the Philippines.

the field of cell-based therapy. We expect to publish our findings in peer-reviewed scientific reports. We plan to collaborate with international laboratories and foreign-based pharmaceutical companies in order to gain more global recognition,” says CTC co-director Francisco S. Chung Jr., PhD. He leads the CTC together with co-director Francisco Vicente F. Lopez, MD. Cutting-edge therapies This bodes well for CTC patients, assuring them that the health facility will provide the most cutting-edge stem cell therapies in the Philippines.

Stem cells are unspecialized cells that have the potential to develop into different cell types in the body. When a stem cell divides, each new cell has the potential to either remain a stem cell, or develop into another type of cell with a more specialized function, such as a heart cell or a brain cell.

In some organs, stem cells serve as an internal repair system, dividing to repair and replace worn out or damaged tissues.

Stem cell technology provides an innovative approach to utilize stem cells for clinical applications.

Clinicians and scientists are looking at the potential of using stem cells to treat a number of conditions, including Parkinson’s Disease, Multiple Sclerosis, cancer, spinal cord injury, heart disease, and other autoimmune diseases. The use of autologous stem cells, like the ones derived from blood, fat, or your bone marrow, is very safe. Several studies have demonstrated support for its safety.

Stem cell treatment gives alternative therapy options for patients who suffer from incurable, chronic, or degenerative diseases.

Several reports also demonstrated its potential in boosting the immune system and controlling the growth of the tumor in the cancer patients who have undergone this kind of treatment. Quality of life is also positively influenced as unwanted side effects from conventional treatment (such as chemotherapy) can also be decreased.

Doctors describe treatment options and the expected results.

Case Study 1: Makati Medical Center Discussions will help weigh the risks and the benefits of stem cell treatment, and guide in making an informed decision.

DOH Accreditation In March 2015, Makati Medical Center’s CTC received accreditation from the Philippines’ Department of Health (DOH), which recognises it as a hospital-based facility that may engage in human stem cell or cellbased therapy in the Philippines. The accreditation was issued under DOH Administrative Order No. 2013-0012, or rules and regulations governing the accreditation of health facilities engaging in human stem cell and cell-based or cellular therapies in the Philippines.

CTC is currently one of only four health facilities with DOH accreditation. CTC is allowed to offer autologous stem cell or cellbased therapies in the Philippines, specifically for hematopoietic stem cell transplantation, corneal resurfacing with limbal stem cells and skin regeneration with epidermal stem cells.

Hundreds of other health facilities have applied for accreditation, but it was only granted to those that met the stringent standards of safety, efficacy and quality set by the government.

CTC’s accreditation is a testament to its exceptional level of quality service and the growing importance of cell-based therapy in addressing practically hard-to-treat diseases.

CTC invested heavily to create

CTC co-director Francisco S. Chung Jr. PhD.

The laboratory boasts the highest safety standards in every procedure, from the screening process for stem cell therapy patients.

CTC’s state-of-the-art facilities

a laboratory that is at par with the United States Food and Drug Administration (US-FDA) sterility standard of a biosafety level 5 facility.

Furthermore, CTC ensures cell purity of at least 90 to 95%, and cell viability of the product.

The facility is continuously monitored to ascertain that the high level of sterility is maintained. In comparison with other laboratories in the Philippines, the Cellular Therapeutics Centre laboratory is at least three notches better in providing a sterile laboratory environment, which is of critical importance to ensure that cancer patients with weakened immune systems receive only the highest quality and most sterile cellular products.

World class standards The laboratory also boasts of the highest safety standards in every procedure, from the screening process, harvesting of cells, cell identification, cell expansion and characterization, and release criteria of the cellular products.

Cell-based therapy (immunotherapy) provides a complementary treatment in fighting cancer. Chung says these immune cells (dendritic cells) can be educated to harness the potent action of other immune cells (T- cells, B-cells) to control the growth of or kill cancer cells.

More importantly, since these cells are patient-derived, there is virtually no side effects as the body is “taught” or the immune system is “revitalized” to take advantage of its ability to fight back cancer cells.

The CTC laboratory is equipped with state-of-the-art facilities from the United States, Germany and Japan, which are critical in ensuring 90 to 95% cell purity and viability as the laboratory performs key procedures such as the separation of cellular products through automated magnetic-based cell separation following good manufacturing practices.

Decades of expertise The Cellular Therapeutics Centre staff bring combined decades of laboratory expertise and patient care. In collaboration with 8 highly trained medical staff members from various specialties, CTC is engaged in investigator-initiated Institutional Review Board (IRB)-approved protocols. These clinicians are heavily involved in clinical studies as principal investigators.

Knowing that a world-class facility requires equally qualified scientists to run it, the CTC laboratory continues to improve its processes and knowledge through its affiliation with the International Society for Cellular Therapy (ISCT), a non-profit organization composed of leading cell therapy experts from 40 countries.

Each IRB-approved protocol is monitored by the Clinical Research Center of Makati Medical Center in adherence to Good Clinical Practice.

Each year, there are many advances to stem cell treatment.

Cellular therapeutics centre scientists are determined to be ahead of the curve in providing the best treatment options to patients with incurable diseases that step through its doors.

HEALTHCARE ASIA 25

post-event coverage: APac medtech forum 2015 challenge of healthcare in the AsiaPacific.

Other points for the first theme included the future of medical education, smarter regulations, and patient engagement and awareness.

For the second theme, talking points included disruptive innovations in healthcare, nurturing local innovation and transforming clinical care through technology.

Meanwhile, the second day centred on the theme of collaboration, where the plenaries tackled topics such as multilateral trade agreements and the development of healthcare capacity in Asia. Panel discussions included subjects such as the anatomy of a successful industry-academia collaboration, and partnering with multilateral institutions and NGOs. Fredrik Nyberg delivers the closing remarks

Asia-Pacific Med Tech Forum spearheads a healthy future

The inaugural two-day conference featured talks which centered on how the massive potential of new technology when harnessed.

T

he Asia Pacific MedTech Forum 2015 is an event for the medical devices and diagnostics industry, the first of its kind in the region, hosted by the Asia-Pacific Medical Technology Association (APACMed). The twoday conference was held at the Raffles City Convention Centre in Singapore on 10-11 December 2015, while a pre-conference workshop for small and medium-sized enterprises (SMEs) was held on 9 December. With the theme, “Pioneering a healthy future together”, the inaugural industry event explored how better access to medical devices, disruptive innovation, and collaboration are the keys to embark on a healthier future.

The event featured a total of 69 healthcare personalities from the AsiaPacific region as speakers, panelists and moderators. Among the speakers, 41 were from Singapore, nine were from the United States of America, five were from Canada, three each were from Japan, Malaysia, and Australia, 26 HEALTHCARE ASIA

In the Asia-Pacific region, two-thirds of the world’s population is ensconced but the majority of healthcare needs remain unmet.

two each were from South Korea and the Philippines, while one was from India. Meanwhile, the speakers for the event included Zee Yoong Kang, Chief Executive Officer of Singapore’s Health Promotion Board; Prahbu Vinayagam, Managing Director of Joint Commission International; John CW Lim, Deputy Director of Medical Services at the Ministry of Health; and Raymond Chua, Group Director of the Health Products Regulation Group of Singapore’s Health Sciences Authority. S. Iswaran, Singapore’s Minister for Industry also graced the event as a guest-of-honour.

Access, Innovation, & Collaboration For the first day of the event, the topics were divided into two themes: access and innovation. Under the access theme, the discussion revolved around how accessible quality healthcare is to the majority of the region, including an update on the progress of healthcare reform in China and a glimpse of tackling the

Challenges for SMEs Additionally, a pre-conference workshop for SMEs was held before the two-day event. The workshop was jointly organised by APACMed, the Medical Technology Association of Australia (MTAA), the Singapore Manufacturing Federation – Medical Technology Industry Group (SMFMTIG) and BioSingapore.

Among the topics discussed in the workshop were the outlook of the medical technology industry in Asia Pacific and globally, challenges in medical technology design and development and effective IP protection for medical technology inventions. Other topics from the pre-conference workshop include designing clinical trials in Asia, capital raising for medical technology SMEs, grants and non-dilutive support, managing pricing and reimbursement, market entry strategies and medical devices distributor channel management.

Fredrik Nyberg, Chief Executive Officer of APACMed, said the forum comes at a critical time in the Asia-Pacific region. According to Nyberg, the US$400b medical technology sector provides innovative solutions to address these challenges.

“Our region is filled with complex healthcare challenges. APACMed is uniquely positioned to provide a unified voice for the industry to shape policies,” Nyberg said.

Co-published corporate profile

Electronic medical records contribute to success of private hospital networks

Access to patient information at any time, on any device, from anywhere supports premium patient care and customer service.

A

s the number and quality of hospitals and clinics in many Asian countries is increasing, private hospital networks are leading the way with electronic medical record (EMR) systems that also provide rich clinical and patient administration functionality.

According Kerry Stratton, Asia Pacific Managing Director for InterSystems, a global leader in software for connected healthcare, EMR systems enable healthcare providers to deliver premium patient care and customer service – both very important outcomes in a competitive market.

Private hospitals and clinics are also looking to EMR systems to make them more efficient and increase the number of patients they can handle, and to ensure that proper procedures are followed, says Stratton. “Many groups are opening new healthcare facilities on a regular basis. To be successful, they need to operate at the highest international standards from day one and to quickly become profitable.”

Luye Medical Group, for example, recently selected the InterSystems TrakCare® unified healthcare information system to support its growth, with plans to open more than 20 specialist hospitals and clinics in China. By deploying a data center with a single instance of TrakCare, Luye Medical Group can share all patient information throughout its network.

Healthcare professionals can access that information from any Internet-connected device, at any time and from anywhere.

Smartphone and tablet access Accessing patient information on smartphones and tablets is not only convenient and attractive for doctors. It also contributes to more efficient patient administration. In a recent pilot for a new chain of healthcare clinics, nurses with iPads used TrakCare to triage patients as they came through the door, making sure that urgent cases could be seen immediately and other patients were also

looked after properly.

This is part of a trend to move away from fixed computers to easy-to-use devices that can speed up the care giving process, says Stratton. Because InterSystems TrakCare is Internet-based and accessed via standard Web browsers that users are already familiar with, they have a head start when using the system on new devices.

InterSystems is continuing to invest in user interface technology, he says. “Just as consumer-based Internet services can detect what sort of device you are using and customize what is displayed, TrakCare will understand how best to present the information that healthcare workers need.”

TrakCare has also supported the rapid expansion of the United Family Healthcare (UFH) group in China for many years.

Clinicians there have immediate access to patient records – including emergency care cases – at any of UFH’s many hospitals or clinics.

Advanced clinical functionality – doctors receive alerts including potential drug interactions and patient allergies, for example – helps ensure the best and safest patient care and attracts highquality medical personnel. TrakCare offers data quality control and audit features to support UFH’s Joint Commission International (JCI) quality accreditation, helping to attract customers. And centralized management and appointment scheduling services facilitate high levels of customer service and allow UFH to manage workloads across its healthcare network.

Measurable KPI improvements According to Dr. Yanwar Hadiyanto, CEO of the Rumah Sakit Pondok Indah (RSPI) group in Indonesia, adopting international clinical practices like electronic medication management allows hospitals to provide a faster, safer, and more efficient service, while supporting clinicians with robust

“EMR systems enable healthcare providers to deliver premium patient care and customer service – both very important outcomes in a competitive market.”

decision support. This means, from a business point of view, that RSPI is able to provide differentiated healthcare services to its patients.

Since implementing TrakCare, RSPI has achieved measurable improvements in key performance indicators (KPIs), including laboratory, radiology, pharmacy, and health check-up turnaround times.

Doctors say their patients have responded very positively. With an EMR, patients no longer need to bring copies of test results, X-rays or MRIs along with them to consultations, whichever hospital they attend.

Electronic ordering and real-time communications have reduced waiting times. With improved laboratory and radiology turnaround times patients can wait for results in the comfort of a cafeteria or lounge before returning to doctors’ consulting rooms. They no longer have to pick up test results, and any medications prescribed by doctors are waiting for them in the pharmacy.

“When people talk about electronic medical records you often hear about patient-centric care,” says Stratton.

“For private hospitals and clinics, that means offering premium levels of service, something that users of TrakCare are doing very successfully in Asia.”

HEALTHCARE ASIA 27

Case Study 2: philippine heart center

Philippine Heart Centre building

PHC expands access with regional centers The Philippines’ end-referral centre for patients with heart disease and complications aims to bridge the geographic distance through well-spread out centres in strategic locations across the archipelago.

I

t’s been a long road for the Philippine Heart Center (PHC) a government-owned and controlled corporate (GOCC) Specialty Hospital which was established on 14 February, 1975 — the first of the specialty hospitals in the Philippines and the ASEAN region.

PHC is the end-referral centre for patients with heart disease, and the primary training centre in the Philippines for cardiovascular specialties i.e. cardiovascular surgery, adult and pediatric cardiology, cardiovascular nursing and other allied specialties. The main hospital is designed with four petals in each floor representing the four chambers of the heart.

Underlying necessity With continued focus on delivering excellent healthcare services, PHC has undergone several international third party audits, and is currently recognised for clinical excellence by Accreditation Canada International, and recently as an Island of Good 28 HEALTHCARE ASIA

Heart disease remains the leading cause of mortality with 109.4 deaths per 100,000 Filipino population.

Ischemic heart disease accounted for 47.5% of all deaths in the Philippines in 2010.

Governance during the APEC Summit 2015 held in Manila.

In the Philippines, heart disease remains the leading cause of mortality with 109.4 deaths per 100,000 Filipino population. Ischemic heart disease accounted for 47.5% of all deaths in the Philippines in 2010.

Increasing burden Even among children, heart disease is the 5th leading cause of mortality.

Addressing the increasing burden of cardiovascular disease (CVD) goes beyond the provision of highly specialised care, particularly heart surgery and interventions with excellent outcomes at the Philippine Heart Center. It is imperative that CVD treatments be made more accessible to as many patients in the 17 other administrative regions of the archipelagic Republic of the Philippines.

PHC has nearly 15,000 admissions per year, around 50% of which come from the Metro-Manila area and the other half from the rest of the regions of the archipelago. It is

not easy for patients to travel to and stay for extended periods of time in Metro-Manila to undergo specialised treatments at PHC. The indirect costs of care are far more expensive here compared with their respective provinces.

But there is simply no choice for most of these heart patients. There is a paucity of specialised facilities, trained cardiovascular specialists, and government financial support that unfortunately is predicated on availability of facilities and specialists, in most regions outside Metro-Manila. Every day, there is the heart-breaking sight of a horde of patients uncomplainingly waiting at the PHC Outpatient Clinics, and an even longer invisible multitude in an unending list, waiting for their consultation schedules, anticipated admissions and definitive treatments.

These heart patients deserve a better choice.

Broadening accessibility The executive director of the Philippine Heart Center, Dr. Manuel

Case Study 2: philippine heart center Chua Chiaco, Jr. recognised the urgent need to expand access to specialised care with excellent outcomes similar to the Philippine Heart Center, but more accessible and affordable to the patients. This in turn led to one of the PHC strategic initiatives in 2012 which was to establish regional heart centres in at least five regions.

Systematic implementation The empowerment of existing regional medical centres to provide specialised heart care was implemented systematically.

Support and endorsement from the Department of Health was secured to facilitate setting up of their respective cardiovascular programs.

A policy of preferential acceptance of nominees from the regional medical centres into the highly competitive PHC CV specialty training programs was implemented, allowing the timely training of subspecialist surgeons, anesthesiologists, adult and pediatric cardiologists, critical care and operating room nurses, perfusionists for open heart surgery and other allied CV specialties to be undertaken, while new heart facilities were being developed.

Outreach surgery missions were conducted since 2013 to show proof that open and closed heart surgery can be performed in these regional hospitals. These successful outreach missions were a concerted effort from the PHC, the regional hospitals

One region at a time for PHC

The first five regional heart centres that have been the focus of this strategic initiative for 2012-2015 are distributed from north to central to southern Philippines.

Heart institutes can be found across the archipelago

and philanthropic organisations who shared the vision to help heart patients within their locales.

A complete team of 15-20 cardiac specialists per mission was sent, usually comprising three to five surgeons, two anesthesiologists, two perfusionists, two OR nurses, two ICU nurses, three pediatric cardiologists, and two to three general staff. PHC transported all essential equipment, OR and perfusion supplies, even bringing the heart-lung machine when necessary. Additional support for closure devices was provided by the Philippine Charity Sweepstakes.

Mending Kids International, a California-based foundation donated 7,500–15,000 USD (Php 300,000700,000) per mission. Philippine Airlines Foundation, Inc. provided free airfares for the surgical team.

The Children’s Heart Foundation, a Philippine philanthropic organisation, covered PDA closure devices for the early missions, and subsequently other operational expenses.

Impact and transformation Significant impact and transformation has been felt with the Regional Heart Centres initiative.

PHC is confident it is fulfilling its mission and vision to be responsive to the health needs of Filipino patients and to improve the health status of the Filipino people by providing the highest standards of cardiovascular care that is accessible to all.

The regional heart centres are very surely gaining the trust of patients by their ability to perform highly specialised cardiac procedures. PHC

trained cardiovascular specialists are finding professional growth in regional hospital practice, rather than choosing to stay in Metro Manila.

The government national health insurance scheme, PhilHealth, is supporting sustainability of the regional heart centre initiative with the preferential accreditation of these regional centres for the Z Benefit Heart Packages, ensuring free or affordable care to many more heart patients. While tertiary prevention in reducing mortality among those already suffering with heart disease is the primary thrust of the regional heart centres at this time, PHC recognises the equally important concern to address primary and secondary prevention strategies that will decrease progression of CVD among those at risk, and actually prevent development among those still without heart disease.

One region at a time The first five regional heart centres that have been the focus of this strategic initiative for 2012-2015 are distributed from north to central to southern Philippines.

The latest regional hospital that has requested and has been receiving full support from PHC is the Amai Pakpak Medical Center in Marawi City, Lanao del Sur, Autonomous Region of Muslim Mindanao. The Philippine Heart Centre, meanwhile, remains fully committed to continue this comprehensive strategic initiative to establish regional heart centres, one region at a time, until heart patients across all regions of the Philippines have access to cardiovascular care.

HEALTHCARE ASIA 29

OPINION

David McKeering

A new service delivery model for the elderly

David McKeering Singapore Healthcare Leader, PwC South East Asia Consulting

T

wo related – and remarkable – changes have taken place in the last century. Thanks to sanitation, safe water, improved nutrition, modern medicine and better housing, we have triumphed over many of the maladies from which our ancestors died. And the average human lifespan has more than doubled. Yet this huge improvement in human longevity carries a price. Whereas infectious diseases strike down young and old alike, chronic diseases become more prevalent with age.

So within current health systems, elderly people consume more healthcare. If we are to cope with this ageing curve, we must adopt a new approach: one in which health and wellbeing services are seamlessly coordinated to meet the needs of individual elderly citizens, many of whom may have complex comorbidities.

The current way of caring for the elderly is economically unsustainable because it is based on a costly, hospital-centred system.

To devise a better alternative, we need to start by understanding the real needs of the elderly and why so much is spent on their care.

Culture is one key factor. Health is usually defined in terms of ‘disease’, and older people have more diseases than younger people do. Hence, seen from a clinical perspective, the elderly suffer more illness – and the solution is more healthcare. But older people themselves often view things differently.

Fundamental characteristics A new service delivery model for the elderly should possess several fundamental characteristics: Put the individual at the heart of the system; Bring the service delivery as close to the citizen as possible; Measure and reward outcomes, not activities; Treat health as a shared endeavour; And focus on wellness and prevention, not just care and cure. It should be far more holistic, with the emphasis on vitality and inclusion as much as on care, and focussed on self-rated quality of life and wellbeing, instead of focussing on illness.

The model should also be organised around communities, not institutions, with clusters of care providers sharing accountability for the budgets they manage and quality of the personalised services they supply. Another important point is to bring support services as close to the citizen as possible.

Companies like Apple, Google and Amazon have upended retailing by taking the store to the customer—and the online experiences they offer are shaping the expectations consumers carry over to other industries, as many of the companies now breaking into the healthcare business recognise.

These disruptive new players are capitalising on wireless connectivity and advanced mobile devices to erase traditional healthcare boundaries and deliver health and wellbeing services anywhere. The new model should also reward outcomes rather than activities, since it is not the number of interventions but their effectiveness that counts. But for many systems this will require a shift in how results are measured. If quality of life is the goal, 30 HEALTHCARE ASIA

The current way of caring for the elderly is economically unstable

client experience surveys can add valuable insight on how we rate outcomes, for example.

Dissolving the divide Lastly, it should be collaborative. Delivering individualised, integrated care entails dissolving ‘the classic divide between family doctors and hospitals, between physical and mental health, between health and social care, between prevention and treatment’ and between private and public. Indeed, many of the factors that influence wellbeing and quality of life –nutritious food, the right housing stock, a reliable communications infrastructure and the like – lie outside the control of healthcare and social care providers.

Maintaining a healthy population is not, therefore, just a job for the doctor, nurse or social worker; it’s a collective challenge and opportunity for many organisations in many different industries.

With the powerful disruption of new technologies and new entrants who are entering healthcare from outside industries, this collective approach empowers the elderly to co-create the health support system we all need, and in a cost-effective way.

Attending to the diverse needs of an ageing society is a key challenge. A more personalised model would allow providers flexibility to address population heterogeneity—to cope with differences between genders, socio-economic class, social network, cognition, mood, loneliness and frailty.

Although difficult, developing a new service delivery model for the elderly requires alignment of change objectives and incentives, including contractual structures and payment, performance measurement and governance models. A successful transformational change strategy aligns all the building blocks in the model.

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OPINION

Dayrit & De Guzman

Reaching the promise of UHC: Healthcare without fear

P

Manuel M. Dayrit Jeremie De Guzman Public Health Leadership Dean, Fellow, Ateneo Center for Ateneo School of Medicine and Public Health Evidence, Action, and Leadership Health

hilippine presidential candidates for the May 2016 elections must underscore a recent Pulse Asia national survey which showed that “keeping healthy and avoiding illness” is the leading concern among Filipino voters (62%), outscoring “providing education to children” (48%) and “having a secure and steady job” (43%). No doubt, the costs of health care, particularly hospitalisation and medicines, have become prohibitive for most citizens. Back in 2011, the Philippine government had launched the national program for Universal Health Care (UHC) -- Kalusugan Pangkalahatan -- which aimed at providing Filipinos with access to health care, without fear of becoming poor or in debt (Department of Health, Administrative Order 2011-0188).

Achieving UHC has become one of the pressing priorities of countries in the 21st century. Many developed countries in Europe have achieved it. The US pursues it with ObamaCare. Thailand declared that it had reached it. Kutzin and Sparkes of WHO define UHC as the situation where “all people are able to receive health services of sufficient quality to be effective without fear that their use would expose the user to financial hardship.” UHC means achieving two key objectives simultaneously: one, ensuring equitable access to adequate quality healthcare for all citizens, including the poor and the marginalised; and two, protecting citizens from catastrophic poverty-causing health expenditures when they use health services.

Achieving these twin objectives is easier said than done. But it can be done: by effectively pooling societal resources to support cost-effective health care and by ensuring those health systems are efficient in providing these services to all citizens.

Social Welfare and Development. This increase in population coverage is good news. But the bad news is that out-of-pocket expenditures (OOP) for hospital care have remained high.

On the average, a patient pays 50%-70% of the hospital bill after the PhilHealth subsidy has been deducted from the total. For a poor pregnant woman who delivers in a health facility for example, OOP may reach USD 80, a huge cut from her family’s household income of USD 200 and clearly, a catastrophic expense!

The Philippines: striving to achieve UHC In 1970, with the passage of the Medicare Law, the Philippines started its social health insurance system (SHI) and began to pool societal resources for health services. But for the next 25 years, only the employed sector, whose health insurance premiums were paid through salary deduction, was covered. Seeking to include the poor and the informal sector, the government passed a law in 1995 establishing the Philippine Health Insurance Corporation (PhilHealth) to attend to this task.

But PhilHealth’s efforts to enrol these two groups were hampered by low government health budgets, weak administrative and information systems, and the 1991 decentralisation of the public health system which fragmented the delivery of health services. The government policy of Kalusugan Pangkalahatan in 2011 and the passage of the Sin Tax law in 2012 infused new vision and resources into what otherwise were feeble efforts at achieving UHC. Today, PhilHealth reports that 88% of the total Filipino population of 104 million are covered by social ­­health insurance, thanks to the billions derived from Sin Taxes which have provided the premiums to enrol the poor. In 2014 for example, the government gave PhilHealth 30 billion pesos to enrol four million poor families identified in a national survey conducted by the Department of

The health financing transition The Philippines, despite 88% population coverage, is still a long way away from UHC considering the high level of OOP. Viewed from a macro perspective, OOP expenditures for in-patient care, when added to the increased consumer spending for health care, amount to 57% of national health care expenditure in comparison to Thailand’s 11%.

But when we examine Indonesia and Vietnam, two countries arguably in a similar stage of economic development, we find a familiar picture: rising SHI population coverage coupled with high OOP. However, the experience of developed countries has shown that with robust economic growth, strong government expenditure on health and the adept handling of risk pools, OOP expenditures can fall. Countries like the Philippines, Indonesia, and Vietnam belong to the low-to-middle income category where OOP averages 52%. As societies become more affluent and address the social determinants that underpin health, a “health financing transition” takes place and the promise of lower OOP and equitable health care comes within reach.

But experts caution that this transition is neither automatic nor inevitable. Governments and societies need to set the right policies to ensure the transition towards genuine UHC.

32 HEALTHCARE ASIA

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