Healthcare Asia - Maiden Issue by Charlton Media Group

Subscription copy

www.healthcareasiamagazine.com

The magazine for healthcare administrators and policy makers

Dealing with disaster

The inside story of how the philippine government responded as typhoon haiyan wreaked havoc

Asia’s healthcare EXPENDITURE

influences on future healthcare policy

Enrique Tayag Assistant Secretary Philippine Department of Health

Future directions of healthcare policyin South EastAsia

HEALTHCARE INSIGHT Who’s winning the $10.8bn Asian mHealth race?

COUNTRY REPORT How will Singapore cope with its aging population?

ANALYSIS Are PPPs in Asian healthcare helping or harming patients?

first The rise of biologics in meeting clinical needs

PAge 14

PAge 28

PAge 18

PAge 10

2 HEALTHCARE ASIA

FROM THE EDITOR Welcome to the first issue of Healthcare Asia, the media devoted to hospital owners, investors, administrators and policy makers. There are many magazines for clinical practitioners in medicine and healthcare, but at Healthcare Asia we want to focus on the running of healthcare organisations, both public and private, and discuss the policy issues that govern healthcare in the Asian region.

Publisher & EDITOR-IN-CHIEF Tim Charlton ASSOCIATE PUBLISHER Laarni Salazar-Navida Assistant Editor Jason Oliver Art Director Jonn Martin Herman Editorial Assistant Queenie Chan Editorial Assistant Alex Wong ADVERTISING CONTACTS Laarni Salazar-Navida lanie@charltonmediamail.com

Each issue will bring a mixture of analysis, case studies, technology, and opinion to help inform the dicussion and continue the debates. ADMINISTRATION Lovelyn Labrador accounts@charltonmediamail.com Advertising advertising@charltonmediamail.com Editorial editorial@charltonmediamail.com

SINGAPORE Charlton Media Group #06-09 E, Maxwell House 20 Maxwell Road Singapore 069113 +65 62237660

HONG KONG Charlton Media Group 19/F, Yat Chau Building, 262 Des Voeux Road Central Hong Kong. +852 3972 7166 www.charltonmedia.com Printing Sun Rise Printing & Supplies Pte ltd 10 Admiralty Street #02-20 North Link Building, Singapore - 757695

Can we help? Editorial Enquiries If you have a story idea or just a press release please Email: ha@charltonmedia.com and our news editor will read it. For a personal message to the editor put the word “Tim” in the subject line.

The magazine is circulated on a controlled basis to the 5,300 senior management and clinical department heads of the largest public and private healthcare groups in ASEAN plus Hong Kong. As well we will be present at major healthcare conferences at the region. There is a lot to be discussed and more importantly a lot to be learnt from peer briefings and case studies and we hope to not only bring these to you, but have you to bring them to us. The participation of leaders in the industry in both the magazine and forums we will organise will be critical to develop a dialogue at the management and policy levels across the region. Which is why we thought looking at how the Philippines Department of health reacted to the unfolding disaster caused by typhoon Haiyan, or Yolanda as its locally called, presents an interesting opportunity to learn how one of Asia’s healthcare ministries dealt with a national disaster. We will also host the inaugural Healthcare Asia Awards 2014 to highlight the best practices and innovations across Asia so if you have been involved in any projects you feel are worthy of recognition drop an email to our team at julie@charltonmediamail.com. I hope you enjoy the read and we welcome your feedback by email to tim@charltonmedia.com. Wishing you all the very best of health.

Media Partnerships Please Email: ha@charltonmedia.com and put “partnership” on the subject line and it will forward to the right person. Subscriptions Email: subscriptions@charltonmedia.com Healthcare Asia is published by Charlton Media Group. All editorial is copyright and may not be reproduced without consent. Contributions are invited but copies of all work should be kept as Healthcare Asia can accept no responsibility for loss. We will however take the gains.

Tim Charlton

Sold on newstands in Singapore and Hong Kong.

*If you’re reading the small print you may be missing the big picture    

HEALTHCARE ASIA 3

CONTENTS

Thailand ahead in 07 FIRST med tourism

18 ANALYSIS ARE PPP

STORY 20 CoVER What lessons can be learnt from typhoon Haiyan?

FIRST 06 Asia hit by medical resources

shortage

07 Thailand ahead in med tourism 07 The Chartist: Healthcare

demand in Asia

08 Innovation in rural Indonesia

s IN ASIAN HEALTHCARE HELPING OR HARMING PATIENTS?

FIRST

PROFILE

12 Raffles Medical looks to cash in on

China’s healthcare boom

REGULAR 14 Healthcare Insight: Who’s winning the $10.8bn Asian mhealth race?

08 Philips’ Ambient Experience

24 Rankings: Check out what’s new at Asia’s largest hospitals

08 Check out these new

28 Country Report: How will Singapore cope with its aging population?

Solution

omni-directional hospital beds

10 The rise of biologics in meeting

clinical needs

Published Bi-annually on the Second week of the Month by Charlton Media Group #06-09 E, Maxwell House 20 Maxwell Road

4 HEALTHCARE ASIA

16 Singapore Medical Group’s new

CEO eyes injecting aesthetics into business model

OPINION 32 What you need to know about Asia’s healthcare expenditure 33 Healthcare influences on future healthcare policy 34 Future directions of healthcare policy in South East Asia

30 Case Study: Patient centricity and teamwork in an organisation

To access the stories online, visit the website

www.healthcareasiamagazine.com

FIRST Healthcare providers then face the challenge of delivering holistic healthcare management.

Hot-spotting in hospitals

With the bed crunch dilemma constantly haunting Singapore hospitals, optimizing hospital resources for critically-ill patients is always a challenge. Alexandra Health, which manages Khoo Teck Puat Hospital (KTPH), addresses this issue through an initiative to manage the over-demand of subsidized beds called the Ageing-in-Place (AIP) Programme. “Through hot-spotting, a form of business analytics, we can target patients with a history of frequent hospital readmissions and find out how we can target intervention to help them to reduce these readmissions,” says Lau Wing Chew, Alexandra Health’s Chief Transformation Officer. They discovered these unmet needs include medical, social, behavioural and environmental issues. Through prudent management of these conditions at home, patients will minimize their incidence of preventable readmissions to hospital. KTPH’s Community Nurses will visit the patients’ homes to develop care plans and at the same time coordinate the necessary followup. Multi-disciplinary team effort The AIP Programme is very much a multidisciplinary team effort comprising community nurses and allied health staff from KTPH, working in collaboration with community partners. “The average readmission was reduced from an average of 3.47 admissions to 1.34 times per patient, an improvement of 61%. With 800 patients (as of end-July 2013) presently under care, KTPH can potentially save up to 1.8 wards worth of beds over a sixmonth period,” notes Lau.

6 HEALTHCARE ASIA

Emerging Asian markets are slower to adapt

Asia hit by medical resources shortage

he changing demographics and evolving trends across Asia-Pacific mean that traditional operating models have become obsolete for healthcare providers. Focusing on cost efficient delivery of healthcare through shared responsibility across the value chain is called for, now more than ever. According to business consulting firm Frost & Sullivan, with a significant increase in the oldage dependency ratio, especially in industrialized countries like Australia, Japan and Singapore, ageing populations have a higher demand for surgical interventions as well as ageing in place supportive care. While these countries are seeing a transition in healthcare infrastructure towards day or ambulatory surgery as well as home healthcare, emerging markets in Asia have been slower to adopt this as healthcare is still very much treatment oriented and hospital focused. “With increasing patient population, budget constraints and shortage of resources impacting the current medical world, Asia has not been spared and efficiency is the buzz word in the management of every hospital and delivery of healthcare services,” says the firm.

Emerging markets in Asia have been been slower to adopt this as healthcare is still very much treatment oriented and hospital focused.

Breaking the status quo The evolution and establishment of polyclinics or clinics, is both complementary to, as well as a threat to, the private hospital sector. “This is changing the way hospitals look at their operations, structure, roles, and activities as well as their key measurements. The traditional operating models are no longer relevant in today’s healthcare environment and healthcare service providers need to focus on areas where they have expertise and can create efficiency and value-based care,” says Rhenu Bhuller, Senior Vice President, Healthcare Practice, Frost & Sullivan, Asia-Pacific. The firm urges healthcare providers and industry players to consider key trends and dynamics which are driving reform in healthcare systems across the Asia-Pacific region. “Key trends to consider in the healthcare industry include mobility and security of information, risk sharing, rebalancing of public and private sector financing and delivery of care, use of data to drive decisions as well as patient engagement,” it adds. According to Frost & Sullivan, governments in the Asia-Pacific region are increasingly introducing populist measures and streamlining healthcare regulations. Transparency in pharmaceutical pricing is an important step towards affordable healthcare for the population.

Top 50 Private healthcare service providers in APAC

Source: Frost & Sullivan

FIRST Over 2.5m patients crossed the borders to Thailand in 2012 alone.

Medical tourism appeal Ng credits the appeal of Thailand’s medical services to the numerous Thai hospitals which received the Clinical Care Program Certification, demonstrating their excellence in the integration and coordination of treatment of specific serious ailments. Aside from this, Thailand is also the first Asian country to achieve the JCI accreditation. Currently, there are 30 JCI-accredited hospitals in Thailand, in comparison with the 20 JCI accredited hospitals in Singapore, and the nine in Malaysia.

Sector will generate approximately THB803bn between 2012-16

Thailand ahead in med tourism

hailand may not match as Singapore as athe destination of choice for complex treatments, but it is certainly welcoming many international patients each year, making it one of ASEAN’s leaders in medical tourism. Over 2.5m patients crossed the borders to Thailand in 2012 alone, and the momentum is expected to increase when the ASEAN Economic Community becomes effective in 2015. CIMB analyst Gary Ng predicts the sector will generate approximately THB803bn (US$25bn) in revenues from medical tourism between

2012-2016. “Given Thailand’s closer proximity to Cambodia, Laos, Myanmar and Vietnam (CLMV) where medical infrastructure is less developed, we believe that there will be more patients from these countries coming to seek medical treatment in Thailand,” he adds. As if foreseeing this massive growth in the sector, the Thai government has been developing the country into a Centre of Excellent Healthcare in Asia since 2004. The Thai government now aims for Thailand to be a World Class Healthcare Provider by

2016. Policies such as setting up a one-stop service centre at Suvarnabhumi Airport to provide information for medical tourists, and developing more clinical professionals to prepare for the greater demand, among others, have already been conceptualized by the government.

Momentum of Thailand’s international patient visits still strong (‘000)

Sources: Department of Export Promotion, Commerce Ministry

The Chartist: Healthcare demand in asia It looks like being a rich country is not all rainbows and butterflies as rising healthcare expenditure reportedly goes up with the national wealth, according to CIMB. The growing domestic consumption however is seen across most APAC countries, allowing greater economic prosperity and rising affluence versus more developed nations. According to IMF estimates, annual growth across APAC is expected to be 4.7% through 2016, 70bp above the global average. The increasing healthcare consumption is largely owed to the growing and greying global population that is swelling the demand for healthcare services. The proportion of the world’s population aged 65 years or over is expected increase from 12% today to 21% by 2050, says IMF.

Improving macro-economic factors

Source: CIMB, Company Reports

Strong but varying fundamentals

Source: CIMB, Company Reports

HEALTHCARE ASIA 7

EQUIPMENT WATCH

Innovation in rural Indonesia

Philips’ Ambient Experience Solution

ith nearly half of the population living in peripheral regions, performing routine and emergency surgeries in rural Indonesia is becoming a tremendous challenge. Low levels of clinical care and a lack of suitable tools and equipment are not helping either. Only 34%, or 747 out of 2,186 hospitals in Indonesia have access to an operating room with anaesthesia equipment, with close to 500 of those hospitals concentrated in the Java and Sumatra regions of the country. GE has developed a new anaesthesia delivery system called Carestation 30 to help Carestation 30 is an integrated SpO2 monitoring fill this gap, and increase the access to much-needed surgical equipment for GE’s new rural anaesthesia delivery these rural healthcare settings. system could be a solution for both doctors and patients.“In Indonesia, GE Breakthrough solution is working hard to help bring better This new system integrates the level of health to more people by leveraging oxygen in the blood (SpO2) and other the best of our resources, expertise, key measurements into one system, products and solutions to address the improving the quality and reliability needs of citizens across the country. of anaesthesia solutions for healthcare Given the access issues facing peripheral service providers in peripheral regions. regions, advancing surgery in the rural Traditionally, clinicians have been primary care setting, particularly in limited in their ability to monitor vital rural Indonesia, is a key area of focus signs such as SpO2 during surgeries, for us,” says David Utama, President & even though the World Health CEO of GE Healthcare ASEAN. Organization’s Surgical Safety Checklist Carestation 30 has also been lists integrated SpO2 monitoring as introduced in Thailand and the one of the most crucial measurements Philippines, but there have been no new during an operation. installs to date.

Only 34%, or 747 out of 2,186 hospitals in Indonesia have access to an operating room with anaesthesia equipment.

Check out these new omni-directional hospital beds Narrow corridors and crowded rooms make moving hospital beds laborious and a shortage of hospital staff is one of the common causes of delay in transporting patients, which could occur in time critical situations. National University of Singapore and HOPE Technik have embarked upon a research collaboration to create SESTO, a motorised, easily-manoeuvrable hospital bed. This will allow beds to move in multiple directions and be operated by only one hospital staff, increasing productivity. A safety feature ensures that the SESTO will stop all movement, should the staff’s hand leave the panel. Ng Kiang Loong, Project Manager, HOPE Technik, reveals that another round of pilot tests were conducted in 1Q14 and production is targeted to start by Q3 2014. “We are implementing some of our unmanned/guided vehicle expertise in to this project,” he adds.

8 HEALTHCARE ASIA

As the demand on healthcare systems rapidly increases around the world, so do the requirements for scanning and patient comfort. In an effort to help patients feel more at ease, Royal Philips announced the installation of the first Philips Ingenia MRI with Ambient Experience in Singapore at Mount Alvernia Hospital. Together, the two solutions will help address patients’ comfort during medical treatments and elevate clinical performance, overall patient experience and patient management. By softening and removing negative elements, the examination room appears more welcoming and fosters patient-staff dialogue. Patients can play with interactive design elements which draw attention away from the imaging machines that might otherwise intimidating. The Philips Ingenia MRI delivers more consistent image quality and comfort for improved patient experience. It is also designed to advance diagnosis and radiology workflow. It introduces fully digital signal acquisition and processing that is directed straight to the patient. This will help clinicians make informed decisions for a wide range of clinical procedures. Ingenia is able to generate up to a 40 percent improvement in signal-to-noise ratio compared to previous systems. These features allow users to spend significantly less time on the logistics related to patient set-up.

FIRST

The rise of biologics in meeting clinical needs

he Asian pharmaceuticals industry is currently evolving under the influence of four innovation trends, according to Richard M. Johnson, President & CEO, Parenteral Drug Association (PDA), a leading non-profit organization advising the pharmaceutical industry. “On the product side, one is the growing importance of biological therapeutics. These products require more complex and highly controlled manufacturing processes, and more advanced facilities and Quality Control methodologies. The second trend is for more self-administration (for example: pre-filled syringes and autoinjectors) versus administration by health care workers,” says Johnson. “On the manufacturing side, there is a new emphasis on meeting global standards in good manufacturing practice (GMP), especially since the global supply chain has become so interrelated. There is also a trend to the design and use of smaller batch manufacturing,” he adds. Biologics Multinational companies like Novartis are investing heavily in biological therapeutics in response to strong demand from Asian patients for more effective and cost-efficient treatments. “In the past few years, biologics

have become increasingly important to Novartis in addressing unmet clinical needs. The special properties of biologics are changing traditional ideas about drug discovery and development and are allowing scientists to create therapeutics that work with remarkable precision,” says Angie Kim, Managing Director, Novartis Singapore. Novartis is investing S$500 million into building a high-tech biologics manufacturing centre in Singapore that is set to be ready by 2016. Kim said the country is an especially attractive hub for biomedical manufacturing because of its good governance and stability, strong intellectual property laws, worldclass infrastructure, exemplary safety and regulatory record, and highly-skilled biomedical workforce. Logistics connectivity Singapore’s location also provides pharmaceutical manufacturers in the country excellent logistics connectivity with target markets, including the fast-growing Southeast Asia market whose populations are increasingly gaining access to medicine and treatments. Meanwhile, developed Asian markets are seeing higher percentages of elderly that are living longer and requiring more

Richard M. Johnson President & CEO Parenteral Drug Association

intensive healthcare needs. Pharmaceutical companies in Asia are also under pressure to meet stringent international GMP standards, so many choose to build manufacturing facilities in Singapore where tough government requirements are enforced. “Since many of the manufacturers in Singapore are manufacturing for export to markets around the world, this international perspective is an advantage as they work to meet the requirements both of Singapore and other Health Authorities,” says Johnson.

healthcare WATCH

Singapore’s healthcare hub goes organic

Singapore’s commercial interior design company Kyoob-id recently completed a consultancy project for Camden Medical Centre’s Orthopaedic Sports and Joint Centre, which has clinics, orthopaedic diagnostics, physiotherapy, pharmacy, and listing. Kyoob-id completed the design conceptualisation to production of tender drawings within a period of three months. The construction was handled by ISG, an international construction services company. Michelle Goh, director of Kyoobid said, “Organic forms are chosen because they are fluid and seamless. We envisioned a space with no sharp corners and edges. Such an environment will be conducive for a recuperating patient. For this project, we’ve also sourced and incorporated many lowcost yet quality materials in the production, which have managed to bring down the cost for our client to a great extent.”

10 HEALTHCARE ASIA

Department of Diagnostic Radiology reception

Health Assessment Centre

Orthopaedic Sports and Joint Centre entrance

Orthopaedic Sports and Joint Centre lobby

FIRST The Analysts’ call

Will RMG succeed in its expansion?

Raffles Hospital, Singapore

Raffles Medical looks to cash in on China’s healthcare boom

affles Medical Group is looking to bounce by breaking into China this year. The Singapore-based health care provider, which operates dozens of medical clinics and laboratories as well as the Raffles Hospital, encountered a slight growth hiccup but it hopes to re-ignite its growth engine through an aggressive China expansion strategy. RFMD announced its collaboration with Shanghai Lujiazui to build a 300-bed hospital in Pudong, the bustling

Raffles Medical has adopted an overall strategy of targeting ‘gateway’ cities in China. financial district in Shanghai, teeming with wealthy expats and a local population of more than 5 million. Raffles Medical has also agreed to work with China Merchant Group for a similar 200-bed hospital venture in Shenzhen, one of the country’s most successful Special Economic Zones situated just north of Hong Kong. Management is even considering building hospitals in the capital Beijing. Maybank Kim Eng analyst James Koh says Raffles Medical has adopted an “overall strategy of targeting ‘gateway’ cities in China.” “The company continues to position itself for overseas expansion to complement its organic growth plans in Singapore. Based on latest discussions with management, we expect to see concrete positive news flow by 12 HEALTHCARE ASIA

year-end,” he adds. Raffles Medical has seen double-digit growth in recent years by successfully riding on the booming private hospital trend in Singapore, but it could expand even faster if it manages to nab a slice of China’s lucrative private healthcare market. Government and Maybank Kim Eng research data show that private healthcare expenditure in China is rising rapidly, doubling to RMB 1 trillion in 2011 in just six years. The fast increase in private healthcare spending can be attributed to China’s greying population. As of 2011, 9.1% of the country or 123 million Chinese is aged 65 and above and require more intensive healthcare services – or 50 million more elderly Chinese than in 1995. More are expected to join China’s old age cohort as life expectancy in China has increased by roughly 6 years in just two decades, from 68.6 years old in 1990 to 74.8 years old in 2010. Maybank Kim Eng’s Koh is confident that Raffles Medical will be able to fund its expansion projects because of its healthy net cash position, strong organic cash flow, and ability to secure 50% project financing for China projects. Given its strong growth prospects locally and overseas, RFMD is currently a great pick for investors, according to CIMB analyst Gary Ng. Chinese hospital ventures will likely be confirmed in the next three months, and will subsequently boost stock prices, he says. Even if the projects fall through, Ng expects shareholders to receive more cash in the form of larger dividends.

James Koh, Maybank Kim Eng Going forward, management remains open to working with various parties, and would evaluate individual specific projects rather than having a ‘preferred’ partner in China. Management is confident that both projects can be executed concurrently, and these projects fit into their overall strategy of targeting ‘gateway’ cities in China. Assuming both China projects go ahead as well as the expansion of Raffles hospital, we estimate this would require investments of S$350m from the company over the next 2-3 years, which can be easily funded by 1) net cash position of S$260m after the sale of Thong Sia 2) project financing for China projects of 50% and 3) strong organic cash flow of around $100m/year. Wong Teck Ching, OCBC Investment Research We are positive about RFMD’s decision to explore business expansion opportunities in China given the immense growth prospects, although regulatory uncertainties would likely be the largest risk, in our view. RFMD highlighted that it hopes to conclude the negotiations with its Chinese counterparts by the end of the year. RFMD aims to capture the top 20% and 10% of the population in Shanghai and the Pearl River Delta region, respectively, as its potential market. Gary Ng, CIMB With the sale of its Orchard building concluded, we are expecting better usage of cash proceeds through its overseas ventures or some form of special dividends for shareholders. Management gave an assured reply on the timeline given to conclude its two Chinese hospital ventures and we expect that to come into fruition in the next three months, serving as stock catalysts.

29 September – 2 October 2014 Suntec Singapore Convention & Exhibition Centre

Meeting tomorrow’s healthcare demands today Facts

Why you need to be here?

300+ Senior hospital executives in attendance 60+ Asia Pacific hospital organisations 30+ Interactive networking hours 25 Countries around the world represented CXO forums 3 1

Exhibition of medical, technology, operational equipment

• Demonstrate your thought leadership by delivering a key presentation • Interact with your potential clients and create brand awareness by leading a roundtable • Showcase your latest products/services • Expand your network in Southeast Asia • Meet industry experts and key healthcare players • Create lasting business relationships • Host a clinic session to better understand the needs of your customers and present your solutions

Who should sponsor? • Legal firms

• EHR or EMR providers

• Business and risk consultants

• Medical technology or equipment suppliers

• Investment banks and project finance

• Logistic service providers

• IT solutions and integration providers

• Healthcare real estate providers

To find out how you can get involved, contact Kenneth Lai at: +65 6322 2792 or kenneth.lai@ terrapinn. com

www.terrapinn.com/healthcareasia

healthcare INSIGHT: E-HEALTH

The most important industry trend to watch is mobile mHealth

Who’s winning the $10.8bn Asian mHealth race?

While Asian governments and users recognize the efficiency of eHealth programmes, eHealth is still in the early stages of adoption.

espite being late to the eHealth race, Asian countries are not only catching up and are leading the world in eHealth programme implementations. Asia is also seeing a record increase in mHealth applications and investments owing to its maturing demographics and widening access to mobile devices. Nations in Southern Asia and Eastern Asia and the Pacific, in particular, are implementing the highest percent of technologyenabled health programmes, according to data from the Center for Health Market Innovations. The World Health Organization (WHO) says these low- and middleincome governments are using information and communication technology (ICT) specifically to improve their health programmes. They do so because of six major benefits: to extend geographic access to health services, facilitate patient

14 HEALTHCARE ASIA

Nations in Southern Asia and Eastern Asia and the Pacific, in particular, are implementing the highest percent of technologyenabled health programmes.

communications, improve diagnosis and treatment, improve data management, streamline financial transactions, and mitigate fraud abuse. Asian governments are fast recognizing the improved efficiency and effectiveness of eHealth programmes, and are funding more of them each year. This in part has convinced corporations and entrepreneurs to venture into the lucrative billion-dollar industry. mHealth boom Mobile healthcare or mHealth is an especially promising eHealth segment, according to technology leaders, reflected in the number of mHealth apps and solutions coming to market. “With no doubt, the most important industry trend to watch is mobile mHealth,” says Karthik Tirupathi, CEO of Napier Healthcare, an integrated healthcare

information technology company. Tirupathi cites a Transparency Market Research forecast that the global mHealth market will grow in the next five years to reach $10.2 billion by 2018, up from $1.3 billion in 2012, at a compounded annual rate of 41.5 percent. Vitalstrak app With more Asians starting to own smartphones and tablets due to the wide availability and decreasing prices of such devices, Health apps such as Vitalstrak and DocDoc have emerged to satisfy their need to access healthcare information in the comfort of their homes without having to visit the doctor’s clinic or hospital. The founders of Vitalstrak mobile app invested more than 10-man years developing it for users who self-manage their health, according to Peter Soh, Co-founder and Executive Director of Vitalstrak, a cloud-based mobile health (mHealth) solution for chronic health and medication management. Soh says the app came about amid a growing number of elderly and individuals suffering from so-called chronic ‘lifestyle’ diseases in Southeast Asia and Hong Kong. “Healthcare professionals can use it

healthcare INSIGHT: E-HEALTH to remotely monitor patients with special care needs. Just like legacy telehealth systems, it also allows large healthcare institutions to provide integrated care for patients with multiple health disorders as each department can personalize its treatment plan in coordination with other departments,” he adds. DocDoc app Another example is the DocDoc app, which offers a free online finder service to patients looking for qualified doctors and dentists. Instead of having to call hospitals or look up directories, a user can access the DocDoc app (or browser for those who do not own smartphones) to search for doctors or dentists, review their qualifications, and book a doctor’s appointment. Near the appointment date, DocDoc users will even receive automated reminders. DocDoc complements its online service with a free, appointment-byphone concierge service for those who want to find and consult with a doctor over the phone. “Our concierge service provides a convenient way for patients to find the right doctor or dentist by phone, get matched by location, medical specialty, or other factors and get live assistance from experienced support staff,” says Max-F. Scheichenost, CoFounder & President of DocDoc Pte Ltd, which has raised approximately $5 million for its systems, websites, databases and administrative tools. With mHealth apps, Asians can spend a few minutes on their smartphones and find doctors, schedule check-ups, receive health and wellness advice, and track their vitals and medicine intake. But where Asia – and the rest of the world – is headed involves far more than remotely accessing information. This future is called the digital hospital, according to HP’s eHealth division. “A digital hospital is a patient-centric healthcare environment in which all systems – clinical, business, and facility – fully integrate and connect, enabling information to flow seamlessly and securely among departments and personnel,” says Wesley J. Krumel, chief architect and IT strategist for

HP’s worldwide eHealth solutions. In its most realized form, HP envisions the digital hospital as being able to admit surgery patients with radio frequency identification. Critical data required for the operation such as necessary labs, images and the patient’s electronic health record (EHR) are then automatically sent to operating room. During the procedure, loved ones will be given a tablet computer that updates the status straight from the operating room doctors. After the procedure, vitals are sent in real-time to the patient’s doctor, who can then remotely observe his recovery. EHR in Asia The EHR, a fundamental part of the digital hospital, is still in the very early stages of adoption in Asia. “Government healthcare institutions worldwide are moving towards the goal of a single health record for each citizen that can be used across healthcare providers,” notes Tirupathi of Napier Healthcare, a Singaporeheadquartered EHR mobile (EHRm) vendor. “In Asia, government healthcare groups and private health networks are still running separate patient record systems and operating on different levels of record management integration.” But several pioneering hospitals such as Jaslok Hospital in Mumbai are moving ahead of the curve and shifting to digital patient record that can be easily and securely shared. Jaslok is in the process of implementing Napier’s open-source based EHRm platform, which Tirupathi says will give the hospital “anywhere, anytime accessibility” to patient EHRs for the 1,100 users, consisting of doctors, management and patients. Given the perceived high cost and minimal benefits of adopting an EHRm platform, Napier Healthcare goes the extra mile in scaling their solutions to widen their potential market beyond large, cashflush hospitals. “It can be a challenge to get private hospitals and general physicians to come onboard the EHR initiative as there are no tangible incentives coupled with costs incurrence,” says Tirupathi.

Karthik Tirupathi

Peter Soh

Max Scheichenost

Wesley Krumel

Still, despite the admirable strides of eHealth in emerging Asia with the proliferation of mHealth apps and pockets of EHR adoption by hospitals, it has a long road ahead before it reaches mass implementation that leads to the creation of digital hospitals. “Despite the increased interest in some individual programmes, in low- and middle-income countries the eHealth field is still relatively nascent,” opined the World Health Organization in its 2011 bulletin. “To date, the literature on eHealth in low- and middle-income countries has largely consisted of articles describing single uses of technology in health care delivery.” The Southeast Asia region, in particular, faces seven key challenges around eHealth, said WHO in a regional workshop in late September: lack of eHealth policy, strategy and legal framework to support the national health system; uncoordinated investment in ICT in health due to the absence of an overarching plan for eHealth; duplication of efforts due to a low degree of cooperation, collaboration and sharing across sectors; limited capacity within the public sector to implement eHealth programs; widely differing levels of eHealth maturity across and within countries; poor quality and disparities in data with health information systems existing in silos - segmented with little interoperability and communication; and poor communication infrastructure and lack of broadband connectivity and internet access.

Technology-enabled programmes by region

Sources: Center for Health Market Innovations

HEALTHCARE ASIA 15

Dr. Beng Teck Liang Group Chief Executive Officer Singapore Medical Group 16 SINGAPORE BUSINESS REVIEW | JANUARY 2014

CEO INTERVIEW

Singapore Medical Group’s new CEO eyes injecting aesthetics into business model Wellness and health screening are also among his biggest priorities.

r. Beng Teck Liang was appointed Group Chief Executive Officer of Singapore Medical Group in December 2013. In this role, Dr Beng will be responsible for leading day-to-day operations and the organisation’s long-term strategy. He recently shared with Healthcare Asia some of his short-term and long-term objectives for the company and gave a glimpse of how he plans to tweak the current business model some tweaking. What makes you excited about your new position? I am excited that I am able to bring my 10 years of MNC experience to managing an SME business that is close to my heart and which I am very passionate about. I left the healthcare scene more than 10 years ago to pursue a career in information technology. It is now a fantastic opportunity for me to come back to the healthcare environment - and what better way, than to be in the company I have a share in, to develop and grow it the way I envisioned it to be. Singapore Medical Group (SMG) is a unique setting that enables me to leverage my background in medicine,

“We will continue to focus on some of the existing verticals of the business such as ophthalmology, orthopaedics, obstetrics and gynaecology, and oncology, but we intend to grow them individually.” management and technology. I am probably one of only a few unique individuals in Singapore with this mix of background. I want to build the SMG brand to be synonymous with quality specialist care and being a patient-centred medical care provider to every individual, both in Singapore as well as overseas. We also have a desire to take Singapore’s high standards of healthcare outside of Singapore to our neighbouring countries. What three goals are you focused on? Firstly, get SMG on track for healthy growth. Secondly, continue extending Singapore’s healthcare services and quality outside of our shores. Lastly, build and apply innovative, simple and useful technologies, in the context of our current environment, to empower our patients. We want to improve patient care and quality. We have started to apply some of these ideas and initiatives in our clinics and we will share more in due course. What changes are you planning for? We have recently launched new clinics, recruited new doctors and introduced a new management with MNC

experience. We intend to grow SMG substantially into a much larger healthcare company and will continue to invest in our people. I want to bring on board the best and brightest people to the team, as we are a ‘people business’ We are tweaking the mix of or businesses. We will continue to focus on some of the existing verticals of the business such as ophthalmology, orthopaedics, obstetrics and gynaecology, and oncology, but we intend to grow them individually by growing our pool of doctors and our clinics. We are also looking into the areas of aesthetics, wellness and health screening. I will personally be taking on the role as Medical Director for a new clinic called The Wellness Suite, where I am taking the opportunity to introduce and encourage the concepts of wellness, prevention and health screening into the organization. This greatly complements the existing businesses we have. We are growing our network of specialists and doctors who want to be part of and be associated with the SMG brand. What are your key business philosophies? I believe in people and I want to build the best possible team. The key is to have the best people. For example, the best doctors, nurses and staff. Everything else will fall into place. Empower the team with the best technologies, tools and environment to do the work they do best in every function. Build active relationships and engage shareholders and potential investors. I am very involved in the business, I am happy to roll up my sleeves and get into direct contact with patients, doctors and my team. I am definitely a believer, builder and user of meaningful technology innovations in healthcare. And I hope to apply some of these technological innovations in SMG in order to create a truly unique and memorable patient experience. What previous positions prepared you for this one and how? I have previously led multi-billion dollar businesses and large teams in the information technology and healthcare sectors across Asia-Pacific and Japan over the last decade. My previous appointments include: - Managing Director for Hewlett Packard (HP) Thailand - General Manager for HP Enterprise Services segment across Southeast Asia - Marketing Manager for the Imaging Information Systems of General Electric (GE) Medical Systems in Asia - Chief Medical Officer, Novahealth I started my professional career as a Medical Officer with the Singapore Ministry of Health after graduating from the University of Manchester Medical School in the United Kingdom. My background in medicine, management and technology is a unique pairing with Singapore Medical Group (SMG). HEALTHCARE ASIA 17

ANALYSIS: ppp in healthcare

What should be the government’s role and to what extent should the private sector engage?

Are PPPs in Asian healthcare helping or harming patients? Experts weigh in on government and corporate partnerships, and striking the balance between efficiency and equity in patient care.

sia’s governments and best medical minds might have united to develop vaccines and provide life-saving treatments to more than four billion citizens, but they continue to be divided over one burning question: “Are public private partnerships (PPPs) the best way to go?” Proponents of PPPs argue that such contracts raise the standard of patient experience because of their proven ability to improve infrastructure and deliver more efficient treatments. But critics claim that leaning heavily towards PPPs could pave the way towards a less equitable delivery of health services in a region where millions depend on governments to take care of them. With many Asian governments finding it increasingly difficult to afford and handle the delivery of public health services, the role of the private sector in healthcare has been increasing in the form of PPPs.

18 HEALTHCARE ASIA

There is a need to establish a PPP framework to establish balance, equity and efficiency.

In an interview with Healthcare Asia, Dr. Gerard Servais, a health specialist with Asian Development Bank, says governments agree to enter into PPPs when they feel they can no longer single-handedly address under capacity and increase efficiency of public health services. In Asia, PPPs in healthcare is a relatively new trend, according to Karen Prosser, EC Harris head of social infrastructure in Asia, even though PPPs have long been used in other countries to develop health care facilities and services. Right mix The debate over PPPs is most heated when it comes to determining the optimal mix for each country with stakeholders asking: ‘What is the right PPP mix?’, ‘What should be the government’s role’, and ‘To what extent should the private sector engage?’ “No conclusive evidence

has been reached yet to determine the optimum mix that could best respond to new country realities and emerging needs of all actors in the key dimensions of PPP,” reckons Kai Hong Phua, professor at the National University of Singapore’s Lee Kuan Yew School of Public Policy. Kai says there is a need to establish a PPP framework to establish balance, equity and efficiency. It should also ensure a greater government role in information exchange and management since it has been noticeable lacking in the past. There is no single perfect model for PPPs in Asian healthcare, analysts agree, because of the diversity of nations in the region. “Experiences in PPP in health in Asia show the extent of changes in government functions, which are being managed in partnership with the private sector. To understand the interplay of these roles, basic factors need to be considered. One is the changing role of the state versus the market as countries transition from one stage of development to the next. Another is how public and private sector interests influence financing,” he says. Analysts say the “perfect” model continues to evolve based on

ANALYSIS: ppp in healthcare stakeholders’ changing perspectives and interests. However, among the many concerns at play, the issue of equity in healthcare should arguably be given the most weight. The problem of equity “Growing evidence attests to the measurable benefits derived from PPPs particularly in improving accessibility, efficiency, quality, and capacity. However, equity should be considered first,” says Kai. PPPs have been shown to help public hospitals deliver an overall better patient experience by helping them build new and more advanced facilities, as well deliver efficient health services, according to a study by Dr. David Dombkins, CEO at Complex Program Group. Dombkins revealed that PPP for clinical services “has by far the greatest impact on patients” compared to other kinds of PPP such as for infrastructure, non-clinical support services and specialist medical support services. Still, despite the demonstrative efficiency and effectiveness of PPP in healthcare, governments should not discount the possibility of market failures. Servais says governments should be careful in designing PPPs because it can either reinforce market failure, or reduce it. He explains that there are particular health services that serve as public goods, including vaccinations to prevent contagious diseases from spreading. A child receiving a shot

Gerard Servais

Karen Prosser

Kai Hong Phua

David Dombkins

Comparisons of incentive regimes for HK, SG, MY

Source: Dr Kai Hong Phua, PPP in Health Manila 2012

against the flu will have spillover effects since his protection from the disease helps the community contain it. “[It] is like public lighting. You cannot make people pay for public lighting. It’s for everyone. So it must be taken by the state. So in this context, the state has a role of providing the services,” he says, emphasizing the government’s responsibility to guarantee equity in the society. Addressing the problems ADB’s Servais says the interest of the population or the patient must be upheld to ensure equity in health care PPPs. “What is missing in the bargaining is the patient interest. Because the hospital will think about: ‘Well, what is my share in this?’ The provider of the equipment will think: ‘What is my share on this?’ The patients are not represented,” says Servais. “Stronger government regulations and better governance usually contribute to achieving equity when managing PPPs,” reckons Kai, noting that governments will increasingly have to listen and involve civil society in PPP decisionmaking as countries democratize and globalize. “The key is applying the right balance. The government must examine areas of competition and assess not only where the market fails but also its own shortcomings in the relevant aspects of PPP. The government should clearly establish balance, equity and efficiency in PPP, and provide affordable social protection in the form of health care reforms, financing public subsidies and others,” he adds. Servais points out that health insurance is one kind of PPP that helps address equity, citing for example, its ability to address equity for poor people who suffer life-threatening illnesses like colon cancer who cannot afford to pay for treatments without insurance coverage. In addition to equity, it is important to ensure that PPPs in health care will result in efficient and high quality services. Prosser says governments should seek the right advice and work with consultants that understand the PPP procurement structure.

International best practices should be assessed and applied if found appropriate. “By applying best practices from other regions and sectors, key factors that are important to contractors, funders and operators can be raised. This does not mean weakening the commercial or legal position but actually providing earlier insight around whether PPP is the right model to be used and if it is, how it should be applied to get the outcomes that a government requires,” she says. Achieving a balanced model Prosser also highlights the importance of developing a legal and regulatory framework to support the PPPs. In the meantime, Kai says recent studies show the potential of hybrid models. “Malaysia, Singapore, and Hong Kong, considered as some of the most advanced in terms of hospital systems, adopt what can be considered as ‘the middle of the spectrum’ approach. That is, between autonomized and corporatized units,” he says. To achieve this so-called balanced PPP model, Kai asserts that incentive schemes are important to influence the supply side of PPP while reforms should be made in the areas of good governance, performancebased purchasing, and transparent information management systems. This is especially important since the region has the largest proportion of private financing. Governments should also be brought to ask whether it has done enough to spur public financing in health care through taxation, social insurance or other schemes. In the end, countries will have to thoroughly study trends and analyze the ground situation to create a PPP framework that works for them— and preferably sooner than later as Asians increasingly demand quality healthcare services. “In general, there is a need to increase universal health coverage in Asia, side by side with the improvement of basic public healthcare facilities, allowing flexibility for those who want more choices; and promoting healthy competition among the three sectors in PPP,” Kai says. HEALTHCARE ASIA 19

COVER STORY

Unattended bodies gave people the impression that the government was unable to work well

What lessons can be learnt from typhoon Haiyan? The inside account of how the Philippines government reacted.

ven before typhoon Haiyan destroyed Eastern Visayas in the Philippines in November last year, officials from the Department of Health (DOH) were already in their bunker in Manila planning for and coordinating post-cyclone healthcare operations. But their scenarios could not prepare them for the scale of damage wrought by the strongest storm to hit the planet in 2013. In an exclusive interview with Healthcare Asia, DOH Assistant Secretary Enrique Tayag says the state agency had a five-day headstart to prepare for the super typhoon. “Immediately, our response was to raise the white alert status in all hospitals in the affected areas. White alert means that hospitals will check their supplies, medicine, should have an inventory of their staff,” he says. In case the alert level is raised, the staff are asked to immediately report to work. But the gravity of the disaster was so immense, some

Even if the national government took over in much of the operations post-Haiyan, it still coordinated with the local government, especially with the challenges posed by language differences and geography.

hospital staff were not able to report to work as they had to prioritize their own families. Hospitals and health centres were wiped out, and the government was faced with a looming health crisis. The scale of Haiyan’s impact on the Philippines specifically on the health sector- and the government’s level of response to an emergency of such scale, bring to the fore the capacity of developing countries to respond to such calamities, tagged by the Philippine Interior Secretary Manuel Roxas II as the ‘new normal.’ Economic effects Typhoon Haiyan, or Yolanda, as it is called by the weather bureau in the Philippines, barrelled through the Visayas region on 8 November 2013, leaving an unprecedented trail of destruction in its path. More than 6,000 people were killed, mostly from storm surges, which caused seas to engulf nearby communities.

What local news agencies referred to as the ‘monster typhoon’ caused an initial estimate of P571.1b ($12.74b) in damage, consisting of loss to infrastructure (P33.98b), agriculture (P62.11b), industry and services (P116b), education (23.9b), health (P5.57b), housing (P325.24b) and local government (P4.3b), according to the country’s National Economic and Development Authority. Socioeconomic and Planning Secretary Arsenio Balisacan expected the catastrophe to negatively dent fourth quarter gross domestic product (GDP) by as much .3 to .8%. Matt Hildebradt of JP Morgan and Chase places the rebuilding cost around $6-7b, or around 2.3% of GDP. This figure is much lower than the initial estimate of $15b. The Eastern Visayas region accounts for 2.2% of the country’s GDP, and the typhoon affected its coconut and rice production, which accounts for 11% and 6% of national production, respectively. JP Morgan raised its inflation forecast to 3% from 2.7% in 2013 and 4.3% from 3.1% in 2014. The bank downgraded its 2013 GDP forecast to 6.9% from 7.1% but raised its 2014 forecast to 6% from

COVER STORY 5.6% due to the boost from rebuilding activities. “President (Benigno Aquino III) stated in a televised address that the country has P18.7b ($414.5m) in funds to help rebuild areas damaged by the typhoon,” JP Morgan says. Economist Michael Wan of Credit Suisse notes that the typhoon’s impact on the country’s headline GDP will likely be small and manageable, and agrees that economic expansion this year will likely be boosted by reconstruction. Remittances are also likely to be boosted in the near-term, which would support the country’s current account, Wan says. Early response Tayag says in case of national calamities, the Philippine government provides for a law that mandates concerned state agencies to coordinate with each other in responding to the needs of the citizens. The National Disaster Risk Reduction and Management Council (NDRRMC) is primarily responsible for overseeing nationwide operations during disasters. The Department of Science and Technology is concerned with mitigation, while the Department of Interior and Local Government is tasked with ensuring the preparedness of local government units. In responding to the needs of victims, at the helm of operations is the Department of Social Welfare and Development. The rehabilitation phase is assigned to the National Economic and Development Authority. Officials and staff from the DOH arrived in Tacloban, one of the hardest-hit cities in Eastern Visayas on the morning of 10 November, two days after Haiyan battered the area. The storm destroyed the Tacloban International Airport, prompting its closure, so officials like Tayag had to take helicopters to arrive at the location. “It was a short visit because we had to go back before the night fell. The purpose of the mission was to make a very quick assessment. Just a quick assessment, then get instructions from the president,” Tayag says. The next day, President Aquino declared a state of national calamity, empowering the national govern-

ment to take over local government units in implementing and executing rescue, recovery, relief and rehabilitation work in areas affected by Haiyan. Tayag clarifies, however, that even if the national government took over in much of the operations post-Haiyan, it still coordinated with the local government, especially with the challenges posed by language differences and geography. In Tacloban City, a majority of residents speak Waray, one of the native languages of the Philippines. “Even if you go there, you don’t know how to go about the place. That’s why you have to really work with the local government,” Tayag says. The government official says that upon their arrival in Tacloban on 10 November, they saw major structural damage to the government hospital, the Eastern Visayas Regional Medical Center. All the other private hospitals were down. Tayag says the hospital was still able to conduct about eight operations a day with the help of a working generator, but they were already running out of supplies. Only about a quarter of the hospital’s personnel had reported for work despite the white alert. “Of course they prioritized their families because they didn’t know what had happened to them,” Tayag says. Others suffered from posttraumatic stress disorders, which needed debriefings from psycho-

Typhoon Haiyan wreaked havoc in Eastern Visayas

President (Benigno Aquino III) stated in a televised address that the country has P18.7b ($414.5m) in funds to help rebuild areas damaged by the typhoon.

social health teams. There were a handful of surgeons and anaesthesiologists who reported to work and attended to the needs of those suffering from wounds and trauma. Tayag’s group also brought antitetanus vaccines, and provided some to other hospitals. The DOH set up a temporary command post in the hospital where people could be attended to, but communications were a problem as the major telecommunication providers were down. Tayag’s group, however, brought satellite phones, which helped them relay information to other groups from on the ground. Help from other areas also started arriving. “We were lucky the 136-contingent from Bicol region arrived, sent by (Albay) Governor (Joey) Salceda,” Tayag says. According to the DOH, P1.45b ($32m) is needed by the regional hospital to provide for public health services and facilities for the

Summary of Health Facility Status Per Affected Region (as of December 26, 2013)

Sources: NDRRMC, DOH

COVER STORY

Enrique Tayag Assistant Secretary Department of Health

typhoon survivors. The bulk of the amount is needed for the provision of safe water, while another considerable chunk is for the restoration of power and transportation. In the four regions affected by Haiyan, 38 hospitals are in immediate need of repair and rehabilitation, which will cost about P1.17b ($30m). In the next few days, the government’s problems started to pile up when the San Juanico Bridge connecting the provinces of Samar and Leyte had a traffic snarl from the volume of people arriving in and fleeing from the provinces. Tayag says after assessing the communications, they assessed the transportation situation so they could determine how to send needed responders and supplies. Due to

Typhoon Haiyan victims in Visayas

problems in transportation, the responders thought of arriving via C130 planes, but that immediately seemed improbable since they had to compete with relief goods and security personnel, he says. “Finally, our secretary negotiated and inked a deal with Air21 and Philippine Airlines (PAL). So by that time, we were able to secure flights to Cebu via PAL,” Tayag says. The responders were initially stationed in Cebu, a nearby city southwest of Tacloban, where they waited until the Tacloban International Airport partially reopened. Lack of communication made the situation a virtual chaos. “There were instructions that were not followed... for a few days we struggled with communications because we were struggling with satellite phones,” he says. Threats to public health “So we were already anticipating public health threats that may arise. We focused more on needs,” Tayag says. He says the government conducted a risk/needs assessment and sent personnel to assess the needs within affected areas. Tayag adds that the government’s priority in evacuation centres was accessibility to potable water, and the sanitation and hygiene situation in the area. “We had to maintain the health services. So we had to deploy medical teams. We had to work with WHO (World Health Organization) because the medical missions started

In the four regions affected Haiyan, 38 hospitals are in immediate need of repair and rehabilitation, which will cost about P1.17b ($30m).

to arrive,” he says. As countries from all over the world started sending their medical teams, the DOH coordinated with the Department of Foreign Affairs and WHO to coordinate with the foreign medical teams. The medical teams were classified according to those which could attend to outpatient concerns and those who could conduct operations. Based on this, teams were deployed where they were needed, Tayag says. As medical teams were deployed, the mounting death toll posed another problem. Tayag says that based on their assessment, even if relief was coming along with food and medicine, there were thousands of dead bodies, a lot of which were not yet retrieved. Among those retrieved, many were not yet identified, and those identified were not yet buried. “If you are not able to attend to that, the people’s impression would be, where is the government?”Tayag says, adding that the unattended bodies gave people the impression that the government was unable to work well and manage the situation. Identifying the dead was a task for the National Bureau of Investigation, but the management of dead bodies was assigned to the DOH. “Only we can declare what the death count is. Secondly, we supply the cadaver bags. Thirdly, we are the ones constantly advising people that they won’t get sick from dead bodies,” he says. Disease surveillance Another concern the DOH focused on was disease surveillance, for fears of possible outbreaks. Wounded victims were attended to and those with severe cases were transferred to Manila hospitals. There were also cases of leptospirosis and measles, and although DOH brought vaccines, they had to airlift a solarpowered refrigerator from Sulu, one of the southernmost provinces in the Philippines, in order to preserve them. Cases of tuberculosis also posed a problem, since the patient’s records were wiped out and conditions made it difficult to monitor whether or not a patient is regularly taking

COVER STORY his or her medicine. Dengue posed a threat which prompted fogging operations. He says with the different concerns of typhoon survivors, they had to make an inventory of how much help was needed to assist in the deployment of responders to various locations. Among them were dedicated teams ensuring the quality of water, sanitation and hygiene in the area. “It should be adequate and safe. Even if the water is safe, if it’s inadequate, people will still get sick,” he says. Mental health is also a concern for the DOH, with a number of people expected to develop mental illness from the traumatic experience. “Our concern is, months from now, there is a proportion of people who will have mental disorders. Actually, our estimate for severe mental health disorder is around 1 percent. Those mild to moderate, around 5-10 percent,” Tayag says. He adds that they are already readying their staff for that situation, and that psychosocial teams are present to conduct stress debriefing to the survivors. Health sector With respect to the health sector, Haiyan wreaked havoc on 1,235 health facilities in the Philippines, leaving only 678 functional. Other facilities were either partially damaged or completely wiped out. Out of the damaged health facilities, 991 were barangay health stations - small health centres located in villages. The typhoon also damaged 153 rural health units, 68 local government hospitals, seven city and district health centre, six retained hospitals, six city health offices, three private hospitals, and one municipal health office. The government estimates the cost of damage to health facilities at P1.123b ($25m), and more than 60% of the damage was inflicted on infrastructure. Typhoon Haiyan exposed the Philippines’ vulnerabilities to natural disasters on massive scales, and it is still uncertain how fast the country will recover from the calamity. When the 2004 tsunami hit Aceh, Indonesia, and killing 170,000 people in the area alone, it took years before the community got

back on its feet. In a report in 2010, the United Nations Development Programme said rebuilding has been remarkable in the area, exceeding expectations from what was imaginable when it hit six years earlier. “We are at the early recovery phase, then, we will have early rehabilitation. We call that post-disaster needs assessment. That means we’re assessing the damage to infrastructure and the impact to health workers. That is going to be planned, that’s what the president will be asking for,” Tayag says. Last December, President Benigno Aquino III appointed former senator Panfilo Lacson as the Presidential Assistant for Rehabilitation and Recovery to allow the government to focus on the task of rebuilding Visayas. It is also his job to coordinate with the NDRRMC and its member agencies and consult with the concerned local government units in the formulation of plans and programs for the rehabilitation, recovery and development of the affected areas. He is expected to exercise oversight on relevant state agencies in the rehabilitation and recovery effort and call upon state bureaus for assistance in carrying out his mandate. Balisacan said it would probably take three to four years for the affected areas to recover. Building permanent settlements for the displaced typhoon survivors would require more time since local gov-

Filipinos seeking help post-Haiyan

Haiyan wreaked havoc on 1,235 health facilities in the Philippines, leaving only 678 functional.

ernment units in the areas affected have yet to update their land use plan and geohazard maps. He says currently, the government’s priority are those who could no longer move back to the hazard zones. The DOH, for its part, is working on a report to be submitted to President Aquino, recommending further steps beyond the early recovery phase. “What helped us here were our skills and experience from past disasters. I was a veteran of the Ormoc flash flood in the nineties. Secondly, we get a lot of help, sometimes, even unsolicited. From international organizations to domestic, everyone helped,” Tayag says. Latest data from the Philippine government show that P25.88b ($579m) have already been pledged by the international community as aid for the Haiyan survivors. The government has so far received P643.2m ($13.34m) in cash out of the total amount pledged. But despite the outpouring of support and experience from previous calamities, Tayag concedes that the government was only able to do so much given Haiyan’s impact in Visayas. “You can only spring back so much. We’re not washing our hands but at least we were able to respond. It may not have been timely, it may not have been adequate, but there was real effort to help. There was real effort to cushion the health impact,” Tayag says.

asia’s Largest hospitals provides oncological consultation and outpatient chemotherapy for CGH patients with breast and gastrointestinal cancer, which are the most common types of oncology cases. The clinic started operations in March 2013 and currently sees about 23 patients for consultation weekly, with numbers growing steadily.

There is a growing trend in preventive healthcare

Check out what’s new at Asia’s largest hospitals

From MRI- safe incubators to integrated chinese and western medicine clinics, Asian healthcare providors continue to innovate.

ealthcare Asia’s spot check of some of Southeast Asia’s largest hospitals, based on number of beds, found interesting innovations and expansionary plans to cater to the growing demand for quality healthcare. Singapore General Hospital (SGH), the second largest in Singapore with 1,600 beds, opened a 300 sq m ‘one-stop’ transplant centre in November last year, to provide integrated services for patients undergoing a kidney, liver or complex cornea transplant. Singapore Around 1000 transplant patients at SGH will no longer have to shuttle between different clinics for various services. Media reports state that the new centre, billed as one-of-a- kind in Asia, can handle some 160 visitors a day. KK Women’s and Children’s Hospital (KKH), Singapore’s 5th largest with 803 beds, has enhanced 24 HEALTHCARE ASIA

However, the focus in AsiaPacific is still very much on treatment, as consumers prefer to seek treatment at hospitals and specialist centres.

its Neonatal Intensive Care Unit (NICU), with greater capacity and new features, to further augment care for newborn babies suffering from serious medical conditions. With an operating capacity of 32 beds, KKH claims its new NICU is the largest in Southeast Asia. KKH is also proud to be the first hospital in Asia to have an MRI-safe incubator. This specially designed incubator ensures added protection, as well as comfort for premature babies who require MRI scans. According to Head and Senior Consultant at KKH’s Department of Neonatology Victor Samuel Rajadurai, the Neonatal ICU manages approximately 400-450 admissions a year. A new oncology clinic by National Cancer Centre Singapore (NCCS) has been set up at Changi General Hospital (CGH), Singapore’s sixth largest hospital with 800 beds. The NCCS Oncology Clinic at CGH

Hong Kong Hong Kong’s Hospital Authority (HA) implemented a new billing system in all public hospitals on January 8 to handle more than one million patient discharges each year. The new system consolidates , in a single bill, charges for a patient in all hospitals on 8 January and treatment episodes within the billing period. Patients can also settle the bill in any hospital shroff, alongside other payment methods such as 7-Eleven convenience stores and internet banking services. According to HA, the newly introduced monthly summary statement will provide patients with a concise overview of all unsettled bills for services used in any public hospitals. HA also welcomed a proposed grant for hospital improvements. The HK Government has proposed a lump sum grant of $13 billion for carrying out minor improvement works in public hospitals and clinics in the coming decade. “Currently under HA, there are 42 public hospitals, 47 specialist outpatient clinics and 73 general outpatient clinics housed in nearly 300 buildings. “While over 56% of the buildings were completed more than 30 years ago and some even over 85 years, many required refurbishment and upgrading in electrical and mechanical engineering standards,” says The Chairman of the Hospital Authority Mr Anthony Wu. He adds that the accessibility of many hospitals and clinics would also need to be improved for the elderly and disabled, while alteration and expansion works in wards and clinics are required to enhance service capacity to meet the needs of a growing and ageing population.

asia’s Largest hospitals It is estimated that the lump sum grant of $13 billion, replacing the annual block funding allocation, could support all minor works projects, costing below $75 million each, at various hospitals and clinics over the territory for the next ten years or so. Hong Kong looks forward to the expansion of the four-decade-old United Christian Hospital from 1,400 to 1,700 bed capacity. Two of the oldest hospitals in Hong Kong – Queen Mary Hospital and Kwong Wah Hospital – will also be redeveloped. Queen Mary Hospital is HK’s fourth largest hospital with 1,698 beds. The five-decade-old Kwong Wah Hospital’s redevelopment will include the construction of a Chinese medicine outpatient clinic and in-patient integrated Chinese and western medicine ward; Chinese medicine laboratory and radiology facilities; an Accident and Emergency department and emergency medicine ward; and in-patient wards, operating theatres, and intensive care units. This redevelopment would make it one of the largest modern hospitals with over 1200 beds in Hong Kong. According to Wu, the Hong Kong government increased its support to HA by 6.7% in annual recurrent funding in 2012-13 to HK$42 billion. Malaysia Malaysia will soon have a dedicated specialist hospital for children with an expected 1900 staff, including 135 specialists and medical officers. The hospital, to be known as the Universiti Kebangsaan Malaysia (UKM) Permata Children’s Specialist Hospital will provide treatment in niche areas in paediatric medicine and surgery. The RM606m project will be built on the grounds of Hospital UKM l, Malaysia’s fifth largest hospital with 1040 beds, and is expected to be ready in 2017. Aiming to make Hospital Kuala Lumpur, Malaysia’s largest hospital with 2229 beds, a world-class hospital, Prime Minister Datuk Seri Najib Tun Razak has asked that a multilevel car park be built and completed by Jan 2015. An allocated budget of RM300m was announced for its upgrading.

The Hong Kong government increased its support to HA by 6.7% in annual recurrent funding in 2012-13 to HK$42 billion

Philippine public hospitals remain in need of funding

Philippines The Medical City, one of Philippine’s 10 largest hospitals with 800 beds, has launched an innovative service that provides its patient-partners with easy and secure access to their medical records via the Internet, free of charge. Dubbed “TMC Partner Link,” the online facility allows patients to view their laboratory and radiology diagnostic results, as well as discharge summaries, wherever they are. It also features various health trackers that enable patients to monitor their vital signs via a graphic interface. “For now, we have trackers for blood pressure, heart rate, blood sugar and weight,” says Dr. Mike Muin, health IT head of The Medical City. “What’s unique about these trackers is that they are integrated with our electronic medical records, and allow doctors to monitor their patients without frequent hospital visits. It fully embraces the concept of patient partnership beyond the walls of the hospital.” Public hospitals in the Philippines remain in need of more funding. The Vicente Sotto Memorial Medical Center (VSMMC), also one of the largest hospitals in the country with 800 beds, is asking the National Government to give them an P8-million additional allocation to address the increasing number of patients following the partial closure of the Cebu City Medical Center (CCMC) and the super Typhoon Yolanda in

November. CCMC’s building was declared unsafe following the 7.2 magnitude earthquake last 2013. The Armed Forces of the Philippines Medical Center (AFP), Philippines’ fourth largest hospital with 1,200 beds has meanwhile signed a Public-Private Partnerhip programme with Philippine business tycoon and chairman of the Makati Medical Center Foundation (MMC) Manuel V. Pangilinan last June. The programme is aimed at improving and expanding the services of the country’s prime hospital for soldiers. The programme allows both AFPMC and MMC to share technical resources and open their hospital facilities for conferences, workshops, training sessions, and coaching and mentoring sessions. The MMC will provide these for free to all AFPMC management staff, residents and doctors. Outlook Moving forward, Frost & Sullivan expects the expansion of private care services in emerging markets. The private healthcare services industry is still in a strong growth phase, with key players eyeing expansion activities in countries such as China and Indonesia where the addressable market remains untapped, says Bhuller. The focus on cross border treatment is also driving new partnerships and services where healthcare services merge with hospitality services.

HEALTHCARE ASIA 25

asia’s Largest hospitals

The largest hospitals in Asia Singapore

No. of Beds

Hospital Head

Hospital Operator National Heathcare Group

Institute of Mental Health (IMH)

2000

Chua Hong Choon

Singapore General Hospital

1600

Ang Chong Lye

SingHealth

Tan Tock Seng Hospital

1500

Philip Choo

National Heathcare Group

National University Hospital

1068

Joe Sim

National University Health System

KK Women’s and Children’s Hospital

830

Kenneth Kwek

SingHealth

Changi General Hospital

800

Lee Chien Earn

Eastern Health Alliance

1843

Albert Lo

Hospital Authority Hospital Authority

HONG KONG 1

Queen Elizabeth Hospital

Tuen Mun Hospital

1784

Tony Ko Pat-sing

Princess Margaret Hospital

1731

Nancy Tung Sau-ying

Hospital Authority Hospital Authority

Queen Mary Hospital

1698

Luk Che-chung

Pamela Youde Nethersole Eastern Hospital

1633

Lau Chor-chiu

Hospital Authority

1478

C.T Hung

Hospital Authority

Prince of Wales Hospital MALAYSIA

Hospital Kuala Lumpur

2229

Y. Bhg. Dato’ Dr. Zaininah Binti Mohd. Zain

Ministry of Health

Hospital Bahagia Ulu Kinta

2200

Hjh Rabai’ah bt Mohd Salleh

Ministry of Health

Hospital Permai

1400

Mohd Khairi Bin Yakub

Ministry of Health

Hospital Pulau Pinang (Penang General Hospital)

1090

Yasmin BT. Sulaiman

Ministry of Health

Hospital Universiti Kebangsaan Malaysia

1040

Dato’ Eisah Binti A. Rahman

Universiti Kebangsaan Malaysia

Hospital Sultanah Aminah

989

Rooshaimi Merican Binti A. Rahim Merican

MInistry of Health

PHILIPPINES 1

National Center for Mental Health

4200

Bernadino A. Vicente

Department of Health

Dr. Jose Rodriguez Memorial Hospital

2100

Edgardo SA. Javillonar

Department of Health

Philippine General Hospital

1500

Jose C. Gonzales

Department of Health

AFP Medical Center

1200

Normando T. Sta Ana Jr.

Department of Health

Southern Philippines Medical Center

1200

Leopoldo Vega

Department of Health

UST Hospital

812

Herminio V. Dagohoy

University of Santo Tomas

INDONESIA 1

RSU Dr. Soetomo

1509

Dodo Anondo

Pemprop

RSU Dr. Mohammad Hoesin

1128

Yanuar H. Hamid

Kemkes

RSU Dr Hasan Sadikin

1100

Bayu Wahyudi

Kemkes

RSU Dr. Saiful Anwar

1070

Basuki B. Purnomo

Pemprop

RSU Dr. Kariadi

1044

Bambang Wibowo

Kemkes

RSU Dr. Cipto Mangunkusumo

983

Czeresna H. Soejono

Kemkes

Thailand 1

Maharaj Nakorn Chiang Mai Hospital

2287

Somsak Chaovisitsaree

Chiang Mai University

Srithanya Mental Hospital

2283

Kritipoom Vongrachit

Department of Mental Health

Siriraj Hospital

2275

Surin Thanpipatsiri

Mahidol University

King Chulalongkorn Memorial Hospital

1443

Adisorn Patradul

Thai Red Cross Society

Suan Saranrom Psychiatric Hospital

1310

Kobchoke Joowong

Department of Mental Health

Phramongkutklao Hospital

1246

Chumpol Piemsomboon

Royal Thai Army

Source: Data are based on website, government health departments, and media reports. 26 HEALTHCARE ASIA

cOUNTRY report: SINGAPORE

Manpower crunch looms in the healthcare sector

How will Singapore cope with its aging population?

Issues for providing healthcare arise as one in five Singapore residents are predicted to be 65 years old or over by 2030.

ealthcare is an important sector in most developed countries, and Singapore has one of the widest varieties of services available at various levels of affordability. The Ministry of Health believes in ensuring quality and affordable basic medical services for all, in conjunction with the promotion of healthy living and preventive health programmes, as well as maintaining high standards of living, clean water and hygiene,to achieve better health for all. Currently Singapore’s healthcare system is designed to ensure that everyone has access to different levels of healthcare in a timely, cost-effective and seamless manner, but there is a general acknowledgement that the capacity of healthcare needs to expand, particularly within the healthcare sector. Healthcare expenditure in Singapore can be categorized into

28 HEALTHCARE ASIA

The country’s healthcare sector faces a challenge in manpower – they don’t have enough healthcare professionals which causes issues for providing healthcare for the population.

public expenditure and private expenditure, where public healthcare is managed through the Ministry of Health. There are eight public hospitals comprising six general hospitals, a women’s and children’s hospital, and a psychiatry hospital. General hospitals provide multi-disciplinary inpatient and specialist outpatient services, and 24-hour emergency departments to residents. Six national specialty centres provide cancer, cardiac, eye, skin, neuroscience, and dental care. Public dental services are also available through the National Dental Centre and in some polyclinics and hospitals. Public healthcare funding in Singapore originates from tax collection and other government income, and the majority is channelled to the Ministry of Health through annual budget allocations. Private healthcare

expenditure is composed of three major components, namely out of pocket expenditure, private health insurance, and contributions from non-profit institutions. SingHealth manages the largest number of public medical institutions, followed by the National Healthcare Group, and citizens and permanent residents are entitled to basic medical services at government polyclinics and public hospitals, where rates are regulated and subsidized. Expansion of healthcare facilities With one of the highest and most rapidly ageing populations in the world, Singapore’s healthcare sector is facing some of its most demanding challenges. According to Alson Goh, Chief Operating Officer at the National Heart Centre in Singapore, it is projected that by 2030, 1 in 5 Singapore residents will be 65 years old or over. “The country’s healthcare sector faces a challenge in manpower – they don’t have enough healthcare professionals which causes issues for providing healthcare for the population. To meet increasing healthcare needs, the government has been increasing healthcare capacity.” Dr Loke Wai Chiong,

cOUNTRY report: singapore Director of Global Healthcare Centre of Excellence at KPMG in Singapore agrees, emphasising that the government is doing just that, having announced plans for at least three new hospitals, up to 14 new polyclinics, and more than 100 additional eldercare facilities to be built over the next couple of years. “In comparison, growth in the private healthcare sector may be slower as overall resources, especially medical specialists, are limited, and is likely to be driven by inbound medical tourism,” Dr Chiong says. Dr Janson Yap, Regional Managing Partner, Enterprise Risk Services and Life Sciences & Healthcare Industry Leader at Deloitte in Southeast Asia, has a similar view with regard to the rapidly ageing population. However Dr Yap believes that Singapore is unique among developed countries in terms of their healthcare. “Healthcare reform in Singapore is being translated from the policy level to continuing changes on the ground with regards to the supporting healthcare infrastructure and capability.” Healthcare providers Additionally, private insurance companies have gained entry into the market with the liberalization of insurance policies, leading to increased competition, lower premiums and broader coverage. This is according to Senior Vice President of Healthcare at Frost & Sullivan, Ms Rhenu Bhuller. She says that more policies have resulted in an increase in funds for private healthcare services, driving more patients towards private hospitals, advising that between 2006 and 2010, private insurance expenditure increased from S$581 million (US$366 million) to S$964 million (US$707 million) at a CAGR of 13.5%, as private insurance provides patients with more flexibility to choose their healthcare service levels and locations. However regulation is still an issue. “The problem is that rates at private clinics and private hospitals are not regulated, and subject to market forces of demand and supply,” says Bhuller. “Within public hospitals, 80% of the public hospitals’ beds

Ho Lee Yen

Loke Wai Chiong

Rhenu Bhuller

Janson Yap

are heavily subsidized, with the remaining 20% with lower subsidy at 20% for class B1 and no subsidy for A class wards.” Parkway, Singapore’s largest private healthcare provider, Parkway has four hospitals, providing a wide range of high-level private healthcare services, with Raffles Hospital considered the other major private hospital. They operate under an employed physician model and have a significant number of primary care clinics around Singapore, which provide services from a primary care perspective. Bhuller also says the healthcare provider has further plans to expand its outpatient presence. Regional Health Systems (RHS) such as the Eastern Health Alliance and the Alexandra Health System, set up in 2009, have also been forming partnerships among GPs, community hospitals, nursing homes and other stakeholders to care for their patients within specific designated zones. Dr Chiong says that new care models, such as Community Health Centres (CHCs) and Family Medicine Clinics (FMCs), have been introduced so that private GPs can relieve the load of polyclinics in terms of delivering care to patients with chronic ailments. Other contributing factors In 2012 The AIA Bloomberg rated Singapore as the world’s healthiest nation. Ms Ho Lee Yen, Chief Marketing Officer of AIA Singapore, says that such pleasing results are due to the positive efforts and policies of the Singapore government, as

well as the dedication of the people of Singapore. But, she says, whilst these results are encouraging, there are other factors that Singaporeans should be aware of in order to keep this healthy rating. “Singaporeans should continue to ensure that they close their protection gap by having adequate insurance coverage,” Yen says. The Singapore government has made it no secret that the national agenda will address the future demand for intermediate and longterm care and to look into providing high-quality and cost-efficient health services to meet the demand of the people/the growing elderly population. According to Maybank Kim Eng, the healthcare measures announced by the Prime Minister in his recent National Day rally speech have been encouraging and support a positive view on the private healthcare sector. Maybank reported that, the private healthcare sector will play an increasingly significant role in this reform. In particular, the extension of Medisave usage, and the removal of the minimum age limit of 40 years under the Community Healthcare Assist Scheme Scheme. Overall, despite the challenges ahead, Singapore is actively taking steps to manage this future population through early health intervention programmes and provision of services beyond the hospital. As the reputation of Singapore is medical excellence grows, medical tourism should be seen as a key driver of the private healthcare market.

HEALTHCARE ASIA 29

CASE STUDY: NHGP

NHGP Management with the Culture DNA Day 2013 jigsaw puzzle

Patient centricity and teamwork in an organisation Find out how Singapore’s National Healthcare Group Polyclinics ensures good clinical outcomes for its patients.

he National Healthcare Group Polyclinics (NHGP) is a primary healthcare service provider that is faced with a high volume of patients daily, each with different needs. Given the high patient load, it is possible for healthcare personnel to view things with a single dimension that is – seeing patients as statistics and as workload. This viewpoint can dehumanise patients, making some staff view service initiatives as a superficial effort that could be just about exchanging pleasantries with patients and nothing more. It was thus a challenge to ensure that every patient receives holistic and efficient clinical care that is delivered, with sincere concern and empathy. NHGP also needed to provide our patients with a good and genuinely caring experience. It is not easy to constantly meet these challenges 30 HEALTHCARE ASIA

Our corporate culture called the Culture DNA, reminds staff that, good care could not be about complying with the company’s rules or meeting KPIs.

but NHGP has started to take its first steps via a transformational journey which aims to change every employee’s mindset through its culture programme. Embedding Values for Change To break away from old ways of thinking and move more towards patient-centricity, NHGP sought better processes to optimise our resources, help us to function efficiently and ensure good clinical outcomes for our patients. While many organisations rely on various service initiatives, quality improvement projects, and key performance indicators (KPI) to motivate staff to provide better services and improve work processes, NHGP management believed that it was more important to engage their staff holistically through a values framework.

“We needed to constantly remind our staff of their purpose of joining the healthcare sector. Most people, if not all, join the sector because they wanted to care for others. Somehow, people forgot about it along the way due to the heavy workload. Our corporate culture called the Culture DNA, reminds staff that, good care could not be about complying with the company’s rules or meeting KPIs; it has to stem from an innate desire to look beyond personal agenda and boundaries, and take initiatives to do what is right and empower others instead of serving one’s own interest. This sustains the meaning at work,” explained Mr Simon Tan, Director of Human Resource and Finance at NHGP. This is a system of thinking that encourages staff to put others first, focus on relationships, and emphasises the ‘right’ outcomes and results, which may not be of the usual statistical variety. It encourages employees to base their decisions from a perspective that puts another person first and to design work processes to meet their needs. NHGP calls this the ‘Way of Being’ (WOB) which is an overarching framework to encourage its staff to ‘see people

CASE STUDY: NHGP as people’, putting themselves in another’s shoes. NHGP’s senior management team takes an active lead in this transformation journey. 16 of them, including senior staff like its Chief Executive Officer (CEO), Mr Leong Yew Meng, personally train NHGP’s staff through the WOB workshop programme. Mr Leong Yew Meng adds, “The difference starts from us, inwardly. To see everyone we meet (be it a patient or co-worker) as an individual with different needs and challenges, and to pause a moment so as to understand their behaviour instead of being judgmental. This helps us to take ownership and rise above our challenges to help them.” Today, most, if not all of NHGP’s staff has attended the culture workshop programme. All new and existing staff are introduced to the key concepts of our culture during orientation with NHGP’s CEO or at staff engagement sessions. To better the service for every patient, all service staff have also undergone training in the service framework

iCare training workshop

In its ECS conducted in early 2013, overall staff rating for the organisation went up by five percentage points to 72%.

The Way of Being workshop

called iCARE, which reminds them to be Confident, Attentive, Respectful, and Empathetic. Every clinic also has a network of iCARE service leaders and ambassadors, who encourage staff to keep practising NHGP’s key service principles. Embracing values for patientcentricity and teamwork, naturally leads to the next pillar of NHGP’s Culture DNA, known as OurCare. Through OurCare, teams are inspired to implement Work Improvement Projects to do better for our patients and their co-workers. Some projects have explored how patient information can be shared with the next clinician better, improving workflows between colleagues and bettering outcomes for the patient. Others focus on how we can improve a clinic visit for the patient, making each visit pleasanter and more effective. The number of such projects within NHGP has grown by over 50% in just one year, from 55 in 2011 to 87 in 2012. NHGP management also embarks on monthly walkabouts in clinics to look at issues ranging from service to safety and improving operations. During each visit, service “stars” are recognised and quality efforts encouraged as they are spotted in action or practise. Mr Leong and his team also visit the nine polyclinics to conduct lunchtime talks for staff, to share plans, insights and stories to inspire staff. These serve to constantly energise staff in making a difference

to every patient. Staff stories are also shared through a culture newsletter, where trainers give tips and staff contribute their own experiences in practicing NHGP’s Way of Being to encourage each other. NHGP also celebrated its Culture DNA Days, on 31 October 2012, and 5 September 2013 where recognition was given to staff who have consistently improved our care either through great service or process improvement. Resonating Values The NHGP Culture Transformation programme has resonated well with its staff’s internal values, and helped them realise their desire to contribute effectively as a team and help patients. Through these efforts, NHGP has improved in its Employees’ Climate Surveys (ECS) and Patient Satisfaction Surveys. In its ECS conducted in early 2013, overall staff rating for the organisation went up by five percentage points to 72%. This is a testament that the organisation is moving in the right direction. Good care also touches the hearts of patients as evidenced in NHGP’s score of 82.2% in the Ministry Of Health’s Patient Satisfaction Survey in 2012. This is an improvement of about 2% from the last survey in 2010. NHGP understands that this is a long-term journey and management continues to share culture principles among staff. As NHGP keeps pressing ahead, it hopes to touch the lives of even more patients and staff. HEALTHCARE ASIA 31

OPINION

Tan Wah Yeow

What you need to know about Asia’s healthcare expenditure

ealthcare systems all over Asia are undergoing significant change. Just as the state of economic development across the region varies, the development of healthcare systems in different Asian countries differs from one another. Among the more developed economies, health systems face rising demand for specialised services. In Japan and Singapore for example, governments and healthcare players are striving to meet the needs of their aging populations. At the same time, there are cost pressures and market restructuring even as competition intensifies. Among emerging economies such as Indonesia and the Philippines, young and mushrooming urban populations are stretching the capacity of their countries’ healthcare facilities. One way by which we can further examine the variance across Asian health systems is by observing their differing expenditure on healthcare. Japan and Singapore At one end of the spectrum, Japan stands out as an example in terms of its advanced healthcare system and high spending at more than US$ 4000 per capita and about 7% of GDP. In 1961, Japan became one of the earliest countries in the world and the first in Asia to implement universal health insurance coverage.

MediShield and MediFund. This involves mandating compulsory savings, and offering high national insurance coverage components. The Government also provides subsidies to those who access the public sector for their healthcare needs. Despite this, key challenges still exist. These include rising healthcare costs and the challenging move towards universal health insurance coverage. The rest in the spectrum Malaysia is a prime example of how healthcare resources are not evenly distributed in many Asian countries. The country now has an abundance of nursing schools, contributing to a rapid increase in the number of nurses. Yet, its hospitals lack the capacity to train these nursing candidates. At the other end of the spectrum, Indonesia stands out. Despite being one of the world’s fastest growing economies with the largest populations, the country has among the lowest healthcare standards in the region. Even as Asia’s healthcare markets are primed for growth, each faces a distinct set of problems and opportunities. There is no single solution. A successful approach to each market requires a tailored solution, and it is up to public and private sector players to deliver. The best players will likely be those nimble enough to spot and capture the unique opportunities in a time of both immense challenges and rapid growth for the region.

“Malaysia’s healthcare spending is about US$400 per capita and four percent of GDP.” Citizens pay between 10% and 30% of healthcare costs as copayments, and have access to an abundance of healthcare facilities. While comprehensive, long-term sustainability of Japan’s model will require work on multiple fronts, not least of which will be to deal with hospital inefficiencies, low profitability and unnecessarily long lengths of stay. Another example is Singapore, where healthcare standards consistently rank among the world’s best for achievement of health outcomes. This achievement is despite a low total expenditure on healthcare at roughly four percent of GDP or around US$ 2,000 per capita. Singapore’s system is unique in terms of its emphasis on personal responsibility, co-payment and choice. Public expenditure is kept low through a combination of the 3Ms of MediSave, 32 HEALTHCARE ASIA

BY Tan Wah Yeow Head of Asia Pacific Healthcare Practice, KPMG Singapore

Health is on its way!

OPINION

Dr Yong Chern Chet

Influences on future healthcare policy

BY Dr Yong Chern Chet Risk Consulting Lead for Health Care Deloitte Southeast Asia

imilar to that of the Internet and web development, the healthcare ecosystem is experiencing an evolution with the manifestation of socio-economic factors such as population, economy and policy changes onto health outcomes. Indeed, the influencers of healthcare policy have changed focus, from healthcare institutions like hospitals, to the doctors themselves, to where it is now â&#x20AC;&#x201C; a consumer-patient archetype that brings together two previously well-established and pre-defined approaches to healthcare, namely the patientcentred care approach and consumer-directed commercial models. Shift in prevailing patient behaviour There is no doubt that patient behaviour is shifting. This ongoing movement has brought forth the importance of the patient-centred care construct and the complementing consumerfocused healthcare commercial models. The present public involvement in healthcare policy have already been advocated as a means to enhance health system responsiveness. However, current research evidence of its impact has been difficult to ascertain as firm conclusions about involvement activities that are appropriate and effective for policy development are difficult to draw. Coming of age for healthcare innovation The gradual coming of age of disruptive healthcare technologies and how it affects the way people perceive healthcare is a material anchor for developing future healthcare policies. As recent as ten years ago, Harvard Business School Professor Clay Christensen examined the dearth of innovation in healthcare and laid out the framework for a challenge that is still largely unmet today. The reasons for the hindrance of innovation within the healthcare sector could be attributed to a few general factors: i) large monopolistic corporations unwilling to allow the entrant of new technology as they view it as a threat to their prevailing business models ii) complicated, expensive and prolonged regulatory process proves to be a virtual bottleneck slowing down the rate of permeation of healthcare innovation. iii) being a capital intensive endeavour, medical institutions and healthcare systems which have invested heavily into previously mainstay

technology and infrastructure are unwilling to upgrade or switch to next generation updates before they achieve the optimal return-oninvestment from their previous expenditure.

Healthcare evolution: Shaping its future

The new normal Nonetheless, innovation is happening. The rate of technology adaption by the overall healthcare industry has quickened to a rapid enough pace that smaller, more innovative corporations can stand toe-to-toe and even triumph over their larger competition in the current business environment. These smaller companies have the advantage of being more nimble in meeting the demand of the consumer (patient) driven market and have the innovation competitive edge. Further challenging the status quo are the service delivery innovations such as retail clinics, medical tourism and technology-enabled self-care / home health solutions. These, along with other new lifestyle phenomena such as enhanced connectivity brought about by the mobile revolution, the rise of smart monitoring devices, the maturing of Artificial Intelligence capability, advanced machine learning capability and social networking, help meet previously unmet health needs. With these factors working cohesively throughout the healthcare supply chain, the game evidently changes. Healthcare policy makers need to be aware that along with consumerism and health reform, disruptive innovation is also part of the equation in shaping the future of healthcare. HEALTHCARE ASIA 33

OPINION

David McKeering

Future directions of healthcare policy in South East Asia

outh East Asia is a very broadly used term and for the purposes of this article, we are focusing on the Association of South East Asian Nations (ASEAN), which comprises of Malaysia, Singapore, Thailand, Indonesia, Philippines, Vietnam, Cambodia, Laos, Myanmar and Brunei. The social, cultural, religious, economic, political and infrastructural fabrics of these nations vary significantly, making this region both extremely diverse and disparate. Setting this context allows us to understand and appreciate the variability in access, affordability and quality of healthcare across this region. World Health Organization data suggests that there has been a significant growth in regional healthcare expenditure over the last two decades in this region. However, the average healthcare expenditure is 4% of GDP in ASEAN as compared to approximately 9% for OECD countries. This is not sustainable given that increasing population, improving life expectancy, rising affluence and changing customer expectations are placing additional pressures on healthcare policy makers to provide improved access to quality and affordable healthcare. Our research shows that Singapore has the more mature healthcare system in ASEAN with Brunei, Malaysia and Thailand following close. At the other end of the spectrum are countries like Laos, Cambodia and Myanmar where the provision of healthcare is highly challenged. ‘Underdeveloped’ health systems are challenged with minimal healthcare infrastructure and investment. Limited access to both healthcare workforce and care settings implies a lower quality and standard of care in these countries. ‘Developing’ health systems provide basic infrastructure and access to basic provision of care. While there is an increased public contribution to healthcare financing, these systems are still largely out-of-pocket driven. We anticipate policy talks for countries in this bracket to focus largely on increased public financing to make healthcare affordable for a larger segment of the population. Vietnam and Philippines are talking about universal health coverage and insurance schemes. Indonesia has implemented universal health coverage at the beginning of this year. We also expect to see continuous investments in healthcare infrastructure and workforce to help provide wider access to quality care. As we

34 HEALTHCARE ASIA

progress towards ‘maturing’ health systems, we find that the healthcare infrastructure is fairly developed and there is wider access to improved standard of care. One way might be able to consider policies that encourage private contributions to healthcare. ‘Mature’ health systems provide advanced healthcare infrastructure. There is extensive access to quality healthcare and highly sophisticated consumer buying patterns emerge. We observe that public policy starts to create a rebalancing of public and private healthcare financing by encouraging or mandating private contributions to healthcare. In the future, we anticipate ‘mature’ countries like Singapore to consider innovative strategies to help drive down the overall healthcare expenditure. Investing in wellness programs would help spread awareness on preventative and not reactive healthcare and in turn help drive down healthcare costs. We anticipate that we will continue to see that policies will be heavily dependent on the stage of maturity of the health system and the specific healthcare needs in each country.

BY David McKeering PwC South East Asia Consulting (SEAC) Public Sector and Healthcare Leader

Expect continuous investments in healthcare