By Kim Mai Tran —
Southeast Asia’s healthcare industry is at a crucial crossroad. Economic development and disposable income have increased the demand for quality healthcare; demographic changes, the emergence of new chronic diseases and health challenges, and the current lack of adequate health infrastructure will only amplify the demand for preventive healthcare. This dynamic creates huge opportunities for technology to transform, improve healthcare in the region, and help bridge the gap between an overall low-quality supply and an increasing demand for high quality healthcare. Healthtech, or the use of information and communication technology in healthcare, is poised to become one of the main elements for healthcare system reform, and enable a more accessible, affordable, and patient-centered care. Southeast Asian countries are well positioned to adopt digital health solutions considering the internet penetration in the region, mobile connectivity (350 million users in 2018), and affordable technologies.
All ASEAN countries have committed to transitioning to Universal Healthcare Coverage (UHC). Malaysia and Vietnam have provided universal healthcare to their citizens for a few decades. Despite some fiscal difficulties, Indonesia is working towards providing UHC through its Jaminan Kesehatan Nasional scheme. President Rodrigo Duterte of the Philippines signed a UHC Act into law earlier this year. Myanmar, Laos, and Cambodia have committed to achieving UHC through various frameworks. Leveraging new technologies will allow government to provide UHC while keeping their costs down and remaining accountable to their citizens.
Overall, ASEAN countries have been underspending on healthcare. Indonesia, Vietnam, Malaysia, and the Philippines have been spending between 1.1-3.8 percent of their gross domestic product on healthcare, the global average being 6 percent. Yet, Southeast Asia is a critical market for medical expenditure and expected to reach $740 billion by 2025 from $20 billion in 2017. With an ageing population and the emergence of new health challenges such as the prevalence of chronic diseases and cardiovascular diseases, ASEAN countries must promptly improve their healthcare system while keeping it at a low cost. According to World Bank data, Indonesia has 0.2 physicians per 1,000 people, Vietnam has 0.8, Thailand has 0.5, Myanmar has 0.6. Singapore is an exception in the region with 2.3 per 1,000, close to the United States at 2.49 physicians per 1,000 people. Similarly, the Philippines needs at least 40,000-45,000 additional hospital beds to meet the needs of its population. In addition to expanded spending, adding practitioners, and deeper infrastructure, Healthtech may be a way to disrupt and transform the healthcare landscape in Southeast Asia for the better.
The broader Asia-Pacific region’s healthtech industry raised about $6.3 billion in investment in 2018, Singapore being the main healthtech hub in the region so far. Healthcare investors foresee the technology aggregator space – that is companies leveraging technologies to deliver healthcare services – to be a promising area for improvement. Also referred to as e-health companies offer services such as emergency medical response systems, mobile health, telemedicine, and remote patient monitoring to deliver healthcare out of the conventional clinical setting often inaccessible to many for financial or geographical reasons.
It is time for ASEAN governments to invest in capacity building, focusing on digital health and public private partnerships. The introduction of digital technologies has the potential to enable healthcare infrastructure to leapfrog in the provision of quality healthcare at an affordable price. For example, Halodoc, an Indonesia-based startup that recently secured funding from the Bill and Melinda Gates Foundation, Allianz X, and Prudential, aims to improve access to healthcare and medicine with a partner network of over 22,000 doctors, over 1,000 pharmacies and about 2 million monthly users. Consultation costs vary between $1.70 to $5.00 which is lower than an in-person consultation at a clinic or hospital. Similarly, Thailand’s Virtual Hospital provides three key services: e-consultations with doctors, tests at home, and medicine delivery, all delivered by the Samitivej Hospital in Bangkok. The hospital teamed up with Line, Siam Commercial Bank, among others to launch the service. Vietnam’s VieVie Healthcare, a telemedicine and online patient engagement platform allows patients to get advice on medical issues, interpretation of lab test results for free and is backed by Clermont Group, a Singapore-based conglomerate who owns Vietnam’s largest private healthcare network. In the Philippines, Lifetrack Medical Systems allows doctors in more rural areas to send X-rays through a cloud service to radiologists overseas to obtain a diagnosis. More recently, China’s Ping An Good Doctor announced a joint venture with ride-hailing platform Grab to give users access to AI-assisted medical consultations, medical delivery, and medical appointment bookings — Thailand will likely be the first testbed.
Another area where digital healthcare solutions will be an actor of change is in improving women’s reproductive health. The maternal mortality ratio (MMR) is still high across the region: 126 per 100,000 live births in Indonesia, 197 per 100,000 in Laos, 178 in Myanmar (in comparison, the United States’ MMR oscillates between 17 and 20). This issue is in part attributed to a lack of access to maternal care. Indonesia is a pioneer in implementing telemedicine for expectant mothers with its Mobile Obstetrics Monitoring, piloted by the Indonesian Reproductive Science Institute, allowing OB-GYNs to remotely monitor their patients and efficiently provide care during home or hospital visits while minimizing risks. The pilot study for the program showed that postpartum hemorrhage and other postpartum complications were lowered.
Singapore has been spearheading a flourishing healthtech industry, however, these innovations are primarily available only in Singapore and healthtech services are still most accessible in urban or suburban areas. In rural and underserved areas, the lack of digital infrastructure and weak internet penetration coupled with more conservative norms that prioritize traditional medicine remain a challenge and present a market risk for e-health platforms. Similarly, whether patients are willing to accept these changes remains an obstacle to the dissemination of healthtech.
Some ASEAN countries like the Philippines and Thailand have developed policies that facilitate the use of technology in healthcare. With its 2014-2020 eHealth Strategic Framework Plan, the Philippines wants to “enable widespread access to health care services, health information, and securely share and exchange client’s information in support to a safer, quality health care, more equitable and responsive health system for all the Filipino people.” Similarly, as part of Thailand 4.0, the Ministry of Public Health has developed a 2017-2026 eHealth Strategy to develop Thailand as a medical hub in ASEAN by 2025.
Southeast Asian governments have recognized the need for healthcare reform and have put forward policy plans to move in that direction. E-health and healthtech present huge opportunities ASEAN governments to translate the various healthcare policies put out in the past decade into wider practice. To bridge the gap between supply and demand for high-quality and affordable healthcare, healthtech providers will have to work in tandem with grassroots communities and educational institutions to give caregivers the necessary and adequate skills to implement these technologies. The strong demand signal should facilitate a more conducive environment for health-oriented investment and start-ups in Southeast Asia that will allow healthtech to flourish in the region and provide affordable, accessible healthcare to those left on the margins of traditional healthcare systems.