A STRATEGY FOR ASEAN. 22 nd to 23 rd August, 2013 Shangri La Hotel Singapore HEALTHCARE. Organiser. Co-Organiser

(1)

Organiser Co-Organiser

HEALTHCARE

22nd_{to 23}rd_{August, 2013}

Shangri La Hotel Singapore

(2)

HEALTHCARE

Moderator

Dr. Penny O’Hara

Partner, Accenture

(3)

HEALTHCARE

Sector Chair

Dr. Lim Cheok Peng

Managing Director, IHH Healthcare

(4)

HEALTHCARE

Co-‐Chair

Mr. Kenneth Mays

Senior Director of MarkeFng

(5)

2500 Singapore Myanmar Cambodia Lao Vietnam Philippines Indonesia Thailand Malaysia 100 600 1100 1600 -100 0 100 200 300 400 500 Mo rt al ity R at e (N um be r of de at hs pe r 10 0k )

Health expenditure per capita (USD)

Low-income: GDP per capita <1k Middle-income: GDP per capita 1-5k High-income: GDP per capita >5k

Figure 1.

Healthcare Spending and Health Profiles of ASEAN countries

Source: International Monetary Fund (IMF), World Economic Outlook Database April 2013; World Health Organization (WHO), World Health Statistics 2013

(6)

THE HAVES VS. THE HAVE-NOTS

•   Not surprisingly, higher-income countries are well-ahead of the lower-income ones in terms of resource availability for health, healthcare coverage and quality of care (see Figure 2).

0.4 5 6 14 28 52 66 89 93 241 Brunei Singapore Lao Cambodia Malaysia Myanmar Thailand Vietnam Philippines Indonesia 1.4 1.6 0.2 0.2 1.2 0.6 0.3 1.2 1.1 0.3 Brunei Singapore Lao Cambodia Malaysia Myanmar Thailand Viet Nam Philippines Indonesia 3.53 1.63 0.95 0.63 2.43 0.53 1.89 0.88 4.26 2.04 Brunei Singapore Lao Cambodia Malaysia Myanmar Thailand Viet Nam Philippines Indonesia 70.2 63.9 8.2 7.9 32.8 8.6 15.2 10.1 60.0 3.8 Brunei Singapore Lao Cambodia Malaysia Myanmar Thailand Vietnam Philippines Indonesia Population - 2010 (in millions) No. of physicians Per 1,000 pop No. of nurses Per 1,000 pop

No. of hospital beds

Per 10,000 pop

Figure 2.

Population and healthcare resource comparison across ASEAN

Source: United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Prospects: The 2012 Revision, CD-ROM Edition.; OECD Health Data 2012; WHO Global Health Observatory Data Repository, national data sources; WHO World Health Statistics 2013

Note: Figures for number of physicians, nurses and hospital beds reflect latest data available

(7)

THE EVOLVING HEALTHCARE LANDSCAPE IN THE REGION

FIRST SECTION – ASEAN COUNTRIES OVERVIEW

Percentage of Population over 65 years old Life expectancy at birth (Male and Female)

60 62 65 65 66 70 71 72 75 78 55 60 63 59 63 68 70 69 73 76 Cambodia Myanmar Philippines Lao Indonesia Thailand Malaysia Vietnam Brunei Singapore 63 65 71 67 69 77 76 76 80 83 58 63 70 61 66 76 74 72 78 80 9% 9% 4% 7% 5% 5% 5% 5% 4% 4% 21% 20% 13% 13% 10% 9% 9% 9% 6% 6% Si n g a p o re Th a il a n d Bru n e i Vi e tn a m M a la ys ia In d o n e si a Mya n m a r Ca m b o d ia Ph il ip p in e s Lao 2010 2030 2000 2010 Figure 3.

Percentage of population over 65 years old and life expectancy across ASEAN

Source: United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Prospects: The 2012 Revision, CD-ROM Edition; WHO World Health Statistics 2013

(8)

THE EVOLVING HEALTHCARE LANDSCAPE IN THE REGION 29 23 28 34 33 29 25 24 24 29 25 23 17 24 29 29 24 20 19 17 25 24 Vietnam Cambodia Lao Myanmar Indonesia Philippines Thailand Singapore Brunei Malaysia Asean

Prevalence of raised blood pressure among adults aged ≥ 25 years (%)

1 2 2 2 3 5 5 7 9 10 2 2 3 4 6 7 8 12 6 7 18 4 Vietnam Cambodia Lao Myanmar Indonesia Philippines Thailand Singapore Brunei Malaysia Asean

Adults aged ≥20 years who are obese (%) Female Male 48 42 51 40 61 47 45 35 32 50 37 Vietnam Cambodia Lao Myanmar Indonesia Philippines Thailand Singapore Brunei Malaysia World Smoking prevalence among males (%) Figure 4.

Indicators of lifestyle-related risk levels to health in ASEAN

Source: WHO World Health Statistics 2013

(9)

CAN ASEAN RESPOND TO THE CALL OF INCREASED HEALTHCARE DEMAND?

Figure 5.

Population and healthcare resource comparison across ASEAN

2.0% 2.6% 2.8% 2.9% 3.9% 4.1% 4.4% 4.5% 6.0% 6.8% 9.2% Myanmar Lao Indonesia Brunei Thailand Philippines Malaysia Singapore Cambodia Vietnam Global Healthcare Expenditure as a % of GDP (2010)

Country Per capita expenditure on health _{at average exchange rate (US$)}

2000 2010 Singapore 663 2005 Malaysia 125 368 Thailand 66 179 Philippines 34 89 Indonesia 15 84 Vietnam 21 83 Cambodia 19 48 Lao 11 30 Myanmar 3 17 US 4703 8233 UK 1765 3495

Source: WHO World Health Statistics 2013

(10)

CAN ASEAN RESPOND TO THE CALL OF INCREASED HEALTHCARE DEMAND?

•   Most countries in ASEAN employ a mix of healthcare financing scheme.

Thailand, Vietnam, Philippines • Employed risk pooling through social health insurance schemes • Coverage remains low Lao PDR and Cambodia • Resource poor countries

• Relied mostly on donor-‐supported health equity funds

Malaysia and Singapore • Use a mix of

ﬁnancing schemes

• Involves saving schemes and provident funds

(11)

MEMBER STATE INITIATIVES TO IMPROVE NATIONAL HEALTH

•   Individually, the member states have made progress in a number of specific areas to improve their healthcare industries in their respective jurisdictions.

SingaporeMedicine: collaborative effort to promote the SG brand overseas MHTC: set up to develop and promote the healthcare travel industry

Signed MOUs with SG and Thailand on healthcare training and services Preparing to implement universal health coverage Moving towards universal health coverage with NHIP

(12)

THE ASEAN ECONOMIC COMMUNITY

•   The ASEAN Economic Community (AEC) aims to achieve economic integration through four pillars:

SECOND SECTION – INTEGRATION EFFORTS

Single market and production base Competitive economic region Equitable economic development Integration into global economy

(13)

AEC’S PROGRESS IN HEALTH CARE

•   Relatively more progress has been made in lowering trade barriers for healthcare in the region.

•   ASEAN has also identified non-trade barriers.

•   Mutual Recognition Agreements (MRA) – that would benefit consumers and

economic growth:

•   MRA on Good Manufacturing Practice was signed by all the ASEAN countries

in 2009

•   ASEAN Common Technical Dossier was also implemented in 2009

•   The MRA on the Post-Marketing Alert System (PMA) for pharmaceuticals has

been set up and the system has been used initially by Brunei, Indonesia, Malaysia, Singapore and Thailand

(14)

•   The ASEAN Medical Device Directive (AMDD) came out in 2012, and

implementation is expected by December 2014.

•   The ASEAN Harmonized Cosmetic Regulatory Scheme was signed in 2003.

•   The development of an ASEAN Regulatory Framework on Traditional Medicines

and Health Supplements and transposition of the ASEAN Regulatory Framework into

national laws of ASEAN Member States.

(15)

-200 400 600 800 1,000 1,200 2007 2010 2013 2016

Malaysia Singapore Thailand

851

425

1013 1692

1309 1293

Singapore Malaysia Thailand

2011 2016

15% 25% 5%

Medical Tourism Revenues in USD M and CAGR in % Number of Medical Travelers

(in Thousands)

Figure 7.

Trends in medical tourism in Singapore, Malaysia and Thailand

(16)

UNIDIRECTIONAL ACCESS TO HEALTH MIGRATION

Thailand, Singapore & Malaysia

•   ASEAN’s leading exporters of healthcare services

•   Developed competitive edge

Singapore, Malaysia, Brunei & Thailand •   Benefit from migration patterns

and are net labor recipients •   Exacerbating mobility of

(17)

BARRIERS TO INTEGRATION

THIRD SECTION – IDENTIFICATION OF BARRIERS & RECOMMENDATIONS

Socio-cultural Economic

Labor Policy Infrastructure

Poor economic conditions in some member-states renders them

uncompetitive and ill-equipped towards healthcare integration.

Inadequate infrastructure including weak regulatory capacity, particularly in less-developed

economies, limits the flow of investments and

promotes market inefficiencies. Shortage in personnel

providing basic healthcare needs of its respective population will exacerbate inaccessibility of healthcare in less-developed

countries.

Language barriers and cross-cultural gaps inhibits the cross-border medical practice and impede effective delivery of cross-border healthcare services.

O utr ig ht Po lic y Ba rrie rs ASEAN Healthcare Integration

Source: Accenture Analysis

Figure 8.

(18)

POLICY BARRIERS

•   Foreign equity restrictions.

•   Other legal barriers.

(19)

ECONOMIC BARRIERS

Country General Policy Financing Type Coverage

Indonesia ASKES Jamsostek (C) CBHI (V)

insurance scheme for civil servants

commercial insurance scheme (employer borne) social safety net program

20% of population Lao CCS (C)

SSO (C) CBHI (V)

social insurance scheme (coverage limited to pilot cities) community-based insurance scheme

5% of population Philippines PhilHealth (C) (G) social insurance scheme 75% of population* Singapore Medisave (C)

Medishield (O) Medifund (G)

individual savings scheme insurance scheme

social safety net program( endowment fund)

Universal Thailand SSS (C)

CSMBS

30 bahts Scheme

social insurance scheme

insurance scheme for civil servants social safety net program

13% 11% 76% Vietnam VSS (C)

VSS (V)

HCFP (scheme for the poor (G)

social insurance scheme for informal sector social safety net program

30% of population

Figure 9.

Financing schemes and coverage (% of Population) in ASEAN

Source: World Health Organization, “Social Health Insurance: Selected Case Studies from Asia and the Pacific, 2005”and “Regional Overview of Social Health Insurance in South-East Asia”, July 2004

(20)

ECONOMIC BARRIERS

THIRD SECTION – IDENTIFICATION OF BARRIERS & RECOMMENDATIONS 85 75 56 47 37 36 36 31 22 12 15 25 45 54 63 64 64 69 79 88 Brunei Thailand Malaysia Lao Vietnam Indonesia Philippines Singapore Cambodia Myanmar Government Private

Share in Funding of Health Coverage in Asean (in %) 0 10.1 0.7 5.5 38.4 17.4 25.5 15.5 0 1.3 Brunei Thailand Malaysia Lao Vietnam Indonesia Philippines Singapore Cambodia Myanmar

Social security expenditure on health as % of general government expenditure on health

98.9 55.8 76.8 78.2 93 75.8 83.8 87.8 75.4 92.7 Brunei Thailand Malaysia Lao Vietnam Indonesia Philippines Singapore Cambodia Myanmar

Out-of-pocket expenditure as % of private expenditure on health

Figure 10.

Distribution of healthcare funding in ASEAN

(21)

ECONOMIC BARRIERS

•   Even with liberalized markets, costs of healthcare in these countries will continue to be a burden

•   Higher costs due to transportation and follow-up treatments

(22)

HEALTHCARE

Co-‐Chair

Kenneth Mays

Senior Director of MarkeFng,

Bumrungrad InternaFonal

(23)

HEALTHCARE

(24)

Network ASEAN Forum 2013

HEALTHCARE

(25)

Source: International Monetary Fund (IMF), World Economic Outlook Database April 2013; World Health Organization (WHO), World Health Statistics 2013 Figure 1. Healthcare Spending and Health Profiles of

ASEAN countries

Healthcare Spending and Health Profiles of Asean Countries

2500 Singapore Myanmar Cambodia Lao Vietnam Philippines Indonesia Thailand Malaysia 100 600 1100 1600 -100 0 100 200 300 400 500 Mo rta lity R ate (N u m b er o f d ea th s p er 1 00 k)

Health expenditure per capita (USD)

(26)

Figure 2. Population and healthcare resource comparison across ASEAN

26 Source: United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Prospects: The 2012 Revision, CD-ROM Edition.;

0.4 5 6 14 28 52 66 89 93 241 Brunei Singapore Lao Cambodia Malaysia Myanmar Thailand Vietnam Philippines Indonesia 1.4 1.6 0.2 0.2 1.2 0.6 0.3 1.2 1.1 0.3 Brunei Singapore Lao Cambodia Malaysia Myanmar Thailand Viet Nam Philippines Indonesia 3.53 1.63 0.95 0.63 2.43 0.53 1.89 0.88 4.26 2.04 Brunei Singapore Lao Cambodia Malaysia Myanmar Thailand Viet Nam Philippines Indonesia 70.2 63.9 8.2 7.9 32.8 8.6 15.2 10.1 60.0 3.8 Brunei Singapore Lao Cambodia Malaysia Myanmar Thailand Vietnam Philippines Indonesia Population - 2010 (in millions) No. of physicians Per 1,000 pop No. of nurses Per 1,000 pop

No. of hospital beds

(27)

27

Figure 3. Percentage of population over 65 years old and life expectancy across ASEAN

Percentage of Population over 65 years old

9% 9% 4% 7% 5% 5% 5% 5% 4% 4% 21% 20% 13% 13% 10% _9% _9% _9% 6% _6% Si ng ap or e Th ai lan d Bru nei Vi etn am Mal ay si a In do ne si a My an m ar Cam bo di a Ph ili pp in es Lao 2010 2030

Life expectancy at birth (Male and Female)

60 62 65 65 66 70 71 72 75 78 55 60 63 59 63 68 70 69 73 76 Cambodia Myanmar Philippines Lao Indonesia Thailand Malaysia Vietnam Brunei Singapore 63 65 71 67 69 77 76 76 80 83 58 63 70 61 66 76 74 72 78 80 2000 2010

Source: United Naòns, Department of Economic and Social Affairs, Populaòn Division (2013). World Populaòn Prospects: The 2012 Revision, CD-‐ROM Ediòn; WHO World Health Sta`s`cs 2013

(28)

28

Figure 4. Indicators of lifestyle-related risk levels to health in ASEAN

Copyright © 2013 Accenture All rights reserved. 29 23 28 34 33 29 25 24 24 29 25 23 17 24 29 29 24 20 19 17 25 24 Vietnam Cambodia Lao Myanmar Indonesia Philippines Thailand Singapore Brunei Malaysia Asean

Prevalence of raised blood

pressure among adults aged ≥ 25 years (%) 1 2 2 2 3 5 5 7 9 10 2 2 3 4 6 7 8 12 6 7 18 4 Vietnam Cambodia Lao Myanmar Indonesia Philippines Thailand Singapore Brunei Malaysia Asean

Adults aged ≥20 years who are obese (%) Female Male 48 42 51 40 61 47 45 35 32 50 37 Vietnam Cambodia Lao Myanmar Indonesia Philippines Thailand Singapore Brunei Malaysia World

Smoking prevalence among males (%)

Source: WHO World Health Sta`s`cs 2013

(29)

32

Figure 5. Barriers to establishing an integrated healthcare sector in ASEAN

Socio-cultural Economic

Labor _Policy Infrastructure

Poor economic conditions in some member-states leads to funding challenges in healthcare and renders them uncompetitive for healthcare integration.

Inadequate infrastructure including weak regulatory capacity, particularly in less-developed economies, limits the flow of

investments and promotes market inefficiencies. Shortage in personnel and

limited access to know-how and technology contributes to inaccessibility of

healthcare in less-developed countries.

Language barriers and cross-cultural gaps inhibits the cross-border medical practice and impede effective delivery of cross-border healthcare services.

O u tr ig h t Po lic y Barriers ASEAN Healthcare Integration

Source: Accenture Analysis

(30)

33

Figure 9. Financing schemes and coverage (% of Population) in ASEAN

Country General Policy Financing Type Coverage

Indonesia ASKES Jamsostek (C) CBHI (V)

commercial insurance scheme (employer borne) social safety net program

20% of population

Lao CCS (C) SSO (C) CBHI (V)

social insurance scheme (coverage limited to pilot cities) community-based insurance scheme

5% of population

Philippines PhilHealth (C) (G) social insurance scheme 75% of population* Singapore Medisave (C)

Medishield (O) Medifund (G)

individual savings scheme insurance scheme

social safety net program( endowment fund)

Universal

Thailand SSS (C) CSMBS

30 bahts Scheme

insurance scheme for civil servants social safety net program

13% 11% 76% Vietnam VSS (C)

VSS (V)

HCFP (scheme for the poor (G)

social insurance scheme for informal sector social safety net program

30% of population

Source: World Health Organiza`on, “Social Health Insurance: Selected Case Studies from Asia and the Paciﬁc, 2005”and “Regional Overview of Social Health Insurance in South-‐East Asia”, July 2004

(31)

34

Figure 10. Distribution of healthcare funding in ASEAN

Copyright © 2013 Accenture All rights reserved. 85 75 56 47 37 36 36 31 22 12 15 25 45 54 63 64 64 69 79 88 Brunei Thailand Malaysia Lao Vietnam Indonesia Philippines Singapore Cambodia Myanmar Government Private

Share in Funding of Health Coverage in Asean (in %) 0 10.1 0.7 5.5 38.4 17.4 25.5 15.5 0 1.3 Brunei Thailand Malaysia Lao Vietnam Indonesia Philippines Singapore Cambodia Myanmar

Social security expenditure on health as % of general government expenditure on health 98.9 55.8 76.8 78.2 93 75.8 83.8 87.8 75.4 92.7 Brunei Thailand Malaysia Lao Vietnam Indonesia Philippines Singapore Cambodia Myanmar Out-of-pocket expenditure as % of private expenditure on health

Source: WHO World Health Sta`s`cs 2013

(32)

A STRATEGY FOR ASEAN. 22 nd to 23 rd August, 2013 Shangri La Hotel Singapore HEALTHCARE. Organiser. Co-Organiser

HEALTHCARE

HEALTHCARE

Moderator

Dr. Penny O’Hara

Partner, Accenture

HEALTHCARE

Sector Chair

Dr. Lim Cheok Peng

Managing Director, IHH Healthcare

HEALTHCARE

Co-­‐Chair

Mr. Kenneth Mays

Senior Director of MarkeFng

HEALTHCARE

Co-­‐Chair

Kenneth Mays

Senior Director of MarkeFng,

Bumrungrad InternaFonal

HEALTHCARE

Network ASEAN Forum 2013

HEALTHCARE

HEALTHCARE

Co-‐Chair

Co-‐Chair