digital healthcare in southeast asia - unimelb gmc 2016
Post on 15-Apr-2017
137 Views
Preview:
TRANSCRIPT
0 Digital healthcare in Southeast Asia
Global Management
Consulting
August 2016
At a glance
As regional growth in
Southeast Asia booms, its
emerging economies seek
for new innovative
solutions to their healthcare
delivery problems.
Digital technology presents
itself as an emphatic tool to
deliver better quality
healthcare in a more
efficient manner.
Digital healthcare in
Southeast Asia:
Bridging development
gaps between ASEAN
emerging markets and
developed economies
1 Digital healthcare in Southeast Asia
Table of contents
Executive Summary 3
Characteristics of emerging markets and it’s
impacts on business models 5
Population demographics 6
Medical talent 9
Infrastructure capacity 11
Private-public-partnerships potential 13
Sources of finance 14
Regulation and governance 15
The value of digital healthcare 17
A shift to a new value chain 18
The leapfrog phenomenon 19
An affordable, proven model 20
Model success and business implications 21
Cut-and-paste models just won’t stick 22
Innovative uses of EHR in emerging markets 23
Hub-and-Spokes model 24
Telemedicine: connecting care 25
Self-management health applications 26
Penetrating the world of Big Data 27
A macro view for micro decisions 28
Next Steps - The Philippines 30
Conclusion 33
Bibliography 34
Characteristics of emerging markets 2
Contacts
This report is the product of a collective of students from The University of Melbourne as part of
the Global Management Consulting program:
Sophie Broadway Jake Fava
Bachelor of Commerce Bachelor of Commerce
Accounting and Management Economics
Shenyuan Liang Ethan Lim
Bachelor of Commerce Bachelor of Commerce
Accounting and Finance Economics and Finance
Bianca Pollock
Bachelor of Commerce
Accounting and Management
3 Digital healthcare in Southeast Asia
Executive summary
Fraught with geographical and economic barriers to
entry, distributing a high quality healthcare system to the
middle and low income populations in Southeast Asia
presents a complex conundrum. Despite significant
economic progress in the past decade and increased
efforts to propel plans that further support healthcare
development, the quality of healthcare services in the
region’s emerging markets lags significantly behind
developed economies.
The source of healthcare development inhibitions
unravels as the national profiles of India, Indonesia,
Malaysia, Philippines, Thailand and Vietnam reveal both
raw opportunities and significant obstacles. Healthcare
investors looking to ride the economic growth wave in
Southeast Asia should be aware of several the region’s
demographic characteristics:
A middle-class uprising and ageing
populations: The large majority of the predicted
3 billion additional middle-income earners are
expected to be found in emerging markets over the
next two decades. This evolution of population
demographics will significantly influence
consumer demand in the sector.
Depleted labour market conditions: Not
only is the nurturing of local medical talent
insufficient to meet rising local health sector
demand, but many graduates seek better
opportunities overseas given better wages and
training opportunities.
A lack of necessary infrastructure:
Equipment directly and indirectly related to the
healthcare sector cannot meet the present and
future demands of the Southeast Asian
population, requiring the sector to explore more
efficient and affordable options without sacrificing
quality.
Characteristics of emerging markets 4
The rise of Public-Private Partnerships: Support in the provision and development of
healthcare has increasingly been sought from a mindset of synergising resources and
knowledge in the private and public sectors.
Insufficient and inefficient finance: Reliance on small bank loans and inadequate
public sector funding has impeded sector growth and calls for new financing sources.
Fragmented business and healthcare regulation: Legal systems are still developing a
coherent and sophisticated legal structure supported with effective enforcement, with many
nations yet to establish specialised legal protection for industry developments such as
eHealth.
Developed economies lead the way in innovatively integrating digital technology and healthcare as a
means of further advancing their healthcare sectors. The exponential development of digital
applications has seen all branches of the health industry integrate digital operations and networks
into production and provision. From sophisticated Electronic Health Records (EHRs) to the
provision of health services through online communications and mobile applications, the birth of a
new era in healthcare provision reveals unprecedented benefits for all those who harness the
technology.
However, a “cut-and-paste” approach to the models of the developed world is met with severe
resistance. Built for well-resourced nations with sophisticated healthcare industries, these models
do not accomodate the fundamental characteristics of Southeast Asia’s emerging economies.
Transplanting them into Southeast Asia’s regional economic body would see them rejected by
market forces.
This is not to say digital technology would completely fail in the region. On the contrary, it calls for
innovators to mould and develop new applications of digital technology that diagnose and treat the
symptoms experienced by the region’s health system, considering the sector’s demographic, legal
and economic environment within the respective Southeast Asian nation.
Many companies have already successfully built digital business models that address issues relating
to their host nation. All have utilised the available digital resources to maximum efficiency in order
to address small, intricate issues within the healthcare system and seek to expand their operations
within and outside their headquartered nation. Potential entrants to these markets should look to
those who have achieved success, building on their progress and filling the gaps in health sector
development in Southeast Asia’s emerging markets.
Of all the emerging nations, the Philippines presents itself as the shining light for healthcare
investors. Whilst the nation lags its own regional neighbours in many facets, it has engaged in a
redevelopment phase, working with businesses and other countries to accelerate its development
and converge with newly established regional standards. Given the Philippines’ geographic
fragmentation, a model that increases connectivity and accessibility to all its islands is a necessity
for future development, providing unique potential for innovators and investors.
5 Digital healthcare in Southeast Asia
Characteristics of
emerging markets
and it’s impacts on
business models
Emerging markets are characterised by their economic potential. As
these markets transition from once under-developed economies,
overall population welfare rises and prompts greater demand for
quality good and services – especially for healthcare as a stable of
sustaining a quality lifestyle. This provides an incentive for
entrepreneurs to chase the market gaps where supply does not meet
demand. However, to take advantage of the emerging market
potential, business models need to be customised for various factors
that differ to that of developed markets. The population demographics,
lack of talent and infrastructure, access to finance and uncertain
regulatory demands mean that business models need to adjust to
capture the opportunities and combat the challenges of Southeast
Asia’s emerging markets.
Characteristics of emerging markets 6
Population demographics
The volatile demographics of emerging markets mean market segments and consumer preferences
are changing rapidly. Emerging markets differ from developed economies due to their population
growth, their capacity to handle population aging, the urban-rural distribution of the population and
the growing middle class. These four key demographic factors differentiate emerging markets from
developed markets, making the application of developed market business models futile.
Population growth
By the year 2050 developed
markets within Asia are
forecasted to have reached
their population peak and
start to plateau, or even
decline (see Figure 1.1). In
stark contrast, many of the
emerging markets’
populations are snowballing
rapidly.
Given already insufficient
infrastructure cannot develop
at the same rate as population
growth, the strain on
resources presents a
significant challenge for the
healthcare sector of growing
emerging markets.
Consequently, business
models in these markets
should prioritise efficiency
and scalability. If managed
effectively, the growing
market presents an
opportunity for businesses to
utilise economies of scale,
keeping costs low and
servicing a wider market.
Population aging
As shown in Figure 1.1,
Thailand and Vietnam’s
growth in population shadows
the trends of developed
Asian-Pacific markets, with
Thailand’s population
forecasted to peak between
2025-2030 and Vietnam
beginning to plateau by 2050.
Thailand and Vietnam’s aging
population are the catalyst for
this trend, with the portion of
the population aged over 65
7 Digital healthcare in Southeast Asia
expected to triple by 2050
(see Figure 1.2). Business
models therefore need to be
tailored to an older market,
responding to the shift in
consumer preferences by
focusing on accessibility and
user-friendliness to ensure
the needs of elderly
consumers are met.
Aging populations place a
large strain on healthcare
infrastructure, therefore a
niche exists in these
economies for affordable,
innovative solutions that can
alleviate this strain, especially
through education and by
enabling care to be provided
by means other than
traditional healthcare
providers (such as mobile
apps and wearables).
Urban-rural
population distribution
The large rural population in
emerging markets makes
accessibility a challenge for
businesses. With the rural
percentage of the population
reaching as high as 67% in
India and similarly high levels
in Vietnam, Philippines and
Thailand (see Figure 1.3),
innovative distribution
models need to be a greater
priority than in developed
markets. When designing a
business model in these areas,
half of the population cannot
be ignored – especially for an
industry as indispensable as
healthcare. Therefore,
digitising processes and
making more efficient use of
existing resources is key to
increasing the reach of
organisations, without major
capital outlay.
Rise of the middle class
The increasing proportion of
middle class in Southeast
Asian emerging markets
provides an incentive for
private organisations to enter
the market to satisfy
increased consumer
expenditure. As the middle-
class of the Asian-Pacific
region are expected to
dominate consumer demand
within the next 50 years (see
Figure 1.4), consumer
expectations shift from simple
access to healthcare to quality
healthcare services.1 Private
companies face significant
potential for success by
leveraging the opportunity
presented by consumers’
increased willingness to
spend in the Asian-Pacific
region.
Rising per capita wealth also
alters the healthcare needs of
the market, with Asia
expected to experience the
highest levels of non-
communicable deaths by
2020.2 Additionally, with 66%
of the global middle class
forecasted to belong to the
Asia-Pacific region by 2030,3
power significantly shifts
towards consumers, meaning
business models will need to
adapt to local consumer
preferences to capitalise on
these opportunities.
Characteristics of emerging markets 8
9 Digital healthcare in Southeast Asia
Medical talent
The existence of highly-skilled talent is widely considered to be one of the top indicators of
determining a country’s competitive aptitude and success.4 However, in recent times the insufficient
access to and retention of this talent has materialised into a world-wide crisis.
Recent research postulated
that by the year 2020, the
global shortage of highly
educated individuals could
reach up to 40 million, with
the gap in the healthcare
sector already reaching 7
million.5, 6
Emerging markets
represent over one-third of
the countries that are severely
impacted by this shortage,
with Southeast Asian nations
suffering in crisis
proportions. 7
Human capital is the core of a
country’s healthcare system,
however this component of
the health-system is often
neglected in emerging
markets.8 The World Health
Organisation (WHO)
stipulates that there should be
a minimum ratio of one
doctor per every 1000 people,
nevertheless this is often not
satisfied (see Figure 1.5), with
the severe lack of physicians
posing as a major obstacle in
many countries.9
When juxtaposing Japan’s
level of talent with Thailand
or Indonesia in Figure 1.5, the
talent gap is clearly
discernible. It is therefore
apparent that a business
model that mirrors that of a
developed country will be
ineffective in an emerging
market due to significantly
less skilled human resources.
With high exportation of
medical talent, an increase in
population growth and non-
communicable diseases, and a
stark disparity in rural-urban
distribution,7 the lack of
quantity of talent is
exacerbated. Pioneering
solutions are essential to
address these dynamics.
Emerging markets also suffer
because of unsustainable
high-quality healthcare
delivery.10 Despite absolute
strategic importance, there is
seldom sufficient funding for
education and often out-dated
delivery methods. Thus,
emerging markets are not
producing the quality of
education the industry
requires.
Characteristics of emerging markets 10
Furthermore, there is often an
incongruity between training
and real-life practice, a
shortage of qualified
instructors to impart
knowledge and a weak or
non-existent continuing
medical educational system,11
making it difficult for
physicians to keep up-to-date
with the latest medical
advances. Figure 1.6 portrays
several high-level education
rankings in Asia, exemplifying
the inadequate education
methodologies in many
emerging markets. Therefore,
despite recent evidence
suggesting that there have
been attempts to improve
technical and vocational
training in these countries12
the need for innovation is still
crucial as emerging markets
cannot meet this demand in
the short term.
11 Digital healthcare in Southeast Asia
Infrastructure capabilities
The current infrastructure in Southeast Asian emerging markets is insufficient to keep up with the
rapid development of the regional economy. According to Business Monitor International (2016), a
chosen sample of Brunei, Cambodia, India, Indonesia, Laos, Myanmar, Philippines and Vietnam
revealed a constant average healthcare expenditure level of 3%-4% of regional GDP. This is despite
significant population growth and aging population concerns.
Infrastructure deficit and
quality problems in Southeast
Asia’s emerging markets have
not dissipated over the
decades. Rankings of the
infrastructure quality
revealed a 40% gap between
Southeast Asia’s emerging
economies and the developed
nations of the US, China and
Japan.14 Underinvestment
follows unprecedented growth
in population size and income
over the past two decades in
emerging Asia-Pacific
nations. There is need for
significant improvement in
infrastructure if such nations
are to achieve and sustain
healthcare quality levels of
the developed world.
Not excluded from this
infrastructure chasm are the
hospital facilities and Internet
infrastructure of Southeast
Asia’s emerging nations, both
of which are imperative to the
development of digital
healthcare and convergence
to developed economy
standards.
Healthcare
infrastructure
Many of the economies in
Asia’s emerging markets are
struggling with a relatively
underdeveloped public
healthcare system. As a result,
the region has a chronic
shortage of hospital beds and
Characteristics of emerging markets 12
problems regarding hospital
distribution.
As shown in Figure 1.7 the
number of hospital beds per
thousand persons in emerging
markets is significantly less
than developed countries. To
meet the standards of
developed economies,
extensive investment into the
health sector is necessary but
excessively expensive. For
example, India urgently needs
to add 100,000 beds this
decade, at a prodigious
investment of $50 billion.15
Digital infrastructure
Mobile phone and Internet
subscription are imperative
for successful implementation
of digital healthcare in any
economy, including mobile
health. However, there is a
profound difference in digital
network infrastructure
accessibility between
developed and emerging
market countries.
In recognition of this
concerning disparity,
government investment into
Internet and mobile
broadband infrastructure has
seen it develop with pace in
recent years. As demonstrated
in Figure 1.8, emerging
markets have recently
exceeded the developed
markets in terms of mobile
cellular subscription, as well
as in other facets of digital
infrastructure
implementation. Forecasts
predict that India, China and
Indonesia will be the sources
of the most dynamic growth
in digital consumption.16
Implication for
business models
Financially, many of
Southeast Asia’s emerging
economies will struggle for
some time to fill the
infrastructure deficiency.
Rather, these nations need to
find affordable and more
efficient options that can help
to meet patient demand until
those gaps are filled.
Digital healthcare provides
such an opportunity. The likes
of mobile health means more
patients can be treated at
home rather than visiting a
medical practitioner in
hospital. This would reduce
the pressure on hospital beds
as more patients can be
treated at home.
Furthermore, the rise in
digital infrastructure growth
means that
the
capabilities of
digital
healthcare are
ever
expanding,
with an ability
for high
quality digital
technology to
be used in
urban and
rural areas.
13 Digital healthcare in Southeast Asia
Public-Private-Partnerships potential
The recognition of necessary interdependence between the public sector and private sector rapidly
expanded the formation of Public-Private-Partnerships (PPP) in many countries. Government alone
could not suffice the required improvements in every area and private players found entry into an
unregulated market too uncertain and expensive. In order to improve domestic healthcare services
and lower the financial burden, a PPP provides a win-win situation.
According to The World
Bank’s database (see Figure
1.9), China and India has been
the frontrunners in PPP due
to strong support from the
government, whereas
Malaysia and Philippines are
leading pioneers in Southeast
Asia regions.17 Government
support region-wide is
strengthening and their
perception of private players
in healthcare has changed.
Governments are seeking
active participations from the
private sectors by relaxing
regulations, thereby opening
more opportunities for
investors. For example, China
and India now allow 100%
foreign direct investments
(FDI) of hospitals.
Furthermore, the percentage
of FDI in healthcare has been
continuously growing in many
emerging countries.18
However, challenges still exist
for investors. The PPP
generally with long-term
commitment, where some
contracts established for up to
30 years. Additionally,
government transparency
within the Asian-Pacific
region is problematic, with
some investors unconfident in
in the integrity of government
given relatively higher levels
of corruption in the Southeast
Asian region.19
Characteristics of emerging markets 14
Sources of finance Globally, the healthcare sector
has been growing at about
3.6% each year, with growth
rates of emerging markets
higher than developed
markets.20
However, despite rapid
growth, businesses still find
difficulties in accessing
finance, relying on small local
bank loans as their main
source of financing. There is
some support from non-
government organisation
(NGO’s) and non-for-profit
organisations (NPO’s), as well
as donations and some direct
FDI, but these contributions
are typically small.21
Furthermore, government
support and expenditure in
the healthcare sector is
insufficient to meet total
demand. Several governments
of emerging markets are
presently experiencing budget
deficits and difficulties in
managing inflation and public
debt.22
Naturally, under these
circumstances, out-of-pocket
healthcare expenditure levels
tend to be high and
expenditure is more focused
on private sectors. Figure 1.10
reveals a stark contrast
among Asian countries: More
developed countries show
higher proportion of public
healthcare expenditures and
lower out-of-pocket
expenditures, whereas
developing countries reveal a
reversed trend.
Overall the above findings
suggest an untapped
opportunity for investors. The
healthcare sector’s reliance on
private providers and high
out-of-pocket expenditure
with rapid growth rate
exposes a profitable
investment opportunity.
Nevertheless, there are
challenges to be resolved.
Most investors are unaware of
the healthcare market in
emerging countries and
perceive such opportunities
risky, even though healthcare
industry is less volatile during
economic downturns given its
nature as a necessary service.
In addition, the fragmented
nature of healthcare
businesses in emerging
markets further complicates
investment. In developing
countries, most services are
provided by multiple
fragmented small-medium
enterprises,21 meaning that
profits are either drawn from
a small niche in the supply
chain, or significant
investment is required to
disperse and integrate
services across multiple
functional and geographical
dimensions of a nation’s
healthcare sector.
15 Digital healthcare in Southeast Asia
Regulation and governance
Political, legal and economic development is staggered throughout Southeast Asia. Where the likes
of Singapore mirror the living standards of Western developed nations, other nations such as
Myanmar and Laos are only beginning to refashion their economies.
However, Southeast Asia is presenting itself as a prime region for investment among the emerging
market realm. Economic growth of Southeast Asia’s emerging economies is forecasted at 5.2% over
2016 to 2020 – lead by the Philippines – as the region seeks to boost living standards.23
Ease of Doing Business
The World Bank’s Ease of
Doing Business 2016 report
exposes the diversity of
economic and legal
development in Southeast
Asian emerging economies.
Middle-income nations such
as Malaysia and Thailand,
whilst still resolving gaps in
their legal and economic
framework,24 have made
significant reforms that rank
them highly against the rest of
the developed world. Whilst
the nations of Vietnam,
Philippines and Indonesia
struggle to make the next step
towards a developed
economy, given inefficient
legal institutions and
lacklustre legal
enforcement.25
Health and privacy
laws
Where developed nations
such as the United States have
started to build new digital
health laws atop their
fundamental privacy and
industry legal framework,
Southeast Asia has made
lesser progress. Much of the
basic and intermediate
privacy, security and industry
regulation remains
fragmented,26 requiring
businesses and the judicial
system to rely on intertwining
non-specific acts and
inferring legality of actions.
For example, Sarabdeen and
Ishak discovered that even in
the relatively sophisticated
legal environment of
Malaysia, the country does
not enforce a specific,
comprehensive act regarding
privacy in e-health data.27 As
a result, intimidation sets into
the decisions of businesses,
especially foreign companies
unaccustomed to the legal
operations in Asia’s
developing nations, who are
considering new business
ventures in Southeast Asia.
The ambiguity is inherently
inefficient for economies who
are pursuing new ways to
propel their progression in
heath and economics to
developed standards.
Intellectual property:
no peace of mind
The legislative gaps do not
preclude intellectual property
laws in emerging Southeast
Asian economies. Not only are
such systems generally
underdeveloped, but a lack of
skilled and experienced
human resources, lacklustre
legal enforcement and
relatively minimal awareness
of the importance of
intellectual property rights for
economic growth has
stemmed its effectiveness in
ASEAN emerging
economies.28, 29 A lack of
confidence in the
enforcement of intellectual
property protection will
deteriorate business
investment, as domestic and
foreign investors alike are
likely to look at safer options
first when developing digital
healthcare technology.
Opportunities
Despite booming regional
growth, the ASEAN
community has become
increasingly aware that
continued development,
standardisation and
harmonisation of economic
policy is required to sustain
future progress. In response,
the ASEAN Economic
Community (AEC) was wholly
established in 2015, pursuing
the three overarching goals of
a single regional market,
equitable regional economic
Characteristics of emerging markets 16
development and regional
globalisation.30
The AEC mutual policies open
several opportunities for
greater domestic and foreign
direct investment, wider
inter-regional trade and more
favourable foreign trade
policies across many sectors,
including healthcare and
related sub-industries. For
example, the AEC plan to
initiate a ‘Single Window’
policy for Customs, where
subsequent Customs checks
on foreign goods that
circulate through the AEC
region will no longer occur
after a first initial check.31
It is widely acknowledged that
different countries are at
different stages of
development – the likes of
Thailand and Vietnam lag the
relatively comprehensive legal
frameworks of Singapore and
Malaysia. Furthermore, small
and medium enterprises
(SMEs) in the ASEAN region
are largely seen as
unknowledgeable and ill-
prepared given the
expectation of trade
legislation reformation over
the coming years.32 However,
the AEC is accommodating by
working with individual
countries to educate,
distribute information and
make it more accessible.
17 Digital healthcare in Southeast Asia
The value of digital
health care
The health sphere has experienced a great shift in their value chain by
moving to a more patient-centric focus. With this has come the
growing need to harness the increasing digital consumption and
resources that already exist in emerging markets. Digitalisation has
become the key to success in the recent decade by encouraging more
efficient and cost-effective delivery processes, and is likely to be key to
combating the healthcare issues experienced in Southeast Asia’s
emerging markets.
The value of digital healthcare 18
The shift to a new value chain
This century has seen
digitalisation flourish,
catalysing the emergence of a
completely new healthcare
value chain by changing the
way healthcare is delivered,
how patients are treated and
how data is managed.33, 34
With the increasing influence
of disruptors in the healthcare
environment there has been
great pressure for a surge of
innovation. This has resulted
in an expansion in
individualising patient care
which has markedly increased
the personalisation and
efficiency of delivery.35
The move to this
individualised system starkly
contrasts the traditional
system (see Figure 2.1), where
consumer options were quite
stringent in terms of their
providers, payment method
and insurance policies.36 A
recent RAND Corporation
study revealed that only
54.9% of recommended care
was prescribed to adults,35
highlighting the importance
of digitalisation given the
complexity and intricacy of
patient care and the flaws
underlining standardisation
within the traditional system.
Figure 2.1 demonstrates the
movement to an ecosystem
where delivery, research and
development, suppliers and
new entrants centre around
the patient and depicts how
emerging markets can
successfully mobilise and
coordinate this new
ecosystem.37 Although
digitalisation will not
decrease the scarcity of talent
or infrastructure in emerging
markets, it will connect
existing doctors to meet the
demand of the most deprived
and burdened areas. This can
be done by powerful health
platforms such as wearables,
cloud and data analysis that
permit a wider range of
accessibility, a deeper
knowledge for both the
provider and the consumer
and the ability to free up vital
healthcare resources.9, 38
The personalisation of
healthcare and the use of
digitalisation is the crux of the
healthcare challenge in
emerging markets as it will
sanction billions of new
people to be empowered by
this new ecosystem.39 Proper
design of digitalisation has
also enabled better patient
outcomes, a lower error in
diagnosis, greater
convenience and reduced
healthcare costs,35, 40 which
highlights the importance of
its adoption in emerging
markets.
19 Digital healthcare in Southeast Asia
The leapfrog phenomenon
The era of digitalisation has
sparked innovations in
emerging markets to respond
to the unique environmental
dynamics, creating an
economy-wide phenomenon
known as the “leapfrog
effect”. The leapfrog
phenomenon suggests that
the innovations implemented
in emerging markets may
eventually replace the
outdated technology
engrained in developed
healthcare systems.41., 42
Necessity breeds innovation
in emerging markets, often
resulting in more affordable,
accessible and high-quality
healthcare delivery.
Entrepreneurs can devise
these innovations by starting
with a blank slate. From this
they must consider how to
radically reduce expenses and
force innovation, thriftiness
and a sophisticated
understanding of the
environment.
This leapfrog effect was tested
with patients in Boston, who
were treated for HIV via a
program that was developed
in rural Haiti. The result was
a 40% decrease in medical
expenses,43 whilst
maintaining, if not improving,
the quality of treatment.
Thus, there is a potential for
emerging markets to bypass
development stages and
sidestep the pitfalls of these
entrenched systems.37
The value of digital healthcare 20
An affordable, proven model
Digitalisation has changed
people’s lifestyles and
revolutionised countless
industries. Now the world is
entering a ‘convergence’ era
where industries are
propelled into furthered
progress and reform via the
implementation of digital
technology. For example,
retail markets have
thoroughly shifted toward
online market, whilst fintech
and smart devices present
new frontiers never seen in
markets. Such innovations
improve market efficiency
and lower costs of businesses.
Within the healthcare sector,
digitalisation has introduced
telemedicine to emerging
economies - a new form of
healthcare provision
developed over the past five
years. By providing health
services via phones or other
digital communication
devices, the customer base
can expand dramatically as
the technology overcomes
geographical constraints.
Founder and CEO of
HealthCursor Consulting
Group spoke of how “remote
healthcare can give hospitals
better ROI. The telemedicine
centre that cost you 125,000
rupees ($2,120 USD) can give
you 25 percent margins by the
end of the year”.44 As a result,
telemedicine model has seen
rapid expansion among
hospitals or private
companies.
In addition to the benefits
digitalisation brings to the
healthcare sector,
continuously falling prices of
electronic goods and services
has supported the
digitalisation process. The
below data retrieved from the
US Bureau of Labour
Statistics (see Figure 2.2),
shows the steady decreasing
price level of most goods and
services in US. As
digitalisation becomes
increasingly common, the
price of these goods has
subsequently decreased,
making the service more
affordable and increasing the
implementation of
digitalisation in emerging
markets.
21 Digital healthcare in Southeast Asia
Model success and
business
implications
Asia’s developed markets have successfully implemented the complex
digital healthcare models seen in Western society, with Singapore’s
National Electronic Health Record (NEHR) leading the way.
However, the internal struggles of the emerging markets of Southeast
Asia rules out similar implementations of a “cut-and-paste” business
models for disturbers in their healthcare sectors. A tailored, bespoke
approach that addresses specific problems in Asia’s emerging
economies, whilst drawing from each nations strengths and
integrating neighbouring markets is essential for the successful
implementation of digital healthcare.
Model success and business implications 22
Cut-and-paste models just won’t stick
Singapore and South Korea as
developed Asian countries
have produced a sophisticated
digital healthcare
system. Singapore’s National
Electronic Health Record
System (NEHR)
systematically saves complete
patient health records and
conveniently shares it with
healthcare service providers.
However, the system’s
development laboured for
four years in order to prepare
and initiate the system,
representing a huge cost to
the nation. In fact, a cost-
benefit analysis revealed that
the breakeven point of the
NEHR will not be reached for
another 9 years.45 Whilst the
benefits will be immense for
Singapore, the system
presents an unfeasible
financial and time burden for
emerging markets.45
Additionally, digitisation at
the primary practitioner level
is immensely expensive.
According to a medical
economics report, U.S.
primary practitioners
experienced an average cost
of $162,000 to implement
health record systems, with
another $85,000
maintenance expense for the
first year.46
However, the problem runs
deeper than the cost of
implementation.
Fundamental gaps in every
aspect disrupt utilisation of
Information Communication
Technology (ICT) in
developing countries. Figure
3.1 demonstrates the gaps in
every pillar.
The lack of infrastructure and
talent results in very low
uptake of ICT in the
government, business, and
household sectors. Thus, the
potential impact of the ICT
will also be relatively lower.
However, with regards to the
affordability of ICT, emerging
countries show strength given
to cheap labour forces and
affordable market prices.47
Nevertheless, there still exists
examples of successful
businesses that changed the
healthcare sector in emerging
markets by introducing
digitalisation with
modifications. Successful
businesses used strategies
that incorporate the
characteristics of developing
countries, using unique
approaches to overcome
constraints.
23 Digital healthcare in Southeast Asia
Innovative uses of EHR in emerging markets
Whilst a fully integrated nation-wide EHR system may not be feasible for emerging markets given
their current level of infrastructure, certain innovative businesses are working to extract some of the
benefits of EHR without the large capital outlay. eKincare is one such example, using Personal
Health Records (PHR) as a means of facilitating the storage and transfer of medical records.
The value chain in healthcare
is becoming increasingly
patient-centric, changing the
way healthcare providers and
disrupters structure their
services. eKincare, an Indian
start-up, has used this
concept to develop their
business model which
facilitates patients’ ability to
consolidate their own PHR’s
and store them in cloud-based
software, extracting some
benefits of an EHR system at
a more affordable price.
Primary research conducted
by eKincare’s founder, Kiran
Kalakuntla, revealed 87% of
individuals in India were
interested in digitising their
medical records either for
themselves or their aging
parents who may live
elsewhere.48 However, these
individuals were unwilling to
spend time filling out forms to
establish the record or pay for
the data storage. eKincare
mitigates these issues by
making the platform
completely free to use, with
no data limitations. Its
differentiating feature from
other PHR apps is its user-
friendliness; Once the user
has photographed and
uploaded the pictures of their
documents, eKincare then
translates the medical jargon
to a more accessible format,
updating the patients’
healthcare record in real time
and highlighting potential
health risks.
eKincare’s monetisation
strategy is to then use this
data to offer in-app purchases
or connect the user with a
specialist based on their
medical information.
eKincare has developed
partnerships with
practitioners and specialists
at over 1,500 locations across
India,49 enabling them to
recommend the appropriate
specialist based on the users’
health needs and provide
price discounts. These
practitioners have access to
the users’ medical records and
can track their health
remotely, allowing the
healthcare provider to
increase efficiency yet provide
a better quality of care due to
greater access to patient
information. The concept has
been recognised for its
innovation and social impact,
notably acknowledged in the
Global Digital Health 100
Award List for 2015.50
eKincare is gaining
momentum in India due to
the high volume of the
population with access to a
smartphone or PC and the
growing need for consumers
to manage their own health to
lessen the strain on the
healthcare infrastructure.
Countries with similar
demographics and consumer
needs, such as the
Philippines, where the
population is growing at an
expeditious rate, may also
reap the benefits of a similar
PHR platform. Another
aspect of eKincare that has
contributed to its success in
India is its ability to enable
users to monitor the health of
family members in addition to
their own. Vietnam and
Thailand’s aging population
could also be receptive to this
concept.
Model success and business implications 24
Hub-and-Spokes Model
It is said that necessity is the mother of invention – India’s ability to develop an innovative model of
healthcare distribution is a prime example of how this is true. The Hub-and-Spokes Model (HSM)
ensures affordable healthcare is accessible to the rural communities who are in dire need.
In India, only one fifth of
healthcare expenditure is
publicly financed and 70% of
workers in rural areas earn
just $3 a day.51 Medical care is
often non-existent or
insufficient in these rural
areas and transport facilities
are poor, limiting access to
the medical care facilities that
are sufficient.
This presents
a huge
challenge for
the healthcare
industry to
provide
services to the
67% of the
population
living in rural
communities
(see Figure
1.3).
HSM models
overcome this barrier
by increasing the
efficiency of existing
resources. This is
done using a central
hub where specific equipment
and doctors treat specialised
cases, and spokes located in
rural areas which provide
basic care. The innovation of
this model lies in the hub and
the spokes ability to
constantly communicate
using ICT. Patients with
specialised needs can then be
referred to the hub, where
their patient information and
history will have been
provided using ICT, enabling
the specialists at the hub to
provide a better quality of
care in less time. The
organisation is able to
increase the provision of
healthcare over a wider
geographic area and reduce
costs by using expensive
resources more efficiently in
the hub, avoiding the need to
replicate these resources in
the rural areas.52
ICT is paramount to being
able to keep the connectivity
between the hub and the
spokes and increase the
efficiency of both parties. The
healthcare workers at the
rural clinics are equipped
with devices such as laptops
connected to a secure
network, including wireless
network cards designed to
work in low connectivity
areas. The devices may also
come encrypted with defined
procedures and process flows
to maintain the quality of
care, security
features to
maintain the
integrity of patient
information, and
communication
tools such as
email, text and
instant messaging
to contact the
hub.51
HSM has the potential to
apply to other emerging
markets with similarly large
rural populations, however
this model of healthcare
provision would crumble
without the necessary ICT
facilities and proper usage. It
is therefore no coincidence
that this model is so
successful in India, which has
the highest rate of ICT literate
graduates and healthcare
workers as well as the most
affordable ICT infrastructure
and devices.51
25 Digital healthcare in Southeast Asia
Telemedicine: connecting care
Emerging markets require the
distribution of knowledge to
extend accessibility and
improve the provision of
diagnosis and treatment.
Telemedicine is one possible
avenue by repurposing
already existing infrastructure
to also increase
standardisation of care,
enable better decision-making
and improve labour force
efficiencies.41, 53
Despite some key
characteristic differences
between Southeast Asia’s
emerging markets, all could
experience the positive
impacts of telemedicine.
Figure 3.2 hypothesises just
how powerful the benefits of
telemedicine would be for the
US. These positive
externalities will be far more
intense in emerging markets,
as it can help the sector to
expand the patient base,
reduce overheads and
transport costs, minimise
brick-and-mortar rural
expansion costs and eliminate
follow up visits. This all
makes vital resources more
accessible.39, 54
Lifetrack medical
systems
One company that has reaped
the benefits by implementing
telemedicine is Lifetrack
Medicial Systems, a radiology
company based in Philippines
that innovatively embraces
telemedicine to address the
lack of resources. In a country
where 56% of its population is
situated in rural areas (see
Figure 1.3) it is crucial for
timely diagnosis and
treatment to avoid a deadly
bottleneck in medical
workflow.55 To access this
sub-population, Lifetrack
pairs an apprentice, often in
rural locations, to an expert
practitioner through a
digitalised feedback system.
This enables remote reading
of medical images as the x-
rays can be accessed and sent
to wherever a qualified
professional is available for
prompt analysis.55
Model implications
The advent of this technology
has improved efficiency by
encouraging timeliness and
quality of diagnosis. Further,
when looking at radiology
from a global perspective, the
acceptance of digitalisation
has reduced the demand for
overburdened radiologists by
roughly 20% in the last
decade.56 This highlights how
important the acceptance of
digitalisation is in emerging
markets from both a
consumer and provider
perspective.
Businesses could also analyse
the success of this model to
extrapolate the need of other
subdivisions in the industry.
Asian emerging markets,
particularly those with a
higher rural to urban
distribution such as the
Philippines, often experience
serious health complications.
Yet they are some of the most
deprived countries in the
world for other specialisations
– for example, pathology.56
Therefore, Southeast Asian
emerging markets represent
the most fertile ground for
digitalisation and
telemedicine, as it would
facilitate a more collaborative
global health ecosystem,
guaranteed improved patient
outcomes, reduced cost
inefficiencies and lower
occurrence of adverse or
preventable events.54
Model success and business implications 26
Self-management health applications
Under-resourced economies
in Southeast Asia face an
uphill battle to source the
financial resources necessary
to overhaul the accessibility
quality of their healthcare
systems. However, other
cheaper and effective
alternatives can be utilised by
these nations to boost the
effectiveness of the healthcare
sector in the short run whilst
the nations focus their
attentions to the long-run
solutions.
Self-management digital
health products are starting to
be implemented as a means of
reducing strains on healthcare
resources for common and
mild health issues. What
started as simple Google
searches for symptoms has
been consolidated into a more
reliable and updated data
bank with easy to understand
information. Simple
sanitation tips, proven
medical remedies, symptom
flags and digital treatment
schedules all help for an
individual to take better care
of themselves without
unnecessary aid from the
healthcare sector.
iClinic in India
iClinic, an Indian start-up
working with hospitals and
pharmacies in distributing
high quality healthcare
services to the general public,
have established their own
supplementary self-
management services on their
flagship website. A symptom
checker section allows
patients to input some basic
symptom information to learn
of a number of possible
illnesses they may be
suffering and provides scope
on details surrounding each
suggested diagnosis. An
online forum also publishes
authorised articles written by
doctors and patients alike,
providing a more detailed
description of several
illnesses.
The benefits of iClinic are
immense. Crucially, the
savings to consumers who
have the option between
expensive physical general
practitioner consultations and
a cheaper self-managed
mobile service for mild to
intermediate symptoms can
widen access to high quality
healthcare in Asia’s emerging
markets.
Other mobile application
health providers are also
adding self-management
capabilities. Aside from its
cloud-based personal health
records system, Singapore
start-up Vitalstrak provide a
mobile system that allows
users to input their
medications and set
reminders via the app, SMS or
e-mail service. Patients can
also record basic symptoms
into the app to take (or send)
to a doctor for diagnosis.
Model implications
One of the model’s most
important features is its
ability to integrate with other
forms of telemedicine and
digital health care services.
The model works best as a
complementary portal of
information that people in
need rely on first. If the self-
management service cannot
provide the relevant
information, be it a more
detailed diagnosis and
treatment plan to a new drug
prescription, patients can be
referred to the relevant source
provided the business model
integrates with other digital
health models.
This not only builds a digital
medical network that
consumers can tap into at any
time, but it allows developers
to connect a low-revenue
product that is digital self-
management products to
chargeable digital medical
services such as online doctor
consultancy and drug
purchases. Repeat customers
are established through this
complementary service given
consumer convenience and
product familiarity. This
approach is taken by most
telemedicine mobile
applications as they build a
self-management section into
their primary model if
medical assistance provision.
27 Digital healthcare in Southeast Asia
Penetrating the world of big data
Digitalisation can allow
pertinent data to be
aggregated and analysed
almost instantaneously. This
collation can assist in forming
a greater knowledge of future
trends and provide more
accurate and appropriate
diagnosis and treatment. One
way to penetrate the world of
big data to provide timely and
accurate solutions is through
artificial intelligence.
IBM Watson
Medical data is forecasted to
double every 73 days by 2020,
however 80% of data is
invisible or unstructured to
current systems, despite
three-quarters of the
information being clinically
relevant.57 IBM Watson is a
pioneering system that
creates a heightened level of
interaction between humanity
and technology with the
objective of redefining and
transforming global health.57
It is also a secure cloud-based
system that can promptly
analyse this previously hidden
data in light of modern
leading medical literature,
electronic health records and
other qualified physician’s
opinions.
Model implications
Recent research conducted by
IBM Watson demonstrates
that 81% of healthcare experts
that are familiar with the
innovation believe that it has,
and will, provide a positive
impact on their business and
the health environment. This
innovation would provide
even greater benefits for
patients who live out of the
reach of world-class medical
healthcare providers; by
migrating to a cloud-system,
emerging markets would have
access to the same tools and
solutions as their wealthier
counterparts.58 This will allow
physicians in Asia’s emerging
nations to have instant access
to current healthcare
advances and procedures
which will assist with any
information gaps not
delivered by their medical
educational system. By
providing these solutions,
IBM Watson would increase
confidence and precision in
decision-making, particularly
when dealing with rare,
complicated or undiagnosed
diseases. Such a system would
also encourage safer
treatment by issuing proactive
and preventative solutions
that are more likely to be
error-free. Further, by being
more unencumbered by their
legal environment in regards
to data, as well as their
increase in digital
consumption, there is an
opportunity for emerging
markets to leapfrog over their
wealthier counterparts with
IBM Watson by targeting
more of their population.
This level of specificity is
creating value for both
consumers and providers in
many countries, such as India
and Thailand, by reducing
cost and providing electronic
health records.57 Further,
Thailand’s provision of cancer
care has improved by leaps
and bounds with IBM
Watson’s ability to
personalise treatments,57
demonstrating how it may be
a system of the future for
emerging markets.
Model success and business implications 28
A macro view for micro decisions
Efficiency is the ultimate goal for emerging ASEAN nations as they rely on limited finance and
resources to grapple with unforeseen healthcare issues. However, information deficiencies regarding
management of the healthcare sector inhibit effective policy implementation and resourceful
governance.
Macro data is the plug to all information gaps; Macro data can now be digitally collected, stored,
analysed and published to governing bodies in the healthcare sector. Transparent and accessible
evidence can thus strengthen the links in the healthcare decision chain and prompt prodigiously
efficient policy approaches.
Data harvesters are already working in conjunction with non-for-profits, universities, governments
and healthcare providers to reform current practices to improve diagnosis and treatment of the
healthcare system itself.
Redefining
Tuberculosis testing in India
With 23% of tuberculosis
sufferers residing in India,
significant challenges lie in
the provision of safe and
effective care and reducing
the prevalence of the disease.
Government initiatives such
as the Revised National
Tuberculosis Control Program
(RNTCP) struggle to identify
and treat the majority of
tuberculosis patients as the
non-standardised, cheaper
and largely unregulated
private sector laboratories
dominate the market. Issues
of misdiagnosis, delayed
diagnosis and mistreatment
are magnified as the private
sector avoid using World
Health Organisation (WHO)
endorsed testing systems, as
they are disincentivised by
lower profit margins it
delivers.
The Clinton Health Access
Initiative (CHAI) partnered
with the SAS Institute and the
Bill and Melinda Gates
Foundation, launching the
Initiative for Promoting
Affordable and Quality TB
Tests (IPAQT) in 2103.59 By
redeveloping WHO-endorsed
tests to maintain their quality
whilst reducing their costs,
CHAI were able to partner up
with current private test
providers. Costs savings were
guaranteed to be passed onto
patients with up to 50%
savings, whilst laboratories
largely maintained their profit
margins. Furthermore, CHAI
worked with local doctors to
educate them about the tests
and encourage greater
referrals, and more patient
data was sent to the RNTCP
program for greater
government support for
patients.
Positive Externalities
of Big Data’s Building
Blocks
Strengthening the data
network between patients,
providers and government
requires innovation in design.
The direct benefits provided
by macro data analysis can be
complemented with a number
of indirect positive
externalities, provided that
disturbers build them into
their business model. The
compounding nature on
financial and social returns is
often incentive enough for
new business innovations to
take them into account.
Utilising Existing
Infrastructure
Data collection is inherently
expensive, requiring complex
systems for systematic
collection, storage and
analysis of the data.
Successful macro data
business models in emerging
markets cut costs by
integrating existing
infrastructure, significantly
cutting upfront capital costs
and maximising economies of
scale.
Fast-tracked development of
telecommunication networks
in emerging markets is
increasingly being utilised by
macro data companies. In the
29 Digital healthcare in Southeast Asia
Philippines, mClinica use
phone networks to collect
data on the stocktake and
pharmaceutical purchasing
histories of consumers in
rural “mum-and-dad”
pharmacies, who incentivise
customers to sign up with
guaranteed discounts, on-
selling the data to big
pharmaceuticals. The system
maximises consumer reach
and circumnavigates health
literacy issues often
experienced in rural
Philippines.60
Creating a transferable data
system for emerging Asian
markets can further boost
financial and social returns to
scale. These costs savings can
then largely be passed on to
the low and middle income
consumers that struggle to
access high quality health
care.
Synergy of Knowledge
Collaboration between private
sector healthcare innovators,
governments, healthcare
providers, non-for-profits,
research centres and
universities establishes a
deeper pool of knowledge.
New, innovative ideas can be
developed faster, cheaper and
with greater effect if
businesses draw from the
ever-growing knowledge bank
when establishing and
delivering solutions to
complex health problems in
emerging Southeast Asian
markets.61
Establishing Quality
and Safety Standards
Regardless of the speed of
legal healthcare progress,
successful innovative
healthcare businesses in
emerging markets can lift and
standardise the quality and
safety of healthcare through
their own market initiatives.
By basing their ideas on
international standards and
striving for greater efficiency
and outcome effect,
disturbers can lead the way in
improving standards in
emerging markets.
Greater transparency of
collected data will also reveal
cases of fraud and
corruption,62 which is more
common in the emerging
ASEAN nations and
healthcare industries that are
predominantly privately
funded. Furthermore,
transparent markets and new
methods of information
delivery help reduce
information asymmetries in
price, quality and access,
further promoting efficiency
in emerging Asian healthcare
markets.
Utilising existing
infrastructure to
its maximum
potential
Next steps – The Philippines 30
Next steps – The
Philippines
The idiosyncrasies of Southeast Asian emerging markets are the
catalyst for barriers to entry. This has led to untapped opportunities
for investors due to the risk of entry and underdeveloped resources
outweighing burgeoning demand. However, as these markets
continue to introduce more ‘investor-friendly’ reforms and digital
penetration facilitates broader access to previously unreachable
consumers, these emerging markets hit their ‘sweet spot’ for
investment. The Filipino market epitomises this concept. Favourable
demographics, progressive reforms and gaps in the market mean that
the healthcare sector in the Philippines is ripe for investment.
31 Digital healthcare in Southeast Asia
A void in the market
The Filipino population is growing at the fastest rate of all the Southeast Asian economies,
forecasted to increase by 168% to 168 million in 2050 (see Figure 1.1). The healthcare infrastructure
in the Philippines is currently extremely under resourced with only 1 bed and 1.16 physicians per
every 1,000 patients.63 The lack of talent is exacerbated by 56% of the population located in rural
areas (see Figure 1.3). The result is a desperate need for innovative solutions to connect the limited
specialists with a rapidly growing and rurally based population.
Challenges for investors
Foreign direct investment (FDI) limitations and the highest corporate tax rate in the ASEAN
region64 have traditionally made the Philippines an uninviting landscape for business. Foreign
investors are restricted to a 40% ownership in local enterprises,65 whereas other ASEAN countries
such as Indonesia permit 100% ownership.18 The Philippines also ranks in the bottom half of
Transparency International’s Corruption Perceptions Index65 – making PPPs that are necessary to
stimulate growth in the healthcare sector riskier for foreign investors.
Furthermore, limited access to talent has made the implementation of healthcare initiatives
difficult. Skilled Filipino healthcare workers often migrate overseas in search of higher paying jobs.
This is illustrated by the Philippines being the third highest source of National Health Service staff
in the UK.66
Progressive reforms
Despite these challenges, recent reforms are working to mitigate FDI issues to encourage the
investment the Filipino healthcare sector desperately needs. The introduction of the ASEAN
Economic Community (AEC) is expected to increase FDI and may result in an increase of inbound
skilled healthcare workers, due to the ability to improve their English in the Philippines and the high
demand for physicians.67 Additionally, in an effort to begin resolving the talent deficit, the
University of the Philippines introduced a return service agreement in 2010, mandating that
students perform three years of medical research, further study or practice locally, or else pay back
the equivalent of 5 years’ tuition.66 The aim is to allay the Philippines’ rapid ‘brain drain’ and
incentivise doctors to work in the rural areas that are desperately in need of healthcare workers.
Unprecedented opportunities for digital healthcare
The Filipino government is currently putting unprecedented resources into the universal health
coverage in order to ensure 100% of the population is covered by the national health insurance
program (PhiliHealth) by the end of 2016.66 The effect of this is a demand for higher quality
healthcare services. The government is calling for the private sector to establish PPPs in order to
implement infrastructure projects and outsource the provision and management of healthcare
services. This should improve the overall quality of the healthcare sector and provide the private
sector with opportunities previously restricted.
Currently, market dynamics in the Philippines are extremely favourable for digital implementation.
The population is extremely receptive to digital forums, with the Philippines having the highest level
Next steps – The Philippines 32
of brand engagement across all online content channels in Southeast Asia.68 Additionally, the
Commission of Information and Communication Technology (CICT) developed its Philippines
Digital Strategy (PDS) in 2011. The PDS aims to increase the access and use of ICT in IT-enabled
sectors. This is congruent with the government's focus on increased Internet connectivity, aiming to
provide WiFi connectivity in public facilities nationwide by the end of 2016.69 This improvement in
digital infrastructure means more opportunities for digital healthcare players to enter a historically
impenetrable market in areas such as mHealth, wearables, telemed and self-
management/educational healthcare applications.
Example: The Hub-and-Spokes Model
One potential model that could capitalise on the aforementioned opportunities is the
implementation of a Hub-and-Spokes Model (HSM) as a management and distribution model for
primary and general healthcare providers. For this model to be successful in providing quality
healthcare to rural communities, access to ICT and retention of skilled physicians are non-
negotiable criteria. The recent RSA and PDS schemes facilitate access to these factors, providing an
unprecedented opportunity for foreign hospital management companies to implement a HSM in the
Philippines.
Previously foreign investors have not had the opportunity to control the management structure of
healthcare providers in the Philippines. Traditionally, private hospitals in the Philippines are
generally smaller and more specialised. However, increased PhiliHealth coverage will lead to the
construction of larger private hospitals that can provide general and primary care where HSM can
be implemented.66 Additionally, PPP, in the form of management contracts are becoming
increasingly encouraged.70. Such a contract would govern the outsourcing of the management of a
public facility, enabling foreign entities to implement HSM in public hospitals.71
One major priority for the Philippines’ healthcare system is to increase access to healthcare.72 A
HSM would be one way to facilitate this goal without adding expensive infrastructure and by using
existing resources. For example, Philippines has an average nurse to patient ratio of 1:15.73 Given a
ratio of nurses well beyond even the ideal nurse-patient ratios in developed countries (1:4 in
Australia74), there is sufficient supply for nurses to act as a surrogate doctor under a qualified
doctor’s supervision using telemed at the rural spokes. A HSM facilitated by ICT can decrease costs
and increase revenues by increased efficiency of equipment and specialists and increasing the
volume of patients served, providing a win-win for both investors and the healthcare sector.
33 Digital healthcare in Southeast Asia
Conclusion
Innovative business models are changing the healthcare sector in
Southeast Asian markets, and existing service providers are
accommodating the digital trend in a unique way. Disrupters reshape
the industry toward a more patient centred system, developing new
services as mobile health, while traditional businesses selectively
adopt new technologies as one part of harvesting strategy.
The seismic change is gathering momentum, advancing patient
treatment in every aspect gradually filling in the fundamental gaps
between developed and developing. Simultaneously, the change opens
new opportunities investors can grasp in countries such as
Philippines. Market conditions are ripe for investment, however
investors should keep in mind the characteristics of Southeast Asian
countries that make business unique from their current environments.
Next steps – The Philippines 34
Bibliography
1. Pezzini, M. (2016). An emerging middle class - OECD Observer. Oecdobserver.org. Retrieved from http://www.oecdobserver.org/news/fullstory.php/aid/3681/An_emerging_middle_class.html
2. Deloitte. (2015). A perspective of future healthcare landscape in ASEAN and Singapore (p. 3). Retrieved from https://www2.deloitte.com/content/dam/Deloitte/sg/Documents/risk/sea-risk-future-healthcare-thought-leadership-noexp.pdf
3. EY. (2016). Hitting the sweet spot - The growth of the middle class in emerging markets (p. 4). Retrieved from http://www.ey.com/Publication/vwLUAssets/Hitting_the_sweet_spot/$FILE/Hitting_the_sweet_spot.pdf
4. Deloitte University Press. (2016). Emerging market talent strategies: Creating an effective global talent model. Retrieved from: http://dupress.com/articles/emerging-market-talent-strategies/
5. McKinsey & Company. (2012). The world at work: Jobs, pay, and skills for 3.5 billion people. Retrieved from http://www.mckinsey.com/global-themes/employment-and-growth/the-world-at-work
6. Forbes.com. (2016). Emerging Market Medical Education Goes Digital. Retrieved from: http://www.forbes.com/sites/techonomy/2015/03/17/emerging-market-medical-education-goes-digital/#3727ebf1b111
7. Nair and Webster (2012), Health professionals’ migration in emerging market economies: patterns, causes and possible solutions. Retrieved from: http://jpubhealth.oxfordjournals.org/content/35/1/157.full
8. Nair and Webster (2012), Health professionals’ migration in emerging market economies: patterns, causes and possible solutions. Retrieved from: http://jpubhealth.oxfordjournals.org/content/35/1/157.full
9. Hongoro, C. & McPake, B. (2004). How to bridge the gap in human resources for health. The Lancet, 364(9443), 1451-1456.
10. EY. (2015). Ripe for investment: the Indonesian health care industry post introduction of universal health coverage. Retrieved from http://www.ey.com/Publication/vwLUAssets/EY-ripe-for-investment-the-indonesian-health-care-industry/$FILE/EY-ripe-for-investment-the-indonesian-health-care-industry.pdf
11. Oracle. (2015). Oracle Cloud Talent Strategy for Healthcare: Finding and Retaining Scarce Talent. Retrieved from: http://www.oracle.com/us/industries/healthcare/healthcare-talent-mgmt-wp-2538994.pdf
12. ICEF Monitor - Market intelligence for international student recruitment. (2015). Challenges in Vietnamese higher education contributing to demand for study abroad. Retrieved from http://monitor.icef.com/2015/09/challenges-in-vietnamese-higher-education-contributing-to-demand-for-study-abroad/
13. Business Monitor International Ltd. (2016). BMI. Retrieved from: https://bmo-bmiresearch-com.ezp.lib.unimelb.edu.au/data/datatool/
14. World Economic Forum. (2014). Global Competitiveness Report 2014-15. Retrieved from: http://www3.weforum.org/docs/WEF_GlobalCompetitivenessReport_2014-15.pdf
15. Deloitte. (2015). 2015 Global health care outlook Common goals, competing priorities. Retrieved from: http://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2015-health-care-outlook-global.pdf
16. Turner, P. (2010, November 24). growglobally. Retrieved from http://growglobally.org/?p=497
17. Kenny, J., Lavanchy, R., & Kjorstad, J. (2013). Emerging Partnerships. International Financial Corporations. Retrieved from http://www.ppiaf.org/sites/ppiaf.org/files/publication/emerging-partnerships.pdf
35 Digital healthcare in Southeast Asia
18. Zimny, Z. (2011). Foreign Direct Investment in Health Services. SSRN Electronic Journal, doi: 10.2139. Retrieved from: http://www.academia.edu/5675217/Foreign_Direct_Investment_in_Health_Services
19. Mitchell, M. (2008). An Overview of Public Private Partnerships in Health. Harvard School of Public Health. Retrieved from https://www.hsph.harvard.edu/ihsg/publications/pdf/PPP-final-MDM.pdf
20. Economist Intelligence Unit. (2010). World Industry Outlook: Healthcare and Pharmaceuticals. Retrieved from http://www.banyanglobal.com/pdf/Guide_for_Investors_in_Private_Health_Care_in_Emerging_Markets.pdf
21. International Finance Corporations. (2010). Guide for Investors in Private Health Care in Emerging Markets. Retrieved from http://www.banyanglobal.com/pdf/Guide_for_Investors_in_Private_Health_Care_in_Emerging_Markets.pdf
22. ESCAP. (2014). Sustainable Development Financing: Perspectives from Asia and The Pacific, United Nations. Retrieved from http://www.unescap.org/sites/default/files/UNESCAP-SDF-Paper-1July2014-share.pdf
23. OECD. (2015). Economic outlook for Southeast Asia, China and India 2016. Retrieved from http://www.oecd.org/dev/asia-pacific/SAEO2016_Overview%20with%20cover%20light.pdf
24. Deloitte. (2016). 2016 Global health care outlook: Battling costs while improving care. Retrieved from http://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2016-health-care-outlook.pdf
25. World Bank. (2016). Doing business 2016: Measuring regulatory quality and efficiency. Retrieved from http://www.doingbusiness.org/reports/~/media/GIAWB/Doing%20Business/Documents/Profiles/Regional/DB2016/DB16-East-Asia-Pacific.pdf
26. World Health Organization. (2012). Legal frameworks for eHealth. Retrieved from http://apps.who.int/iris/bitstream/10665/44807/1/9789241503143_eng.pdf
27. Jawahitha, S., Ishak, M., & Mazahir, M. (2007). E-data privacy and the personal data protection bill of Malaysia. Journal of Applied Sciences, 7, 732–742. Retrieved from http://scialert.net/fulltext/?doi=jas.2007.732.742
28. SEA-EU-NET. (2014). Intellectual property rights in Southeast Asia. Retrieved from https://sea-eu.net/object/document/130/attach/IPR_final24032014.pdf
29. Menon, J., & Melendez, A. (2015). Realizing an ASEAN economic community: Progress and remaining challenges. Retrieved from ADB Economics Working Paper Series: http://www.adb.org/sites/default/files/publication/160067/ewp-432.pdf
30. ASEAN Economic Community. (2015).ASEAN Economic Community Blueprint 2025. Retrieved from http://www.asean.org/storage/2016/03/AECBP_2025r_FINAL.pdf
31. ASEAN Briefing. (2016, May 31). The ASEAN economic community and what it means for intellectual property - ASEAN business news. Retrieved July 30, 2016, from ASEAN Briefing, http://www.aseanbriefing.com/news/2016/05/31/aec-intellectual-property.html
32. Menon, J., & Melendez, A. (2015). Realizing an ASEAN economic community: Progress and remaining challenges. Retrieved from ADB Economics Working Paper Series: http://www.adb.org/sites/default/files/publication/160067/ewp-432.pdf
33. ibm.com. (2016). Say Hello to IBM Watson. Retrieved from: http://www.ibm.com/watson
34. Forbes.com. (2016). 2016 Predictions: Digital Health’s Second Wave and Thirteen Transformative Healthcare Trends.
35. Topol, E. and Steinhubl, S. (2015). Moving From Digitalization to Digitization in Cardiovascular Care: Why Is it Important, and What Could it Mean for Patients and Providers? Publmed. Retreived from: http://www.ncbi.nlm.nih.gov/pubmed/26403346
36. PwC (2016). The birth of the healthcare consumer: Growing demands for choice, engagement and experience. Retrieved from: http://www.strategyand.pwc.com/media/file/The-birth-of-the-healthcare-consumer.pdf
Next steps – The Philippines 36
37. Lamiaux, M. and Zarate, L. (2016). How Emerging Markets Use Partnerships to Leapfrog in Health Innovation. BCG Perspectives. Retrieved from https://www.bcgperspectives.com/content/articles/biopharmaceuticals-medical-devices-technology-health-systems-leapfrogging-emerging-economies/
38. Harvard Business Review. (2002). Let’s Put Consumers in Charge of Health Care. Retrieved from https://hbr.org/2002/07/lets-put-consumers-in-charge-of-health-care
39. Stern, C. (2016). Goldman Sachs says a digital healthcare revolution is coming — and it could save America $300 billion. Business Insider. Retrieved from http://uk.businessinsider.com/goldman-digital-healthcare-is-coming-2015-6?r=US&IR=T
40. Accenture.com. (2016). Singapore's MOH Holdings - Electronic Health Record System - Accenture. Retrieved from: https://www.accenture.com/us-en/success-moh-holdings-national-electronic-health-record-system
41. McKinsey & Company. (2010). The emerging market in healthcare innovation. Retrieved from: http://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-emerging-market-in-health-care-innovation
42. Deloitte. (2016). Healthcare and Life Sciences Predictions 2020: A bold future? Retrieved from: http://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-healthcare-and-life-sciences-predictions-2020.pdf
43. Forbes.com. (2016). The Leapfrog Opportunity In The World’s Undeserved Heath Care Markets. http://www.forbes.com/sites/unitystoakes/2015/08/01/the-leapfrog-opportunity-in-the-worlds-underserved-health-care-markets/#6d517c8876fe
44. Lalmalsawma, D. (2014). Telemedicine in India Might Be Just What The Doctor Ordered. Retrieved from
http://blogs.reuters.com/india/2014/06/04/telemedicine-in-india-might-be-just-what-the-doctor-
ordered/
45. Muttitt, S., McKinnon, S., & Rainey, S. (2012). Singapore’s National Electronic Health Record (NEHR)
The Journey to 2012 and Beyond. HIMSS. Retrieved from:
http://69.59.162.218/HIMSS2012/Venetian%20Sands%20Expo%20Center/2.22.12_Wed/Marcello%20
4502/Wed_0945/95-21_Sarah_Muttitt_Marcello%204502/95Muttitt.pdf
46. McBride, M. (2012). Understanding The True Costs of An EHR Implementation Plan. Retrieved from:
http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-
medicine-feature-articles/understanding-true-costs-ehr-?page=full
47. Dutta, S., Geiger, T., & Lanvin, B. (2015). The Global Information Technology Report 2015. World
Economic Forum. Retrieved from: http://www3.weforum.org/docs/WEF_Global_IT_Report_2015.pdf
48. Amberber, E. (2015). The story of eKincare, Hyderabad based healthcare startup. YourStory.com. Retrieved from: https://yourstory.com/2015/01/ekincare/
49. eKincare. (2016). Ekincare.com. Retrieved from: http://www.ekincare.com
50. eKincare.com. (2016). eKincare featured in the Global Digital Health 100 Award List. Retrieved from https://blog.ekincare.com/2016/01/11/ekincare-featured-in-the-global-digital-health-100-list/
51. Devarakonda S. (2016). Hub and spoke model: making rural healthcare in India affordable, available and accessible. Rural and Remote Health; 16: 3476. Retrieved from: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=3476
52. Private Sector Innovation Programme for Health (PSP4H), (2014). Understanding the India Low Cost Model of Healthcare Delivery: A Review of the Literature. Nairobi, Kenya: PSP4H. Retrieved from http://www.psp4h.com/wp-content/uploads/2014/05/Understanding-the-India-Low-Cost-Model-of-Healthcare-Delivery-3.pdf
53. Simon, P. (2015). The place of personalised medical e-consultancy in the practice of telemedicine. European Research in Telemedicine / La Recherche Européenne en Télémédecine, 4(3), pp.71-80.
54. McKinsey & Company. (2014). Healthcare’s digital future. Retrieved from: http://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/healthcares-digital-future
37 Digital healthcare in Southeast Asia
55. Forbes.com. (2016). Philippines Start-up Takes On Global Radiologist Shortage. Retrieved from: http://www.forbes.com/sites/techonomy/2014/11/08/philippine-startup-takes-on-global-radiologist-shortage/
56. Napolitano, A. (2015). How Telemedicine Answers Global Pathology Demands. Proscia Retrieved from: https://proscia.com/blog/global-crisis-digital-solution/
57. IBM, (2016). IBM Watson Health: Welcome to the New Era of Cognitive Healthcare. Retrieved from: http://www.ibm.com/smarterplanet/us/en/ibmwatson/health/
58. Harvard Business Review. (2014). IBM’s Emerging Market Strategy Has 3 Pillars. Retrieved from: https://hbr.org/2014/11/ibms-emerging-market-strategy-has-3-pillars
59. Clinton Health Access Initiative. (2016). CASE STUDY: Catalyzing the market for accurate tuberculosis testing in India’s extensive private sector through IPAQT. Retrieved from: http://www.clintonhealthaccess.org/content/uploads/2016/06/Case-Study-India-IPAQT-June-2016.pdf
60. Balea, J. (2014, October 31). Connecting Asia’s startup ecosystem. Retrieved August 1, 2016, from Tech In Asia, https://www.techinasia.com/mclinica-pharmaceutical-health-care-startup
61. WHO. (2015, February 26). Big data in global health: Improving health in low- and middle-income countries. Retrieved August 1, 2016, from World Health Organization, http://www.who.int/bulletin/volumes/93/3/14-139022/en/
62. Raghupathi, W., & Raghupathi, V. (2014). Big data analytics in healthcare: Promise and potential. , 2, . Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341817/
63. NationMaster.com. (2016). Countries Compared by Health > Physicians > Per 1,000 people. Retrieved from: http://www.nationmaster.com/country-info/stats/Health/Physicians/Per-1,000-people
64. BusinessInAsia.com (2016). Taxes and mandatory contributions that a medium-size company must pay or withhold in a given year in Asia. Retrieved from: http://www.business-in-asia.com/asia/taxation_asia.html
65. KPMG. (2015). ASEAN: Poised for accelerated economic growth. Retrieved from: https://www.kpmg.com/SG/en/IssuesAndInsights/ArticlesPublications/Documents/ASEAN-Poised-for-Accelerated-Economic-Growth.pdf
66. Oxford Business Group. (2015). Universal health care drives health sector growth in the Philippines. Retrieved from: http://www.oxfordbusinessgroup.com/overview/universal-health-care-drives-health-sector-growth-philippines
67. Dam, R. (2015). Getting ready for the AEC. Legalbusinessonline.com. Retrieved from: http://www.legalbusinessonline.com/features/getting-ready-aec/69283
68. Wood, C. (2014). The Rising Digital Storm: SEO and Online Marketing in the Philippines. SEO Hacker. Retrieved from: https://seo-hacker.com/rising-digital-storm-seo-online-marketing-philippines/
69. O'Brien, R. (2015). Digital Asia: ASEAN in ascendance (p. 16). Retrieved from: http://www.tekes.fi/globalassets/global/ohjelmat-ja-palvelut/kasvajakansainvalisty/future-watch/digital_asia.pdf
70. Philippine Institute for Development Studies. (2014). Public Private Partnership Options Towards Achieving Universal Health Coverage in the Philippine Setting. Retrieved from: http://dirp3.pids.gov.ph/webportal/CDN/PUBLICATIONS/pidsdps1448.pdf
71. Philippine Institute for Development Studies,. (2014). Assessing the Feasibility of Public-Private Partnerships in Health in the Philippines. Retrieved from: http://dirp3.pids.gov.ph/webportal/CDN/PUBLICATIONS/pidsdps1449.pdf
72. World Health Organisation (WHO). (2014). Country Cooperation Strategy - Philippines. Retrieved from: http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_phl_en.pdf
73. Philstar. (2016). State of Phl nurses today. Retrieved from: http://www.philstar.com/letters-editor/2015/06/08/1463396/state-phl-nurses-today
74. Australian Nursing Federation. (2016). Why investing in nurses makes sense (p. 7). Retrieved from: http://anmf.org.au/documents/reports/Issues_Ensuring_quality.pdf
top related