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INDONESIA DEVELOPING HEALTHCARE MARKETS: OPPORTUNITIES & CHALLENGES dr. Santoso Soeroso, Sp. A Dr. Ahyahudin Sodri, M.Sc. VDI

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Page 1: INDONESIA DEVELOPING HEALTHCARE MARKETS - …indonesien.ahk.de/fileadmin/ahk_indonesien/Business_Delegations/... · Siloam Jakarta, RS Gading Pluit, Rumah Sakit Rujukan Nasional Rumah

INDONESIA DEVELOPING HEALTHCARE MARKETS:

OPPORTUNITIES & CHALLENGES

dr. Santoso Soeroso, Sp. A

Dr. Ahyahudin Sodri, M.Sc. VDI

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OUTLINE

1. About PERSI

2. Background

3. Data and Trend

4. Opportunities and Challanges

5. Conclussion

DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 2

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ABOUT PERSI

. PERSI (Perhimpunan Rumah Sakit Seluruh Indonesia/Indonesian Hospital Association) established in April 12, 1978

. PERSI has 32 provincial chapter (of 35 Province of the Republic of Indonesia}

. Total number of Hospital in Indonesia : 2.750

. Private Hospital : 1049

. Non profit Private Hospital : 695

. Government owned Hospital : 943

. State owned Enterprises Hospital : 63

. Total number of accredited Hospital : 1.096 (39.8%)

DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 3

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PENGUATAN SISTEM RUJUKAN

REGIONALIZATION OF REFERAL SYSTEM

RSU H Adam Malik

RSU Dr. M.Jamil

RSU Dr. Mohammad Hoesin

RSU Dr. Cipto Mangunkusumo

RSU Dr Hasan Sadikin RSU Dr. Soetomo

RSU Dr. Kariadi

RSUP Dr. Sarjito

RSUP Sanglah Denpasar

RSU Dr Sudarso PTK

RSUD H A WahabSjahranie

RSU Prof.Dr. R.D Kandou

RSU Dr W Sudirohusodo

RSU Jayapura

RSU Dr. Zainoel Abidin

RSUD Kep. Riau

RSUD Arifin Achmad

RSUD Raden Mattaher

RSU Dr. Ir. SoekarnoRSUD Dr. M. Yunus

RSU Dr. H. Abdul Moelok RSU Tangerang

RSUD Tarakan

RSUD Dr. Doris Sylvanus

RSUD Ulin

RSU Sorong

RSU Dr. Hasan BusorRSU Prof. Dr. Aloei

RSUD Mamuju RSU Kendari

RSU Dr. M Haulussy

RSU Prof. Dr. WZ JohanesRSUD Prov NTB

ClassNational

Province

H.Class A 12 2

H. Class B 2 15

H. Class C -- 3

Total 14 20

REGIONAL REFERAL

HOSPITAL : 110

H. Class A 2

H. Class B 59

H. Class C 45

H. Class D 4

**Kepmenkes HK.02.02/MENKES/390/2014 dan HK.02.02/MENKES/391/2014 NATIONAL REFERAL HOSPITAL

PROVINCE REFERAL HOSPITAL

4

MENTERI KESEHATANREPUBLIK INDONESIA

STRENGTHENING ACCESSIBILITY

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1. BACKGROUND

DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 5

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DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 6

Before the introduction of UHC in 2014,

Indonesia spent only 3.1% of its GDP

on health care in comparison to the

Philippines (4.4%) and Thailand

(4.6%).Source: World Bank and OECD

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7

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DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 8

67% of Indonesian adult males are

cigarette smokers which is likely to be

a significant cause of lifestyle-related

diseases.Source: World Health Organization

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Source: https://www.slideshare.net/JuliendeSalaberry/powering-the-future-of-healthcare-in-asia-etpl-iot-for-health-program-the-propell-group

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2. DATA AND TRENDS

DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 10

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21.196Fasilitas Kesehatan Tingkat Pertama

(FKTP/HEALTH CENTERS/CLINICS)

2.230

Fasilitas Kesehatan Tingkat Lanjut (HOPITALS

AND SPECIALIST CLINICS)

1.007 OPTICS

2.342 PHARMACIES

379 LABORATORIES182.036.673

TOTAL MEMBER OF BPJS

NUMBER OF HEALTH FACILITIES SERVED THE JKN

27.154

Sumber: BPJS Kesehatan Per 1 Oktober 2017

PROVIDER OF THE NATIONAL HEALTH SECURITY SYSTEM (JKN)

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Sumber: RS Online, Kementerian Kesehatan Republik Indonesia

33 33 33 33 33

96 98 113 120 129

455 463 469 480 501

92 93 98 97 96

3 8 8 13 16

118 127 125 125 126

41 42 42 42 44

724 737706 702 695

599

740

834

925

1.047

67 67 62 64 63

2013 2014 2015 2016 2017

KEMKES

PEMDA

PROVINSIPEMDA KAB

PEMDA KOTA

KEMENTERIANLAINTNI

POLRI

SWASTA NON

PROFITSWASTA

TOTAL

2.750

TOTAL

2.601

TOTAL

2.490

TOTAL

2.408TOTAL

2.228

(Data per 12 Okt 2017)

TOTAL NUMBER OF HOSPITAL IN INDONESIA2013 - 2017

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GAMBARAN RUJUKAN PELAYANAN CATHLAB-JANTUNG

DISRIBUTION OF CATH LAB and CARDIOLOGICAL SERVICES, 2016

5

13

3

5 3

1 3

3532

211

136 2

0

53

1

3

1

2

6

4

11

19

11

5

4

5

8

3

38

221

110

40

25

126

19

7 2

4

4

4

1

11

19

4

2

9

1

2

Total of Cath Lab: 199 Cath Lab in 171 hospital Total cardiologist = 758 (2015) --> 850 in 2016

1

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Radio therapy devices 48 unit (32 LINAC & 16 Cobalt)in 31 hospitaI n 18 cities, 14 ProvinceRatio 1 unit : 5,2 million POPULATION

RSU H Adam Malik

RSU Dr. M.Jamil

RSU Dr. Mohammad Hoesin

RSCM, RS Persahabatan, Dharmais

RSU Dr Hasan Sadikin

RSU Dr. Soetomo, RS RamelanRS Syaiful Anwar

RSU Dr. Kariadi

RSUP Dr. SarjitoRSUP Sanglah Denpasar

RSU Dr Sudarso PTK

RSUD H A WahabSjahranie

RSU Prof.Dr. R.D Kandou

RSU Dr W Sudirohusodo

RSU Jayapura

RSU Dr. Zainoel Abidin

RSUD Kep. Riau

RSUD Arifin Achmad

RSUD Raden MattaherRSU Dr. Ir. Soekarno

RSUD Dr. M. Yunus

RSU Dr. H. Abdul Moelok RSU Tangerang

RSUD Tarakan

RSUD Dr. Doris Sylvanus

RSUD Ulin

RSU SorongRSU Dr. Hasan Busor

RSU Prof. Dr. Aloei

RSUD Mamuju RSU Kendari

RSU Dr. M Haulussy

RSU Prof. Dr. WZ JohanesRSUD Prov NTB

X

X

X

xx

XX X

X

X

X

X

MRCC, RS Pusat Pertamina, RS Siloam Jakarta, RS Gading Pluit,

Rumah Sakit Rujukan Nasional

Rumah Sakit Rujukan Provinsi

Rumah Sakit Swasta

RS Memiliki Unit RadiotherapyX

X

X

XX

X

X

X

X

X

THE REFERAL SYSTEM OF RADIO THERAPY SERVICES

SEBARAN FASILITAS RADIOTERAPI

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TOTAL NUMBER OF HOSPITAL AND SPECIALIST CLINIC PRIVATE HOSPITAL AND

SPECIALIST CLINIC : 47 %

HOSPITAL AND SPECIALIST CLINIC

INVOLVED IN JKN

2.412Sumber: BPJS Kesehatan Per 1 Oktober 2017

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ANNUAL TREND OF UHC UTILIZATION (VISIT)

2014 2015 2016 2017

FKTP (Puskesmas/DokterPraktik Perorangan/KlinikPratama)

Poliklinik Rawat JalanRumah Sakit

Rawat Inap Rumah Sakit

Keterangan: Total Pemanfaatanadalah dalam kunjungan

66,8 Juta

100,6 Juta

134,9 Juta

21,3 Juta

39,8 Juta

50,4 Juta

4,2 Juta6,3 Juta

7,6 Juta

92,3 JUTA 146,7 JUTA 192,9 JUTA

Sumber: Laporan Bulanan BPJS Sampaidengan Bulan Juni 2017

106,2 JUTA

73 Juta

29,2 Juta

4 Juta

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4. OPPORTUNITIES AND CHALLENGES

DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 17

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2015 2016 2017 2018 2019

Penduduk (Jiwa) 255 259 262 265 268

Peserta JKN (Jiwa) 136 156 211 231 258

PBI-KIS (Jiwa) 88 92 97 102 107

255 259 262 265 268

136 156

211 231

258

88 92 97

102107

00

50

100

150

200

250

300

PROJECTION OF TOTAL POPULATION, COVERAGE TARGET OF JKN & PBI-KIS 2015-

2019

Tahun%-Peserta

JKN

2015 60%

2016 70%

2017 80%

2018 90%

2019 95%

UNIVERSAL HEALTH COVERAGE

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19

267 millionpeople will need to be insured in Indonesia by 2019, when

universal public healthcare is fully established.

USD 363 billionis the national healthcare expenditure expected to rise by

2025; a CAGR of more than 20% compared to 2010

(USD 20 billion).

The rising middle class is expected to drive demand for

affordable health care.

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About a quarter billion Indonesians will demand quality

healthcare services, faster disease screening,

advanced medical technologies for early diagnosis,

and low cost, high quality efficacious medicines for

treatment

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PROVINSI SULBAR

* 5 Provinsi dengan Rasio TT < 1:1000 penduduk (Jumlah Total TT di RS)

PROVINSI RIAU

PROVINSI LAMPUNG

PROVINSI JABARPROVINSI NTB

Demand for More Hospital Beds

Indonesia is expected to add about 40,000 beds by 2019 and JKN

would be a key driver; one of the early reports shows how the daily

patient volume in some of the provinces jumped up after JKN initiation.

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DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 22

1. Hospital development must be shifted to outside Java island. Is it economically profitable?

2. Bed capacity is almost saturated in Java, but there is still requitements in certain area in Sumatra, NTT-NTB, Kalimantan and Sulawesi Island.

3. Speciality services, such as cancer centre, cardiac centre, women & child centre (include NICU & PICU) will be required for new investment

Demand for More Hospital Beds

Including Paliative hospital

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Demand for More Drugs (Generics)

As more patient get access to healthcare

through JKN, demand for prescription drugs

(generics) will grow; some companies have

already preempted this and increased their

production capacity to address the increased

demand.

Up to 50% of the revenues of a hospital can

come from sale of medicines to its patients.

Pressure on margin from UHC patients affects

manufacturers of generic drugs.

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ACCORDING TO INTERNATIONAL DIABETES FOUNDATION (2015) , INDONESIA HAS 12 MILLION PEOPLE LIVING

WITH DIABETES (THE 5TH WORLD RANK)

BPJS Kesehatan data indicate that

In 2016, the use of insulin analogues was 99.5% compared to human insulin which was only 0.5%.

JKN spending for insulin – both human and analogues –increased in 2016, which was three times as high as in 2014. The spending was approximately IDR 1.1 billion (3,998 vials) for human insulin and IDR 243 billion (805,287 vials) for insulin analogues.

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SYSTEMATIC REVIEWOF INSULIN ANALOGUE VS HUMAN INSULIN

Sabirin and Rahim ,et al. (2012) concluded that : insulin analogues compared with human insulin offer minor advantage in

controlling glycaemia reflected in HbA1c level, postprandial blood glucose

and fasting blood glucose, but they have advantages in reducing

occurrence of hypoglycemia, particularly nocturnal hypoglycemia and

severe hypoglycemia.

recommended that insulin analogues are used for type 1 diabetes and

type 2 diabetes who have recurrent hypoglycemia and not for gestational

diabetes.

there is need evidence for long-term safety and effectiveness of insulin

analogues.

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MARKET ANOMALI

On one hand, it is surprising to see that lower-middle income countries such as Ghana list all types of analogue insulin given their limited healthcare resources. On the other, countries such as Germany with larger resources have purposefully rejected the general reimbursement of analogue insulin and allow it only in specific circumstances; general reimbursement is only allowed if their price is equal or lower than their human insulin counterparts .

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DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 28

Demand for More Medical Equipment and Demand for More Diagnostic Tests

Demand for medical devices is expected to

grow at much faster rate in the future as

compared with the

historical growth rate, especially for

consumables and imaging devices.

Domestic consumption of following

are expected to increase:

• X-ray films

• Consumables like gloves,

chemicals, catheters

• Computed tomography/magnetic

resonance imaging (CT/MRI)

equipment and consumable

associated with advanced imaging

procedures

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INDONESIAN RENAL REGISTRY 2016

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INDONESIAN RENAL REGISTRY , HEMODIALYSIS

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T

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32

Demand for Qualified and Skilled Healthcare Professionals

The already scarce medical professionals (doctors and

paramedical staff), which are way below the global

and Organisation for Economic Co-operation and

Development (OECD) averages, will be put under

pressure by the burden of the increasing number of

JKN patients.

investors need to recruit and retain good doctors, in

particular, specialists who play an important role in

upholding the standard of care and reputation of a

hospital, which are ultimately profit-drivers in the

business.

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DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 33

Telehealth Services

Medical device companies will adopt

collaborative business models to penetrate

the rural markets with remote patient

monitoring and tele-health devices that can

improve patient access and increase the

awareness and reach of their products

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DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 34

1. First-level outpatient services covered under JKN: Simple

laboratorium diagnostic tests (blood tests, urine tests, stool

tests, and blood glucose tests)

2. Market segments:

o Immunochemistry testing

o Microbiology testing

o Molecular diagnostics testing (high growth area)

• Virology

• Bacteriology

• Molecular blood donor screening

• Genetic testing

InVitro Diagnostics Market

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The origin of Medical Tourist McKInsey Quaterly, 2008

• 93% Asia population flight to

other Asia countries for medical

services

• Potential of Medical Tourism Asia

in 2013, US$ 8.5 billion (Global

Information Inc., 2012)

• Potential of Medical Tourism

Global mencapai US$ 100

billion with growth of 20%-

30% (McKinsey & Co., 2012)

THE OPPORTUNITIES FOR

MEDICAL TOURISM IN

INDONESIA

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DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 36

The new Indonesian Government has recently introduced a new

“one-stop-shop” to make it easier to start a business. However,

opening and

operating new hospitals and clinics without a local partner remains

a challenge in Indonesia.

Second-tier cities, such as Palembang or Batam, with comparably

low bed-to-population ratios, provide good opportunities for

investments

Though a majority of publicly-listed hospital players have reported EBITDA margin

of up to 33% (EBITDA to net revenue margin) in the last five years, hospital

operators still need to maintain a strong hold on cost and capital.

Foreigners are restricted from ownership in general hospitals. The upper

middle class (as a % o f total population) has risen significantly from

0.3% in 2003 to 1.5% in 2010. However, high-end private specialized

health care remains a niche market in Indonesia and competes with

medical tourism to other ASEAN countries.

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DISAMPIKAN PADA HOSPITAL EXPO INDONESIA, 21 OKTOBER 2016 37

The recent introduction of Indonesian

Government supported Universal Health

Coverage (UHC) for all citizens and

residents provides opportunities for

investors to develop the health care

sector.