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A Perspective of Future Healthcare Landscape in ASEAN and Singapore

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A Perspective of Future Healthcare Landscape in ASEAN and Singapore A perspective of future healthcare landscape in ASEAN and Singapore Economic prosperity, aging population, the growing middle income population and sensitive public policy are key demand drivers of better healthcare and infrastructure. This will ultimately manifest in a gradual but undeniable shift in health outcomes of the population together with the related areas of the healthcare ecosystem. Minister for Health Singapore, Mr Gan Kim Yong 2 WhatTo start a new section, hold downwe the apple+shif t keknowys and click in ASEAN today and to release this object and type the section title in the box below. estimate tomorrow A sad reality: “Health is a striking example where least progress has been made in Asia, despite the high economic growth and great success in poverty reduction”1 Average life expectancy in ASEAN Meet the over 65s in ASEAN – by countries in 2012 was 73 2020 they will number 46 million – 7.8% of ASEAN Population , an increase of YEARS 8 – one in every3: years since 1990: Singapore 6 Singaporeans achieves the highest with 83, 14 Indonesians and Laos and Myanmar the 26 Laotians lowest with 66. Cambodia experienced the largest increase Nurture the under 14-year-olds – 26% of ASEAN’s by 18 years to 771 population in 2013 with ongoing decline through 2020. Lowest rate in Singapore (16%), highest rates Health expenditure per capita in Philippines and Laos (34, 35%)4 in ASEAN is around 4% of GDP - as compared to the Chronic diseases due to OCED average of 9.5% - sedentary lifestyles are becoming despite the ASEAN health more prevalent as ASEAN nations expenditure increase by 250% get richer: Type 2 diabetes , and between 1998 and 2010 to over obesity - over 190mil with USD 68bn diabetes in Asia Pacific - however pain, antibiotics and hypertension Growth in average annual still dominate developing markets healthcare spending between 2014-18 is expected to be around Cardiovascular diseases are 11% of GDP in ASEAN - but with predominant concern in ASIA highly varied rates among the because of tobacco, hypertension and countries: Vietnam with the highest at 6.6% and obesity - Asia Pacific will have greatest Myanmar with the lowest at 1.8%. The number of NCD (non-communicable combined public and private healthcare spending diseases) deaths among all global greatly varies: In 2012 average spend of USD443 regions by 20205 in ASEAN with USD2,426 in Singapore and USD20 in Myanmar. Government Healthcare Communicable diseases, like TB/HIV, are still spend in ASEAN 6.7% of GDP compared to OECS highly prevalent in ASEAN countries - Cambo- average 17.2%2 dia 400 cases in every 100,000 population in 2013 compared to ASEAN average of 190 Generics will take a larger share of pharma-emerging markets medicine Inexpensive medical devices, spend and will increase from 58% in such as prosthetic and diagnostic tools are 2012 to 63% in 2017 compared researched and manufactured to global increase from 27% in the region for the region (USD261bn) to 36% (USD421bn) during that period Sources: 3. Aging in ASEAN http://www.aseanaffairs.com/asean_analysis_21_june_2010/ 1. Life expectancy data, WHO http://apps.who.int/gho/data/node. ageing_in_asean_window_of_opportunity Health in the Post-2015 Development main.688?lang=eng Agenda for Asia and the Pacific, ADB September 2013 2.Medicines Outlook through 2017 IMS Institute for healthcare informatics http:// 4. http://data.worldbank.org/indicator/SP.POP.0014.TO.ZS/countries?display=default www.pharmaasia.com/article/frost-sullivan-indonesia-one-of-more-attractive- 5. Footnote: Health in the Post-2015 Development Agenda for Asia and the Pacific, markets-in-asean-for-foreign-healthcare-cos/10568) ADB September 2013 3 Healthcare landscape outlook - Southeast Asia Healthcare demand in Southeast Asia (SEA) is increasing A raft of healthcare Private Equity rapidly, driven by population growth rates that are expected to outstrip those of other geographies, and (PE) activity is demonstrating the an epidemiological shift from infectious diseases to a increasing importance of the SEA chronic disease pattern matching western markets. Most of SEA’s spending on healthcare comes from health care sector, with Singapore, the public sector (sometimes augmented by state-run insurance funds and personal expenditures), and many Malaysia, Vietnam, and Thailand of the region’s fiscally constrained governments are finding it challenging to meet their citizens’ escalating coming in top for recent deals by needs, as evidenced by a sampling of countries’ current and projected healthcare spending patterns. geographies. Hospital-based In Malaysia, estimated healthcare spending was businesses (general medical and equivalent to 4.4 percent of GDP in 2013. That proportion is expected to rise slightly, to 4.5 percent, by 2018 as growth outpaces economic expansion. In surgical facilities) were the main dollar terms, the nation’s healthcare is projected to rise by an average of 10.5 percent a year, growing from focus of deal activities, accounting an estimated $13.7 billion to $22.9 billion by 20186. Continued spending growth will help to offset demand, for 60 percent of transactions as Malaysia’s elderly increase in number, continued 10 urbanisation spawns western lifestyle diseases, consumer during 2004-2013. awareness of healthcare services grows, and access to these services is improved.7 Spending on healthcare in Singapore is relatively low as a proportion of GDP, at an estimated 3.9 percent in 2013, and is projected to remain stable in 2014-20188. The recent budget announcement on 5th March 2015 highlighted that 11 percent of the S$75.9 billion in government expenditure is dedicated to healthcare in 2015 and the city state’s total healthcare spending during the period is estimated to rise 8.9 percent annually. Unlike many of its neighbours, most of Singapore’s spending on healthcare comes from private- sector savings and state-run insurance funds, although direct government spending on healthcare has risen sharply in recent years.9 6Industry Report, Healthcare: Malaysia, Economist Intelligence Unit, April 2014 7Ibid 8Industry Report, Healthcare: Singapore, Economist Intelligence Unit, July 2014 9Ibid 10Thomson Banker, Al Masah Capital Research 4 While the level of per-head healthcare spending in the Indonesia’s situation is representative of SEA’s personnel Philippines is one of the lowest among the SEA’s major shortage. The country has only 0.2 doctors per 1,000 economies, spending as a proportion of GDP, at 4.6 people. From an infrastructure perspective, Indonesia percent in 2013, is similar11. Because of weak public has only 0.6 hospital beds per 1,000 population when financing, however, that share is likely to dip to 4.5 compared to the global average (three beds per 1,000 percent by 201812. population) and that in OECD countries (five beds per 1,000 population).15 Meanwhile, spending growth is projected to average 8.0 percent annually, increasing from an estimated $12.5 While much of SEA’s public healthcare sector struggles billion in 2013 to $20.0 billion in 2018. The Filipino with growth and funding issues, the region’s private government has promised to respond to the growing healthcare market continues to enjoy solid growth, need to improve healthcare coverage, and this promise especially in the more developed areas such as came one step closer to reality with the 2013 passage Singapore, Malaysia, and Thailand. Major players in into law of the Universal Healthcare Bill, which promises these geographies offer world-class services to both health insurance for all Filipinos, especially the very poor. local and international. Building on the reputation of Singapore’s healthcare services, which has been At an estimated 3.3 percent of GDP in 2013, Thailand bolstered by the city state’s growing clinical-research spends proportionately less on healthcare than the and biomedical industries, the government is promoting Philippines, Malaysia or Singapore, but more than its healthcare industry as a regional center of excellence Indonesia (at 2.8 percent in 2013)13. Thailand’s for general surgery and medicine and specialist services, healthcare spending is estimated to rise by 8.0 percent including cardiology and organ transplants.16 a year in 2014-2018 to reach $18.7 billion, up from an estimated $12.8 billion in 2013. Thailand’s healthcare The SEA region has an active medical tourism industry, system continues to struggle to meet demand following due to its balance of quality and advanced medical care/ the 2001 introduction of a universal healthcare system. technology and relatively affordable cost compared However, because the government is working to reduce to the rest of the developed nations. This is why less- a budget deficit, healthcare’s share of GDP is expected developed countries like Indonesia lose a significant to remain flat, despite population growth and rising share of their domestic healthcare market spending; demand.14 Indonesian residents travel to neighboring countries like Singapore and Malaysia to seek medical treatment — Many of the economies in SEA are struggling with a nearly 1.5 million Indonesians comprise overall medical relatively underdeveloped public healthcare system. The tourism numbers, with a corresponding outflow of $1.4 region has a chronic shortage of medical personnel: the billion yearly.17 average number of physicians in SEA is 0.6 per 1,000, lower than that in developed economies such as the UK The lack of qualified medical personnel will continue to (2.8), Germany (3.7), and the U.S. (2.4). Additionally, the be a barrier as these SEA economies continue to struggle number of dentists and nursing and midwifery personnel despite their increasing healthcare spending. is much lower than that in developed economies. 11Industry Report, Healthcare: Philippines, Economist Intelligence Unit, June 2014 12lbid 13 Industry Report, Healthcare: Thailand, Economist Intelligence Unit, April 2014 14lbid 15World Health Organization, World Health Statistics 2013 16Industry Report, Healthcare: Singapore, Economist Intelligence Unit, July 2014 17The Association of Indonesian Tour and Travel Agencies 5 Healthcare landscape outlook - Singapore Circa 2010 – Healthcare issues faced by the 4.
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