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​Digital health: Emerging healthcare trends in Southeast Asia

JUNE 28, 2019 @12.33PM

Within Singapore itself, 10% is in the healthcare stats and a number of companies are entering this market.

Last year, Singapore emerged as no 1 for the volume and the amount of money invested in healthcare which surpassed the United States. Singapore actually beat Japan and was no 1 in its investments.

“Within Singapore itself, out of all the start-ups there is, about 10% is in the healthcare stats and a number of companies are entering this market,” said Dr Zubin J Daruwalla (pix), Health Industries leader, PWC South East Asia Consulting while presenting at the Telemedicne: 4th Industrial Revolution in Healthcare conference recently.
 
“Lots of people use to say a few years ago that South East Asia (SEA) had no hope because of poor infrastructure and access is a problem. However, this actually isn’t the case. There are advantages to SEA and its emerging economies.

In ‘The Digital Healthcare Leap’, published by PWC in 2017, the consulting company suggested that the emerging economies are going to lead the development market. It also gave examples of solutions in the healthcare space across SEA that are very successful.

“We believe that harnessing the power of digital technologies will be key to helping SEA’s health industry bridge the gap and provide access to quality healthcare, as well as catalyze the proliferation of quality care delivery in the region.

Since technology is a lot more affordable today, healthcare organisations themselves have much to benefit from a developed digitalised health market.
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How can they benefit?
Patient empowerment and eccentricity. Patients today determine what they see and what they do. There is improved client engagement and patient experience.

Return on investment (ROI). 
“Today is not about ROI. It should be and it is return on experience; a by product by providing a good experience which will increase revenue and profits – so you will get your money back.

“Reduction in human error, investment in patient safety, improved productivity and efficiency. All these could be achieved with digital health technologies.

Challenges
However, the reason for the slow adoption in the healthcare industry are very complex as is the industry. The rationale being; as Zubin explained - that we - the patients are very different.
 
“A lot of times, organisations or vendors will push their solutions that has worked in other markets. It isn’t necessarily the case with the healthcare industry.

He pointed out to four differentiating factors that need to be taken into consideration: population growth, population ageing, population distribution and the rising middle class that we are seeing across Asia.
 
Firstly, the rate of population growth in emerging markets present a significant challenge because the infrastructure is not being developed as fast as the population is growing.

“However, this is not a problem,” said Zubin, pointing to the second factor – the ageing population.

“The portion of the population aged over 65 is increasing exponentially whether it’s Singapore or the rest of SEA and this is a huge problem. This means as the population ages, there is no one to care for the older population. It’s just not doable because you don’t have the manpower – so you have to ensure workforce transformation to protect our future.

“The population distribution in SEA is very different from the rest of the world. Rural versus urban population is pretty big across SEA and Asia.
 
The income rise of the middle class basically means that more people have more money to spend and are also more willing to spend it on healthcare. What happens when that takes place? The expectations change, they want better services, more quality. How are we going to cater towards that?

So, the shift occurs from basic and simple care to one that is more complex. Other sources of inhibitions also exist such as the market conditions which depends on the workforce, insufficient and inefficient financing and system.

Quality to value-based care
Singapore - three years ago emphasised the need to move healthcare to health, from hospital to home, from quality to value based care. That last point – quality to value-based care is currently happening in America, and is starting to happen in SEA. Hong Kong also shifted to value-based care earlier this week with IE packages, fixed prices tagged to outcomes.
 
“The Tan Tock Seng Hospital - one of our biggest hospital in Singapore recently put out a tender to a vendor to actually pile it to a new finance mechanism.

"If we carry on the way we are today – and this is across the region, we are not going to sustain our health industry – provided that we are not going to be able to provide the care that we are today,” he added.

A fragmented, legal and regulatory environment – the fact that fundamental gaps exist in every expects of information, communication technology makes it unlikely for emerging economies to adopt the traditional digital health model.

So, what does digital healthcare mean?
As we don’t have legacy systems in place, there’s not much bureaucracy, infrastructure is lacking – so probably other technologies can solve problems that arise.  
 
“In SEA, we can jump to development markets and we can get to a point of riding emerging health problems - perhaps open source, integrated, social, mobile. Places like Indonesia and Myanmar – mobile penetration is quite high and infrastructure is getting better and better. There are no reason why digital technologies can’t rate success stories in emerging economies.
 
So, the cost, ROI, provider – these are the challenges. 

Return on investment (ROI)
Again, there may be concerns as to defining and measuring value and how to formulate an ROI?
 
Zubin answers this by explaining that despite the high upfront maintenance cost that exist – the transition to paperless reports signals a paradigm shift from traditional medical practices.

“Upfront cost to acquire technology may be high as you’ll need to train employees – especially the older ones and training doctors who are very fixed in their ways. However, with a changed management programme – there should be no reason why you would not succeed.

In addition to this, creation of governance and compliance strategies is yet another task. System innovation and maintenance – we want this one system and obviously do not want a point of distribution. Investing in resources and greater capabilities which all cost money.

But how then, do you define and measure value, ROI?

“Different stakeholders see value differently. A simple example is the hospital versus the patients. The hospital makes money by adding patients in. Some hospitals make money by adding their patients out as well. Patients obviously spend that money when they’re at the hospital.

Zubin emphasised the need to take into account all possibilities in healthcare investments.

"For example – how do you measure the value of a vaccination programme? Or the eradication of polio? There are much wider consequences that we need to take into account. The future is certainly shrouded in uncertainty especially in the United States.  So, the question is how do we calculate long term investments?

"We often look at the cross-functional and the broad and active technologies. Not just to the patient and the hospital. You have to be careful as to how you actually calculate your cost. There should be different things to define ROI. Patient safety, clinical outcomes, patients experience, social and organisational benefits and patient engagement which is what everyone really wants today.

As we all age and live longer, you also have to factor in what will be the cost of serving that older population in the future.

The success factor for implementing health tech solutions
Zubin identified the first two as awareness and education and just being aware.

"We have to be aware of the technologies that are on the horizon. So, we can access and identify, validate and decide if we should implement them or not.
 
“So, being aware and educated about different stakeholders, regulators, manufacturers, providers – what each of their roles are and what needs to be done is crucial. The health industry is always lagging behind – the last to implement things. We never want to learn and regulate from other industries. It isn’t a technology problem, but a people problem.

Therefore, using health tech solutions to compliment practices at this point is essential, rather than replace them as they can really improve outcomes for patients.

With these health tech talk, are we going to reach a point like the movie Matrix where we are plugged into our computer system? Is that going to happen? Is there going to be a convergence of capabilities and are we going to be run by brain machine interfaces and AI?

Zubin stated that this might be possible.

“We are already seeing technology – where you get Nano box circulating in your blood and give you real time diagnostic – 24/7. If you fail to prepare, you prepare to fail.

At this juncture, he pointed out to three key factors: adequate preparedness, to make sure you are secured while connecting to devices or platforms, data governance, protection and privacy.

The eight C’s
To sum it all up, Zubin pointed out to eight key factors to ensure that the cost is foreward to be sustainable.

• Convenience and connectivity. Are you convenient to make sure that you are accessible to the masses of people who have invested in healthcare and are you ensuring connectivity? If connectivity doesn’t exist, there are online and offline solutions to help you solve the problem.
• Consent – you have to ensure that you receive consent and if you don’t – you should be doing something that is actually allowed.
• Change management – if you’re inventing new technologies, please run a change management programme within your own organisation or an external party.
• Make sure that you are covered. We are in an industry where credibility is really key. If you don’t ensure credibility – you are in a telemedicine platform, and you are a doctor – how would anyone know if they are actually speaking to a doctor? Are you credible and how do you ensure that?
• Cyber security – the biggest concern today.  
• Culture - Within SEA and Asia - we are different. If you look at it from a cultural perspective, we are so different. Even within a country – whether its Malaysia or Singapore – we have so many cultures and we have to respect that. You have to be aware of the different cultures that exist before you can actually address them.
• Collaboration - Something that is such a simple solution, yet so difficult to execute. 

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