SE Asia pushing to primary care – but volumes and logistics are key
Providers in Southeast Asia have made a pronounced push towards primary care in recent years – but it hasn’t been all plain sailing with logistical challenges and high costs to contend with. Singapore and the Philippines are leading the way, as attendees at the recent IFC conference in Cape Town, South Africa, heard.
Click here to see the largest players in primary care in HBI Intelligence.
“It’s all about volume; primary care cannot stand alone unless there is a clear financial benefit for client, payor or patient,” said Singapore-based Group CEO at HMI, Chin Wei Jia at the Health Service System Business Models panel. “I strongly believe it goes back to relationships. When doctors can see the results and talk to each other, that’s when the continuity of care can happen. With value, you’ll find growth and sustainability. If we grow patient volume, we (can) reinvest.”
Primary care can be very difficult to make financially sustainable, however. Paolo Borremero, CEO of Ayala Healthcare agreed that volume is key, but explained that it needs demonstratable benefits for stakeholders. He speaks from experience, having identified a gap in the Philippines, and subsequently been forced to shut down 70 clinics nationwide: “The pandemic made operating them a lot more difficult, but even without the pandemic, a model without universal health coverage from the government requires significant inpatient foot traffic. Like in retail, you need real significant volumes and within that you want to maximize sales per square metre so to speak. Even then we weren’t able to generate a decent enough return on investment and made the difficult decision to close.”
In another panel, entitled ‘Innovating to strengthen health systems’, John Graham, CEO at Zuellig Pharma said that close collaboration with the government across all different departments is essential in order to get an understanding of what it actually takes to supply healthcare to where it is needed. The sheer size and fragmentation of the Philippines presents logistical barriers to implementation, however. This was amplified during the pandemic – warehouse packaging, reduction in commercial flights, and disrupted delivery routes added to the problem: “In Asia, lockdowns were quite severe with movement control in Indonesia, Vietnam, and the Philippines. The importance of logistics to the administration of health services was underestimated. You’re talking about an archipelago of 7,000 islands with products that need to arrive in good quality. We saw tremendous levels of ignorance as to how the supply chain works – sometimes it took us months to smoothen that passage.”
Notwithstanding this, given the unrelenting demand and the fact that providers want to scale, Adrienne Mendenhall, director at law firm Crowell & Moring International was more optimistic about progress: “Most universal healthcare programs aren’t covering cancer and most chronic diseases aren’t covered. In Asia as of 2017, 75% of people who were diagnosed with cancer had either died or gone bankrupt within a year. People need more coverage – they want to pay for it and need ways that doesn’t put them into bankruptcy, don’t lead to them avoiding care, and that allow the breadwinner to keep working.
“If national insurance programs can’t expand coverage, they are starting to partner with private insurers in a new way – we see this in China and Singapore. It’s not perfect but it is a model to be inspired by. The questions that we are getting from countries in Southeast Asia is ‘what does this insurance PPP or complimentary insurance look like?’”
Borremeo added: “Since the pandemic, we’ve evolved our thinking because we know we need more primary care. We’ve evolved into more brick and mortar tertiary concepts and are opening the first cancer hospital in the Philippines, four multi-speciality hospitals, ten multiple specialty clinics which are larger format. Primary care is evolving more through digital telehealth channels and platforms and we’re using that to service the primary access points and referrals from there.”
We would welcome your thoughts on this story. Email your views to Michaila Byrne or call 0207 183 3779.
