Malaysia poised to become ASEAN healthcare hub

Amidst rising costs, the country has been aggressive in pushing for better healthcare delivery.

When the Malaysia Healthcare Travel Council (MHTC) launched “Mum’s Diary”, an in vitro fertilisation campaign for Chinese couples, the initiative chalked up a successful 80% conversion rate from the targeted audience. Next to Indonesia and India, China is one of the topmost origins of Malaysia’s medical travellers, the total population of which already exceeded one million in 2017.

After the Chinese government scrapped its one-child policy a few years ago, around 90 million couples, many of whom are already in their 40s, have begun considering a second child. MHTC saw this as a great opportunity to position Malaysia as a regional hub for fertility, especially since the country’s IVF success rate of 66% has continually beaten the global average of 50%.

Shobena Singam, vice president, Public Relations and Brand Communication, Malaysia Healthcare Travel Council, said that Malaysia’s medical tourism industry has been seeing a healthy growth over the past six years, with revenue generated from healthcare travellers in 2017 expected to reach RM1.3b at 16% y-o-y growth. According to her, medical travellers to Malaysia come for oncology, orthopaedics, cardiology, fertility, health screening, and neurology treatments.

Despite rising healthcare costs, Malaysia’s healthcare travel profile continues to rise on the back of world class hospitals with the latest technology; strong regulations from the government in managing fees and quality of healthcare provision; collaborative efforts between healthcare players; effective marketing branding; and unique offerings in certain therapeutic areas like fertility.

Furthermore, rising costs from regional competitors such as Singapore have pushed patients to seek alternatives in other countries. Regulations on fertility treatments in Thailand and cardiology in India have also created a vacuum for services, thus further encouraging patients to look elsewhere for the treatments that they need.

“We are very fortunate to possess a strong foundation to compete against the world’s best in healthcare travel. Malaysia has the infrastructure, the facilities, the expertise as well as the regulatory and quality framework to ensure that safe, effective and patient-centered healthcare services are being provided at competitive prices. Encouragingly, we are witnessing the growing trend of private hospitals and private healthcare providers offering high-end medical services to both local as well as foreign patients coming from all over the globe,” said Datuk Seri Dr. S. Subramaniam, former minister, Minister of Health (MOH).

All roads lead to Malaysia

Malaysia has been strategic in looking at healthcare gaps across the region and working on initiatives that would bridge these gaps and further attract an influx of medical tourists. When MHTC commissioned a consumer behaviour study for Indonesia and Australia, it discovered several points of entry for its healthcare providers and workers in these two different markets.

According to Shobena, Indonesia’s local healthcare is severely lacking in many aspects even in the private sector, with long waiting times, unnecessary laboratory tests advised by doctors, inconsistent and inaccurate results, and the lack of treatment options offered by practitioners. Furthermore, Indonesian patients perceive that medical staff are indifferent and lack empathy towards their patients.

As Indonesian patients continue to be underwhelmed by the services that they receive in their country, they increasingly find ways to have their needs met elsewhere. Shobena said that Melaka and Penang tend to attract the majority of Indonesian patients into Malaysia. However, she added that push factors such as the perceived lack of leisure activities and rude public transport drivers and front liners still exist.

Meanwhile, in Australia, the study highlighted that while local public healthcare is sufficient, it continues to face challenges in terms of the long waiting times for specific procedures and lack of coverage for others. Due to limited funding, public healthcare services that are deemed non-life threatening take the longest waiting times.

Australian private healthcare, on the other hand, is very expensive with complex insurance coverage still resulting in costly out-of-pocket components. Dental and cosmetic surgery are not covered by the country’s public healthcare system and are therefore very expensive in the private sector. These factors have led to Australia becoming Malaysia’s eighth major source of medical tourists.

For the Australian market, the travel component and connectivity are very important. Shobena said that Kuala Lumpur tends to cater to the medical aspect for this group, while Penang and Borneo are the top choices for the travel component. However, at present, Thailand remains to be the main destination for Australian patients.

“We also work together to strengthen the ecosystem, from the point the healthcare traveller arrives in Malaysia, we have got pre-arrangements. We can actually meet the patients, bring them to a concierge, let them rest and transportation will be arranged either to the hospital or the hotels. So it’s from pre-arrival to arrival to post-treatment. We ensure that the whole ecosystem is taken care of,” Shobena added.

Along with several Malaysian hospitals, MHTC also did a marketing drive in Shanghai to promote the country’s healthcare services. Chin Tuck Piew, administrator of human resources, Gleneagles Kuala Lumpur, said that the drive was especially successful since it was organised in a shopping district, which has become a very ideal place to raise awareness about Malaysia’s expertise in the healthcare sector.

Furthermore, Shobena said that Malaysia healthcare is moving towards its identity and niche. Currently, the MHTC’s brand promise is quality care for peace of mind and their brand proposition touches on three things: quality, affordability, and accessibility. She added that one of the brand values that they are pushing for this year is the trust element. Malaysians need to trust our own healthcare system and believe it first before they could fully promote it to the world.

“While Dubai is aggressively promoting their healthcare services, they have yet to establish one niche positioning. When you talk about India, what comes to mind? Incredible India--India has been strong in cardiology and orthopedics for years. When you talk about Thailand? Aesthetics, cosmetics, sex change. When you talk about Singapore, oncology, cosmetics, plastic surgery. They have all their ways of branding and positioning their countries,” Shobena said.

Health and tech

PwC, in its 2017 report entitled Digital Health, reported that access to healthcare remains limited despite increasing technology penetration. At present, Malaysia has only four healthcare workers (doctors, nurses, and midwives) per 1,000 people, amid mobile penetration reaching 75% of the country’s entire population. According to PwC, greater connectivity has resulte in a more informed and empowered customer base, as mobile phones become channels for accessing health information, doing consultations, and managing payments even in rural areas.

“Harnessing the power of digital technology will be key to helping Southeast Asia’s health industry bridge the gap between access to and the affordability of care, as well as catalyse the proliferation of quality care delivery in the region,” PwC said.

Malaysia has responded well to the challenge of going digital, and has strongly campaigned its vision to be a Smart Digital Nation by 2020. Last 2017, MOH launched the Malaysian Health Data Warehouse (MyHDW), a state-of-the-art data warehouse system that will allow easy access to multidimensional health information without the usual time and location constraints. However, MOH cautions that those who wish to access the data should know that access to information is highly regulated by a Data and Information Governance Committee.

MOH also recently partnered with transportation platform Grab to provide users with transportation to and from selected hospitals from 01 April 2018 to 28 February 2019, a project which aims to make journeys easier for patients and visitors to public hospitals as well as reduce transportation costs for them.

Malaysia’s reputation as a potential Smart Digital Nation has also raised the expectations of its patients when it comes to the latest technology and equipment available for them. The country’s healthcare sector has taken note of the rising expectations, and continues to ensure that its services are competitive and adequate for any procedure or treatment.

“Taking into account the existing branding and recognition of our competitors (especially our neighbouring countries), as well as Malaysia’s strength and capabilities, two areas have been identified to anchor the Malaysia Healthcare proposition on. With excellent success rates as well as existing seed markets like China and India, potential for Assisted Reproductive Technology (ART) is immense. Drawing from Malaysia’s advanced capabilities and technological leadership, alongside changing landscape for competitors, a competitive edge exists for cardiology,” Shobena added.

Footing the bill

Despite several developments in the delivery of healthcare services, Malaysia’s patients cannot discount how costs continue to rise for the treatments and medicines that they need the most. Koh Kar Chai, honorary general secretary, Malaysian Medical Association, said that whenever they speak with patients in Malaysia, they often hear of complaints about their insurance bills going up. According to him, patient expectations have evolved in this day and age, and hospitals and doctors have been striving to meet the minimum standards.

According to Koh, insurers, doctors, and hospitals are the top three factors behind the rise in Malaysia’s healthcare costs. As doctors and hospitals work to bring the best services and the latest technology to their patients, all while spending advertising money on these services, the costs of healthcare incrementally go up and burden the patients. Koh added that patients must also know how to strategise the use of their insurance cards, and move away from using it like a membership card anytime they want.

“Doctors are expected to perform beyond expectations nowadays. This is not that simple, but doctors will still try to address that. Patients demand hospitals to have the latest technology. They all want a good hospital with a nice lobby like a five-star hotel. Statistics show that hospitals are doing well, even if patients say they cannot afford the services,” Koh said.

Koh also pointed out that Malaysia’s dichotomous healthcare sector has not been particularly helpful in keeping the costs down. While the government-led public sector and the thriving private sector have collaborated in what seemed to be a working public-private mechanism, the delivery of services has been less than efficient, with a few doctors and practitioners in the public sector catering to a majority of the population.

“If you have a strong preventive care system in place, you can reduce the overall cost of healthcare in Malaysia. This will only happen if there is a healthcare transformation, if the dichotomous system in Malaysia becomes a single system. We are talking about many many years,” Koh said.

The country’s healthcare expenditures have also been skewed towards curative care. Koh said that inpatient expenditure takes up the bulk of the pie at 62% while outpatient expenditure is at 32%. He added that contrary to what most believe, general practitioners and doctors in private healthcare are actually very interested in preventive care, but the lack of funding hampers them to explore this very important aspect of healthcare. Koh said that in fact, private practitioners in Malaysia constitute a wide network that can serve as centres of dissemination of information relating to healthcare, particularly preventive healthcare.

At the end of the day, Piew emphasised that preventive healthcare begins with the individuals. Piew said that it is critical for Malaysians to maintain a healthy diet and weight, do regular exercise, take sufficient rest, and avoid smoking and excessive alcohol consumption. Malaysia is known to be the fattest country in Asia, with nearly half of the entire population in the overweight or obese category.

“We need to push the number of patients from one: hospitals to primary care and two: from curative care to preventive care, these are the things we need to look at. We have been trying for so many years and we are not there yet. Healthcare costs are still rising. Everyone is talking about reformation, but it is a long journey. The simplest thing we can do is we start with primary care and we can move on to the next steps of reducing healthcare costs,” Koh said.

Public or private?

Piew added that some people feel that more hospitals should be built in districts rather than expanding big hospitals, a common issue among healthcare systems in the ASEAN region. In fact, the Malaysian Medical Association records 46% of clinics in urban areas, 35.5% clinics in semi-urban areas, and only 17.8% clinics in rural areas.

Furthermore, allocations to medical supplies, vaccines, consumables and medical support may not also be adequate considering the influx of people moving from private to public healthcare, particularly for outpatient care. Piew said in 2016 alone, there was a 10 million increase in outpatient cases in public hospitals, compared to previous years.

The healthcare workforce is also faced with its own challenges. While patients are moving from the public sector to the private sector, doctors and healthcare workers are moving from the public to the private sector with the promise of better salaries. There is also a surplus of medical schools and graduates, many of whom fail to do houseman training in the country. According to Piew, delays in the appointment of housemen after graduation from medical schools has led to some of the brightest people doing their houseman training in other countries in the region. This further leads to a lack of competent and skilled doctors at the hospital level.

“If we are seeking services from the public sector, we will expect that these will be either free of charge or very low and we can expect to have facilities or more hospitals that will come up over the next few years. I’m really concerned that we have too many medical schools and too many graduates. We may have good hospitals but if we do not have competent people for them, that’s going to be a problem,” Piew said.

Integration between public and private healthcare in Malaysia remains to be seen even as costs continue to rise and government subsidies fall. Analysts hope that public healthcare will be better regulated in the future and healthcare workers will be provided with better incentives to stay in the public sector.

Fresh start?

Malaysia’s new Minister of Health Dr. Dzulkefly Ahmad could probably lead the country in a direction that will fill the gaps of the current healthcare system. Dr. Ahmad has been consistent in saying that the job of MOH is not just about curing complex medical problems, but ensuring the strategic management and delivery of healthcare services.

With an increased budget of RM27b in 2018, from RM23b in 2017, the MOH hopes to meet growing health demands better. RM4.1b will go to medical supplies, consumables, and medical support. RM1.4b will be allocated for upgrade and maintenance of healthcare facilities, medical equipment, and ambulances for Muar, Banting, and Balik Pulau Hospitals. The Sungai Pentani Hospital will also benefit from an allocation of RM500m for the construction of a 200-bed cancer centre. RM100m will go to the upgrade of hospitals and clinics, including wiring systems.

Piew said that new hospitals and wards will be built in Pahang, Penang, Putrajaya, and Kedah alongside a RM380m-worth forensic medical centre to be based at the Kuala Lumpur Hospital (HKL). The government is also expected to ramp up promotion efforts of heart health and create awareness among non-communicable diseases nationwide. The country’s goal to become a fertility and cardiology hub will also benefit from increased advertising and campaign expenditures, with a total of RM30m allocated to MHTC. MHTC will also use the money to introduce its flagship Medical Tourism Hospital programme which offers special incentives to private hospitals to attract medical tourists.

Koh said that while there may be large investments in infrastructure, the system in place remains to be inefficient. Piew added that the Private Healthcare Facilities and Services Act regulates doctors professional fees, i.e. they should not charge more than 20-30% of the private hospital bill. However, according to him, private hospitals continue to operate on a unregulated basis. A decade ago, a hospital bill worth RM100,000 was uncommon. However, today this amount is actually a normal occurrence.

As long as Malaysia’s healthcare system delivery is challenged, the country will continue to be plagued with increasing costs around its major healthcare concerns. The country is also experiencing a demographic transition, with the aging segment widening over the past years. Diabetes, hypertension, and obesity are on the rise as are non-communicable diseases and infectious diseases.