Asean and universal health care

ASSOCIATION of Southeast Asian Nations (Asean) has traditionally relied on a mixture of public and private health care with an emphasis on the latter. It is a structure that is likely to continue as more countries in the region begin to move toward the provision of universal health care.

For those shortly to implement such schemes in the cases of Indonesia and the Philippines, there are big challenges ahead. However, even in these countries, which together account for more than half of the region’s 600 million population, the private sector is likely to continue to play an important role in the provision of services to state-insured patients.

Thailand is already a pioneer in the region having introduced free universal health care at the point of delivery in 2002 and demonstrating that the concept is not out of reach of middle income countries. Virtually, the entire 67 million Thai population is now covered for primary care through to hospital treatment.

The Philippines aims to attain universal health care by 2016. From this date, around 100 million Filipinos would be covered by insurance according to Philippine Health Insurance Corp. (PhilHealth).

Singapore has a well-funded compulsory insurance scheme that allows some of the most advanced levels of health provisions to be offered. The Parkway Group’s Mount Elizabeth hospital is the first center among the Asean to offer stem-cell transplant therapy for acute tumors.

Many countries in the region will have to make very substantial increases in annual investments in health care to catch up with averages in Organisation for Economic Cooperation and Development (OECD) countries. Even in Malaysia, spending is still only one-tenth of that in Western Europe and in Indonesia one-seventieth according to the World Health Organization (WHO) 2011 figures.

Finding sustainable methods to fund basic health care is a challenge and involves a keen focus on cost containment throughout the Asean area. There are no easy choices to obtaining the most from limited budgets.

The Philippines, for example, is estimated to require more than 152,000 new hospital beds to serve its population.

The region urgently needs to train more health professionals including technicians, as well as doctors and nurses. According to a recent survey by Frost & Sullivan, the proportion of health-care workers in the Asia-Pacific region is 6.8 percent per 1,000 of population compared with 18.9 percent in Europe and 24.8 percent in North America.

It is believed that the region’s shape of future health-care provision is unlikely to replicate systems in the West but provide an environment for innovative forms of public-private partnerships to develop. This may see the government’s role steadily shifting from provider to regulator with private health companies working in partnership with the state in the provision of services.

The private health-care sector is also very active in providing services to foreign “medical travelers.” Singapore is estimated to receive more than 400,000 foreign patients are year.

The growing international number of patients are attracted by low-cost treatment. Hospitals in the region can offer complex operations ranging from heart-bypass procedures to hip and knee replacements.

Thai hospital groups have positioned the country as a hub for a variety of procedures; the Tourism Authority of Thailand estimates that 2.4 million foreign visitors arrived in 2012 for health services, generating revenues of $439 million.

The Philippines is gearing up for “medical travel,” too, given the focus on transparency of costs and quality management.

The Asean region is also poised to occupy a critical and distinctive place in the future of the global technology industry both as a pharmaceuticals manufacturing hub and as a location for biosciences research and development.

Cross-border investments will result from the liberalization due to follow Asean’s economic integration in 2015. –Henry J. Schumacher / Asean-EU Perspective