A glimpse in digital health and healthcare in the APAC region
Healthcare expenditure and digital health investments I Alternative careers for doctors in Malaysia I COVID, Australia & My Health Record I What is Pakistan doing right in healthcare digitalization?
Looking at digital health investments in the APAC region, according to Galen Growth Asia, in 2021, China took the highest amount of funding (58.6%) for digital health, followed by India (22.3%), Australia (5.6%), Soth Korea (4.3%), and Singapore (3.8%).
Healthcare expenditure differs a lot among countries: According to the World Bank, China attributed 5,3% of its GDP to healthcare, India 3%, Australia 9.91 %, and Singapore 4%. How do these healthcare systems differ and does healthcare expenditure relate to investment in digitalization?
In a series of discussions in June 2022, discussions on Faces of digital health explored the optics of healthcare in a few countries in the APAC region.
Healthcare in Malaysia was presented by dr. Selina Chew, Co-Founder of Medic Footprints Malaysia - a franchise of a UK-based organisation connecting doctors to alternative careers.
WHO estimates a projected shortfall of 18 million health workers by 2030, mostly in low- and lower-middle-income countries. The needs for doctors are increasing, but many clinicians are leaving the profession because they are burned out and are looking for other career opportunities. “Two things are especially problematic in healthcare in Malaysia. One is bullying, and the second is the rigid hierarchy. You have a houseman that's the medical officer, then the registrar, the specialist, and the consultant. There are too many levels, and there's always this wall you have to climb over to talk to people, to your superiors. So one of the things I envision for healthcare here in Malaysia is that we break this down. I'll just give you an example: in public healthcare, we have multiple daily rounds. First, the houseman comes very early to do a medical round to see patients. Then the medical officer comes, and that's the same medical round again. And then later, the specialist will come and do the same rounds. They ask the same questions or maybe additional questions. And then on the fourth round, the consultant will come in and do their rounds with all of this, the houseman and specialists. I see this as very redundant. Why can't we go as a team and see patients? I am hoping that we can change this. It's going to be a very tall mountain to climb, but that is something I envisioned for our health care here,” says Selina Chew.
Malaysia has a dual-tiered system of healthcare services: a government-led and funded public sector, and a thriving private sector creating a dichotomous yet synergistic public-private model. There is not a unified system of universal access to healthcare for every citizen. The public sector caters to the bulk of the population (~65%), but is served by just 45% of all registered doctors, and even fewer specialists (25-30%), wrote David Queck, Senior Consultant Cardiologist, Member of the Malaysian Medical Council, in 2014.
Diversity of healthcare systems
The APAC region is very diverse in all possible meanings: the culture, development, and size of countries and the way healthcare systems are designed. “Australia has a completely publicly funded healthcare system. In Japan the government requires you to have health insurance, but healthcare services are provided by private healthcare providers. Then you have countries like India, where you need to get yourself covered through private insurance. Singapore has a completely different model with co-pays for healthcare. The patient pays a small portion, but the government subsidizes a massive portion,” says dr. Keren Priyadarshini, Regional Business Lead of Worldwide Health for Microsoft Asia, who leads the company’s healthcare business segment across 17 markets in Asia Pacific. The specific of Singapore is also a compulsory medical savings account with which residents pay for inpatient care and selected outpatient services.
Many populations in Singapore indicate good national health, with 13% of the population older than 65, and life expectancy of 84 years. Yet the country only attributes 4% of its GDP to healthcare, which is considered low compared to for example, most European countries.
COVID showed the usability of My Health Record in Australia
Australia spends 9.91% of its GDP on healthcare, has a high live expectancy (83 years). Australia is vast, has 25.7 million people, and managed to implement a national EHR infrastructure called My Health Record. According to official statistics in April 2022, 23.3 million My Health Records are currently on the platform. The implementation of this infrastructure hit many bumps on the way - going from an opt-in to an opt-out system, raising concerns regarding data privacy, in the end was and still is critiqued because it may well happen that the records on the platform are incomplete because not all providers use it in practice. However, says Peter Birch, Host of Talking HealthTech podcast, My Health Record turned out to be very useful for COVID vaccine certificates. “My health record was used as the place of reference for your vaccine certificate. That's where we have seen a huge uptick in the use of My Health record because there's actually a reason to use it now. The user experience with accessing the vaccine certificate is also quite nice - you don't open up a little PDF and zoom up to the QR code. So I think this demonstrated that, if there's a reason to use My Health Record, it will be used. The challenge now will be for us now start investing in more use cases that more of the public would see benefit and interest in.”
What Can Developing Countries Learn from Pakistan About Healthcare Digitalization?
Another APAC country we looked at is Pakistan. Pakistan has the 5th largest population in the world, but 50% of the population doesn’t have access to primary healthcare. People have access to mobile phones, but not necessarily smartphones. The country has poor health outcomes and low healthcare expenditure (3.38% GDP), and a strained healthcare workforce. The average number of doctors per 1000 patients measured in 2019 in Pakistan was 1.1, which is low; for example, Australia has 3.8 doctors per 1000 people.
“The problem is not, that not enough doctors are trained,” says Zahid Ali, HIMSS TOP 50 Digital Health Leader of 2021, “the country produces 20,000 new doctors annually, but many of them move abroad. Many women with a medical degree don’t transition to the healthcare workforce due to marriage and childcare.”
In the US, Zahid Ali has been working with the ONC and the Department of Human and Health Services to help set up regulatory frameworks, especially for mobile apps. Coming from Pakistan, he is working with the government to raise digitalization efforts. “If we look at developed countries like the US, UK, France - these countries already have well-structured healthcare systems and digitalization. Pakistan does not. Most of the healthcare work has been done manually, and people aren’t receptive to change,” Zahid Ali explains, adding that the landscape is changing primarily because of easy access to information and knowledge.
To address the pandemic, Pakistan took a collaborative approach to build an early warning system in three phases. “First, we invited private and public providers to provide healthcare services and create an integrated care delivery model. If a doctor wanted to dedicate his time to patient care, he was added to the national platform.” Then, an additional platform was built, named Friend of the country. “We enrolled roughly 5,000 people outside the country to provide care. We took this to the next level with a single digital front door where all available capacities were gathered,” Zahid Ali describes.
The beauty of this approach was that it did not require high-tech solutions or innovation; it was only infrastructure and organization that leveraged existing resources. “What we did uniquely was to build a complete mechanism for awareness of the people, with the help of mobile ring tones. When people were getting these messages, they started complying to recommendations and requirements about masks and other recommendations.”
Faces of digital health podcast steers away from American-centricity in reporting about digital health. The content gives policymakers, healthcare experts, patients, and entrepreneurs an insight into how healthcare systems around the world adopt technology and what problems innovators from different cultures are trying to solve. Diversity and different perspectives can only enrich ideas for the problem-solving of healthcare.
Are you ready to travel? Subscribe to the newsletter and tune in to the podcast.
Tjasa Zajc
Founder and Host of Faces of Digital Health