Shifting forces of supply and demand test Asia's health care systems

August 29, 2014 | South China Morning Post

by Steven Yeo

Steven Yeo says changing demographics and levels of affluence across Asia are presenting governments with the challenge of providing equitable health care amid a talent crunch.

History and geography, along with growing affluence and geopolitical significance, are combining to make the Asian market one of vast social, economic and political diversity. The region is disparate both in population and in the evolution of its various health systems. However, the majority of Asian nations have been proactive in their approach to regional health challenges such as accessibility, cost and quality.

A growing population of educated and affluent consumers is placing demands on health care systems.

Asia is facing a "silver tsunami", a rapidly ageing population. For example, it has been predicted that more than 30 per cent of China's population will be over 60 years of age by 2050. And based on the UN's 2006 report on world population prospects, Singapore will be the world's second-oldest country by 2030, with 27.4 per cent of its population above the age of 65.

In response, a massive build-up in health care infrastructure will increase access for millions as ambitious plans to develop and expand public and private facilities are undertaken across the region.

In a sense, starting new construction projects is relatively easy, with many stakeholders to share the blame or make accusations if difficulties and delays arise. Staffing ratios, payment incentives and patient mix, in comparison, will be more difficult to manage.

The information technology sector offers insights into the challenges ahead. IT is becoming even more crucial in health care as a means of adapting to the manpower shortages, particularly in patient care. Consequently, the demand for experienced IT professionals, trained and familiar with health care informatics, is rising. And so is the need for data analysts, data scientists, functional analysts, IT security experts, enterprise architects, technology managers, database experts, procurement officers and interface specialists.

From being a problem for rich countries like the US and Canada, medical inflation has become a global concern. According to Towers Watson's 2014 Global Medical Trends Survey report, average costs rose 7.9 per cent in 2013. It says that the rising medical trend "continues across the globe, and insurers see no end in sight".

In Hong Kong, this newspaper has reported on the potential lack of available hospital beds by 2026. This is despite the Hospital Authority setting its target ratio of one public hospital bed for every 182 residents in 2011. The ratio currently stands at one bed for every 200 residents, and is expected to rise to one for 208 residents in the next 10 years. That's despite at least three new private hospitals being built by 2018.

Many countries have strengthened their social protection mechanisms and essential health services. Examples include Thailand's health card and 30-baht schemes, the Health Care Fund for the Poor in Vietnam, the health equity funds in Cambodia and Laos and, in affluent Singapore, the Medifund, a subsidy programme for citizens in need.

While experiments in health care financing will continue, such as compulsory medical savings and social insurance for long-term care, existing policies of decentralisation and liberalisation, equity issues and poor infrastructure will continue to present challenges.

And not all Asian governments can provide public health services equitably. The expanding urban middle class' demand for high-quality care has therefore created a vibrant private sector. Market forces have turned certain aspects of health care into a new industry in countries like Singapore, Malaysia and Thailand, leading to imbalances in the distribution of health workers throughout the region.

Whatever the nature of the changes that Asian nations are undergoing, staffing is set to be a major problem. The long list of much-needed talent is headed by top-level management executives in both acute and primary care, and nursing homes; medical consultants or doctors; nursing practitioners or nurses; allied health professionals and health information or analytics professionals.

But economics is causing problems, too. Experts warn of professionals flocking to more lucrative opportunities in cardiology, cosmetic and aesthetic surgery, ophthalmology, and others, instead of general family medicine for example.

There are various ways to address the region's health care issues, including:

• Increasing capacity in universities for training medical (doctors and nurses) and allied health professionals. New courses on health informatics and health analysis need to be introduced.

• Aiming to balance the number of health care professionals working in specialties such as cardiology, cosmetic and aesthetic surgery and ophthalmology, for example, with areas of more urgent and relevant need - such as general family medicine, geriatrics and rehabilitative services.

• Attracting and retaining doctors in rural areas versus cities.

• A review of remuneration packages in order to attract the best talent, especially for top management positions.

• Adopting health care IT to promote efficiency gains, productivity and transparency, and regulatory quality standards.

The future of health care in Asia is exciting and evolving. But, rather than seeing issues as obstacles, they should be viewed as opportunities and challenges that must be met. This is critical for the region's health - physical, social, economic and political - to grow and improve.

Steven Yeo is executive vice-president of DHR International.

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