F041–045 Digital health in Asia: China, India, South Korea, and Singapore

 

“If Asia used to be seen as an unstable region, the geopolitical changes with the Trump presidency and Brexit are turning the perception around, with the West seen as less predictable and Asia becoming increasingly appealing for investments,” says Julien de Salaberry, CEO and Founder of Galen Growth Asia.

Photo by  Alex Knight  on  Unsplash

Photo by Alex Knight on Unsplash

Asia is the second-largest digital health ecosystem in the world. 2018 ended with a record-breaking US 6.8B invested. According to IBC Asia, the digital health market is expected to reach $379 billion by 2024.

See Galen Growth’s 2019 Half Year Asia HealthTech Landscape report for the latest information about Asia. https://bit.ly/2ZbgeKf

A five-part series of Faces of digital health podcast offers an overview of Asia, with an insight in Singapore, knows as “Asia for beginners”, South Korea, in the media in 2018, due to its announcement of a 5G futuristic hospitalChina, the AI superpower with rapid advancements in AI due to widespread data collection, and India, anticipating the announced healthcare reform known as Modi care.

Episode one: Introduction — what are the specifics of digital health in Asia? (Julien de Salaberry) Released 26 July 2019.

Founded in late 2015 by Singapore based HealthTech innovators, Galen Growth Asia (GGA), is at the epicenter of HealthTech innovation, aka digital health, in Asia Pac currently a $75+B startup ecosystem. Galen Growth has built a portfolio of solutions which enables it to be the catalyst of direct collaboration between enterprises, startups and investors to prototype, evaluate and implement HealthTech solutions to solve healthcare system pain points and create significant financial and social value in the region.

The founder and CEO Julien de Salaberry led multinational teams across the Asia-Pacific region. He lived in Australia, Japan and elsewhere before settling in Singapore, where GGA has one of its offices.

He observes several things:

  • Bringing convenience and better care to patients is a central focus in Asia.

  • A lot of successful digital solutions in Asia are offering services that help people avoid time delays due to heavy traffic, “an absolute nightmare” in Jakarta or New Delhi, for example.

  • Chinese top-funded deals are all addressing population health issues because of China’s dire need to improve primary care.

  • Entering the digital health market in Japan is incredibly difficult, since — among other things — the average age of doctors in Japan is 65+.

Some questions addressed:

  • How much do Asian market differ?

  • The top countries in the Asian market are South Korea, Japan, Hong Kong, India, Singapore, Indonesia, Australia. What about places like Vietnam, Indonesia, the Philippines, or Iran?

  • How are trade wars affecting digital health? In April 2019, President Donald Trump ordered the Chinese majority owner of healthcare company PatientsLikeMe to sell his stake.

  • If a company wants to expand in Asia, a good local partner is essential. What does that mean from country to country, culturally speaking?

  • What are some of the specific of China, India and Singapore?

Episode 2: China — working by copying x enhancement + collaboration with the government (Julie Wang, LinkedCare) Released on 2 August 2019.

Photo by  Jezael Melgoza  on  Unsplash

China has a larger population than the US and Europe combined. It is becoming an AI leader because Chinese Tech giants and government agencies are investing heavily in the key component for successful AI development: infrastructure for structured data. In healthcare for example — the tech company Yitu has a team of about 400 doctors, most of whom work part-time for about 10 hours a week to help label data, while one-fifth of its full-time employees have a medical background.

According to Phillips Future Health Index 2019, China is an outlier in terms of healthcare professionals encouraging their patients to track healthcare data. Ping An Good Doctor (a leading Chinese health care platform) has begun installing unstaffed, AI-enabled kiosks, called “One-Minute Clinics,”at Shanghai Jiao Tong University, across enterprises, large communities, chain pharmacies and expressway service areas in China. Users sit in a small booth and talk with an “AI Doctor”, developed by the R&D team with over 200 world-class AI experts and has accumulated more than 400 million pieces of consultation records. Patients talk about their symptoms and medical history; the virtual doctor then makes a diagnosis and treatment recommendation. More than 1,000 in-house medical personals and nearly 5,000 renowned external contracted doctors are in the network.

The speaker talking about the Chinese market is Julie Wang - the VP of Customer Success at LinkedCare, a leading digital health platform in Asia, offering a range of diverse products and services including cloud-based electronic health record platform, clinics management system, and supply chain management solutions. Since its establishment in 2015, LinkedCare has grown quickly into the largest solution provider in Chinese dental market, with a rapidly increasing presence in medical cosmetology and general practice clinics across Asia.

Some questions addressed:

  • Chinese size and population which is bigger than the US and Europe combined, have enabled China to become the leader in AI, because AI development requires large amounts of data. Why do the Chinese seem to be open to open space surveillance if it brings convenience?

  • What is the attitude of the Chinese people towards data protection and privacy, which is especially sensitive in the healthcare sense?

  • How do Chinese consumers differ from Western consumers?

  • How is WeChat entering the healthcare space?

Episode 3: India (Kartik Dhar, Sunil Anand, Project ECHO India) Released on 9 August 2019.

Photo by  Ron Hansen  on  Unsplash

Photo by Ron Hansen on Unsplash

India has roughly the same population as China, 1,4 billion people, more than the US and Europe combined. Knowing the struggles of interoperability and access to care in large countries, the latest goals for healthcare improvements in India are beyond ambitious:

  • In February 2019, India’s Health Minister Jagat Prakash Nadda said “Our vision is to create an integrated digital health platform and have longitudinal electronic health record for 1.3 billion people of India.”

  • The government announced a healthcare reform Modicare — is the biggest government sponsored healthcare scheme in the world, which is supposed to cover 500 million people with an insurance coverage of ₹500,000 (7200$) per year per family. Critics say Modicare was only a political stunt prior to elections.

  • India also plans to have 150,000 Health & Wellness Centres at the primary and sub centre level which provide not only curative services but also preventive and promotive services to citizens at the cutting-edge level.

Technology will play a major part in these goals.

See the video from 2016 below, showing Mohala clinics in New Delhi, aiming at bringing better population health overview in India.

Project ECHO® is one of the players with an important role of bringing patients quality care with the help of a revolutionary medical education project. The ambition of Project ECHO is to touch the lives of 1 billion people by 2025. The project works by connecting doctors on the local level, allowing them to share and discuss their clinical cases through the lens of the latest clinical guidelines.

If anyone, India is in dire need to increase access to quality care. According to WHO, the density of doctors of all types (allopathic, ayurvedic, unani and homeopathic) in 2001 was 80 doctors per 100,000 or 8 per 10.000 of the population and the density of nurses was 61 per 100,000 or 6 nurses per 10.000 people.

The executive director of Project ECHO India — Sunil Anand and Kartik Dhar , Leading the ECHO Digital technical solutions development and India based product teams, talk about the current state of healthcare in India.

Observations regarding mobile health: many startups are trying, penetration is not visible yet. More and more startups are shifting towards solutions in local language and there is a visible focus on mental health.

Some questions addressed:

How is the government reshaping the healthcare system in general and in the digital sense?

  • According to some estimates, 60% of family expenditure goes to healthcare?

  • How did Project ECHO spread in India?

  • What is the general assessment of digital health innovation in India? According to some estimates, 24% of people have smartphones, 40% have mobile phones, 35% have nothing. This means only a quarter of the population has smartphones, but 24% in India is still 320 million people. What does this mean in terms of mHealth apps?

  • India is still seen as the “world’s back-office” because it provides the backbone for foreign technology firms. What is the state of innovation?

  • India has the vision to give everyone EHR. The country has 1.4 billion people; is giving EHRs to everyone even remotely possible?

Episode 4: Singapore — (Tony Estrella, Investor, Founder, Novelist) (released on 16 August 2019)

Photo by Hu Chen on  Unsplash

Photo by Hu Chen on Unsplash

Singapore, also known as Asia for beginners, is a 5.6 million people country, offering an encouraging environment to tech companies and expats. The government in Singapore is promoting IT adoption and innovation in healthcare. National Electronic Health Record system was rolled out in 2011. Combine that with countrywide connectivity, mobile-first population, and a lot of openness for collaboration with the private sector, and you get a healthtech epicenter in Asia.

Excluding China and India, Singapore took the lead by deal volume share in Asia in 2018 with 30%, followed by Japan with 27% and South Korea with 13%, according to Galen Growth.

Tony Estrella is a startup founder, investor, corporate innovation leader, and strategic advisor, with work experiences in the US, Europe and Asia. He is partnering with Asia-focused companies who are developing solutions to change the face of cancer and human longevity with core IP stemming from AI, Genomics, Blockchain, and smart devices. He recently published a fiction novel Comatose, which opens many ethical dilemmas regarding the future of healthcare technology development.

Some questions addressed:

  • Given that you lived all around the world, what are your observations of Asia?

  • Singapore offers universal healthcare coverage through a mixed financing system. How does the government support digital health development?

  • What drives innovation in Singapore?

  • The Accenture digital health in Singapore 2016 survey found that two-thirds (66%) of consumers who believe they should have EHR access want to see exactly what the doctor sees — not a summary. Opinion?

  • Your novel Comatose book opens up several ethical questions concerning patient data privacy, clinical trials and involuntary inclusion in medical research, hacking, medical ethics etc. How do you see the future of these issues and the actual fear from unintended consequences?

  • What has the process of writing a book taught you about business? (perseverance, dedicated time, did you ever get stuck. How did you design the outline of the story etc.)

Episode 5: South Korea — robotics leader where telemedicine is prohibited (Ogan Gurel) (released on 23 August 2019)

Photo by  Sunyu Kim  on  Unsplash

Photo by Sunyu Kim on Unsplash

South Korea is known for many things globally:

  • it is the most robotized country in the world,

  • home to tech giants such as Samsung and LG Electronics,

  • it’s a beauty-obsessed nation, where, as reported by the New York Times, the government issued new guidelines for local broadcasters and TV show producers to refrain from showing too many K-pop stars that have similar appearances.

  • South Korea is the third-largest market for virtual currency, behind the United States and Japan.

To establish big data in the medical field, the nation is currently gathering the medical records of about 50 million people from 39 hospitals nationwide by 2020.

Ogan Gurel is a though leader, doctor, professor, entrepreneur, who has been living in South Korea for the last nine years. His teaching experience includes cellular & molecular biology, neuroanatomy, bioinformatics, mathematical modeling and technology marketing at Columbia, Roosevelt, Harvard, SAIHST and DGIST — Daegu Gyeongbuk Institute of Science and Technology in South Korea. He has also served as an independent consultant to several medical device firms in which he was specifically involved with both European and FDA clinical trial development and oversight.

As he observes healthcare access in South Korea is very good. So good, that in fact, telemedicine is illegal. Ogan Gurel talks about Samsung, which he joined when he moved to South Korea nine years ago. In all his time in Korea he observes a so-called “Korean gravity” - the initial ambition of Korean entrepreneurs to become world leaders, that is later replaced by complacency with the national market. Korean healthcare is so good, that you can access your doctor any time without long waiting times. Telemedicine is illegal. When he was still working in the US, dr. Gurel walked from Chicago to Washington in 2009, with the purpose of talking to people to gather their experiences with healthcare. What surprised him was that even those with health insurance had problems with access to care.

Some questions addressed:

  • In 2018, for Mena FN you talked about so-called Korean gravity, which is an obstacle to faster breakthrough of solution globally. Can you explain what is Korean gravity?

  • South Korea caught the attention of the global digital health community last year with the announcement that 25 miles out of Seul, the capital of South Korea, a futuristic hospital with hologram visitors, indoor navigation, facial recognition security, and voice-controlled rooms is supposed to open it’s door next year. Is this a highly anticipated opening?

  • In the early 2000s, it introduced two major reforms: merger of insurance societies into a single insurer system and the separation of medicine prescribing and dispensing. Health care is financed through National Health Insurance covering the entire population. Despite universal coverage of the population, financial protection and high out-of-pocket (OOP) payments have remained a key policy issue?

  • Worldwide, the Republic of Korea has by far the highest robot density in the manufacturing industry — a position the country has held since 2010. What does this mean in terms of digital health development?

  • South Korea is famous for many things: it’s market as a beauty obsessed country. According to a recent Gallup poll, one in three South Korean women has undergone cosmetic surgery between the ages of 19 and 29. South Korea’s government is even trying to limit the stars’ presence on television because the starts look too much alike. Does this in any way translate to how people take care of their health?