business environment analysis and scenario planning on health sector

Columbia Asia

Business Environment Analysis and Scenario Planning on Health sector

1. INTRODUCTION

This report is based on the health industry in Asia and the external factors affecting

the health industry today. We will be identifying and analyzing the crucial factors that

will affect the industries business environment and we will propose three scenarios

that can help Columbia Asia to explore possible developments for the future.

1.1 Columbia Asia

The operation of Columbia Asia began in South East Asia in 1994 as Columbia

Pacific Healthcare Sdn Bhd (CPH) and operated under the Columbia Asia logo since

May 2001. CPH is a joint venture between Chemical Company of Malaysia Berhad

and Columbia Pacific Management (CPM), which is an international healthcare

provider operating a chain of modern hospitals across Asian countries (Association

of Private Hospital of Malaysia, n.d.). Their service is provided in Malaysia, India,

Indonesia and Vietnam. The hospital delivers effective services at an excellent

value. The organization is focused on building hospitals of future that are driven by

excellence in quality and modern technology targeting the middle income group

(www.columbiaasia.com). Refer to Appendix One for internal strengths and

weaknesses of Columbia Asia.

http://www.columbiaasia.com/

Columbia Asia


2. Analysis of the Business Environment

In order to find the driving forces affecting the health industry in the four countries,

Malaysia, India, Indonesia and Vietnam; we will be analyzing the external forces

namely, Political & Legal Environment, Economical Environment, Social

Environment, Technological Environment and Ecological Environment.

2.1 Political & Legal Environment

Government’s Role in the Health Sector

Government’s role is vital for the health sectors growth. Hence public health

investment is crucial for the country because the improvements in the health support

provides an opportunity for better and quality services to the people of the country

which leads to increase in educational attainment, labor productivity and economic

growth (Goldman Sachs Global Investment Research, 2009).

In 2008 Malaysian government allocated US$609 million for the development of

health care, which is to be used for construction and upgrading of hospitals and

clinics, and also to implement new facilities and technological systems to provide

better services to the patients. Implementation of the Harm Reduction Programme

and financial assistance by the government will help the lower income groups get

medical treatment especially for chronic diseases (Invest Penang, 2008).

To strengthen and upgrade India’s health system their budget for health in 2008-

2009 had an increase of 15% with a special emphasis on HIV/AIDS, polio and health

care for the rural and urban poor (ThaIndian News, 2008).

Indian government encourages private sector to provide healthcare infrastructure for

urban middle and high-income groups by allowing 100% FDI for health related

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services and allowing lower tariffs on medical equipments and also by amending its

Income Tax Act, while the government through its Common Minimum Program and

National Rural Health Mission 2005-2012 focuses in providing effective and

affordable health service to the rural areas (PricewaterhouseCoopers, 2007)

Introduction of a new government health insurance scheme in 2007 ‘Rashtriya

Swasthaya Bima Yojna’ to Below Poverty Line (BPL) families, makes health care

more accessible to them as 75% is covered by the government and the balance is

paid by the state government. (Asian Development Bank, 2008). Introduction to

‘Cashless Hospitalization’ by Insurance Regulatory Development Authority in 2002,

added a new dimension to Medical Insurance. It allowed a strong health

reimbursement infrastructure in receiving world-class health care (The Indo-Italian

Chamber of Commerce and Industry, 2007)

Indonesia lags behind in many areas of healthcare provision as health has been a

very low priority in the macroeconomics reconstruction. The government has

allocated 1% towards the health section from 1997-2006. Health sector expenditure

in 2009 is US$ 13.2 billion and is expected to grow to US$ 15.8 billion in 2011

(Espicom Business Intelligence, 2007 cited in Invest Penang, 2008).

From 2005 – 2010 the Vietnamese government projected to spend USD 1.5million

for building 57 new hospitals, in which over USD 1 billion will be spent on medical

equipment. The Ministry of health launched an ambitious strategy to develop 3 hi-

tech centers nationwide & increase the number of skilled & well trained medical

personal. The Vietnamese government will also provide USD 23.9 million to develop

new infrastructure and modernize district denied nationwide. Foreign aid and loans

would be used to upgrade provincial hospitals, districts clinics and communal health

center, as well as funds for epidemic prevention drives and medical checkup for the

poor (Emergo group, n.d.).

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Government of Vietnam aims to achieve the objective of Universal health insurance

coverage by 2010. With the assistance of Asian Development Bank, it plans to use

Electronic Health Insurance cards to expand the health services for rural and poor

families, to improve administrative efficiency, reduce the time for reimbursement and

payment processing and reduce fraudulent claims by providing more timely and

accurate client information (Asian Development Bank, 2002).

G overnment’s laws and Regulations

Control of Tobacco Productions Regulation 1993 which was enacted under the Food

Act 1998 in Malaysia (Tobacco Control Unit, 2003), The Tobacco Control Act 2003

in India (World Health Organization, 2009) which was amended in 2008 and

Indonesian government’s regulation 10/2003 in the subsequent governor decree

No.75/2005 bans smoking in numerous public places, health facilities, work places

and educational institutions (Seorojo, 2009). Malaysian regulation also prohibits

smoking for less than 18 years old. And it also states that none of the tobacco

companies can promote or advertise their products to the public as this will only

increase the number of smokers (TobaccoControlUnit, 2003).

Affective from 2009 April the Income Tax Act in India, allows 5 years of tax free

service with the establishment of new hospitals in nonmetropolitan areas (Asian

Development Bank, 2008). This regulation will encourage investors to develop

health sector in these areas.

In July 2006, at the 11th National Assembly of the Socialist Republic of Vietnam, a

law was passed on HIV/AIDS prevention and control. The law stated protection of

AIDS carriers and non-carriers, and free examination and treatment of opportunistic

infections and free ARVs for people affected due to occupational accidents (National

Assembly’s Standing Committee, 1995).

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2.2 Economical Environment

Growth of Health Sector

Malaysia private sector development especially in health sector increased efficiently

during the past few decades. The consumer market worth US$0.97bn in 2008 is

expected to increase to US$1.89bn by 2013 (Research and Markets, 2009).

Currently there are more than 210 private hospitals operated in Malaysia with

qualified medical specialists and staffs (Thomas, 2007).

Despite the recession, with a current GDP of 7.5 India is the second fastest growing

economy in the world (Ministry of Finance Indian Government, 2009).Health sector

contributes 5.2% revenue to the country’s GDP and it is expected to grow by 2012,

due to its demographic profile changes accompanied by lifestyle diseases thus

increasing medical expenses. In 2012 6.5% to 7.2% revenue of GDP will contribute

from health sector, increasing direct and indirect employment (The Indo-Italian

Chamber of Commerce and Industry, 2007).

Medical/ Health Tourism

Because of their low cost advantage medical tourism offers tremendous

opportunities to developing countries and is one factor that leads to the growth of

health sector and improvement in the health infrastructure in Malaysia and India.

(Sustainable Industrial Networks SINET, n.d)

Malaysia is experiencing a constant increase in ‘health tourism’ due to availability of

high quality standards of medication at reasonable cost whereby patients from less

developed countries (Indonesia, Bangladesh, Vietnam etc) as well as high medical

cost countries seek treatment in Malaysia. In 2006 the number of foreign patients

increased to 300,000 with a total spending of USD 60.69 million. From January to

March 2007, around 77,009 medical tourists visited Malaysia and the government

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expects an increase in medical tourism by 30% annually. In 2012 the turnover is

expected to reach to US$0.6 billion (Malaysian-German Chamber of Commerce,

2008).

India is considered the leading country in health tourism with its unique medical

treatments in yoga, meditation, ayurveda, allopathy, and other systems of medicines

which cannot be matched by other countries. Affordability and availability of quality

health care as well as the high success rates and the great reputation of Indian

doctors boosts the growth of medical tourism to 30% per year. Studies indicate that

by 2012 medical tourism in India could bring revenue of US$1 to US$2 billion

(Sustainable Industrial Networks SINET, n.d).

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2.3Social Environment

Demographic Trends

Population in Malaysia is expected to increase to 33.3 million in 2020. Due to an

increase in life expectancy ageing population is predicted to increase by 3.3 million

in 2020 creating an increase in the prevalence of ill health. (Mohamed, 2000).

Mentioned above one driver of growth in the healthcare sector is India’s booming

population, increasing at an annual rate of 2%, which is currently 1.1 billion. It is

projected that by 2030 India will be the most populous nation surpassing China. Also

due to the decline in infant mortality resulting in better health care facilities and

government’s emphasis on eradicating diseases among infants will lead to a

population of 1.6 billion in 2050. By this time it is estimated that 189 million Indians

will be at least 60 years of age which is triple the number in 2004 and will place a

bigger burden on India’s healthcare infrastructure (PricewaterhouseCoopers, 2007).

Growing of Income groups

Gross national income per person in Malaysia was US$6,033 in 2006 with a

purchasing power parity of income per capita US$12,700bringing them to the same

level as Chile and Russian Federation (Wong, 2006). There was a 4.3% annual

growth in the average household income in 2007 (Refer to Appendix two), the

poverty level also declined by 43% in 2006, as per the 9 th Malaysian plan that target

to eliminate the number of poor household by 2010 (Bernama, 2008).

Thriving urbanization and expanding middle class in India leads to more disposable

income to spend on healthcare (Refer to Appendix three). Due to reduction in

poverty level, it is projected that by 2025 the middle-income group in India to grow

from 50 million people to a staggering 583 million, due to reduction in poverty level.

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(Indus Business Journal, 2008).Life style diseases common to middle-and upper-

income groups, such as hypertension, cancer, obesity and diabetes also rises and it

is expected that life style diseases will grow at a faster rate than infectious diseases

in the next 5- 10 years creating massive demand for health care and rising costs

(PricewaterhouseCoopers, 2007).

Changes in Lifestyle and Trends

HIV/AIDS

Since 1986, the number of Malaysian infected by HIV/AIDS has grown and it is

estimated that 300,000 will be infected by 2015. Currently there are 73 thousand

people out of 30 million population is HIV/AIDS positive. The rise in heterosexual

relationships is getting significant and numbers of youngsters infected by HIV/AIDS

has increased by years (Biomedicine, 2007).

India is home to 2.5 million HIV/AIDS patients, including over 70,000 children below

the age of 14. Due to government spending and awareness, the dominance of

HIV/AIDS in the country had come down from 0.9% to 0.36%. The National AIDS

Control Organisation (NACO) is the body that prevents the disease by educating

people about HIV/AIDS (ThaInidan News, 2008).

The number of known HIV/AIDS cases in Indonesia has almost tripled since 2005

the high rate of HIV/AIDS among the population in large part is because of

inadequate health care. Some transgendered people living with HIV in Indonesia

face discrimination and experience stigma when accessing health care (AFP, 2009).

In Vietnam, HIV/AIDS are a growing pandemic with over 132,628 cases of HIV and

26,828 cases of AIDS as of 31 August 2007. There have been a total of 15,007

deaths due to AIDS in Viet Nam. HIV exists in all 64 provinces/cities, in 96% of the

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659 districts and in more than 66% of the 10,732 wards/communes. Of all reported

HIV cases, 78.9% are in the age group 20–39, with males accounting for 85.2% of

total reported HIV cases. People living with HIV are getting younger and

heterosexual transmission is becoming more significant (National Assembly’s

Standing Committee, 1995).

Columbia Asia


2.4Technological

The technological environment consists of those forces that affect the economy and

industries by creating and developing existing or new products, new markets, and

new marketing opportunities.

Development of Information & Communication Technology & the growth of

Tele Medicine

The growth of Information & Communication Technology leads to the development

of telemedicine. Main reason for the expansion of telemedicine is that it shall

increase the patient base in rural areas, which in turn will increase occupancy rates

of hospitals in the integrated telemedicine model (The Indo-Italian Chamber of

Commerce and Industry, 2007).

In Malaysia Tele-consultation services will be further expanded to enable the

provision of specialist services for the rural population. By these services, rural

population could get medication without having to worry about the geographic

barriers. (Malaysian-German Chamber of Commerce, 2008)

A nation-wide information system will be established by the Malaysia government to

link public and private health facilities for timely, quality and reliable information. A

National Health Informatics Centre will be opened for health and health-related

information to be processed centrally. (Malaysian-German Chamber of Commerce,

2008).

Columbia Asia


2.5 Ecological Environment

Natural Disasters and its impact on health sector

Natural disasters are also said to affect the health industry, for instance Indonesia is

known for earthquakes and volcanoes while Malaysia and India experiences

landslides. The people affected by these natural disasters are most of the time

unable to be attended due to lack of medical staffs and public hospitals.

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3.0 Alternative Scenario

Scenario planning is a flexible approach to strategy formulation by looking at

possible changes in the environment asking the question what if? The process

promotes the current state of the organization, as it challenges an organizations

perception and encourage people to learn and adapt (Willmore, 1998).

Below are the three possible future scenarios which could happen in 5-10 years.

3.1 First Scenario: HIV/AIDS Medical and Convention Center (HIV/AIDS-MCC)

The number of people infected by HIV/AIDS is increasing over the past years in

these four countries with a high number of affected younger populations. Although

the government and NGOs have implemented awareness programs to reduce the

infected, it has been not reached to most part of the population. To overcome this

problem, the government can come up with a plan to build up a HIV/AIDS Medical

and Convention Center where all the HIV/AIDS treatment, testing and awareness

programs can be conducted in one central place which is accessible to all HIV/AIDS

patients.

3.1.1 Impact of the Scenario on the Company/Industry

HIV/AIDS patients will get full specialized doctors in the field and fully equipped

services with high technology which will help them feel secure and get their

treatment effectively.

HIV/AIDS-MCC could be used to do research in finding a cure. The Rehabilitation

center in the building may help the sufferers to learn and share their past

experiences and boost their confidence in applying to job market hence contributing

to the economic growth.

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The spacious Convention Centre in the building can be used for the sole purpose of

creating awareness to the population on HIV/AIDS by the government as well as the

NGO’s working for the prevention of the disease. Due to this a greater number of

populations can attend the awareness programs which will make it more effective in

the prevention HIV/AIDS in the future.

3.1.2 Proposed Action

Columbia Asia is not specialized in providing services to HIV/AIDS patients hence,

the company can take the opportunity to establish the HIV/AIDS-MCC by doing

research, getting advance equipments and specialized doctors in the field.

As India has an increase number of patients and is also forecasted to be most

populous country in the future, Columbia Asia can invest to open the HIV/AIDS-MCC

in India by working closely with the government.

3.2 Second Scenario: Introduction of Electronic Health Care Card (E-HCC)

The government can introduce the use of Electronic Health Care Card (E-HCC) that

can be used as a device that connects the government and all private and public

health care facilities with an automatic updating database of the patient’s medical

record, whereby the patient’s medical history can be seen from the connected

database from any hospital that they visit. This will make the service more efficient

and effective to both parties. Increase in population and demand for better health

services as well as the development of Information & Communication Technology in

Malaysia will contribute to the introduction of this scenario in order for the

government to achieve creating a better health sector in the country.

Columbia Asia


3.2.1 Impact of the Scenario on the Company/Industry

The people will be prone to efficient and quick services in every health facility that

they visit, as the doctors can be able to diagnose the problem using their medical

history from the linked database.

The Government will find it more efficient and effective to control and monitor the

information on the health sector while the Ministry of Health can minimize paper

work and retrieve up to date data to see a better view on the health state of the

whole population which will guide them in making effective decisions for

improvement of health sector. E-HCC increases privacy and transaction security it

will be uniquely programmed utilizing sophisticated encryption technology which will

authenticate each transaction and will be difficult to fraudulently modify or duplicate.


Columbia Asia must work with the government in developing and establishing a

compatible software system for E-HCC and also train competitive staff to maintain

the database.

3.3 Third Scenario: Consultation through Video conferencing

Improvement in the technology mainly in the way of telemedicine and tele-

consultation the government can come up with a plan of developing the rural health

sector by way of video conferencing to carry on surgical procedures and other

medical procedures that cannot be provided for the rural due to shortage of facilities

in the rural areas. Since the governments of India and Malaysia are emphasizing on

increasing spending on health sector and developing telemedicine; adopting this

scenario could help them reach their objectives easily.

Columbia Asia


3.3.1 Impact of the Scenario on the Company/Industry-

Video Conferencing uses high tech clear digital devices to carry on surgery and

other medical procedures without the doctors been outsourced. Specialists from

local and foreign hospitals can observe surgical and medical procedures and give

their assistance and feedback through video conferencing.

This will solve the problem facing difficulty in shortage of specialized doctors since

the hospitals can utilize the specialists through video conferencing to diagnose

patients in rural and geographically difficult areas to travel. This also reduces costs

for the hospitals and government like employing specialized workers from abroad

and travelling expenses.

One potential issue that may arise from this scenario is connection or streaming

errors due to poor network reception especially when communicating to long

distances. Other problems include camera and speaker issues, IP configuration

issues and power complications.


For proper implementation, Columbia Asia needs to take certain measure and

action. The initial investment in implementing the scenario maybe high and Months

may be required to enable video conferencing capability within a large organization;

this is including time required for designing the network and installing video

conferencing equipment.

Columbia Asia can get external specialists assistance in setting up the systems and

operating it. They could seek assistance from a 3rd party vendor that specializes in

video conferencing or video communications services. The highest level of video

network functioning can be expected from a well-trained experienced team of

experts managing your internal video conferencing network.

Columbia Asia


4.0 Conclusion

The increased emphasis on the health sector by the governments and the increasing

population along with technological developments holds a potential scope for growth

of Columbia Asia despite the negative effects of the external environment. Hence,

proper forecasting and scenario development for its future can make Columbia Asia

among one of the most competitive companies in Asia.

Columbia Asia


Appendix One

Strengths Weaknesses

Provide trusted affordable care with an emphasis on the most prevalent medical issues of a region.

Delivers advanced medical care through facilities located in neighborhoods, rather than the central city.

Managed by well-trained and experienced doctors and other health professionals with the help of progressive medical protocols and modern equipment.

Availability of advanced technology through which all the hospitals in every country is connected by a common software operating system.

Columbia Asia is rapidly becoming the healthcare provider of choice for the emerging middle-income group of Asia.

Columbia Asia hospitals are smaller in size with a typical hospital having about 65 adults’ beds.

Central focus is only in the Southeast Asia. With no immediate plans of expanding into other parts of Asia.

No association with the western medical professionals as Columbia Asia is known for employing its doctors and staff largely from the local areas.

Labor shortages with a total of only 2600 employees.

Lack of exposure in the media

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Appendix Two

Average Monthly Household Income

2004 2007

US$ 928 US$1053

Source: Bernama, 2008

Appendix Three

Indian Middle Class Income Group

Year % of Entire Population

1998-1999 44.92

2000-2002 50.53

2009-2010 (estimate) 62.95

Source: CRIS Infac, 2005 cited in PricewaterhouseCoopers, 2007

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http://www.bo.camcom.it/ALTRI-SERV/DEPOSITO-D/Seminari-s/Report-Healthcare-Sector.pdf

http://www2.goldmansachs.com/citizenship/global-initiatives/research-and-conferences/recently-published-research/gmi-global-health-factsheet.pdf

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