亚洲医疗产业的快速发展与趋势.doc

大的亚洲财团纷纷进入私立医疗产业，一个消费者花费年增长幅度达25%的产业。 HEALTH:A FIRST-CLASS CUREBig Asian groups are entering the business of private health care, an industry in which consumer spending is growing 20% every year. What does it mean for you?By Susan Berfield WHAT IS THE SUREST remedy for anxiety about your health? Have yourself admitted into the most expensive private hospital in town, say many in Asias new moneyed class. Call it the status cure. Take 28-year-old Thai homemaker Amornrat (not her real name). Last September, she booked a room in the maternity ward of Bangkoks Samitivej Hospital for a Caesarean section. She knew the doctor. The nurses were attentive. The room was plush, the food tasted great and the bill came to 70,000 baht ($2,810). Thats about seven times what she would have been charged in a public hospital for the five-day stay. I dont mind paying for private care, says the new mother, because then I have no worries. 什么是对您的健康的焦虑的最好的药？ 现在亚洲的“新贵族”认为是住进当地的昂贵的私立医院是健康的最大保证。虽然花钱多一些，但是不会有什么后顾之忧。我们称它为“有地位的医疗”。（后面是案例）But the status cure has one potentially troublesome side effect. If you are prepared to pay for expensive care, then there may be people ready to gouge you. When an Australian expatriate in Jakarta forgot to fast the morning before an operation to reverse his vasectomy, the doctor didnt offer to reschedule. But the patients lapse apparently so complicated the surgery that afterward the doctor had to quadruple his original estimate to $1,600. The patient balked, but hospital administrators refused to intervene. Only after the check he was issued bounced did the doctor agree to reduce the bill to $1,000. It was highway robbery, fumes the expat. Little surprise that the doctors here drive such expensive cars. 负面效应：“敲诈“Expect heavy doses of enthusiasm and cynicism about the regions private health-care industry in the next few years. In the past decade, overburdened governments have begun to encourage local firms to enter the health business, some with more conviction than others. The result is one of the most widespread, welcome - and controversial - medical advances in Asia. For many patients, easy access to sophisticated technology and quality service is about the best thing to come along since antibiotics. But worried consumer advocates say the free market is not always a healthy place for patients. And competition has so far meant better service - but not cheaper bills. 竞争意味着更好的服务，但是更贵的价格。Companies such as Singapores Parkway Group Healthcare are hoping to break down the resistance to private health care. They are succeeding. Spending on non-government medical treatment has been growing at an average of 20% a year in Malaysia, Singapore and Thailand. And the bonanza extends to all sectors of the health-care market, from wheelchair makers to hospital owners. BEHIND THE BOOM 快速发展的背后私立医院快速发展的原因：1、 由“富贵病”带来的医疗费用的上升2、 政府提供基本医疗，而不愿在高科技上进行投入。3、 富裕的亚洲人倾向于远离拥挤的和人员不足的公立医院4、To understand why private hospitals could soon be as common as private schools, consider three factors. One, health care whether private or public has become more expensive in recent years. More people are suffering from high-priced ailments. These so-called diseases of affluence - among them heart problems and cancer - require costly diagnostic procedures and protracted treatments. And as people live longer, they are more likely to develop illnesses that linger. The result is fat hospital bills. Two, governments dont want the full responsibility of providing hi-tech care. They would prefer to spend more of their money on primary health. Many are beginning to expect people who can afford it to pay their share of hospitalization. Nations such as Indonesia, the Philippines and Thailand could manage when the most common disease was malaria. But today they cant afford to offer world-class care for every illness. Others are on their guard against what they see as the excesses of a subsidized health system. The U.S. spends 5.6% of GDP on public medical benefits. Singapore and Malaysia allocate less than 3% - and they intend to keep it that way. Finally, many affluent Asians are opting out of the overcrowded, understaffed public hospital system. When an appointment at a public hospital means a four-hour spell in a rundown waiting room and a doctor who doesnt know you from Chan or Maria, many will dig deep into their pockets to pay for private care. Even when government hospitals can compete with private facilities, as they do in Singapore, people choose to go to private hospitals because they are like designer brands, says Singaporean Sam Hong. Governments are passing on the responsibility for advanced medical care to the private sector, though they are moving at different speeds. In Thailand, 30% of all hospital beds are already in private facilities. Bangkok offers a five-year tax waiver on hospital income and does not collect import duty on medical equipment. It is also selling off public facilities. Kuala Lumpur has already turned over many services, such as the supply of pharmaceuticals, catering and laundry, to private firms. Manila is just now entertaining bids from firms to provide administrative services at four major hospitals. 吗来政府将科伦坡总医院的心脏病科进行公司化运转。现在名叫“国家心脏研究所”，完全国有，但企业化运作。The idea of privatizing hospitals, however, is not yet widely accepted. The Malaysian government has corporatized the cardiac unit of state-run Kuala Lumpur General Hospital. Now known as the National Heart Institute, the unit is entirely owned by the government but is operated like a private company. Malaysias minister of health, Chua Jui Meng, says the state is thinking of doing the same with some of its larger hospitals. Malaysia is relying on entrepreneurial drive to rev up private care. Businessmen have been quick to see the enormous potential in the health-care industry, says Chua. To further encourage the private sector, the 1996 budget has eliminated taxes on medical equipment and supplies. So far only 23% of beds are in private facilities. Thats slightly higher than Singapores 20%. Health Minister George Yeo Yong Boon said in a recent White Paper that he wants the proportion to increase to 30%. But Singapore does not actively promote private-sector involvement. The government inadvertently spawns private hospitals in its efforts to contain health-care costs, says a spokesperson for the Consumers Association of Singapore. CASHING IN Big companies, even those without a medical pedigree, are the prime beneficiaries of government policies. Listed firms with excess funds are increasingly moving into the health-care business, notes Anthuan Ratos, group administrator at Malaysias City Medical Center, which his family owns. Until recently, Singapores Parkway was better known as a property developer. Though the start-up costs can be high, so are the returns. Hospitals that generate patient goodwill are cash cows,（让病人满意的医院是现金牛） says Christine Pillsbury, who manages a health-care fund at Lloyd George Management in Hong Kong. The occupancy rate at the regions top private clinics is about 85% and most payments are in cash. Managers in the U.S. are pleased even when just half the beds are occupied. But youll never hear an executive call his hospital a moneyspinner. In health care, if you have too big a profit margin, you are criticized for taking advantage of people, says Dr. Thongdee Shaipanich, managing director of Samitivej Hospital. Its a question of staying within the margin of appropriateness. Parkway Healthcare says turnover last year was $176 million, though chairman Tony Tan Choon Keat declines to give a profit figure. For the first nine months of 1995, Bangkoks Bumrungrad Hospital rang up sales of $40.2 million and earned $3.6 million. The Thai hospital Samitivej took in $3.3 million on turnover of $32.6 million in the same period. Bangkok Dusit Medical Services, Thailands largest private hospital operator, earned twice that much. All that money is attracting investors. The three Thai medical providers above and Prasit Patana, which built its first hospital 20 years ago and recently broke ground for its fourth, are all listed companies. Fund manager Pillsbury particularly likes Bangkok Dusit. Punters can gain exposure to Parkway Healthcare through its listed parent, Parkway Holdings. Tony Tans family controls the holding company, though Malaysian tycoon Vincent Tan (no relation) recently bought a 20.1% stake. For investors, the more Parkway focuses on health care, the better, says Pillsbury. Some analysts, however, say the stock is on the expensive side. But then Parkway, like most other companies, is expanding. It is building hospitals in Malaysia, Indonesia, Sri Lanka and India (see interview, page 49). We want to provide a totally integrated approach to health care, says Tony Tan, who is also group managing director of the holding company. Were using our ability to go out to the region and provide hospitals under our brand name. Parkway owns the well-known Mount Elizabeth, Gleneagles and East Shore hospitals in Singapore. Tan says about 30% of their patients come from Malaysia, Indonesia, China, the Philippines, Bangladesh and Sri Lanka. Wont they stop coming once Parkway facilities are up in their own countries? 30%的病人来自包括中国在内的5个国家，如果医院开到他们的国家他们不可能不来。Tan says his strategy is to open basic medical centers that will refer patients needing advanced care to Parkway hospitals in the Lion City.PRAKWAY的战略是开办最基本的医疗中心，然后介绍需要高端医疗的病人到狮城的parkway医院来。 （中山医院可以利用社区医疗中心来实现同样的策略，同时可以以地区医疗中心的形式向全国拓展，医院本部将提供高端技术难度高的医疗服务）Thats assuming other companies do not build sophisticated facilities in their homeland. Malaysias Lion Group, a conglomerate owned 25.8% by Mirzan Mahathir, a son of Prime Minister Mahathir Mohamad, has opened Mahkota Medical Center in Malacca state near Singapore. The come-on: cheaper charges than those levied by private hospitals in the city republic - and at the same quality. Lion plans to build hospitals in Kuala Lumpur, Ipoh and Seremban, says Albert Phua, general manager of Mahkota Medical. Our priority is to play our role in Malaysia, he says. When the time is ripe, we will definitely consider the possibility of providing health-care services in China. Other groups have their own regional plans. Health Solutions International, a subsidiary of Singapores Provisions Suppliers Corp., intends to make health care its core business. HSI managing director Don Kaye says talks are underway to build and manage hospitals in Malaysia, Indonesia, India and Australia. Health Management International, a wholly owned subsidiary of HMI Balestier Hospital in Singapore, announced in August that it has signed an agreement with Beijing to build and run Chinas first private medical center. For some operators, the priority is to expand nationally outside the capital. The top Thai companies are building, or investing in, provincial hospitals that can screen out less critical cases and treat them there. Bangkok Dusit already operates a facility in Phuket and in three other towns. Samitivej has a 20% stake in a hospital in Chonburi province. Bumrungrad is putting money in facilities in Phuket and Khonkaen. It is also spending $110 million on its Bangkok medical center to nearly double the number of beds to 554, which will make it the citys biggest hospital. The aim, says Bumrungrad CEO Curtis Schroeder, is to provide one-stop shopping. Given the amount of investment, Thai hospitals can hold their own against foreign competition. Less advanced countries may be more vulnerable. Indonesias top medical centers often counsel high-profile patients to go overseas for critical care. Foreign Minister Ali Alatas had heart bypass surgery in Australia; so did tycoon Liem Sioe Liong. We just couldnt afford the risk of something going wrong, says a hospital executive. But dont be misled, says Empie Lembong, president-director of Medistra Hospital, one of Jakartas half-dozen upscale facilities. The quality of health care here is as good as anywhere else but for the most sophisticated surgery. He is not worried about Parkway or other newcomers: The market here is big enough. Nearly 20 private hospitals operate in metropolitan Manila, but few meet international norms. Canlubang Medical Center, which opens south of the capital in 1998, hopes to stand out by teaming up with the Hospital Corp. of America. It will be the first Philippine private hospital to be managed by a foreign company. We will elevate our standards so we can compete with hospitals in the U.S. and elsewhere, says Dr. Angelita Trinidad-Reyes, president of the Canlubang hospital. The facility will hire Filipino doctors who have trained and practiced abroad. Given the competition, analysts say a shakeup is inevitable. Many conglomerates will jump on the bandwagon without really understanding the nature of the business, says Chan Foo Yau, managing director of Malaysian health-care management firm MediScreen. How will they fit health care in their overall corporate objectives? It looks like a good business, but it may not be that profitable if you dont know how to run a hospital. In the next three years or so, you will see a lot of people falling off. He and other experts expect a consolidation by the turn of the century. WHAT IT MEANS FOR YOU What is the prognosis for patients? Competition is always a healthy way of controlling costs and improving quality, says Mahkota Medicals Phua. It was difficult to get a CAT scan in many Malaysian states six or seven years ago. Today, the service is commonly available. Theoretically, fees could go down as people realiz