solidiance
Emerging Opportunities in
Myanmar’s Diagnostic Imaging & In-vitro Diagnostics
DECEMBER 2015 Solidiance has produced this white paper for information purposes only. While every effort has been made to ensure the accuracy of the information and data contained herein, Solidiance bears no responsibility for any possible errors and omissions. All information, views, and advice are given in good faith but without any legal responsibility; the information contained should not be regarded as a substitute for legal and/or commercial advice. Copyright restrictions (including those of third parties) are to be observed.
CONTENT executive summary
Myanmar’s Healthcare economics
3
4 15 Diagnostic Imaging (DI) in Myanmar: market potentials
21 In-vitro Diagnostics (IVD) in Myanmar: market challenges
28 Registration & licensing of Diagnostic Imaging (DI) and In-vitro diagnostic (IVD) equipment 29 Case studies 33 key takeaways 34 INFOGRAPHIC 37 ABOUT US
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executive summary Economic growth and demographic changes in Myanmar are driving healthcare spending throughout the country. Myanmar’s total healthcare expenditure is set to cross USD 2 billion for FY 2015-2016. Rapid growth in healthcare demand is inevitably resulting in the development of the healthcare system. There is also growing awareness of regular health check-ups for early detection of non-communicable diseases. Diagnostic Imaging & In-Vitro Diagnostics have witnessed quick penetration into Myanmar since 2012. However, demand is increasing faster than supply and global healthcare players need to adapt to a fast evolving market. Myanmar presents a set of unique growth opportunities for global healthcare players and a sustainable longterm strategy is required to capitalize on these opportunities.
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Myanmar’s Healthcare economics
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Percentage of contribution from government to total healthcare expenditure has grown from 12% in 2010 to 40% in 2014
Myanmar’s Total Healthcare Expenditure Split (USD Mn) 1,903
Comparison of Total Healthcare Expenditure in USD Bn (2014) 27.5
1,613 1,378
757
17.2
572 456
908 704
2010
11.16
118
85 619
14.1
13.04
922
790
1,041
1,146
1.9
2011
2012
Private Spending
2013
2014
Public Spending
•
2.7% of total government budget was allocated to healthcare in 2014
•
Government proposed a plan in parliament in January 2015 to increase healthcare budget allocation with an annual growth rate of 6% until 2020
Source: World Health Organization (WHO), Ministry of Health (MOH), Solidiance Research and Analysis
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Myanmar has the lowest healthcare spending in Southeast Asia Myanmar’s Healthcare Expenditure (% of GDP) – 2014 6.0%
4.6%
4.6%
4.0% 3.1%
2.7%
Indonesia
Singapore
Malaysia
Thailand
Myanmar
Vietnam
Comparison of Per Capita Total Healthcare Expenditure (USD) – 2014 2,507
•
Around 70% of Myanmar’s population stay in rural areas with minimal access to healthcare services that are primarily concentrated in the big cities: Yangon, Mandalay, and Nay Pyi Taw
•
Majority of the increase in healthcare expenditure is targeted to tier-2 cities
423 107
264 35
Source: Solidiance Research & Analysis, WHO, MOH
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111
Out-of-pocket payment is the key dominant source for healthcare financing, accounting for 78% of the total healthcare expenditure in Myanmar
Myanmar’s Health expenditure by financing agents, 2014
1%
Out-of-pocket (OOP) expenses are mainly used for self-prescribed medicine, diagnostics and private clinics. Public hospitals are subsidizing costs of diagnostics and providing
6%
medicine for the most needed people.
15%
Under the Social Security Scheme, all employers and employees who contribute to the scheme are entitled to healthcare benefits and treatment in certain hospitals which are listed by Social Security Board.
78%
International NGOs (INGO) are financially supporting to strengthen primary healthcare services and facilities in rural areas.
OOP
INGO
Public & Government Hospitals
Social Security Scheme
Myanmar’s new health insurance scheme In July 2015, the Myanmar government approved to sell “Health Insurance” to the public through Myanmar’s Insurance and 12 private
Source: Ministry of Health (MOH), Solidiance Interviews and Analysis
insurance companies. •
Cost of one health insurance unit is MMK 50,000, or approximately USD 45 – and a person can buy up to 5 units
•
The coverage of healthcare expenses for one unit of health insurance is mainly for hospitalization expenses, which is MMK 15,000 per day for five times in 30-day period of hospitalization (up to 150 days)
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Effects of increased government spending in the last 2 years can be seen in the public hospitals in Myanmar’s tier 2 & tier 3 cities
14%
1%
Myanmar’s Type of Hospitals by level, 2014 (1,192 hospitals)
2% 3%
Public Primary Care Hospitals
3%
Public Secondary Care Hospitals Public Tertiary care Hospitals
7% 69%
Military Hospitals Government's Ministry Hospitals Private General Hospitals Traditional Medicine Hospitals
Source: WHO, Health System Review 2014 Report from MOH, Solidiance Research and Analysis
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Public tertiary care hospitals are catering to
7%
Hospital Beds in Myanmar by sector, 2014 (73,040 beds)
Public sector Private sector
93%
specialized medical treatments and services in big cities like Yangon, Mandalay, Nay Pyi Taw, and Taunggyi. The Ministries of Railways, Labour, Mines, Industry, Energy & Cooperatives as well as Home Affairs are providing medical care and treatment to their employees through their own run hospitals. The majority of hospitals are providing basic
Source: WHO, Health System Review 2014 Report, MOH, Solidiance Research and Analysis
x-ray and ultrasound services.
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Private hospitals account for 14% of total hospitals and contribute to 7% of total beds in Myanmar
Number of hospitals in Myanmar - 2014 950
316
135
Public hospitals account for ~86% of hospitals but are far behind regional quality standards.
167
In public hospitals, selected medicines and lab tests are being offered for free to the
850
1,000
1,184
less fortunate since in the late 2014.
1,025 Private hospitals have increased in number by 10% between 2011 and 2014.
Public Hospitals
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Private Hospitals
Source: Central Statistical Organization, MOH, Myanmar Private Hospitals’ Association, Solidiance Research & Analysis
Kayah State Chin State
Myanmar’s Private and Public hospital distribution across the country, 2014
Nay Pyi Taw Kayin State
Public Hospitals
Taninthayi Region
Private Hospitals
Mon State Rakhine State Kachin State Magway Region Ayeyawady Region Bago Region Mandalay Region Yangon Region Sagaing Region Shan State 0
20
40
60
80 100 120 140 160
Source: Central Statistical Organization, MOH, Myanmar Private Hospitals Association, Solidiance Research & Analysis
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Half of the private hospitals in Yangon have less than 25 beds
32%
50%
Yangon hospitals by number of beds, 2014
Number of beds
Number of hospitals
200
3
Total
52
>200 100-200 25-100
15%
100 beds)
List of hospitals with ≥ 25 beds in Yangon, 2014 #
Name of the Hospital
# of beds
#
Name of the Hospital
# of beds
1
Pinlon
300
15
Thiri Sandar
38
2
Asia Royal
232
16
Shwe La Min
34
3
Shwe Gon Dine Specialist Centre (SSC)
200
17
Rose Hill
30
4
Sakura
150
18
Kaung
25
5
Bahosi
120
19
Aye Myittar
25
6
Pun Hlaing
100
20
Aye Myittar (Baby Clinics)
25
7
Witoriya
100
21
Aye Yeik Thar
25
8
Aung Yadanar
70
22
Kant Kaw Diagnostic & Neuro Centre
25
9
Ma Har Mying
70
23
Kaung Myat Mon
25
10
Parami
65
24
Myat Tar
25
11
Green Cross Specialist
50
25
Royal
25
12
Thu Kha Kabar
50
26
Shwe Baho
25
13
Shin Par Ku
49
27
Win
25
14
Academy
40
Source: Solidiance Research & Analysis, Central Statistical Organization, Ministry of Health, Myanmar Private Hospitals Association
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Mandalay Hospitals by no. of beds, 2014
2,8%
50% 14,58%
100 - 300
Most of the private hospitals in Mandalay and Nay Pyi Taw have less than 25 beds
8,34%
25 - 99
