Southeast Asia

All ASEAN 5 countries are being subjected to challenges related to ageing populations, shortages of medical staff and a rising burden of non-communicable diseases. Moreover the implementation of UHC policies, a growing middle class, and medical tourism contributes to a further increase of the demand for health care. These challenges require solutions that increase the accessibility to care (mainly related to the rural areas of Vietnam, Indonesia, Malaysia and Thailand), efficiency and effectiveness of care.

All countries consider E-health as the main driver to transform healthcare in the coming year. E-health solutions can increase the efficiency, reduce unneccessary hospital visits and improve access in remote areas.

The Covid-19 outbreak has accelerated the digital transformation of health care delivery models. It is also important to emphasize that 80 percent of the medical devices in the ASEAN 5 countries are being imported. A strong growth forecast is expected in the medical device market. From the perspective of the Netherlands the following market trends in the ASEAN 5 market are of interest:

Trade

1. Advanced devices and e-health technologies to increase the accessibility, efficiency and effectiveness of cares

• Advanced medical devices for diagnosis and treatment
• Robotics
• E-health
• Telemedicine and monitoring tools/apps
• AI and other key enabling technologies nanotechnologies, advanced materials, and advanced manufacturing and processing (production technologies) and biotechnology.
• Data infrastructure (connecting data, systems, information and persons in a convenient, safe and secure way) – Note: different stages per country with Singapore being the most advanced.

2. Healthy ageing to optimize the opportunities for physical, social and mental health of elderly people

• Promotion of healthy living
• Prevention of non-communicable and communicable diseases including screening programmes
• Rehabilitation
• Elderly care at home (to help senior people living an mobile and independent life.)
• Growing importance of mental health

3. Health infrastructure to improve the access to health care in rural areas and increase the efficiency in urban areas

• Smart and sustainable hospitals/clinics (physical infrastructure)
• Using technologies to overcome the lack of health infrastructure in rural areas (digital infrastructure)
• Management of internal processes of care providers, including value based healthcare

Research & innovation

Singapore
The National Research Foundation is investing S$4 billion (ca 2.8 billion EUR) in Health and Biomedical Sciences (HBMS) to support the top universities (NTU & NUS) and research institutes (A*STAR). Priorities for Singapore are healthy ageing, digitalization in healthcare an  improving diagnostics and quality of life for the five priority diseases. These connect well to the Dutch missions of improving access to care, decreasing disease burden and increase societal participation for chronic patients. Moreover, Singapore’s multicultural population and the goal of genetically sequencing a large portion of the population, provides interesting research opportunities for studying disease pathways. Digital health in Singapore was a priority topic before the pandemic and opportunities in this sector are diverse: tools for patient-doctor communication, remote monitoring, AI to support better and more efficient diagnostics, treatment and prevention. With data coming from various sources, such as apps, wearables,  electronic medical records on top of the traditional clinical trials, there is also a need for solutions for a secure and accessible data infrastructure.

Singapore and the Netherlands have a good working relationship and there is interest to collaborate together on solving national challenges. Singapore joined the EUREKA network early 2021 and SME’s from both countries can use support under Eurostars and Cluster calls for R&D collaborations.

IA-Singapore has taken up LSH as one of its priority areas, and has focused initial activities on fact finding and building a network in the domain of digital health related to:

• Preventive care and chronic disease management
• Dementia and healthy ageing
• Medical imaging & medical devices (MedTech)

A market report has been commissioned that looks into the healthcare and R&D landscape in Singapore, MedTech R&D, genomics R&D and market entry and partnerships in Singapore. The report is expected in December 2021.

Indonesia
NWO invests in bilateral research cooperation with Indonesia via Merian Fund. Indonesia and the Netherlands have a long history of collaboration in science, and joint fundamental and applied research programmes by Indonesia and the Netherlands have been carried out for decades. Indonesia is in the top five of most promising emerging markets. Partnerships between the Netherlands and Indonesia have increasingly focused on societal challenges and include in the research, next to bilateral researchers, stakeholders from the public and private sector. The overarching theme for the Cooperation Indonesia (RISTEK-BRIN) programme is 'Resilient Societies' – including Health and quality of life. As of 2021 NWO works together with DIKBUDRISTEK, the Indonesian Science Foundation (DIPI), and other partners in South East Asia and Europe via the Joint Funding Scheme Southeast Asia-Europe (JFS).

Invest

LSH is not a proactive focus sector in these countries.  Reactively, NFIA is open to any LSH opportunity that presents itself.

Singapore
Most of the Singapore companies that land in the Netherlands are under:

• Red Biotech (Healthcare): Red biotech includes producing vaccines and antibiotics, developing new drugs, molecular diagnostics techniques, regenerative therapies. One example is Cetas Healthcare.
• Medical Equipment

Singapore has a vibrant biomedical and health tech ecosystem, housing many R&D centres, start-up incubators and VCs in this field.  With diversity of corporate and public HealthTech innovation partners, Singapore has created a dynamic ecosystem where talent, capital and expertise meet to pilot and scale digital healthcare and wellness solutions for Asia. 

Investments have mainly been in wellness, health management solutions and medical diagnostics.  In early 2021 the “Go Beyond” program was launched to support start-ups and tech enterprises from Singapore to access the Dutch market as a gateway to Europe. The program lays down a guided pathway for ventures to scale to the Netherlands and other European markets.

Malaysia
For 2021, there has been number of interests from Malaysian companies/investors in considering the Netherlands as their next place of operation. For LSH in particular, we received couple of requests especially in the area of:

• Clinical R&D
• Biotech
• Medical devices

Regional priorities

Indonesia
The development of Health-Tech and Tele-Medicine has grown rapidly, partly due to the pandemic. The Government approved a number of Health-Tech and Tele-Medicine start-ups to assist in the handling of those who have to undergone independent quarantine at home. Hospitals are providing ‘tele-medicine’ services for patients who do not want to come to the hospitals, although in practice it is only a doctor-patient consultation through an online meeting platform. Future development will primarily be focused to bridge the geographical gap, especially in the remote and outer areas.

Indonesia has the plan to move its capital to Kalimantan. In the long run this may also offer opportunities for health infrastructure related projects.

A new challenge in Indonesia, especially in the medical device market is the requirements for local contents. In June 2021, Indonesia introduced a new regulation requiring 40% local content of over 5,400 medical device products in 79 categories from the e-Katalog public procurement system used by Government’s hospitals and clinics.

Singapore
Singapore’s focus is on finding ways to deal with the stress the ageing population and increasing disease burden places on the healthcare system. Besides focusing on prevention and promoting a healthy lifestyle, digitalization is one of the pillars to help safeguard effective care in the future. Under Singapore’s Smart Nation Initiative, health is one of the focus areas.

New market opportunities might emerge in the field of digitalization and innovation. Singapore looks at technologies that facilitate telemedicine, telemonitoring, personal health management and prevention.  Examples are home monitoring for the elderly or patients after a surgery and apps or wearables to improve healthy living. In addition, robotics and assistive technologies such as artificial intelligence and augmented reality are used, e.g. data analytics to improve daily operations in hospitals and in diagnostics and treatment. Personalised medicine is another promising area, as Singapore is building a genetic biobank as part of its National Precision medicine program, and is home to many pharmaceutical MNCs. 

Malaysia
Malaysia’s current focus is ensuring the healthcare system remains effective in tackling the Covid situation including alternative care models beyond the traditional settings. Because of Covid-19 there is an accelerated adoption of innovative projects by hospitals including telemedicine services, decentralisation of care and FMR systems. There is also a renewed recognition and emphasis on investing in capacity building, improved diagnostics & supply chain management solutions. At USD 1.4 billion annually, Malaysia is the second largest market for medical devices of 4 ASEAN countries, it is expected that there will be a jump in demand for a diversity of medical devices particularly those that increase operational efficiencies in primary care, diagnostics, EMR, aged care and supply chain management.

Moving forward, the management of Non-Communicable Diseases (NCDs)  such as diabetes  and hypertension would be high in the agenda. has gained significant budget allocations this year targeted at the bottom 40% (B40) households. The government will also look into the construction of new health facilities particularly in rural areas to cope with the pandemic. Malaysia has recently announced its readiness to become a hepatitis C treatment hub in the region. The revival of medical tourism  travel plays a key role in the healthcare ecosystem and further would further drive the demand for medical devices and private healthcare facilities.

Thailand
Before COVID-19, Thailand became one of the largest medical tourism industries in Southeast Asia. From 2000 to 2017, Thailand's international medical tourism industry quadrupled in size, going from 2.4 billion USD in revenue to 11 billion USD. During the spread of the pandemic, the Thai medical devices market shrunk to 10.2% in 2020. However, the country forecasts that the market will grow steadily at 6.5% in 2022-2023.

Many hospitals and health care facilities in Thailand now apply more E-health technologies such as medical robotics, software and telemedicine. Demand driven factors are rising cases of NCD’s (for instance, heart disease, stroke, cancer and diabetes) and the ageing population. The rebound of foreign patients (medical tourism) and the expansion of new private hospitals and health care facilities will also enlarge the total market. Aiming to remain the medical hub in the region, the Thai government has provided investment incentives in the medical device sector and in research activities in medical robotics for manufacturers of advanced medical equipment that includes robotics software and hardware.

Both public and private hospitals have started pilot projects to apply 5G, AI technology or even block chain technology to enhance healthcare services. For instead, using 5G-powered medical equipment to monitor patients‘ conditions and AI to help assess and analyze illness data to more precise treatments and send alerts. Many hospitals are interested to emerge these new approaches and technologies, especially the Internet of Medical Things to improve the quality of its healthcare services and build more responsive and efficient healthcare systems in the next coming years.

Vietnam
Vietnam’s medical device market is one of the fastest growing in Asia. The best business opportunities for medical devices and equipment in Vietnam are those related to cardiovascular, cancer, diabetes, radiotherapy equipment, neurosurgical devices, operating theatre equipment, sterilizing and infection control devices, imaging diagnostic devices (e.g. for viral infections and diabetes), orthopaedic implants and related devices, lab instrument and devices. The use of telecommunication and information technologies in order to provide clinical health care at a distance could also be an interesting area.

The Dutch interest in the ASEAN 5 countries is still considerable. Between 2019 and 2021 RVO received 238 ASEAN related requests. This is signiciantly lower compared to the 500 requests reveived between 2018 and 2019. A possible explanation is the Covid-19 pandemic starting in early 2020. Because of the travel restrictions many Dutch LSH companies reduced their international activities and/or gave priority to more nearby markets. The majority of Dutch organizations active in ASEAN 5 can still be found in the category of small and medium sized businesses.

Prominent multinationals that are active in the region are Philips, Elsevier and Danone-Nutricia. When looking at Dutch knowledge institutes all university medical centers are collaborating on research and/or education with their counterparts in Indonesia and Singapore.

Most prominent NL valuechains

The most prominent value chains for the ASEAN-5 market are Medical devices, E-health and Infrastructure solutions that ensure more efficient and more accessible care. The accessibility of care concerns both the provision of care solutions in rural areas and solutions that contribute to the longer independent living of the elderly at home.

1. Value chain Accessible medical technology for sustainable health and care: instruments, appliances and materials that impact the delivery of health services and processes within a healthcare provider.

• demonstrated (or expected) impact and activities
  • LifeSense Group (wearable technology to combat urinary incontinence) has signed contracts with partners in multiple ASEAN countries.
  • Demcon a supplier of contract research and advanced medical systems (including ventilation) established   an Asian subsidiary in Singapore in 2019 focusing on supporting R&D for medtech OEMs and contract manufacturers based in Singapore.
  • Sioux Technologies supports high-tech medical OEMs with integration, assembly, testing and delivery of modules and applications from concept to market launch, data analysis and system engineering, established an Asian subsidiary in Singapore in 2019 to service the automotive, medtech, semicon and agrofood sector.
• potential opportunities
  • growing private sector, demand for quality brands and preference for quality over costs
• barriers: lack of transparency (Indonesia), strong competition and small market (Singapore), low reimbursement public sector (Malaysia, Thailand and Vietnam, Indonesia) strengths of Dutch LSH sector not well known in Malaysia, Thailand and Vietnam.
• preferred region(s): Malaysia, Thailand, Indonesia, Singapore & Vietnam.

2. Value chain The digital transformation of health and care: The application of both digital information and communication solutions to support and / or improve health and healthcare processes. In ASEAN-5 context, specifically E-health and Artificial Intelligence.

• demonstrated (or expected) impact and activities:
  • Philips and Elsevier’s tools to support clinical decision making are used by high-end health care facilities
  • Delft Imaging is using its Computer-Aided Detection for Tuberculosis (CAD4TB) in the prisons of Jakarta, Indonesia
• potential opportunities: Telemedicine considered as a promising solution, to increase quality, efficiency and effectiveness but also to improve access to healthcare in rural areas and facilitate elderly care and self-management at home.
• barriers: different stages of data-maturity per country, requires knowledge about the privacy and data protection laws and regulations.
• preferred region(s): Singapore, Malaysia, Thailand, Indonesia and Vietnam.

3. Value chain Care Infrastructure:  products and services concerning the design, building, furnishing, equipping, operations and maintenance of hospitals, clinics and health care facilities. In ASEAN-5 context, specifically hospital build.

• demonstrated (or expected) impact and activities:
  • Hospitainer has signed a MoU with Desa Emas. Together they will work on a plan for 3 pilots in the coming two years. One clinic in the ground, One clinic on wheels and One clinic on a vessel.
  • Telecom has implemented medical pneumatic tube systems in several Thai hospitals.
• potential opportunities: health infrastructure in remote areas and a cluster approach (including financing) to look at opportunities for Hospital development under a PPP scheme.
• barriers: Long and complex projects.
• preferred region(s): Malaysia, Thailand, Indonesia and Vietnam.

Overview milestone & flagship

Collective Activities to ASEAN 5
During the last five years three large trade missions to Indonesia took place with Prime Minister Rutte, Minister Bruins, and the royal couple. In 2016 Singapore was visited as well. With regard to the other countries only smaller trade and/or innovation missions without government officials have been organized.

2018

• Trade mission to Indonesia with Minister Dekker
• MoU Healthcare signed on November 2018 in Bali. Implementation plan agreed on Apr 2019 in Geneva. Last Joint Working Group on March 2020.

2019

• ASEAN Market Study covering Malaysia, Thailand, Singapore and Vietnam
• LSH mission to Thailand & Malaysia
•  LSH Mission to Indonesia, Hospital Expo
• First Global Stars Call Singapore and EUREKA countries

2020

• Trade mission to Indonesia with the royal couple 
• Second Global Stars Call Singapore and EUREKA countries

2021

• Launch of Strategic Multi-Annual Market Approach (SMM) Connected Care (June)
• Virtual LSH mission to Indonesia, Thailand and Malaysia (June-July)
• Launch of Market study (SMM) Indonesia (September)
• Appointment of liaison (SMM) for Indonesia (November) 
• Meet & Greet with liaison (SMM) (November)
• Virtual expert sessions during the Singapore / Netherlands Digital Health week (November)
• Launch of Marketstudy on healthcare and R&D landscape in Singapore including MedTech and genomics  (December)

During the last six years three large trade missions to Indonesia took place with Prime Minister Rutte, Minister Dekker, and the royal couple. In 2016 Singapore was visited as well. With regard to the other countries only smaller trade and/or innovation missions without government officials have been organized.

The way forward

• To keep: Small scale trade and innovation missions.
• To strengthen and deepen
  • Trade missions with government officials (until now mainly focused on Indonesia)
  • Enhance the positioning and visibility of the Dutch LSH sector 
  • Strengthen the connections with Key Decision-Makers 
  • Provide the LSH stakeholders with more insight into connections with financing programs for projects in the target market: both national (RVO) and international (ABD/WB)
  • Get more insight in the success and failure factors of Dutch LSH companies that are already active in the region 
  • Collect more in-depth market entree knowledge for specific subsectors: registration of medical software (Indonesia) 
  • Strengthen collaborations between universities in NL with universities in ASEAN5 
  • In Singapore the focus will be on innovation within LSH.
• (New) activities to be explored: