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While FDI and Japan's contribution to ASEAN healthcare industry are increasing, Japanese medical devices companies are facing several issues in South East Asia. On one hand Singapore is a prominent value-driven healthcare environment, on the other hand Indonesia possesses large mid to long term opportunities in the healthcare sector. What winning market strategy should Japanese medical devices companies apply when entering the ASEAN market.
Factors such as medical technology readiness, reimbursements, health and primary education, medical innovation, channels sophistication and hospital infrastructure need to be taken into account to explore the potential markets.
This document addresses the current market trends and opportunities in ASEAN healthcare as well as the challenges faced Japanese healthcare companies investing in the region, delivered by Solidiance.
Visit www.solidiance.com for more insights on how we can help you position and grow your business in Asia Pacific.
本日のプレゼンテーター プラニート・メロトラ Praneet Mehrotra プリンシパル、ヘルスケア Principal, Healthcare アジアでのヘルスケアビジネス、戦略コンサルティングに20年近くの経験を持つエキスパート。 メディカルデバイスを中心にフォーチュン500カンパニーまた政府関連のプロジェクトを多数 手掛ける。 • IMI 経営学修士（MBA） • デリー大学 経営学部卒業 では、日系企業のビジネスチャンスは？ 中村 有希 Aki Nakamura ヘッド・オブ・ジャパンビジネスデベロップメント Head of Japan Business Development 米系・日系企業中心にセールス＆マーケティング、新規事業企画に15年以上の経験を持つ。 セクターフォーカス： 消費財、メディア、せービス関連全般 • UCLA アンダーソン・スクール・オブ・マネジメント経営学修士（MBA） （シンガポール国立大学ビジネススクールとのダブルデグリープログラム） • 慶應義塾大学 文学部卒業 12 12
Healthcare in Emerging Markets: Trends, Challenges and Opportunities for Japanese CompaniesPresented by Praneet Mehrotra April 18, 2012Principal at SolidianceThis document has been produced by Solidiance exclusively for JCCI. Copyright restrictions (including those of third parties) are tobe observed. All information, views and advice are given in good faith, but without legal responsibility. Whilst every effort has beenmade to ensure the accuracy of the information and data contained herein, Solidiance accepts no responsibility for any errors andomissions, however caused. The information contained herein should not be regarded as a substitute for legal advice.
Today’s discussion FDI and Japan – significantly increasing its influence in ASEAN Within ASEAN – where is investment going and why? Is Indonesia potentially the next big investment destination? Conclusions Note: All data sources are ASEAN Secretariat, IMF, EIU, Nomura, World Bank, USAID, WHO and Solidiance analysisRestricted & Confidential 14
Contribution from Japan is increasing Japan’s Contribution to FDI in ASEAN, 2008-10 10,000 15% Japan’ Net FDI Inflow in ASEAN Japan’s Share of Net Inflow to ASEAN 8,386 11.0% 7,500 9.8% 10% 8.8%US$ Million 5,000 4,129 3,763 5% 2,500 0 0% 2008 2009 2010 Japan is a strong trade partner and doubled its FDI inflow into ASEAN between 2008-10Restricted & Confidential 15
ASEAN – FDI inflows and GDP growth ASEAN – Top 6 – FDI Inflows and GDP Correlation, 2007-10 Singapore Indonesia Viet Nam Thailand Malaysia Philippines 2007 35,778 6,928 6,739 11,330 8,538 2,916 2008 10,912 9,318 9,579 8,570 7,318 1,544 FDI Inflows (USD Millions) 2009 16,809 4,877 7,600 4,976 1,381 1,948 2010 17,341 6,244 4,310 3,512 3,313 732 Correlation Co-efficient, with 0.40 0.28 0.32 0.78 0.15 0.99 (nominal) GDP 1. FDI Inflows into Indonesia are not only at par with that of Thailand and Vietnam, but have bounced back to pre-crisis levels the fastest 2. Indonesia’s output not mainly dependant on FDI inflows (read: capital investments), but the size of its domestic market is a key driver of economic growth, going forward Indonesia’s attractiveness is not un-noticed by foreign investorsRestricted & Confidential 16
GDP forecasts growth suggests greater opportunity going forward Average real GDP growth (%) forecast 2012-2020 8 7.4% 7.2% 7 6.0% 5.8% 6 5.8% 5.2% 4.9% 5 4.7% 4.3% 4 3.6% 3 2 1 0.9% 0 India China Indonesia Vietnam Myanmar Philippines Malaysia Thailand Singapore Taiwan Japan ASEAN growth to be driven by a combination of demand growth and investmentsRestricted & Confidential 17
Today’s discussion FDI and Japan – significantly increasing its influence in ASEAN Within ASEAN – where is investment going and why? Is Indonesia potentially the next big investment destination? Conclusions Note: All data sources are ASEAN Secretariat, IMF, EIU, Nomura, World Bank and Solidiance analysisRestricted & Confidential 18
Singapore is the pre-eminent investment destination “Nestle plans to invest S$ 5.5 Mn. to strengthen its R&D base and also plans to set up its main training for the whole of Asia in Singapore. Singapore was chosen for its well-connected infrastructure, deep talent pool and stable economy.” - Today Online, 22nd March 2012 “Completed in 2008, Abbott’s nutritional powder manufacturing plant in “Baxter announced the expansion of its Singapore Singapore is Abbott’s first manufacturing facility, with the addition of a major capital investment in biopharmaceutical facility. The company has had Asia and its largest investment a long standing presence in Singapore, producing ever. The S$450 Mn. state-of- a number of products for over three (3) decades. the-art facility enables the The Singapore facility is a one-million-square-foot facility that houses three (3) plants manufacturing company to meet increased products that are marketed in over 60 countries.” demand for Abbott nutritional - Baxter (2009) products in the region.” - Abbott Singapore (2009)Hi-tech (R&D and high value products) investments taking place in the healthcare sectorRestricted & Confidential 19
How Medtech companies pick their manufacturing sites? 25% 20% 15% 10% 5% 0% Talent pool Local Cost of Stability Domestic Tax sourcing labour market incentives growth Order of preference Singapore is well positioned as a regional hub, but other countries will catch upDisclaimer: This survey is for reference only, based on 50 interviews and as such may not be statistically representativeRestricted & Confidential 20
Most attractive Medtech markets in ASEAN, ex-Singapore 10% 12% Vietnam 40% Malaysia Thailand Indonesia Philippines 14% Others 22% Perceptions about Indonesia and Vietnam have improved substantially in recent past!Disclaimer: This survey is for reference only, based on 50 interviews and as such may not be statistically representativeRestricted & Confidential 21
Key issue is competitiveness – that which is already established Global Competitiveness Index (GCI), Average for ASEAN, 2011-12Restricted & Confidential 22
Key issue is competitiveness – and that still needs investments Global Competitiveness Index (GCI), Average for ASEAN, 2011-12Restricted & Confidential 23
Today’s discussion FDI and Japan – significantly increasing its influence in ASEAN Within ASEAN – where is investment going and why? Is Indonesia potentially the next big investment destination? Conclusions Note: All data sources are ASEAN Secretariat, IMF, EIU, Nomura, World Bank and Solidiance analysisRestricted & Confidential 24
Why keep investing in ASEAN?1) Several ASEAN nations are rated among top host economies for FDI in 2010-122) ASEAN nations are ranked well in Ease of Doing Business Rankings – emerging economies such as Indonesia, Malaysia and Vietnam took the leadRestricted & Confidential 25
Why Indonesia warrants a closer look? Key risks: protectionism, coalition politics and regulatory unpredictabilityRestricted & Confidential 26
Indonesia’s path to decentralization in healthcare is yet to play out… Key Improvements Results Issues transfer of authority & A. Only ~3/4th of publicStructural reform & devolution 1. Decentralization responsibility for health budget is governmental spent year-after-year of powers and expenditure from governance national to local Departemen Central level Kesehatan government B. Absenteeism remains 2. Rapid currently approx. high and rampant Dinas Kesehatan 8,000 puskesmas, (up to ~40% for Provincial level expansion in Propinsi 22,000 pustus and health doctors remain 6,000 mobile health infrastructure centres absent from duties) Dinas Kesehatan District level quadrupled betweenTingat Kabupaten 3. Significant 2001 and 2007, C. continued public dependence on Sub-district increasing to 1% of Puskesmas expenditure on GDP for the first time pharmacies/drug- level health (‘07) stores for diagnosis & Integrated prescription – self Pustu Instruksi presiden led Health Post 4. Large increase to increase in no. of treatment (for those in capacity to doctors, nurses & ill) remains high (~50% deliver midwives, among in ‘06) othersRestricted & Confidential 27
…though the country has set ambitious goals Key vision/mission Presidential regulation No. 7/2005 on medium-term development plan (RJPM 2004-09), MoH strategic statements exist plan (2005-09) (revised ‘06) and the RKP (annual) Focus Access infrastructure that set out policy Policy areas: i. Increasing quantity & quality of Coverage directions health centres & of health personnel Funding ii. Health insurance for poor Personnel iii. Awareness & health education Quality of Care iv. Enhancing primary health facilities Awareness Targets that the Select goals: government then i. Improve free health services for poor households in puskesmas Disease-specific presents as targets targets on diagnosis, on an annual basis ii. Increase % of villages for universal treatment and care child immunization rates of 95% Targets for coverage, iii. Increase tuberculosis case quality of services detection rate (CDR) to 70% and funding iv. Increase CDR & provide 100% ARV treatment for those with HIV/AIDSRestricted & Confidential 28
Market potential is significant and not yet fully explored! Private sector dominant in provision of tertiary care healthcare services High involvement of private sector (and continued marginal role of public sector; read: government) entails potential opportunities for market development and adoption of ‘new business models’Restricted & Confidential 29
A typical example of how medical products get sold Point of Sale (PoS) Institutional (<25%) Hospitals and nursing homes Company Distributors Retail (>75%) End Users Modern stores Sales & Marketing (Supermarkets, hypermarkets and convenience stores) Products may be imported from within ASEAN Pharmacy chains Mom & pop shops (including Apotiks) Key Players Influencing Product Sales Rationale • Sales through hospitals and nursing homes are primarily End Users Institutional PoS triggered by recommendations from healthcare 80% ~90% of the Decision practitioners, and therefore account for most of the made by time, end users initial or first-time purchases do NOT decide • Sales of therapeutic products are mainly through the brand hospitals and pharmacies, while consumers prefer Retail PoS purchasing generic products from supermarketsLegend: Low influencing power Medium influencing power Strong influencing power Restricted & Confidential 30
Today’s discussion FDI and Japan – significantly increasing its influence in ASEAN Within ASEAN – where is investment going and why? Is Indonesia potentially the next big investment destination? Conclusions Note: All data sources are ASEAN Secretariat, IMF, EIU, Nomura, World Bank and Solidiance analysisRestricted & Confidential 31
FDI overview in Indonesia Japan’s Contribution to FDI Inflows in Indonesia, 2011 Total Value = US$ 5,130 Mn. Total Volume = 1,300 projects 1,400 1,300 7% 1,200 1,000 800 1,166 600 400 200 134 93% 0 Japan Japan Others Total Others Though Japan accounts for ~10% of total number of FDI projects, the $ value contribution is only 7%. Average project value for Japanese investment is US$ 2.7 Mn., compared to US$ 3.9 Mn. overallRestricted & Confidential 32
Broad market and business potential evaluation parameters route-to-market – partnerships – which bottom-up demand how to grow share, are the key local – what programs and prioritize across partnerships to /investments can different products, ensure reach and pay-off first? buyers, price points? scale? quality of care – is awareness – what products – what there likely to be CSR initiatives can product portfolio, acceptance for open up future incl. value-added outcome-based opportunities? products? curative goals? funded programs – disease focus – stakeholders – who which state which key disease all and how could programs can areas to focus on? they be aligned? companies ride on? Any comprehensive assessment in Indonesia should include all the aboveRestricted & Confidential 33
Key conclusions1. Japanese investments must do more (read: better directed & also larger investments) to capitalize on the longer-term opportunities within ASEAN2. All factors that ensure successful investments are not necessarily in place3. Indonesia is the largest, yet untapped opportunity, including in healthcare4. Japanese business interest must increase in this large market as must evaluation of business potential parameters Restricted & Confidential 34
Questions? 質疑応答 Thank You ありがとうございましたRestricted & Confidential 35
更なるご質問・お問い合わせは下記までお願いいたします www.solidiance.com Singapore China Praneet Mehrotra プラニート・メロトラ Principal, HealthCare/プリンシパル ヘルスケア India firstname.lastname@example.org DID: +65 6408 8202 Indonesia Thailand Aki Nakamura 中 村 有希Head of Japan Business Development/日系事業部長 Vietnam email@example.com Malaysia DID: +65 6408 8206 36