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Telehealth services rush to relieve ASEAN hospitals' COVID burden

Startups play bigger role as pandemic spurs demand for online appointments

Indonesian startup Halodoc, which lets customers consult virtually with licensed doctors via the internet, has experienced increasing demand due to the coronavirus. (Photo by Kentaro Iwamoto)

SINGAPORE -- Operators of telehealth services, which allow patients to consult virtually with medical staff, are riding a demand surge in the Association of Southeast Asian Nations as the coronavirus pandemic increasingly pushes the healthcare sector online.

In Thailand, Indonesia and Singapore, telehealth providers are seeing use of their services pick up on fears that physical visits to clinics and hospitals could lead to contracting COVID-19 while in range of the infected. Such services hold promise for taking some of the load carried by ASEAN's medical institutions grappling with virus cases.

"When the COVID-19 hit, we witnessed a significant demand," Thailand-based digital healthcare startup Doctor Raksa Chief Executive and Founder Jaren Siew said in an interview with Nikkei Asia. The startup virtually connects patients to doctors and pharmacies through a mobile application and its business and profitability saw 300% on-year growth in the third quarter amid the pandemic.

"Cost efficiency and accessibility of doctors has always been an issue for health systems," Siew said. "Telehealth addresses both of these pain points. It removes geographical boundaries and allows patients to be in touch with doctors anytime, anywhere."

Siew expects the pandemic will continue to reshape care delivery and open big opportunities for virtual services in the near term, with his startup currently looking for partners to expand overseas in new markets.

Indonesian startup Halodoc, which lets customers consult virtually with licensed doctors via the internet, found that active users of its services have reached more than 20 million people in Indonesia, which was a 10-fold increase in the first quarter of 2020 from the year before, Chief Executive Jonathan Sudharta told Nikkei. 

"As social distancing is becoming the new norm, it will continue to drive demand for remote healthcare. Telemedicine has proved to be an easy medical access to patients who live in rural communities many miles from good healthcare," he stressed.

Internet giant Google, Singapore state investor Temasek and U.S. consultancy Bain and Company noted in a November report citing World Health Organization data that several countries in Southeast Asia have a lower ratio of doctors to the general population compared to countries like the U.S. and China. 

Indonesia and Thailand have a ratio of just 0.4 doctors per 1,000 people, the report said. Some ASEAN peers are higher, with Vietnam at 0.8, the Philippines at 1.2, Malaysia at 1.6 and Singapore at 2.3. China's ratio stands at 2.2 while that for the U.S. is 2.7.

Telehealth operators offer a wide range of services ranging from general consultations to continued monitoring of specific medical conditions and home-based therapy sessions for patients, all of which can be conducted without visiting clinics and hospitals. A report from Fortune Business Insights forecast the global telemedicine market to grow from $34.3 billion in 2018 to $185.7 billion by 2026 at a compounded annual growth rate 23.5%.

Lockdowns and movement restrictions in the 10-member ASEAN imposed at various times this year have also left patients with little choice but to consult with medical experts remotely for regular checkups.

"Telehealth emerged as an essential area during the pandemic to ensure that people could receive care without physically entering a hospital, unless it was necessary," said Rachel Coxon, Vice President for Healthcare at technology solutions company Barco Asia-Pacific. 

Indonesia, Southeast Asia's most populous nation, has over 600,000 coronavirus cases -- among the most in the region. Data and analytics company GlobalData observed that the lack of adequate healthcare infrastructure and dependency on other countries for medical supplies has made it challenging for the country in tackling the pandemic.

The analysis company noted that the popularity of Indonesian telehealth companies such as Halodoc, Alodokter and GrabHealth has skyrocketed during the pandemic and is expected to remain as a fixture of the domestic health care market post-COVID.

Halodoc's Sudharta is hoping to plug the healthcare gaps in the country, noting that major hospitals are considered among the main sources of coronavirus transmissions and telemedicine can reduce potential infectious exposures in medical institutions.

Investors have taken notice. Halodoc, backed by regional super-app provider Gojek, is a beneficiary of increasing interest. In July, it announced that it raised close to $100 million, with backers including Prudential, Allianz X and the Bill and Melinda Gates Foundation. 

Singapore-based startup See-Mode Technologies, which seeks to improve stroke prediction with artificial intelligence-based medical software, is another beneficiary, raising $7 million, it announced in August. Another Singapore startup, Doctor Anywhere, raised $27 million and is looking to expand into other parts of Southeast Asia, with Malaysia and the Philippines in the pipeline.

Besides startups, some medical institutions have been pushing for the greater use of telehealth services.

Alexandra Hospital in Singapore carried out its first inpatient psychology video consultation in its rehabilitation ward in February this year. In March, video consultations were made available in its rehabilitation medicine specialist outpatient clinic.

Dr Effie Chew, head of Rehabilitation Medicine at the hospital told Nikkei that since the onset of the pandemic, her institution has seen patients, deterred by the pandemic, reschedule outpatient appointments by an increase of 10% to 15%. "While COVID-19 was devastating in its impact and effect in so many areas of healthcare delivery, it also presented opportunities to have us rethink and reset a new normal," Chew said. 

The pandemic has prompted governments in Asia to reexamine how telehealth, or telemedicine, fits into their overall healthcare systems. In Japan, regulations have been eased temporarily to allow doctors to conduct first-time visits virtually, a shift from previous rules whereby medical professionals were only allowed to treat returning patients remotely.

In Indonesia, Thailand and Singapore, regulations allow telehealth operators to conduct their services in a relatively unhindered manner. Indonesia, for instance, requires medical professionals who intend to provide treatment through telehealth mediums to at least have a registration letter and practice permit at their respective healthcare facilities, according to law company Baker McKenzie.

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