“In 2005, you only had 15 hospitals in Asia accredited by JCI [Joint Commission International, the international division of the organisation that accredits healthcare providers in the US]. Today you have 110,” says Bhuller. She notes that as the market becomes increasingly crowded, countries have started to position themselves more distinctively in the market, with hospitals in Japan and Thailand carving a reputation for a high standard of care and aesthetic services while Singapore focuses on advanced surgeries.

There are other ways in which hospitals can differentiate themselves from the rest, says Bhuller. The use of high technology through robotic surgery is one such example, as is specialising in minimal invasive surgeries, common in Singaporean hospitals. Some opt for ‘holistic healthcare’, which includes preventive and well-being services, while others bet on high-end design and service to attract wealthy patients, just like a five-star hotel would do.

Mays sees another consequence of increased competition on hospitals’ plans. “The more obvious niche strategy is to target a few countries in close proximity. Japanese hospitals are looking at Russia, while the Taiwanese target the Chinese market,” he explains, stressing that it also takes time and resources to train staff on foreign languages and culture.

As more players join the market, the competition for a skilled labour force is also likely to increase, pushing salaries and training costs up. Bhuller expects newcomers to face a labour shortage and therefore try to set up collaboration with universities and nursing schools and use more technology and automation in the procedures. “This will remain a very competitive industry,” she says. “Groups who are consolidated with investment in different countries have a better chance because they can balance the less performing markets with the high performing ones.”

Happy few

According to the World Health Organisation, private expenditures account for 58.7% of total health expenditure in the region. That is 8% more than in Africa and the Americas and 35% more than in Europe. Regardless of the economic gain brought by an efficient industry, a growing concern is that a prominent private sector will only exacerbate the shortage of competent medical workforces available to the larger parts of the population in the poorest countries, impacting negatively on their development.

“That is a justified concern, but one should not ignore that by developing a competitive healthcare industry, we are able to avoid a brain drain and to attract doctors who otherwise would be working in Western countries,” says Mays.

Yet in many countries, quality healthcare remains limited to the wealthy few, reflecting the widening gap between rich and poor and between cities and rural areas in Asian societies. In Vietnam, for example, 8.1% of households spend more than 20% of their total household expenditure on health and 3.7% are impoverished as a direct result of their high healthcare spending, according to the United Nations Development Programme.

To ensure the poor benefit from the healthcare boom,  one way forward would be for governments to prioritise public healthcare plans and innovative public-private partnerships and enforce regulations. “Some governments are now giving more flexibility to specialists who can work in both the private and the public sectors at the same time. This benefits everybody, including the doctors themselves,” explains Bhuller. “In some countries, the best physicians are to be found in the public sector because they are faced every day with a wider range of pathologies. In private hospitals, they lose this expertise.”