Jalan Pintas menuju AFTA dalam Industry Kesehatan

Jalan Pintas menuju AFTA dalam Industry Kesehatan Boenjamin Setiawan, dr.,PhD Honorary Chairman PT Kalbe Farma Tbk

11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia

Boenjamin Setiawan, Peluang dlm Industri Kesehatan Indonesia

The Dawn of the Knowledge Era  Human Resource Development is the KEY for IRRADICATING POVERTY and Economic Development  Spectacular developments in science and technology  Unparalleled economic growth – globalization, competition, innovation at the vanguard

 Uncontrolled exploitation of earth’s resources

21st century will be the century of knowledge

.…the process of transition is on 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Innovation is the KEY of WEALTH Creation • Innovation is the lifeblood of our global economy and a strategic priority for all CEOs everywhere. We’re all familiar with classic cases where revolutionary ideas upended industries and generated enormous wealth: • 1) the Apple iPod’s outplaying the Sony Walkman; • 2) Starbucks’ beans and atmosphere flooding out traditional coffee shops; • 3) Skype’s using a strategy of “free” to unspool AT&T. • 4) But how about Reckitt Benckiser Group, the British consumer products giant (Lysol, Woolite, Clearasil), which looks to customers, among others, to find new methods to detect parasites? 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


R&D Innovation

Idea

People

Tools

Products and Productivity

Goal: Strengthening the Economy 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia








Government-University-Industry Partnership (ABGC)

R&D

Promote and Stimulate

Set R&D Policy and Provide Funding


University Resources

Government Driver

Industry


Products

Government • Conduct research critical to national interests • Federal labs (NIST, NREL, Oak Ridge, etc.) • Provide research funding via government agencies

University • Basic and applied research (Open) • Training and prepare future workforce • From ideas to bench-scale prototypes

Industry • Market-driven product research and innovation • From ideas to prototypes, to large scale manufacturing and marketing



U.S. Science and Technology Policy • National Science and Technology Council (cabinet-level council) – Chaired by the President – A primary objective of the NSTC is the establishment of clear national goals for Federal science and technology investments in a broad array of areas



If INDONESIA is serious about competing in the global market, it is time to understand the impact of Science and Technology and Education on the economy. One I-phone 5 costs more than a ton of rice Innovation versus Business as Usual 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Industry-University Cooperative Research Center (IUCRC) • Researchers from partner universities submit ideas and proposals competing on a specific problem • IAB reviews and select projects for funding based on quality and competitive process (not institution) • Outcomes and innovation from projects are jointly owned by the researchers and all industrial partners 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Financial Support: Seed Funding and Membership Fee

Industrial Partners (IAB) -set problems

Federal, State, and Lead University

IUCRC Center

Consortium of Universities and Researchers R&D

Research Outcome Full-scale product and Innovation

manufacturing

IUCRC for a Specific Industrial Interest 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


What about Indonesia ?? • We have to set priorities in a multicomplex environment, which are as folllows: 1. Education and Health for the population 2. Innovation through R&D by increasing the budget to achieve 1% of GDP in 2017 3. Infrastructure has to be developed 4. Energy, Biofuel, Solar/Wind/Nuclear/Hydro/ energy must be developed 5. ICT, Nano, Robotics, Biotechnology, Genetic engineering etc. 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Proyeksi kedepan, Indonesia akan menjadi negara berpendapatan tinggi di tahun 2025, MP3EI PERSIAPAN

PERCEPATAN

KEBERLANJUTAN

Indonesia menjadi negara berpendapatan tinggi dengan GDP per capita USD 14,250-USD 15,500

$46,900 $38,600 $30,400

$22,500

GDP Nominal per capita

$14,900 $3,005

$5,300

2010

2015

$9,000

2020

2025

2030

2035

2040

2045

GDP Nominal (US$ Miliar) 1,335 2,416 711

4,257

6,793

9,706

12,98 9

16,57 8

286

302

319

336

353

Populasi (Juta orang) 237 253 269 11 Octber 2014, Diskusi Panel Ikatan Mahasiswa Sumber: KEN,Senat Proyeksi Ekonomi Indonesia 2011–2045 Kedokteran Indonesia


Visi 2025 100 tahun kemerdekaan

“Mengangkat Indonesia menjadi negara maju dan merupakan kekuatan 12 besar dunia di tahun 2025 dan 8 besar dunia pada tahun 2045 melalui pertumbuhan ekonomi tinggi yang inklusif dan berkelanjutan”

berbasis IPTEK 2010

2045 2025

PDB ~US$ 16.6 Trilyun Prediksi Pendapatan/kapita ~US$ 46,900 Diprediksi menjadi terbesar ke-7 atau ke-8 dunia*)

PDB: 3,8 – 4,5 Trilyun US$ Pendapatan/kap: 13.000 – 16.100 US$ Terbesar ke-12 dunia Proyeksi KEN Pendapatan/kapita ~US$ 14,900 (high income country)

PDB ~ US$ 700 Milyar Pendapatan/kap US$ 3,000 (2010) Terbesar ke-17 besar dunia

(Sumber: Master Plan Percepatan dan Perluasan Pembangunan Ekonomi Indonesia 2011 – 2025 )

Pencapaian Visi 2025 dan 2045 memerlukan penyiapan generasi yang mampu berperan aktif 11 Octber 2014, Diskusi Panel Boenjamin dlm Industri dalam kegiatan pembangunan. Dan harusSetiawan, dimulaiPeluang sekarang dan generasi sekarang (PAUD) Ikatan Senat Mahasiswa Kedokteran Indonesia

Kesehatan Indonesia

World Health Care Industry 2013 1. Total World GDP is around 70 trillion USD 2. Total world health care industry is about 9% of world GDP = 6.3 trillion USD 3. Market size of Medicines is 15% of total health care industry = 945 billion USD. 4. Market size of Medical Devices is about 4% of World Health care Industry = 253 billion USD 5. Market size of Human Services of the Health care Industry in the US is about 8% of the Total Health Care Industry = 560 billion USD 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Which Country have the most Efficient Health Care System •

U.S. outpaces industrialized nations on health costs, not quality

•

For the rankings, Bloomberg researchers used data from the World Bank,International Monetary Fund, World Health Organization (WHO), and Hong Kong Department of Health. Researchers ranked only countries with a population of at least five million, a life expectancy of at least 70 years, and a gross domestic product (GDP) of at least $5,000. Each of the 48 qualifying countries' health care system was evaluated based on:

•

1.Life expectancy, which accounted for 60% of the ranking;

•

2. Relative per capita cost of health care (percentage of GDP per capita), which accounted for 30%; and

•

3. Absolute per capita cost of health care (expenditures covering preventive services, family planning, nutrition, and emergency aid), which accounted for 10%.



Bloomberg Score of Most Efficient Health Care System , 2014 • Bloomberg gave each country an efficiency "score," with a score of 100 representing a perfect system. • According to Bloomberg, the top 10 countries and their scores are: • 1. Hong Kong (92.6) 2. Singapore (81.9) 3. Japan (74.1) 4. Israel (68.7) 5. Spain (68.3) 6. Italy (66.1) 7. Australia (66) 8. South Korea (65.1) 9. Switzerland (63.1) 11 Octber Diskusi Panel 10.2014, Sweden (62.6) Ikatan Senat Mahasiswa Kedokteran Indonesia


1. The Global Health Care Industry 1.1. The global Health Care industry is one of the world's fastest growing industries, absorbing over 10% of gross domestic product of most developed nations. It constitutes of broad services offered by various hospitals, physicians, nursing homes, diagnostic laboratories, pharmacies and ably supported by drugs, pharmaceuticals, chemicals, medical equipment, manufacturers and suppliers. The medical and health care industry provides enormous employment opportunities to choose from. Apart from using the services of medical professionals, this industry also utilizes the expert services of public policy workers, medical writers, clinical research lab workers, IT professionals, sales/marketing professionals and health insurance providers.

1.2. SIZE OF THE INDUSTRY The United States of America has one of the largest medical and healthcare industries in the world, followed by Switzerland and Germany. The USA's medical industry comprises of more than 750,000 physicians and 5,200 hospitals. USA witnesses approximately 3.8 million inpatient visits and 20 million outpatients visit on a daily basis. Furthermore, the United States of America has the largest workforce i.e. one in every 11 US residents employed in the health care business. 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


The Global Health Care Industry 1.3. The global healthcare industry market is forecast to reach $7 trillion in 2012 (10% of world GDP), according to research from Global Industry Analysts. Investment in sectors such as home healthcare, healthcare IT and telehealth are expected to continue fuelling market expansion. Due to the world’s aging population, the demand for home healthcare is likely to continue climbing over the years to come. 1.4. The healthcare services industry is labor intensive and overburdened in many regions, making telehealth and healthcare IT attractive options. With medical technologies continually developing, these options are proving beneficial to patients and the overall healthcare system. 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


GLOBAL SPENDING ON MEDICINES Annual global spending on medicines will reach nearly $1.2 trillion by 2016, as the pharmerging markets, biologics and generics contribute more to spending. In the developed markets, including the United States, Europe and Japan, spending will decline to 57% of the global total due to expiring patents for a number of significant brand-name drugs, slower increases in spending on branded products, and increased cost containment measures by payers. Alternatively, pharmerging markets will reach 30% of global spending by 2016, as population and economic growth contribute to dramatically higher use of medicines in these markets. Overall, the top 20 therapy areas will account for 42% of global spending, led by cancer, diabetes and asthma/COPD. An accelerated shift to the use of generic medicines is expected, both from an unprecedented level of patent expiries in the U.S., and from volume-driven growth in the largely generic-using pharmerging markets. At the same time, lower-cost versions of expensive biologic medicines, or biosimilars, will continue to be launched, though slowly, and will account for only $4-6Bn, or 2%, of the $200-210Bn in spending on biologics by 2016.



Opportunities in ASEAN’s Healthcare Sector Healthcare in ASEAN The Association of Southeast Asian Nations (ASEAN) is a geo-political and economic organisation comprising of Singapore, Indonesia, Malaysia, Thailand, the Philippines, Brunei, Myanmar, Cambodia, Laos and Vietnam. Established in 1967, the group has been instrumental in promoting the region’s economic growth and development. Collectively, the group has established economic links and entered into free trade agreements with various countries including China, Japan, South Korea, India, Australia and New Zealand.

With a combined nominal GDP of over 2.3T USD, ASEAN as a bloc is presently the eighth largest economy in the world. In recent times, despite weak economic conditions in the US and EU as well as slowing growth in China, the ASEAN economy has maintained its robust growth trajectory. When the ASEAN

Economic Community (AEC) will be implemented in 2015, the common economy is expected to join the ranks of China and India as a major economic growth force in Asia. Healthcare is a priority sector that the ASEAN governments have identified for region-wide integration. The upcoming AEC formation is expected to further accelerate the growth of the region’s healthcare industry, driven by additional foreign direct investments, freer flow of trade, manpower and capital within ASEAN, and growing affluence among ASEAN countries. Table 1 below provides a rough indication of the overall potential size of the AEC market. 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


ASEAN Opportunities in Health Care



ASEAN Total Population Growth rate and GDP 2012





The Outlook for Medical Tourism in Asia

December 2012 – An interesting article recently came out declaring that medical tourism in Asia could reach USD 8.5 billion by the end of next year. [1] This is a very impressive figure but according to recent estimates by McKinsey & Co., worldwide medical tourism is a USD 100 billion industry [2], a figure which leaves Asia ample opportunity to catch up and grow further. Likewise, research firm, Global Information Inc., elaborated in its report that Thailand and India have been dominating the industry for quite some time, while the Philippines, Malaysia, Singapore and South Korea have put in place government-supported medical tourism programs to capitalize on this growing industry. Case in point, Singapore and Malaysia have been posting double digit annual compound growth rates of 11.9 and 29.3 percent respectively, in terms of international patient arrivals for the past couple of years. Unfortunately INDONESIA is left behind 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Medical Tourism So what could be the factors fueling this rapid growth? Advancements in service delivery models and medical technology, rise of low-cost travel, extensive tourism infrastructure and the evolving methods of medical marketing through social media are emphasized by analysts as the main elements that affect the decision for offshore medical care. These factors continually lure costconscious patients with the consolation of exploring Asia, since the bargain of combining cost-effective treatment and travel in one airline ticket is hard to beat.

With spiraling medical costs in the United States and to a certain extent, Europe's bleak economic outlook, patients are now looking elsewhere for medical treatments. The US Medical Tourism Association compared the actual costs for specific medical procedures in various countries including some in Southeast Asia. The data below highlights the disparity between Asian countries and the United States when it comes to cost of certain treatments. 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Cost comparison for selected surgeries, 2007 Surgery

U.S.

India

Thailand

Singapore

Heart bypass

$130,000

$10,000

$11,000

$18,500

Heart valve replacement Angioplasty

$160,000

$9,000

$10,000

$12,500

$57,000

$11,000

$13,000

$13,000

Hip replacement

$43,000

$9,000

$12,000

$12,000

Hysterectomy

$20,000

$3,000

$4,500

$6,000

Knee replacement $40,000

$8,500

$10,000

$13,000

Spinal fusion

$5,500

$7,000

$9,000

$62,000

Source: American Medical Association, June 2007, available at: http://www.medicaltourism-guide.com/2008/04/03/cost-comparison/ 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Economic Update, (Oxford Business Group) Investing in Indonesia's private sector health care OBG Indonesia | 15 Aug 2013

With Indonesia’s new universal health care programme expected to put pressure on the public hospital system, investors are looking to develop private sector medical facilities as an alternative for the growing middle class. Under the government scheme, all Indonesians will have some form of health coverage by 2019, up from around 50% at present. The system will provide insurance to millions who lack access to employersponsored plans and cannot afford private coverage, but it is also likely to stretch capacity at state hospitals and clinics. Initial trials of the comprehensive scheme in Jakarta saw sharp increases in the numbers of patients attending government facilities, many of whom were visiting the hospital for the first time.



Indonesia’s Health Spending Trends, 2010 Total Expenditure on Health as % of GDP

• •

•

•

Total expenditure on health averaged 2% of GDP over the 11 year period 1996-2006. The Government is planning to implement the National Social Security System. Since 2004, the Government has implemented healthcare program for poor people through Asuransi Kesehatan Masyarakat Miskin (Health Insurance for Poor Population) or Askeskin program and currently is replaced by Jaminan Kesehatan Masyarakat (Public Health Insurance Scheme for the Population) or Jamkesmas program. In Q4 2009, the new Healthcare Law has been approved and provides guideline for Government to increase the healthcare spending from 2% up to 5% of GDP , but until today not yet realized. In 2013 the Health Insurance System will be realized

2.5 2.0 1.5 1.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Source: The World Bank

Share of Total Health Expenditure (%) 1996-2006 70 60 50 40 30

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

public

private

out-of-pocket private

Source: WHO National Health Accounts database, September 2008

Total Expenditure on Health as % of GDP

Indonesia Philippines Malaysia China India Vietnam

2.5 3.2 4.2 4.7 5.0 6.0 -

1.0

2.0

3.0

4.0

5.0

6.0

Source: Daily Newspaper Suara Pembaruan , 29 March 2010



31

7.0

Indonesia’s Key Healthcare Indicators shows that Demand is Growing

Fast, and providing many Business Opportunities, from increasing healthcare spending & industries, rising middle class, greying population and chronic diseases as well as implementation of SJSN in 2014 Healthcare Key Drivers



Source: Frost & Sullivan, 2012

Rising of middle class and greying population increase the incidence of chronic and autoimmune diseases. It will drive demand for newer, better and targeted therapeutics. Some opportunities are: Biologics & Biosimilars, New Technology / Invention and Ethical Originator, Vaccine, Molecular Diagnostics, Point of Care Testing products and use of STEM CELLS

INDONESIA



Some examples of E-Health Services are: Home Monitors E-Prescribing

Telemedicine Kiosk


i-Pods for medical history


Craig D. Jerald, Break the Curve Consulting NSBA 2009 Federal Relations Conference Washington, DC

February 1, 2009

Preparing Students for the

st 21 Century

I. How is the world changing?



Forces changing skill demands • 1. Automation • 2. Globalization • 3. Workplace change • 4. Demographic change

• 5. Personal risk and responsibility



Automation



Changing mix of jobs in the economy 1969 40%

1999

38%

Percent of employed adults

33%

25%

22% 18% 14%

12%

12%

14%

8%

0% Blue collar workers

Admin support workers

Sales related occupations

Technicians, professionals, managers, administrators

Service workers

Source: Levy, F. & Murnane, R. J. (2004). The new division of labor: How computers are creating the next job market. Princeton, NJ: Russell

11 Octber Diskusi Panel Sage2014, Foundation. (p. 42, Figure 3.2) Ikatan Senat Mahasiswa Kedokteran Indonesia


Globalization



Implications for your students “Suddenly more people from more different places could collaborate with more other people on more different kinds of work and share more different kinds of knowledge than ever before.” —Thomas Friedman (2005)

“Highly skilled people with roughly the same qualifications are competing directly with each other, no matter where they are located on the globe.” —the New Commission on the Skills of the American workforce (2007)

Sources: 1) National Center on Education and the Economy. (2007). Tough choices or tough times: The report of the New Commission on the Skills of the American workforce. San Francisco, CA: Jossey-Bass. (p. 19) 11 Octber 2014, Diskusi 2) Friedman, T. L. (2005). ThePanel world is flat: A brief history of the twenty-first century. New York: Farrar, Straus and Giroux. (p. 81)

Ikatan Senat Mahasiswa Kedokteran Indonesia


Workplace change



More important in the 21st Century • Postsecondary education and training • Academic knowledge and skills • Practical literacies: The ability to use knowledge of math, English, science, civics etc. to meet real-world challenges. • Broader competencies: Critical thinking and problem solving, communications and collaboration, creativity, self-sufficiency etc. 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Broad Competencies: Which are most critical? The 3 C’s!

1. Critical thinking and problem solving – Labor economists Levy & Murnane call it “expert thinking”

2. Communication/Collaboration – Levy and Murnane call it “complex communications”

3. Creativity 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


History of Kalbe Farma Tbk • Founded on September 10th, 1966. • Started its operation in a modest garage at Jalan Simpang I No. 1, Tanjung Priok.



10 Companies that started in a garage • • • •

1. Apple started by Steve Jobs (21) and Steve Wozniak (26) 2. Amazon, started by Jeff Bezold in 1994 3. Disney, started by Roy and Walt Disney in 1923 4. Google, As Stanford Graduate students, Larry Page and Sergey Brin in September 1994, started what’s now known as Google from Susan Wojcicki’s garage.

•

5. Harley Davidson, In 1901, 21-year-old William S. Harley drew up plans to create a small engine to power a bicycle. 6. Hewlett-Packard, Bill Hewlett and Dave Packard In 1939, founded HP in Packard’s garage with an initial investment of $538.

• • • • •

7. Lotus cars, In 1948, at the age of 20, Anthony Colin Bruce Chapman started Lotus Cars 8. Maglite, In 1955, after saving $125, Tony put a down-payment on his first lathe. Then he started working out of a Los Angeles area garage to manufacture precision parts. He incorporated Mag Instrument in 1974 and released their first flashlight in 1979. 9. Mattell, Harold “Matt” Matson and Elliot Handler founded Mattel out of a garage in Southern California as picture frame company in 1945, Today Mattel, Inc. is the highestgrossing toy company in the world. 10. Yankee Candle Company, In 1969, at 16 years old, Michael Kittredge made his scented candle in his garage out of melted crayons as a gift for his mother. 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


What were the Reasons for Success?? 1. The RIGHT time, because in 1966 the Suharto Gov. opened the doors for foreign investment. 2. The RIGHT products and RIGHT pricing, because as a pharmacologist and practising physican I knew the needs of doctors 3. The RIGHT marketing strategy, following the footsteps of the foreign companies by promotion through Medical Reps. 4. The RIGHT company strategy by Professionalizing our team from the beginning 5. The RIGHT and BRIGHT people to run the company 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Act Local, Go Regional (ASEAN) THINK GLOBAL and MOVE FAST, 2010-2020 1. PT Kalbe Farma is now the largest Pharmaceutical Public Company in Indonesia 2. Go Regional, we must aim to become number one in ASEAN 3. The next step is to think and become a GLOBAL PLAYER 4. All this can only be achieved if we have the BEST and the BRIGHTEST PEOPLE in our company 5. R&D on Biosimilars and Stem Cell research must be prioritized for Degenerative Diseases and Cancer Therapy 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Toward the New Sustainable Model: A Roadmap 1.

4.

The Healthcare Industry must Diversify and enter into the whole range of the Healthcare Industry The Health Care Industry must Adapt, Adopt, Align, Agree and Act to the Changing Environment The HCI must go into Biosimilars, Biotechnology, Stem Cells, Changing Demography, and Personalized Medicine The Health Care Industry must be able to make use of the New Technologies

5.

The Health Care Industry must Adapt

2. 3.

INNOVATION 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia

Through Continuous


Summary and Future Directions 1. 2.

There are presently still many opportunities to invest in the Health Care industry in ASEAN as well as in Indonesia New scientific knowledge provides a huge opportunity for improvement to TARGETED THERAPY, PERSONALIZED MEDICINE, e-Care/Home care and the Digital Hospital

3.

The biomedical research community should have a greater role in many aspects of drug discovery and development

4.

Stem Cell Research will be the Future to Combat the

5.

many Degenerative Diseases of Old Age Future drug development must include many innovative partnerships between ACADEMY, BUSINESS and GOVERNMENT. The clinical research enterprise in the WORLD must be transformed into a more EFFICIENT and EFFECTIVE Organization. 11 Octber 2014, Diskusi Panel Ikatan Senat Mahasiswa Kedokteran Indonesia


Will the Health Care Industry Change? Yes, Survival of the Fittest and Most Intelligent Industry through INNOVATION





Jalan Pintas menuju AFTA dalam Industry Kesehatan

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