Healthy Contrasts: A Look at Markets and Health Systems Across the ASEAN Region

Sep 02, 2006
Volume 30, Issue 9

Southeast Asia strikes the visitor as diverse and fascinating. In the shadows of the global giants China and India, 500 million people now thrive across a multitude of nations—ranging from very large to tiny city-states, scattered over mainland and archipelagos—impressing the first-comer with unrivaled cultural wealth and diversity.

From regional human powerhouses like Indonesia—the most populous country of Southeast Asia and the world's fourth-largest,—to the island city of Singapore, the region is a patchwork of languages, cultures, and environments.

A sweeping financial collapse across the region reshuffled the cards in 1997–1998. Moving from "the Asian Miracle" to a post-crisis situation, most of the region's countries displayed resilience and optimism and hit the growth road again. Almost 10 years later, the scars still show, but Southeast Asian nations have addressed some of the structural weaknesses that made the 1997–98 meltdown possible, and have strengthened their economies. Life science is one keystone of the recovery.

Across the region, from Indonesia to Malaysia and Singapore, and from the Philippines to Thailand, local players have expanded in their domestic markets, using state support and market protection to take full advantage of sizeable home turfs. Many have become serious regional contenders with ambitions stretching across Southeast Asia and beyond.

Sorting through inequalities

Indonesia is the region's most populous country and its economic leader, with $865.6 billion (2005 est.) GDP (Purchasing Power Parity) and 224 million people. Thailand follows with 64 million people sharing an estimated $560.7 billion (2005 PPP). These two countries lead the way despite having been very adversely affected by the financial crisis. Behind them comes the Philippines, with 89 million inhabitants and $451 billion in estimated 2005 GDP.

The development star of the region is Malaysia, which—with 24 million people and $290 billion of GDP (2005 estimate)—also benefits from a solid growth, excellent infrastructure, and a stable political life. Singapore shares these strengths, but has a much smaller population and less economic clout with 4 million Singaporeans and Singapore $124.3 billion (US $78.9 billion) at Purchasing Power Parity (2005 estimate). Yet, the city-nation is also recognized as the key financial and service center of the region and is often the destination of choice for regional headquarters of global corporations.

The region's pharmaceutical industries are equally diverse and reflect their countries' histories, development paths, and social conditions. While Indonesia, the Philippines, and Thailand have benefited from state protection and patronage when building a local industry, Singapore has striven to attract foreign players, offering investment incentives and granting market access in return for manufacturing plants, research labs and regional marketing offices. Meanwhile, Malaysia has mixed both approaches, helping to create a national champion through monopolistic positions while allowing local private players to thrive and keeping the door opened to foreign players.

Public health can also differ rather dramatically from one country to another: rural Philippines rank low in the United Nations Development Program (UNDP) Human Development index (84th out of 177); less than 30% of its population benefits from regular access to essential drugs. In Indonesia, more than 52% of the population lived on less than $2 per day for the period 1990–2002. The country spent $113 per capita on healthcare in 2003 (according UNDP/WHO figures). In the same time, Singapore has developed as a worldwide medical center of excellence and records some of the highest per-capita medical expenditures in the world at $1156 (WHO, 2003). Thailand and Malaysia take the middle ground, with healthcare spending at $260 per capita for Thailand, $374 for Malaysia. Estimated healthcare spending is expected to grow strongly in the region over the next 5 years.

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