What is the best cancer healthcare eco-system for Malaysia?  

KAWAHARA Norie welcomed ISOBE Masahiro from PMCare Sdn. Bhd. She noted that together with the National Cancer Society of Malaysia, PMCare is working to promote cancer prevention and early detection in Malaysia through enhanced health education and literacy. Alongside this, the Asia Cancer Forum (ACF) is not just focused on screening, but is also committed to building a treatment inclusive ecosystem and driving existing strategies for the realization of universal health coverage (UHC). ACF has been engaging in awareness activities using local beauty salons and barber shops as a touch point. However, challenges relating to medical costs and difficulty in transitioning to treatment have been faced. In this context, workplace screening supported by medical insurance holds the promise of opening a new world in healthcare.

It is in this context that public private partnership is very important. Mr. Isobe is a key partner who shares ACF’s vision for the future. The theme of the lecture is “What is the best cancer healthcare ecosystem for Asia?”

Mr. Isobe began with an introduction to PMCare, which is a group company of Sumitomo Corporation, a Japanese company, since 2019. PMCare is located in Kuala Lumpur, Malaysia. Healthcare is a broad topic, and there is always government involvement when discussions arise about changing healthcare systems or creating better ecosystems.

Mr. Isobe noted that he is a business person working in the healthcare space in Malaysia. What he is trying to do is firstly make a change in the private sector, and ultimately contribute to healthcare in Malaysia overall. 

Sumitomo Corporation is an old Japanese brand, and today it is a well-known Japanese conglomerate. It was originally founded in Kyoto in the 17th century. The very first Sumitomo shop was a small book and medicine store. In that sense, Sumitomo has been involved in healthcare from its inception, and subsequently diverged into several companies, one of which is Sumitomo Corporation. Sumitomo Corporation has 75,000 employees all over the world, spread across nearly 900 subsidiaries, with profit after tax of US$4B. Sumitomo Corporation has been listed on Fortune Global 500 for more than 26 years.

As a conglomerate Sumitomo is engaging in a wide range of businesses, with healthcare business assets in Malaysia, Vietnam, Singapore and the U.S. 

PMCare Malaysia was founded in 1995 as a Managed Care Organization (MCO). It has wide-ranging features, including a digital platform capable of engaging in data analytics, and providing healthcare solutions to clients. As an MCO, PMCare provides comprehensive healthcare management and solutions to various corporate clients, some of which are international household names.

The Malaysian health care system is divided into public and private sectors, with spending in each sector being similar (USD 6.9B for the public sector, and USD6.6 B for the private sector) (figures according to the WHO Global Health Expenditure Database). 

In terms of primary care, there are about 3,000 public clinics in Malaysia, and 8,000 private clinics. In terms of pricing, public clinics are very cheap, whereas private clinics are much more expensive. Public health care facilities therefore work as safety net for those who cannot afford to pay for their health care. As a consequence, there is an imbalance in the numbers of patients between public and private sectors, as shown in Figure 1. 

Figure 1: Overview of the Malaysia healthcare system

Managed care is a concept that started in the U.S. Managed care in the United States is a healthcare delivery system organized to manage cost, utilization, and quality. This approach is primarily seen in health maintenance organizations (HMOs), and preferred provider organization (PPOs). Key characteristics include provider networks, emphasis on prevention, gatekeeping, cost control, quality oversight, and restrictions on coverage.

Overall, the goal of managed care is to provide quality care in a cost effective manner, but it can sometimes result in tensions between cost savings and the provision of comprehensive care.

In terms of the eco-system in Malaysia, there are two main players in healthcare, the payer and provider. Payer means corporations or insurance companies that are paying medical costs for their employees or dependents. Provider means the provider of medical care and treatment to the patient, which is usually hospitals or clinics. 

The eco-system for private care is actually a non-controlled environment because patients can go to any providers within their medical benefit coverage package, and companies have no way of controlling costs. Costs are dealt with on a reimbursement basis, with the employee paying first and then request reimbursement at a later date. 

PMCare’s goal is to manage healthcare costs properly for payers while maintaining the health of the population. As an MCO, PMCare first creates a network of providers. There is usually an agreement between the MCO and the providers regarding pricing and services.

Once this network has been established, employees or dependents can only go to the approved network of providers to receive cashless treatment. Employees do not have to pay anything upfront and the providers send a bill directly to the MCO as a medical claim.

Using this system, information about diagnosis and costs, as well as laboratory-related information can be accumulated in the MCO, which uses the information to provide healthcare management services to the payer (client). Using this structure, as an MCO we can review medical claims on behalf of the payer and use data analytics to propose ways of effectively managing medical costs. 

Figure 2: PMCare eco-system in Malaysia 

The homework assignment was designated as follows:

Please find a healthcare startup company in Asia which is trying to improve the health of people. Please specify the name of the company and provide a brief description of their services.

A question was asked whether PMCare is working to go beyond national borders to promote its business. It was also noted that PMCare has signed an MOU with the National Cancer Society, Malaysia (NCSM) and the Asian Cancer Forum (ACF), and a question was asked about the motivation for signing an MOU with these not-for-profit NGOs. 

Mr. Isobe responded that PMCare intends to expand its business beyond Malaysia and has already begun a similar business in Vietnam. There are plans to expand further to Indonesia, the Philippines, Singapore, and possibly India. 

With regard to the signing of an MOU with NCSM and ACF, both of which are non-for-profit organizations, the hope of PMCare is that it will be possible to leverage market mechanisms to promote cancer screening.

For example, if there is a return on investment for cancer screening, a company would be willing to pay for cancer screening for their employees if it resulted in early detection of cancer. This is because costs for cancer treatment are low if it is discovered in its early stages, which would enable companies to save money. It therefore makes sense for HR departments at companies to pay for cancer screening.

We are looking to create a cancer screening package product together with NCSM and ACF, which could be sold to corporations. If there is a clearly defined ROI, such a package could conceivably be sold. We are hoping to tap this health cancer screening market in Malaysia. 

At the current point, cancer screening demand is not so high in Malaysia, so our motivation in joining with NCSM and ACF is starting from more of a CSR-type perspective. However, we would like to use market mechanisms and leverage our position as a private sector actor. 

  A student referred to the government’s efforts to build a traditional health system in Malaysia to improve basic health. He asked for more information about efforts to improve basic health and health conditions.

  Mr. Isobe noted that PMCare is just one company, and therefore it is not possible to totally reform the Malaysia healthcare system alone, as it is the Ministry of Health that is expected to take the leadership role. The government healthcare system in Malaysia works as the safety net for the low income population because healthcare pricing is so cheap, but waiting times are extremely long, resulting in adverse health outcomes. The government needs to mitigate this crowded environment. 

From the perspective of PMCare, the company is working in the private sector, in the area of corporate health. Therefore, in terms of the public sector, first steps should be taken by the government.

  When asked whether there are any opportunities for PMCare to interact with the national government of Malaysia to exchange ideas about what can be done for the improvement of cancer prevention, Mr. Isobe responded that as of now no specific conversations have taken place with the government on cancer prevention, but the company is in regular contact with the ministry, discussing what we can do about the national health agenda as a private sector player and as an MCO. There may be future opportunities to improve cancer screening in the country.

  A student asked whether in the future there could be a public-private partnership between the government and private sector companies. Mr. Isobe responded that the ministry’s white paper includes reference to public-private partnerships. One idea is that the government will come up with a basic health benefit package, which will be used in both the private and public sector. Discussions are still ongoing. Another initiative is in digitization, relating to the create of digital platforms and exchanging information. As a private player we also have a digital platform as an MCO, and we can contribute to building this kind of digital infrastructure.

  Another student noted that many of the works being done by PMCare could be automated by AI to further reduce costs. He asked whether PMCare has plans to implement AI in daily operations. Mr. Isobe responded that there are many possibilities for AI in the future and it is hoped that AI can be harnessed to create predictive analytics in the future. By so doing, it could become possible to provide more personalized care to individual patients and service users. For example, users could be provided with incentives or stimuli to improve their daily behavior, with a view to reducing future risk of cancer. To do this on a national population level will likely require the use of AI. Any such system is still far from realization, but AI models are being developed for various kinds of work and there is potential for the future.

  A student asked about hurdles to introducing new technologies for screening, and whether there is any reluctance on the part of users to engage with new technologies. 

  Mr. Isobe responded that PMCare acts as a bridge to connect all the healthcare providers. Another stakeholder is the pharmaceutical companies and what those pharmaceutical companies want is data relating to the medication and treatment regimens. PMCare has various pharmaceutical-related information and the pharmaceutical companies would like access to this information, which could be used in the development of new drugs. However, in Southeast Asia, the research and development functionality of pharmaceutical companies is not very strong at the current point. Another point is that pharmaceutical companies seek to reach out to patients to provide specific drugs for specific diseases. In such scenarios PMCare could share information to indirectly support pharmaceutical companies’ activities.

  It was noted that while universities in Japan have also come to realize the importance of using data for business purposes, in order to promote businesses it is still very important to nurture inter-personal relations, as it is people who provide the “human touch.” Mr. Isobe was asked what kind of people PMCare seeks to employ in their business activities in Malaysia and more broadly in Asia. 

  Mr. Isobe responded that key personnel include data scientists in the healthcare sector, who are capable of analyzing data to inform business decisions. Unfortunately, it is very difficult to find such people in the domestic labor market in Malaysia. It is therefore very challenging to create a bridge between data science and healthcare. 

  It was duly noted that this lecture series considers an interdisciplinary approach to tackle very comprehensive issues like a cancer prevention to be of great importance. The experience of PMCare in Malaysia demonstrates the importance of just such an interdisciplinary approach. 

A student noted that in Japan health checkups are mandatory and it is the responsibility of schools and companies to implement screening. She asked whether health checks are mandatory in Malaysia. Mr. Isobe responded that checkups are not mandatory in Malaysia, which is part of the reason why there is such low uptake. Even with corporate support for health checkups, the uptake rate is still very low in Malaysia. In Malaysia the focus is still on sick care, rather than preventive care and people are unwilling to pay themselves for health screening. A potential solution will be to incentivize employees to receive screening, by implementing a rule that unless they receive screening checkups, points will be deducted from their performance review, etc.

A student asked a question about dilemmas relating to acquisition and usage of information, particularly given the fact that PMCare is a company belonging to a Japanese conglomerate, which is acquiring and using patient information in Malaysia. Mr. Isobe responded that the process is more like one of harmonization between the countries of Malaysia and Japan. If harmonization can be realize effectively, it will positively impact healthcare delivery in Malaysia. 

Mr. Isobe also noted that there is a strict data protection act in Malaysia, which prohibits taking out information from the country. This does present something of a dilemma, but there are many possibilities and potential in the domestic market in Malaysia.

When asked whether there is any competition in this particular field in Malaysia, Mr. Isobe responded that there are competitors engaged in similar business and the question is therefore about how PMCare can differentiate itself in the market. What PMCare does that other companies don’t, is to obtain and analyze data, and provide healthcare solutions based on that data. There is no other company doing this activity in Malaysia.

  A student noted that healthcare screening on site at companies is very a good initiative and it is to be hoped that it will become increasingly popular. He asked whether there were any differences in uptake among the different ethnic groups in Malaysia. Mr. Isobe responded that in general the uptake among ethnic Malays is low, and higher among the ethnic Chinese population, which tends to be more health-aware. Providing onsite screening services at client companies has proven to be popular among ethnic Malay people. 

In terms of the obesity issue in Malaysia, various factors have combined to make Malaysia the most obese country in the region.

It was also noted that differences between ethnic Malays and Chinese had been raised in previous lectures, particularly the fact that Chinese people are more open to receiving screening. 

Dr. Kawahara noted that the lecture series is not just a matter for science, but is related to issues affecting basic humanity. It is by bringing science and humanities together that we can shape effective healthcare strategies. It is hoped that in the coming lectures the students will continue to explore and discuss critical issues about bridging the gap between science and the humanities to create a more effective healthcare system and harmony between Malaysia and Japan.