Graduate Studies Blog
Dr Koh Hau Tek
Nanyang Business School (NBS) sat down with Dr Koh Hau Tek, Nanyang EMBA alumnus, to get his expert opinion on China’s ageing population – the implications it will have on the local and international healthcare sector. Dr Koh is a medical doctor and the current Healthcare Business Executive of Raffles Medical, China.
NBS: In your opinion, how is China’s healthcare system coping with the problem of its rapidly ageing population?
Dr Koh: The elderly population in China is growing exponentially. If Singapore is going to be hit by a tsunami, China could well be engulfed multiple times over. At this point, eldercare facilities and infrastructure have not caught up with the ageing demographic shift. Step-down care facilities and community hospitals are still developing in many cities.
China is also trying to catch up on eldercare skillsets, especially because eldercare requires a multi-disciplinary team – geriatricians, physicians, nursing staff, pharmacists etc. And most doctors do not have enough time with each elderly patient who has multiple medical conditions increasing the complexity of the cases.
A regular complex case consult can be around half an hour. But in many places in the national system, these can be as short as 2 minutes. When a consult is 2 minutes long, the quality can be compromised significantly.
NBS: Is the Chinese government doing anything about it?
Dr Koh: Yes they are. The government is trying to start a trend of moving away from public hospitals to community care. They also introduced medical reform in April last month because they wanted to shift the focus from drugs dispensing to the professional fee model in consultations. That means that whatever the patient pays for goes towards the consultation fee. Drugs and investigative procedures are charged to patients at cost.
The Beijing government is also planning to set up an online platform that allows people to choose their family doctors. This will help to shift the care focus to primary care, preventive care and even step-down care.
In fact, most eldercare can be managed by the community hospitals, nursing homes and at home. There is less need to go to the government hospitals unless there are acute conditions.
NBS: What impact do you think the international private healthcare sector can have in China? What role do you see them playing?
Dr Koh: The international healthcare system can contribute by managing chronic diseases well. They can help to prevent or at least, delay complications arising from chronic diseases. When diseases are confined to the primary care sector, preventive measures are much more viable.
For Raffles Medical China, we aim to treat patients the same way we do in Singapore – no over-prescription, no over-treatment, providing world-class healthcare at affordable prices.
Local Chinese hospitals are usually very big with many beds (some up to 10,000 beds) and specialties. In contrast, Raffles medical and our hospitals which are being built now are smaller with up to 700 beds as we do not need to keep patients in hospital for as long. The idea is to discharge patients as quickly as possible – the faster the better – and to follow up with good continuity of care from hospital to home. Long stays in hospitals have been shown to have increased complications and not in patients’ best interest. An example is that infections occur more often within hospitals, therefore quicker discharge significantly lower the chance for complications.
A higher discharge rate also means that patients can return to nearer their homes and access care from there. That means cutting down on travelling and cost. Ultimately, we want our patients to trust that we have their best interests at heart. Only then will they be willing to pay a little more for that premium. It’s a win-win!
NBS: What are some challenges you foresee the international private healthcare system facing?
Dr Koh: The first major challenge is changing the mindsets of people. Whilst many people like those in Beijing and Shanghai are generally more well-travelled and have been exposed to global healthcare providers, the large majority still prefer public hospitals. Some would queue overnight just to receive treatment!
And there is always the phobia of a big bill. Some patients are afraid of bankrupt. On the other hand, the government takes very good care of its people. There are heavy subsidies in place and patients need only to pay a minimal sum. Besides long waiting times, there are no strong incentives to direct to appropriate and cost effective level of care out from government hospitals.
A challenge for international private healthcare system is employment of suitable manpower, specifically skilled manpower – the doctors, nurses and allied health professionals. And even after recruiting these personnel, the next challenge comes in managing the quality of care. Because doctors from all over the world are trained differently, it’s difficult to find a standard level of quality.
NBS: In what way has the Nanyang EMBA shaped your career?
Dr Koh: The EMBA helped me view management roles in a more structured way. Before that, a lot of what I did and knew came from on-the-job experience and learning from my supervisors and superiors. The EMBA programme provided me with a much deeper and broader insight into, for example, finance, accounting, the strategic management of HR.
The segment at Berkeley was very helpful as it delved into areas of innovation which were very useful. It helped me to think outside the box – and even get rid of the box! It brought us deeper into Silicon Valley, and we learnt why it works so well and why people are attracted to it.
The finance segment in Wharton helped us to more deeply understand the numbers behind the business & company. It has guided me in how financial hypotheses and applications can be used to measure KPIs from a management perspective. These knowledge and its applications are very useful for my work.
NBS: In what ways has the programme inspired you?
Dr Koh: The LiNC project allowed my team and I to focus on Helicopter Emergency Medical Services (HEMS). We travelled to Penang and Langkawi to conduct our qualitative analysis and we managed to interview many people. From there, we came up with a report, a business model, and financial projections for viability. That was a very good learning experience for me. We were assuming the role of entrepreneurs, getting to the ground with our business model and seeing if it would work.
If there was a chance for us to execute the LiNC project, I would love to! There is a demand for HEMS in certain countries and I do think it is crucial in saving lives in remote and less accessible geographies.
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