Telemedicine to Enhance Medical Access in Remote Areas
Telemedicine to Enhance Medical Access in Remote Areas
Business Model Description
Through B2B and B2C models, companies can develop telemedicine system and digital platform and offer it to healthcare providers to enable online medical consultation and diagnosis of illnesses to patients in remote areas. The companies can generate revenue from selling the platform to hospitals or offer as services to hospitals, individual doctors, and patients.
This IOA help reduce inequality in terms of access to healthcare as doctors concentrated in big cities can treat patients located in remote areas, reduce patients travel time and cost, and reduce wait time and concentration of patients waiting in hospitals. Investors can invest in companies that develop the system and digital platforms. Examples of companies active in this space are:
Doctor Raksa is a telemedicine platform provider, founded in 2016, that offers online consultations and online medicine prescriptions and delivery. Users can schedule a session with doctors from leading hospitals. Doctor Anywhere acquired Doctor Raksa in 2021, expected five times growing number of 1.5 million existing users and expanding services to 38 provinces in Thailand (1).
Ooca is a telemedicine platform provider, originated in 2017 that focuses on mental health. Users can schedule sessions with psychiatrists and counseling psychologists. Ooca expanded the service from private users to organizations, government agencies, and institutions that was scalable 2-3 times in 2019 (10).
Aor Sor Mor Online is an application developed by AIS, a telecommunication service provider in Thailand over 30 years, as a CSR program to help Village Health Volunteers across the country exchange information regarding epidemic control and to track the status of chronic patients living in remote areas. The application was launched during the end of 2015 to support public health system, and communications networks during the COVID-19 pandemic (17).
Expected Impact
Telemedicine allows for patients in rural ares to gain access to healthcare through the internet without having to travel to the hospital.
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- Thailand: Countrywide
- Thailand: Countrywide
Sector Classification
Health Care
Development need
Challenges for SDG3 remain in terms of increased premature loss of life due to non-communicable diseases (NCDs). Approximately 354,000 deaths annually (or 71% of all deaths) are caused by NCDs, which equates to a USD 9.33 billion (THB 280 billion) economic loss. This situation will exacerbate as Thailand becomes a "super-aging society" by 2033 (1).
Policy priority
The 20 year National Strategy (2018-2037) sets out for Thailand to become a center for the medical industry and services in response to increasing demand for medical services due to an aging society globally and to promote medical tourism (2).
Gender inequalities and marginalization issues
There are inequalities between genders and between urban-rural with rural women’s morbidity rate higher than that of urban women by 2,000 per 100,000 people. Also, men use more health resources than women, with male in-patients stay on average 1 day more than women in-patients (3).
Investment opportunities introduction
Thailand ranks the world’s 5th biggest medical tourism market with over 3.5 million medical tourists per year besides the increasing domestic demand from the aging society (4). Thailand had a health expenditure of USD 17.6 billion (THB 528.8 billion) for public hospitals, and USD 4.96 billion (THB 148.9 billion) for private hospitals in 2019 (5).
Key bottlenecks introduction
Key challenges in the health sector include increasing demand for healthcare services, especially in public hospitals, leading to overcapacity. From 2013 to 2017, out-patients increased from 155 million to 300 million, and in-patients increased from 120 million days/year to 290 million days/year (6).
Health Care Providers
Development need
A large discrepancy in access to healthcare between big cities and rural areas remains an issue. In 2020, the population per doctor ratio was 1,794 for Thailand and 548 for Bangkok. The population per bed ratio is 393 for Thailand and 183 for Bangkok. There were 4,005 ICU beds in public hospitals under the Ministry of Public Health and 2,423 ICU beds in private hospitals (7).
Policy priority
Developing a modern public health service system is key to the 20 Years National Strategy (2018-2037). Integration of advanced technology and innovation to enable remote healthcare service systems to address doctor shortages in remote areas, lower medical service costs, enhance Thai people's quality of life and generate income through medical tourism (2).
Gender inequalities and marginalization issues
High concentration of healthcare services and resources in major cities cause inequalities between major cities, smaller towns, and remote areas. For example, in 2017, Bangkok the capital city had an average household income of USD 1524 per month (THB 45,707 per month) and had doctors to population ratio of 1: 630.
While in the Northeastern Region, Bueng Kan province had an average household income of USD 756 per month (THB 22,668 per month) and had doctors to population ratio of 1: 5,021 (6), (8).
Investment opportunities introduction
Thailand's shift to an aged society and consumers’ trend toward preventive health care are strong contributing factors that will make the health technology market perform relatively well in the forthcoming period.
Currently, the investment in healthcare technology in Thailand in 2021 is modest at USD 10 - 13.3 million (THB 300 - 400 million) but is expected to be on the rise (9). The sales from private hospitals were as high as USD 4.95 billion (THB 148.4 billion) with a profit of USD 486.7 million (THB 14.6 billion) in 2020 (5).
Key bottlenecks introduction
Healthcare technology requires access to the internet, but only 56.8% of the population above 6 years old have access to the internet (10).
Health Care Delivery
Pipeline Opportunity
Telemedicine to Enhance Medical Access in Remote Areas
Through B2B and B2C models, companies can develop telemedicine system and digital platform and offer it to healthcare providers to enable online medical consultation and diagnosis of illnesses to patients in remote areas. The companies can generate revenue from selling the platform to hospitals or offer as services to hospitals, individual doctors, and patients.
This IOA help reduce inequality in terms of access to healthcare as doctors concentrated in big cities can treat patients located in remote areas, reduce patients travel time and cost, and reduce wait time and concentration of patients waiting in hospitals. Investors can invest in companies that develop the system and digital platforms. Examples of companies active in this space are:
Doctor Raksa is a telemedicine platform provider, founded in 2016, that offers online consultations and online medicine prescriptions and delivery. Users can schedule a session with doctors from leading hospitals. Doctor Anywhere acquired Doctor Raksa in 2021, expected five times growing number of 1.5 million existing users and expanding services to 38 provinces in Thailand (1).
Ooca is a telemedicine platform provider, originated in 2017 that focuses on mental health. Users can schedule sessions with psychiatrists and counseling psychologists. Ooca expanded the service from private users to organizations, government agencies, and institutions that was scalable 2-3 times in 2019 (10).
Aor Sor Mor Online is an application developed by AIS, a telecommunication service provider in Thailand over 30 years, as a CSR program to help Village Health Volunteers across the country exchange information regarding epidemic control and to track the status of chronic patients living in remote areas. The application was launched during the end of 2015 to support public health system, and communications networks during the COVID-19 pandemic (17).
Business Case
Market Size and Environment
USD 100 million - USD 1 billion
10 - 20%
According to 6Wresearch, the Thailand Telehealth Market is projected to grow at a compound annual growth rate (CAGR) of 10.1% during 2021-27 (2).
The South East Asia telehealth market size was valued at USD 194.5 million in 2020 and is expected to expand at a CAGR of 17.6% from 2021 to 2028 (3).
Indicative Return
15% - 20%
According to expert interviews, the ROI is 15-20% due to high labor costs from hiring doctors and medical staff.
Investment Timeframe
Medium Term (5–10 years)
According to expert interviews, familiarity with the technology among patients especially those in rural areas can take time, but increasing access and affordability to the internet and smart phones can help expand the market size and reduce the investment timeframe.
Ticket Size
USD 500,000 - USD 1 million
Market Risks & Scale Obstacles
Business - Supply Chain Constraints
Impact Case
Sustainable Development Need
There is significant disparity in the geographic distribution of human resources in the healthcare sector between the urban and rural areas, predominantly Bangkok and the rural areas. There were 1,794 people per doctor ratio for Thailand and 548 people per doctor for Bangkok in 2020 (4).
There is an increase in demand for healthcare services due to an aging population and increased prevalence of non-communicable diseases (11). In addition, this implies an increased medical costs for households.
There is still a shortage of doctors and other medical staff in Thailand. The World Health Organization recommends 2.8 doctors per 1,000 people. But in Thailand, it is only 0.4 per 1,000 people, significantly lower than in Singapore (1.92) and Malaysia (1.2) (18).
Gender & Marginalisation
Limited access to formal and high quality healthcare services for the poor and those living in rural/remote areas. In-patients in Bangkok stay an average of 9 days, which is 3-4 days longer than those of other regions, as Bangkok is the center for treating complex and severe health problems (5).
More women reported experiencing illness than men with 4,000-5,000 per 100,000 persons, but the in-patient stay for men at a hospital was on average a day longer than for females (5).
More men were treated for traffic accidents and injuries, which are high-risk behaviors, while more women were treated for pregnancy and other related health matters (5).
Expected Development Outcome
Increase accessibility and afforability of healthcare services, reduce the disparity of healthcare human resource distribution and lower the cost of healthcare services.
Telemedicine can be used for screening and preliminary diagnosis. This will help reduce the pressure on healthcare facilities and personnel as it will reduce the number of people coming and waiting at hospitals. Moreover, it can reduce exposure to COVID-19 for patients and healthcare workers.
Telemedicine can enhance the ability for doctors to provide healthcare services to a larger number of patients. Doctors can reach high-risk or difficult to reach patients and monitor remote patients to increase efficiency, and therefore the capacity to provide services (19).
Gender & Marginalisation
Reduce rural-urban disparities in healthcare access as low income individuals and those living in rural areas will face lower costs and shorter times to receive healthcare from telemedicine.
Improve women's access to healthcare services, particularly those residing in rural areas.
Primary SDGs addressed
3.c.1 Health worker density and distribution
There was a 1,794 people per doctor ratio for Thailand but a 548 people per doctor ratio for Bangkok, and a 393 people per bed ratio for Thailand but a 183 people per bed ratio for Bangkok in 2020 (4).
Reduce disparity and inequality of access to healthcare by achieving 0.7 in all provinces for Human Achievement Index in health dimension by 2037 (compared to 0.57 in 2016) (7).
3.8.2 Proportion of population with large household expenditures on health as a share of total household expenditure or income
Health care spending exceeding 10% of household consumption rate dropped from 6.0% in 1996 to 2% in 2015. Additional numbers of non-poor households falling below the national poverty line incidence decreased from 2.2% in 1996 to 0.3% in 2015 (12).
Data not available
3.8.1 Coverage of essential health services
There is still a shortage of doctors and other medical staff in Thailand. The World Health Organization recommends 2.8 doctors per 1,000 people. But in Thailand, it is only 0.4 per 1,000 people, which is significantly lower than in Singapore (1.92) and Malaysia (1.2) (18).
Improve quality of medical services and accesibility for all people. The goal is for Thailand to be ranked within the top 15 countries globally in terms of efficiency of the public health system by 2037 (in 2018 Thailand was ranked 27) (7).
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Planet
Corporates
Public sector
Indirectly impacted stakeholders
People
Gender inequality and/or marginalization
Planet
Corporates
Public sector
Outcome Risks
Telemedicine can pose data privacy risks to patients, where patients' medical history can be leaked or illegally stolen if data protection and cybersecurity are not well strengthened.
Gender inequality and/or marginalization risk: It was reported that telemedicine adoption was lower for female reproductive and sexual health services (12). Increasing awareness for female patients are necessary to increase female adoption of telemedicine.
Impact Risks
Alignment risk: Telemedicine increases medical access by reducing travel and wait-times, but it does not set a price limit for consultations, which may ultimately exclude low income individuals.
External risk: Telemedicine is limited by having access to the internet and smart phones. As of 2020, only 56.8% of the population have access to the internet and smart phones (13).
Stakeholder participation risk: Some patients are not familiar with telemedicine and still perfer face-to-face healthcare services.
Drop-off risk: If different doctors are assigned to the patients for each telemedicine consultation, the treatment may lack continuity.
Gender inequality and/or marginalization risk: Low income individuals can have less access to smart phones and internet.
The IOA does not address gender inequalities among doctors as only around 40% of doctors are females (21).
Impact Classification
What
Telemedicine can increase access to healthcare services for people living in rural areas through an online platform.
Risk
Telemedicine does not set a price limit for the service, and requires access to internet and smart phones, which can still exclude low income individuals.
Contribution
Additional contribution is likely better than base case as there is existing momentum from private hospital to offer telemedicine services.
Impact Thesis
Telemedicine allows for patients in rural ares to gain access to healthcare through the internet without having to travel to the hospital.
Enabling Environment
Policy Environment
Thailand's 4.0 Policy aims to promote a digital economy, medical hubs, and affluent medical tourism (8). This policy supports the IOA by promoting innovation within the healthcare sector.
Digital Economy Promotion Agency (DEPA) Master Plan (2018-2022) aims to promote digital transformation in businesses, growth for tech-companies and start-ups, and also aims to promote smart cities, big data utilization for businesses, and cybersecurity (14).
This policy supports the IOA by supporting innovation and helping build ecosystems that will enable growth and survivability of start-ups that include telemedicine.
Universal Healthcare Coverage Scheme provides free healthcare, such as general treatment and rehabilitation, high cost treatments, and emergency care. The scheme is funded by taxes and covers people in the informal sector that are not protected by social security and civil servant benefits (20).
This policy is relevant to the IOA as telemedicine can be used by public hospitals to improve efficiency and coverage of healthcare.
Financial Environment
Financial incentives: Digital Economy Promotion Agency's (DEPA) Digital Transformation Fund provides up to USD 100,000 (3 million baht) for digital transformation projects including AI, intelligent applications, internet of things, digital platform, etc (https://www.depa.or.th/th/smart-city-plan).
Fiscal incentives: Board of Investment Promotion offers offers 5 - 8 years or more of corporate income tax exemption, import duty exemption on machinery and raw materials, and other non-tax incentives for hospitals, specialized medical centers, and medical technology digital services (16).
Regulatory Environment
National Health Act (2007) establishes the primary healthcare law and establishes the right to live in a healthy environment, the right to receive sufficient health information to make an informed decision to accept or refuse any health service, etc. (9). This regulation is relevant to the IOA as telemedicine still has to follows the legal requirements just like regular hospitals.
Medical Council of Thailand Notification on Guidelines in respect to Telemedicine and Online Clinics No. 54 (2020) establishes guidelines for practicing telemedicine; must be operated from existing facilities, doctors must follow laws, and take cybersecurity and data privacy into account (15).
This regulation is relevant to the IOA as telemicine still has to follow legal requirements and standards as regular hospitals.
Ministry of Public Health Notification regarding Standards of Service in respect of Medical Facilities via Telemedicine System (2021) requires it must not affect existing healthcare facilities, inform patients, keep all records, ensure that doctors comply with laws, and maintain equipment (15).
This regulation supports the IOA as it help ensure that telemedicine will not affect other healthcare services and ensure that telemedicine is still being provided at high standard.
Medical Facilities Act (1998) regulates business operations and management of medical facilities, competent practioners, and penalties (6). This regulation is relevant to the IOA as telemedicine still have to be provided by doctors from medical facilities that have good quality.
Personal Data Protection Act (2019) (PDPA) establishes a legal framework for enabling personal data protection for businesses, including appointing a Data Protection Officer; limitations for collection, use, and disclosure of personal data; access to data; security; and penalties for offences (15).
This regulation is relevant to the IOA as telemedicine exposes patients to cybersecurity threats that must be accounted for and minimized.
Marketplace Participants
Private Sector
Telemedicine platform providers (i.e. Doctor Raksa, Ooca, Doctor Anywhere), private hospitals, insurance companies (i.e. AIA), internet providers, doctors practicing in private hospitals, pharmacy, corporate venture capitalists, (i.e. InnoSpace, InVent by Intouch Holding, True Incube) The Board of Investment of Thailand (BOI)
Government
Ministry of Public Health, Medical Council of Thailand, public hospitals not under the Ministry of Public Health i.e. university hospital, doctors practicing in public hospitals, National Health Security Office, Digital Economy Promotion Agency, The Board of Investment of Thailand (BOI).
Multilaterals
Asian Development Bank (ADB), International Finance Corporation (IFC)
Non-Profit
-
Public-Private Partnership
Siriraj Connect, NIA Deep Tech Incubation Program
Target Locations
Thailand: Countrywide
Thailand: Countrywide
References
- (1) https://www.who.int/docs/default-source/thailand/ncds/ccs-ncd-proposal-thai.pdf
- (2) http://nscr.nesdb.go.th/wp-content/uploads/2019/10/National-Strategy-Eng-Final-25-OCT-2019.pdf
- (3) https://tdri.or.th/en/2019/03/addressing-the-male-biased-gender-health-gap
- (4) https://www.boi.go.th/upload/content/Medical_Webinar_Europe_SG_June20.pdf
- (5) https://www.krungsri.com/getmedia/982c8330-d9ff-4941-b2a2-4f0c261f5aaf/II_Hospitals_EN.pdf.aspx
- (6) https://infocenter.nationalhealth.or.th/node/27630
- (7) https://bps.moph.go.th/new_bps/sites/default/files/Report%20Health%20Resource%202020.pdf
- (8) https://view.officeapps.live.com/op/view.aspx?src=http%3A%2F%2Fstatbbi.nso.go.th%2Fstaticreport%2FPage%2Fsector%2FTH%2Freport%2Fsector_08_4_TH_.xlsx&wdOrigin=BROWSELINK
- (9) https://www.kasikornresearch.com/en/analysis/k-econ/business/Pages/Health-Tech-z3243.aspx
- (10) https://sustainabledevelopment.un.org/content/documents/279482021_VNR_Report_Thailand.pdf
- (1) https://www.marketingoops.com/news/biz-news/doctor-anywhere/
- (2) https://www.6wresearch.com/industry-report/thailand-telehealth-market-2021-2027
- (3) https://www.grandviewresearch.com/industry-analysis/south-east-asia-telehealth-market
- (4) https://bps.moph.go.th/new_bps/sites/default/files/Report%20Health%20Resource%202020.pdf
- (5) https://tdri.or.th/en/2019/03/addressing-the-male-biased-gender-health-gap/
- (6) http://web.krisdika.go.th/data/document/ext809/809996_0001.pdf
- (7) http://nscr.nesdb.go.th/wp-content/uploads/2019/12/%E0%B8%AA%E0%B8%A3%E0%B8%B8%E0%B8%9B%E0%B9%80%E0%B8%9B%E0%B9%89%E0%B8%B2%E0%B8%AB%E0%B8%A1%E0%B8%B2%E0%B8%A2-Update-04-12-2562.pdf
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- (9) http://thailawforum.com/laws/National%20Health%20Act_2007.pdf
- (10) https://www.bangkokbiznews.com/tech/814742
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- (12) https://link.springer.com/content/pdf/10.1186/s12939-020-01273-6.pdf
- (13) https://sustainabledevelopment.un.org/content/documents/279482021_VNR_Report_Thailand.pdf
- (14) https://www.depa.or.th/storage/app/media/file/depa-Promotion-Plan-Book61-65.pdf
- (15) https://www.kap.co.th/thought-leadership/telemedicine-the-future-of-digital-healthcare/
- (16) https://www.boi.go.th/upload/content/BOI-A%20Guide_EN.pdf
- (17) https://www.bangkokpost.com/business/2244971/digital-leader-with-an-eco-heart
- (18) https://www.krungsri.com/en/research/industry/industry-outlook/Services/Private-Hospitals/IO/io-Private-Hospitals
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- (20) https://www.social-protection.org/gimi/gess/RessourcePDF.action?ressource.ressourceId=54059#:~:text=The%20UCS%20was%20launched%20in,regardless%20of%20their%20socioeconomic%20status%E2%80%9D
- (21) https://apps.who.int/iris/bitstream/handle/10665/344697/GER-Thailand-eng.pdf?sequence=1&isAllowed=y