Hospitals in YangonTwo hospitals, Witoriya and Pin Lone also serve as partner hospitals to which...

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August 6, 2017

Hospitals in Yangon Industry Survey

Author

Thidar Soe

Tel: (95) 9 42 112 6155

Tel: (95) 9 79 589 0758

First Rangoon Corporation

148 A1 Street

Yangon, RGN 11061

Myanmar

As Myanmar undergoes political and economic openings,

healthcare industry is witnessing profound changes. Our

analysis suggests that there are significant demand and

spending power in Myanmar for quality healthcare and

medical products.

In recent years, public outcry has led to increases in government

health budget, and economic liberalization has led to Burmese

individuals and businesses looking abroad for better products

and services.

This is the second of three reports that First Rangoon has

compiled to analyse the healthcare sector in Myanmar. The first

report provided a general overview of history and current

condition of Myanmar's healthcare sector. This second report

will be an industry analysis on hospitals in Yangon, followed by

a third report on pharmaceutical and medical equipment market

in Myanmar. These segments are identified as areas where

there are large needs and ample opportunities.

There are not enough quality providers of healthcare in

Myanmar. By 2030, Myanmar will need to build around 140

hospitals and spend up to $3 billion on building new hospitals

and acquiring quality medical facilities and instruments.

Emerging middle class is accustomed to paying for

healthcare services out-of-pocket. By 2030, annual private

healthcare spending is expected to reach $7.8 billion – growth

of 17.5% annually.

Public and private sector demand for pharmaceutical

products is increasing. The government has increased

procurements, and customers are moving upmarket; annual

imports of medicines will reach $1.3 billion by 2020.

There is a shortage of qualified specialist doctors

presently. Number of doctors, nurses, and dentists per capita

is low, and waiting periods to see specialists are long. In-country

and overseas further education is much in demand.

Hospitals in Yangon

March 25, 2019 2

Contents

Hospitals in Myanmar Survey .......................................................................................................... 3

Medical Departments ................................................................................................................. 11

Medical Staff ............................................................................................................................... 14

Revenues and Costs .................................................................................................................. 20

Medical Travel ............................................................................................................................ 27

Data Envelopment Analysis ........................................................................................................... 28

Medical Agencies in Myanmar Survey........................................................................................... 30

Cost of Medicare Abroad............................................................................................................ 34

Medical Agency Staffing ............................................................................................................. 36

Prescription Filling ...................................................................................................................... 37

Appendix I: Hospital Room Amenities ........................................................................................... 37

Hospitals in Yangon

March 25, 2019 3

Hospitals in Myanmar

Major hospitals in cities such as Yangon and Mandalay already have a large pool of middle-class

consumers. Yet, as the consumer class grows, they will look for more sophisticated healthcare

services. The recent relaxation of laws governing foreign investment in healthcare, coupled with

current lack of high-quality government healthcare facilities, may provide opportunities for foreign

healthcare providers.

Multinational companies and regional companies across ASEAN, have invested in Myanmar’s

healthcare sector, especially in provision of medical equipment, and hospital operation. First

Myanmar Investments Co Ltd (FMI) and Indonesian conglomerate Lippo Group has a healthcare

joint venture which planned a $420 million national roll of 20 hospitals within the decade. In the

initial phrase, Pun Hlaing Siloam Hospital in Yangon underwent a $10-million upgrade of

equipment, systems and services. Thonburi Hospital Group (THG), Thailand’s third-largest private

hospital group, is working with Ga Mone Pwint company (GMP Group) to build two hospitals in

Yangon, worth $100 million. Malaysian firm IHH Healthcare is building a US$70 million 250-bed

hospital in Yangon through a Singaporean subsidiary; the new Parkway Yangon Hospital is

expected to open in 2020.

In July 2017, a questionnaire containing twenty-seven questions was surveyed at fourteen

hospitals, all of them located in the Yangon region. The full questionnaire is included in Appendix

II.

The surveyed hospitals, in alphabetical order, are:

Name Township Location

Academy Ahlone

Asia Royal Sanchaung

Aung Yadanar Thingankyun

Bahosi Lanmadaw

Grand Hantha International Kamaryut

Maha Myine Sanchaung

Pin Lon North Dagon

Pun Hlaing Hlaing Tharyar

Sakura Sanchaung

Shin Par Ku Tamwe

Shwe La Min Lanmadaw

SSC Bahan

Thuka Gaba Kamaryut

Witoriya Mayangone

Before the questionnaire is conducted, the surveyor is required to ascertain the cleanliness of the

hospital visually. This is done so in order for First Rangoon to establish a proxy for patient

satisfaction and an additional proxy input for data envelopment analysis. It should be noted that

cleanliness variable can also be used as a baseline to categorize whether a hospital is “Tier-1”,

“Tier-2”, or “Tier-3”, but we haven’t done so in the following pages, as the sample size is small.

Surveyor is asked to rank the hospitals on a scale of one to ten, with one being bad, and ten being

excellent.

Apart from one hospital, Aung Yadanar in Thingankyun township, the rest scored above 7 on visual

cleanliness inspection. Only one, Pun Hlaing hospital, scored the perfect score of ten.

Hospitals in Yangon

March 25, 2019 4

List of Figures

Figure 1: How many Beds do you have in the Hospital? ........................................................................ 5

Figure 2: What is the average daily occupancy? .................................................................................... 6

Figure 3: What percentage of beds is used by surgery patients?........................................................... 7

Figure 4: What types of rooms do you have in your hospital? ................................................................ 8

Figure 5: How many out-patients do you received daily? ....................................................................... 9

Figure 6: How many X-rays do you perform daily? ............................................................................... 10

Figure 7: Percentage of Hospitals with the Following Departments ..................................................... 11

Figure 8: Do you offer the following services? ...................................................................................... 12

Figure 9: How many operation theatres do you have? ......................................................................... 13

Figure 10: How many administrative staff do you have?? .................................................................... 14

Figure 11: How many doctors (non-specialists) do you have?? ........................................................... 15

Figure 12: How many nurses do you have?? ....................................................................................... 16

Figure 13: Number of Staff Per Bed ...................................................................................................... 17

Figure 14: Average Number of Specialists by Department ................................................................... 18

Figure 15: Average Number of Technicians by Service ....................................................................... 19

Figure 16: How many duty shifts do you have per day? ....................................................................... 20

Figure 17: Hospital Manpower by Shift ................................................................................................. 20

Figure 18: What is the price of walk–in consultation with General Practitioner (Non-Specialist)? ....... 21

Figure 19: What are the prices of rooms and overnight stays at the hospital? ..................................... 22

Figure 20: Specialists’ Commission ...................................................................................................... 23

Figure 21: Specialists’ Salaries ............................................................................................................. 24

Figure 22: Doctors’ Salaries .................................................................................................................. 25

Figure 23: Nurses’ Salaries ................................................................................................................... 26

Figure 24: Nurses’ Shift Salaries .......................................................................................................... 26

Figure 25: Which countries do your patients typically go? .................................................................... 27

Figure 26: Efficiency Levels Based on DEA ......................................................................................... 29

Figure 27: How many patients do you have in the Hospital? ................................................................ 31

Figure 28: What are the diseases/procedures for which patients go abroad? ..................................... 32

Figure 29: Hospital Room Rates Per Night ........................................................................................... 34

Figure 30: Cost of Medical Treatment Abroad ...................................................................................... 35

Figure 31: Days Needed to Fill Foreign Prescriptions .......................................................................... 37

Hospitals in Yangon

March 25, 2019 5

Average number of beds varies from 70 to 200, with mean of 140 (and median of 150). Grand

Hantha International Hospital noted that it will be expanding from 200-bed to a 700-bed hospital,

which will make it the largest hospital in Yangon.

Figure 1: How many Beds do you have in the Hospital?

Source: Survey Data

0 20 40 60 80 100 120 140 160 180 200

Thuka Gaba

Shin Par Ku

Academy

Maha Myine

Witoriya

Pun Hlaging Hospital

Aung Yadanar

Sakura

Shwe La Min

Bahosi

SSC

Asia Royal

Grand Hantha International

Pin Lon

Hospitals in Yangon

March 25, 2019 6

Average daily occupancy varies from 60% to 100%, with mean of 82.5% (and median of 80%).

From these two questions, we can note that of 1,964 beds surveyed, 1,604 beds are occupied.

Figure 2: What is the average daily occupancy?

Source: Survey Data

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Maha Myine


Pin Lon

Sakura

Academy

Shwe La Min

SSC

Witoriya

Asia Royal

Bahosi

Thuka Gaba

Shin Par Ku

Aung Yadanar

Pun Hlaing Hospital

Hospitals in Yangon

March 25, 2019 7

Of 1,604 occupied beds, 1,041 beds are taken up by patients awaiting/recovering from surgeries.

This suggests that around 65% (mean of 64%, median of 70%) of beds are used for surgery.

Standard deviation is 27.6%.

Therefore, if there is a need for imposing a protection level to reserve capacity for surgeries, the

hospitals should use mean of 64% and standard deviation of 27.6% along with critical fractile score

of net contributing margin per procedure.

Figure 3: What percentage of beds is used by surgery patients?

Source: Survey Data

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Hospitals in Yangon

March 25, 2019 8

Of these beds, some hospitals reserve some in private rooms and double rooms. (Hospitals

where there are double rooms are designated with an asterisk below).

The percentage of private rooms vary from a fraction in some hospitals to totality in others. For

instance, at SSC and Witoriya, all rooms are private single rooms.

Figure 4: What types of rooms do you have in your hospital?

Source: Survey Data

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Witoriya

SSC

Shin Par Ku*

Sakura

Pun Hlaing Hospital*

Pin Lon

Maha Myine


Aung Yadanar

Asia Royal*

Academy

Private Deluxe Private Special Private Single/Double* Beds in Hall

Hospitals in Yangon

March 25, 2019 9

Average number of patients daily ranges from around 100 at Pun Hlaing hospital to up to 2,000

at four hospitals.

Median figure is 1,000, and mean is 983, with standard deviation of 497 patients.

In addition of these patients who are local, the hospitals also receive a very small number of foreign

patients. At Asia Royal Hospital, they receive up to five foreign patients per day, due to their

affiliation with SOS International, but at other hospitals it varies from 1-3 foreign patients per day

to as few as one per week.

Figure 5: How many out-patients do you received daily?

Source: Survey Data

-

500

1,000

1,500

2,000

2,500

Nu

mb

er o

f P

atie

nts

Dai

ly

Low High Average

Hospitals in Yangon

March 25, 2019 10

We also surveyed how many X-rays each of these hospitals perform daily. This is a measure which

can be used as a proxy for laboratory and testing services usage, as in Myanmar, general

practitioners and private clinics refer patients to larger hospitals for these services.

As noted below, hospital’s radiology departments are not strongly utilized in Myanmar, with even

bigger hospitals only performing 2-3 X-rays per day, compared to over 1,000 patients they see

each day.

Figure 6: How many X-rays do you perform daily?

Source: Survey Data

0 1 2 3 4 5

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Hospitals in Yangon

March 25, 2019 11

Medical Departments

In hospitals in Yangon, the most common medical departments are Accident & Emergency

(A&E)/Casualty, Anesthetises, Ear Nose and Throat, Surgery, Gynaecology (OG), Nephrology,

Neurology, Paediatrics, Radiology/Radiotherapy and Urology. All the surveyed hospitals have

them.

The least common department is plastic surgery department. Only Pun Hlaing hospital and Grand

Hanthar have a dedicated department to plastic surgery.

Figure 7: Percentage of Hospitals with the Following Departments

Source: Survey Data

All hospitals have diagnostic imaging services in location, and in other locations affiliated with the

hospital. Two hospitals, Witoriya and Pin Lone also serve as partner hospitals to which other two

hospitals, Sakura and SSC respectively, refer diagnostic imaging patients.

All percent of hospitals have laboratory services in location, and in other locations affiliated with

the hospital. Three clinics -- Ni Ni Lab, NHL, Parami – are used for some laboratory services.

All of the hospitals surveyed have ambulance services.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Accident & Emergency (A&E)/Casualty

Anesthetises

Cardiology

Critical Care

Dental Care

Ear Nose and Throat

Gastroenterology

Surgery

Gynaecology (OG)

Haematology

Maternity Ward

Nephrology/Kidney Department

Neurology

Oncology/Cancer

Ophthalmology/Eye care

Orthopaedics + Rheumatology

Physiotherapy

Paediatrics/Childcare

Radiology/Radiotherapy

Urology

Dermatology

Chest

Psychiatric Care

Liver

Plastic Surgery

Hospitals in Yangon

March 25, 2019 12

All of the hospitals surveyed have pharmacy attached to the hospital.

In hospitals in Yangon, the most common technical service are Ultrasound, General Radiography,

and Annual Medical Check-ups. All the surveyed hospitals offer them. The least common are

pacemaker insertion and mammograms.

Figure 8: Do you offer the following services?

Source: Survey Data

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

Annual Medical Check-up

Breast Screening/Mammogram

Electrocardiogram (ECG)

Pacemaker Insertion

Echocardiogram

General Radiography (X-ray)

Ultrasound

Angiography

CT Scan

MRI Scan

Endoscopy

Hospitals in Yangon

March 25, 2019 13

Yangon hospitals have on average 6.4 operation theatres (with standard deviation of 3.6).

Median value is 6, and Grand Hantha Hospital is an extreme outlier – with 17 operation theatres.

Figure 9: How many operation theatres do you have?

Source: Survey Data

0 2 4 6 8 10 12 14 16 18

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Hospitals in Yangon

March 25, 2019 14

Medical Staff

Number of administrative staff varies from 160 in Shin Par Ku to 1500-2000 at Pun Hlaing hospital.

Median value is 1,000, with mean of 897 and standard deviation of 496.

Figure 10: How many administrative staff do you have??

Source: Survey Data

0 200 400 600 800 1000 1200 1400 1600 1800 2000

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Hospitals in Yangon

March 25, 2019 15

Number of non-specialist doctors varies from 25 to 300.

Median value is 100; with mean of 145 and standard deviation of 98.

Number of foreign doctors is still extremely limited – only 27 doctors across all hospitals surveyed.

Pun Hlaing has 14 foreign doctors, and three other hospitals have foreign doctors (Foreign doctors

are excluded from mean-value calculations).

Figure 11: How many doctors (non-specialists) do you have??

Source: Survey Data

Median value of nurses is 150; with mean of 275 and standard deviation of 253.

Asia Royal Hospital is the extreme outlier – with 1,000 nurses. Excluding Asia Royal, mean is 219,

with standard deviation of 160.

0 50 100 150 200 250 300 350

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Local Doctor Foreign Doctors

Hospitals in Yangon

March 25, 2019 16

Figure 12: How many nurses do you have??

Source: Survey Data

0 200 400 600 800 1000 1200

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Hospitals in Yangon

March 25, 2019 17

In addition to numerical values, we should also pay attention to staffing levels on per bed basis.

Our analysis suggests that the staffing levels are as follows, on per bed basis:

Beds Admin Doctors Nurses

median 6.3 0.9 1.5

mean 6.3 1.0 1.8

st dev 3.1 0.5 1.2

Figure 13: Number of Staff Per Bed

Source: Survey Data

- 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Nurses Doctor Admin

Hospitals in Yangon

March 25, 2019 18

Specialist staffing differs dramatically from department to department. Gynaecology departments

are the best staffed – with average of 17.4 doctors per hospital (with max of 42), followed by

maternity wards and A&E.

Dermatology, haematology, and psychiatric care departments are least staffed.

Note: the figures include On-Call Doctor figures, and foreign specialists who flew in from time to

time.

See the raw data for more details, and breakdown by hospital.

Figure 14: Average Number of Specialists by Department

Source: Survey Data

In addition to specialists, there is a small group of supporting technical staff.

This staff can be as few as 11 or as many as 102. Mean-value is 58 persons, with standard

deviation of 27.5.

- 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

Chest

Haematology

Psychiatric Care

Dermatology

Neurology

Ophthalmology/Eye care

Liver

Oncology/Cancer

Ear Nose and Throat

Plastic Surgery

Physiotherapy

Urology

Gastroenterology


Radiology/Radiotherapy

Cardiology

Orthopaedics + Rheumatology

Dental Care

Paediatrics/Childcare

Anesthetises

Critical Care

Surgery

Accident & Emergency (A&E)/Casualty

Maternity Ward

Gynaecology (OG)

Min Average Max

Hospitals in Yangon

March 25, 2019 19

General Radiography and Ultrasound are the best staffed on average – with average of 8.6 and

7.9 technicians per hospital respectively (with max of 15).

Seven other services are staffed at a maximum of ten per service, with endoscopy having the least

amount of dedicated technicians – just 5.6 average across just seven hospitals which offer it.

Figure 15: Average Number of Technicians by Service

Source: Survey Data

0 5 10 15 20 25

Endoscopy

Echocardiogram

Breast Screening/Mammogram

CT Scan

Pacemaker Insertion

Angiography

MRI Scan

Annual Medical Check-up

Electrocardiogram (ECG)

Ultrasound

General Radiography (X-ray)

Min Average Max

Hospitals in Yangon

March 25, 2019 20

Typically, hospitals in Yangon have 2-3 duty shifts, with dual shifts being more common.

In dual shift hospitals, the shift times normally run from 7 am – 7 pm, and from 7 pm to 7 am.

In triple shift hospitals, the shift times are normally from 7 am – 1 pm, 1 pm – 7 pm and from 7 pm

to 7 am.

Manpower (both doctors and nurses) is almost always equally divided between shifts. Outliers are

Pun Hlaing hospital and Shwe La Min hospital, which have slight fewer doctors and nurses during

morning shifts.

Figure 16: How many duty shifts do you have per day?

Source: Survey Data

Figure 17: Hospital Manpower by Shift

Source: Survey Data

Revenues and Costs

The price of walk–in consultation with General Practitioner (Non-Specialist) has median value of

10,000. (Mean of 13,750 kyats, with standard deviation of 7322).

Price of walk-in consultation varies with time, with evening/night visits costing around 10,000 kyats

more.

71%

29%

2 shifts

3 shifts

0 10 20 30 40 50 60 70

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Nurses Doctors

Hospitals in Yangon

March 25, 2019 21

The diagram below are prices for locals. For foreigners, walk-in consultation fees vary from $30 -

$55.

Figure 18: What is the price of walk–in consultation with General Practitioner (Non-Specialist)?

Source: Survey Data

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

Hospitals in Yangon

March 25, 2019 22

The price of over-night stay in a hospital room varies from 200,000 kyats to 25,000 kyats. Overnight

stay at a hospital hall has minimum value of 7,000 kyats.

Yangon region therefore has maximum overnight cost of 200,000 kyats, minimum of 7,000 kyats,

median value at 45,000 kyats, and mean of 55,069 kyats (with standard deviation of 43,592 kyats).

For room types and amenities, please see Appendix I, or raw data.

Figure 19: What are the prices of rooms and overnight stays at the hospital?

Source: Survey Data

Hospitals in Yangon

March 25, 2019 23

Apart from Pun Hlaing hospital, all other hospitals paid specialists commission based on the

number of patients they see.

This commission ranges from 50% to 100% of the consulting fees – ten hospitals paid the

specialists the full 100%.

Figure 20: Specialists’ Commission

Source: Survey Data

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Hospitals in Yangon

March 25, 2019 24

The specialists’ salaries are based primarily on their commission payments. However, the range

can differ dramatically based on the hospital’s footfall.

Mean-value is 1.28 million kyats – with standard deviation of 0.48 million.

Figure 21: Specialists’ Salaries

Source: Survey Data

500,000

1,000,000

1,500,000

2,000,000

2,500,000

Hospitals in Yangon

March 25, 2019 25

Doctors’ salaries vary from 500,000 kyats to 1 million kyats, with the salary band between

800,000-1,000,000 kyats being most common.

Mean-value is 789,286 kyats – with standard deviation of 181,441.

Figure 22: Doctors’ Salaries

Source: Survey Data

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

1,100,000

Hospitals in Yangon

March 25, 2019 26

Nurses are either paid for by the hospital or engaged by the patient.

Nurses’ salaries from hospital vary from 300,000 kyats to 1 million kyats. Mean-value is 462,857

kyats – with standard deviation of 138,844. Nurses engaged by the patient are paid from 3,000

kyats to 35,000 kyats per shift. Mean-value is 10,786 kyats – with standard deviation of 6,149. In

both scenarios, Asia Royal is an extreme outlier.

Figure 23: Nurses’ Salaries

Source: Survey Data

Figure 24: Nurses’ Shift Salaries

Source: Survey Data

200,000

400,000

600,000

800,000

1,000,000

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Hospitals in Yangon

March 25, 2019 27

Medical Travel

All hospitals indicated that they refer serious patients to Yangon General Hospital (YGH). However,

nearly all respondents indicated that patients prefer to go abroad.

Patients primarily go to Thailand (67%) and Singapore (26%), followed by Malaysia, India, and the

US.

Figure 25: Which countries do your patients typically go?

Source: Survey Data

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Yangon Total

Witoriya

Thuka Gaba

SSC

Shwe La Min

Shin Par Ku

Sakura

Pun Hlaing Hospital

Pin Lon

Maha Myine


Bahosi

Aung Yadanar

Asia Royal

Academy

Thailand Singapore Malaysia India USA

Hospitals in Yangon

March 25, 2019 28

Data Envelopment Analysis

The data envelopment analysis (DEA) method can be used to determine whether a hospital is

operating efficiently. Specifically, DEA is used by inefficient organizations to benchmark efficient

and best-practice organizations.

In a general DEA analysis, a hospital’s inputs and outputs are first be defined. Then for each input

or output, a unit of measurement must be selected. Neither of these is necessarily an easy task,

because organizations such as hospitals consume a variety of inputs and produce a variety of

outputs that can be measured in alternative ways.

To keep the model small, we assume that each hospital uses three inputs to produce three outputs.

The inputs are:

• input 1: capital (measured by hundreds of hospital beds)

• input 2: high-cost labor (measured by number of doctors per shift)

• input 3: low-cost labor (measured by number of nurses per shift)

The outputs produced by each hospital are

• output 1: out-patients (measured by average daily number of out-patients)

• output 2: in-patients (measured by average daily occupancy of beds)

• output 3: cleanliness (measured visually by surveyor)

DEA shows that in efficient hospitals, inputs and outputs can be priced in such a way that this

hospital gets out all of the value that it puts in. The pricing scheme depends on the hospital.

Each hospital tries to price inputs and outputs to put its operations in the best possible light.

If DEA finds that a hospital is inefficient, there is no pricing scheme where that hospital can

recover its entire input costs in output values. Thus, inputs are wasted or hospital will have to

increase output prices and hence become uncompetitive among its peer group. DEA simply shows

that if a hospital is inefficient, then a combination of the efficient hospitals can be found that uses

no more inputs than the inefficient hospital, yet produces at least as much of each output as

the inefficient hospital. In this sense, the hospital is inefficient.

Hospitals in Yangon

March 25, 2019 29

Figure 26: Efficiency Levels Based on DEA

Efficiency Score

1 Academy 86.4%

2 Asia Royal 86.9%

3 Aung Yadanar 100.0%

4 Bahosi 91.2%

5 Grand Hantha International

75.6%

6 Maha Myine 82.4%

7 Pin Lon 80.0%

8 Pun Hlaing Hospital 100.0%

9 Sakura 75.0%

10 Shin Par Ku 100.0%

11 Shwe La Min 81.5%

12 SSC 88.1%

13 Thuka Gaba 100.0%

14 Witoriya 86.4%

Source: Survey Data

Using above three inputs and three outputs, we find four hospitals are DEA-efficient – i.e., their

output levels are priced-justified by their input levels.

It should be noted that Aung Yadanar, which scored low on cleanliness, is DEA-efficient. This is

because it enjoys high occupancy and footfall, while maintaining low staffing levels. On the

opposite end, Pun Hlaing hospital also scored 100%, based on high occupancy and cleanliness

but has low footfall. These two examples show different efficient frontiers possible in health

services sector in Myanmar.

For inefficient hospitals, they can increase their score by reducing inputs or increasing outputs. For

instance, Pin Lon hospital, which scored 80%, can increase their outputs by 20% or decrease their

inputs by 20% to approach the efficient frontier.

Disclaimer: DEA-efficient hospitals can be found inefficient, and vice versa, if different

inputs/outputs are used to measure them.

Hospitals in Yangon

March 25, 2019 30

Medical Agencies in Myanmar Survey

Due to the lack of international quality healthcare services currently available in Myanmar, many

affluent Myanmar citizens and foreign expatriates prefer to fly to neighbouring countries, such as

Thailand, Malaysia, India and Singapore, to receive medical treatment. Thailand is the preferred

choice due to its proximity, similar culture, low costs, and the fact that it offers visa exemption to

Myanmar nationals. Many Myanmar citizens are interested in foreign healthcare treatments;

however, lack of information on foreign companies and concern over language barriers limit their

ability to access these foreign treatments. To attract this customer group, many foreign hospitals

have now established subsidiary offices in Myanmar.

Some foreign-partnered hospitals in Myanmar, mostly from Thailand, are as follows:

• Bangkok Hospital (Thailand)

• Bumrungrad Hospital (Thailand)

• Chaophya Hospital (Thailand)

• Praram 9 Hospital (Thailand)

• Samitivej Hospital (Thailand)

• Vejthani Hospital (Thailand)

• Vibhavedi Hospital (Thailand)

• Yanhee Hospital (Thailand)

• Parkway Hospital (Singapore)

• Raffles Hospital (Singapore)

• Singapore General Hospital (Singapore)

• Tan Tock Seng Hospital (Singapore)

• Amri Hospital (India)

• Apollo Hospital (India)

• Mahkola Hospital (Malaysia)

In July 2017, a questionnaire containing twenty-seven questions was surveyed at five medical

tourism agencies, all of them located in the Yangon region. The full questionnaire is included in

Appendix III.

The surveyed agencies are:

Name Township Location

Sea Lion Group Botataung

Nakornthon healthcare San Chaung

Bangpakok Kamayut

Pacific Medical Center Bahan

Enquiry Ulink Myanmar Botataung

As the survey sample size, as indicated by the client is small, we have tried to have a diverse

group of respondents.

Sea Lion Group is a large medical agency – with 11 branches throughout Myanmar. The other four

are single outlet small medical agencies. Altogether, they are partnered with 12 hospitals in three

countries. Broadly speaking, three of them send patients mainly to Thailand, and the other two

send patients to Singapore and India respectively. This mix is chosen in accordance with the

answers from a previous questionnaire in Chapter 2. (It should be noted that all the surveyed

agencies sent out their patients to Thailand for surgery).

Hospitals in Yangon

March 25, 2019 31

Of the firms surveyed, one firm – Bangpakok – operates on a clinic model, where locals can also

see specialists and doctors in Yangon.

As the sample size is small and respondents are varied, it is instructive for the client to refer directly

to the raw data in certain cases.

Sea Lion agency receives around 500 patients per month – 45 patients per branch.

Smaller agencies receive around on average 7.75 patients per month, and they manage to send

out 5.5 patients per month abroad.

72% of all these patients sent out are in-patients, and others are out-patients.

No foreigner usage is detected in the surveyed sample.

Figure 27: How many patients do you have in the Hospital?

Agency New Patients Per Month (A)

Patients Sent Out Per Month (B)

Of (B), in-Patients

Of (B), out-Patients

Sea Lion Group 500 500 N/A N/A

Nakornthon Healthcare 6 2 0 2

Bangpakok 10 8 8 0

Pacific Medical Center 10 7 5 2

Enquiry Ulink Myanmar 5 5 3 2

Source: Survey Data

Among those who go abroad, the main purpose is for surgery – 24% of all those who go abroad

for medical treatment go for surgery. This is followed by Annual Medical Check-up at 22.0%,

Kidney diseases at 17%, and Cancer treatments at 12%, Cardiology at 8%, and Dental Care at

4%.

Other twelve procedures make up the remaining 13%.

For seven treatments, patients do not go abroad. They are anaesthesiology, A&E, cardiology,

maternal care, psychiatry, radiology, and urology.

Hospitals in Yangon

March 25, 2019 32

Figure 28: What are the diseases/procedures for which patients go abroad?

Source: Survey Data

Note: In the survey in Chapter 2, we found that patients primarily go to Thailand (67%) and

Singapore (26%), followed by Malaysia, India, and the US. Weighed by the treatment, in our

surveyed sample, 66.2% of patients go to Thailand, 15.4% of patients go to Singapore, and 18.4%

of patients go to India. Using this market share, we can survey-adjust the preceding data.

With market share adjusted, surgery patients are 27% of all those who go abroad. This is followed

by Annual Medical Check-up at 20.5%, cancer treatments at 15%, and kidney treatments at 10%,

Cardiology at 9% and Dental Care at 4.9%.

Surgery24%

Annual Medical Checkup

22%


17%

Oncology/Cancer12%

Cardiology8%

Dental Care4%

Others13%

Hospitals in Yangon

March 25, 2019 33

The reasons patients go abroad are listed below:

Agency 1

• Medical check-up results are more trustworthy than in Myanmar

• Medical treatment is fast & good

• More trust

Agency 2

• Seeking better services

• Trust the quality of foreign hospital/medical personnel more than local ones

• Unavailability of some services (e.g. artificial insemination) in local ones

Agency 3

• Weak technologies in local hospitals

• More perfect medicine and medical equipment

• Wealth enables patients to go abroad

Agency 4

• lower cost than other alternative countries to go

• Better treatment

• Food & services support are better than in Myanmar

Agency 5

• Better Care

• Better Technology & Treatment

• Medical services are better

Hospitals in Yangon

March 25, 2019 34

Cost of Medicare Abroad

Medical Package costs vary from $300 to $30,000, depending on the procedures involved.

Agency Cost

Sea Lion Group $300-$1435

Nakornthon Healthcare $300

Bangpakok $2000-$30000

Pacific Medical Center $1500-$25000

Enquiry Ulink Myanmar $1500-30,000

Hospital Room Rates abroad vary from $50 to $700, with average of $210. Median is $200, with

standard deviation of 133.33.

Figure 29: Hospital Room Rates Per Night

Source: Survey Data

Transportation costs for patients to go abroad vary from $100 to $300.

US$ Thailand India Malaysia Singapore

Average 191 240 250 250

Median 180 200 250 300

StDev 49 49 41 71

0

100

200

300

400

500

600

700

800

USD

Hospitals in Yangon

March 25, 2019 35

Medical Procedure Costs are varied and depends on the detailed procedure. However, a

generalized cost structure is produced below for the most common ailments.

Most expensive treatments are for Cardiology and Oncology/Cancer – two ailments for which large

number of Burmese people go abroad.

Average cost of cardiology treatment is $60,875 – with minimum at $15,000 and maximum at

$200,000. Average cost of oncology treatment is $100,000 – with minimum at $10,000 and

maximum at $200,000.

For others, the cost structure is as follows:

Figure 30: Cost of Medical Treatment Abroad

Source: Survey Data

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

US$

Min Max Average

Hospitals in Yangon

March 25, 2019 36

Medical Agency Staffing

Medical Agency staffing varies from company to company. Sea Lion which has 11 branches has

only one doctor per branch, while Nakornthon Healthcare, affiliated with the hospital of the same

name in Thailand, has 30 doctors working for them.

Two of five firms have foreign specialists working for them in Yangon; and one firm has one foreign

specialist visit from abroad per month.

Number of Doctors

Number of Foreign

Specialists

Number of Foreign

Specialist Visits from Abroad per

month

Sea Lion Group 11 No No

Nakornthon Healthcare 30 No No

Bangpakok 2 2 1

Pacific Medical Center 4 No No

Enquiry Ulink Myanmar 5 3 No

Hospitals in Yangon

March 25, 2019 37

Prescription Filling

Another business for medical agencies is prescription filling – import of medicine when a patient

orders prescription medicine (prescribed by doctors at hospitals abroad). On average, it takes two

weeks for medical agencies to fill foreign prescriptions.

Figure 31: Days Needed to Fill Foreign Prescriptions

Source: Survey Data

0

5

10

15

20

25

30

35

Sea Lion Group NakornthonHealthcare

Bangpakok Pacific Medical Center Enquiry UlinkMyanmar

Nu

mb

er o

f D

ays

Hospitals in Yangon

March 25, 2019 38

Appendix I: Hospital Room Amenities

Academy

Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa.

Type(B): Single room, Bed chair, Air-Conditioned, Fridge, TV, en-suite bathroom,

Hall: Air-Conditioned

Asia Royal

Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, water-

cooler

Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom

Special (C): Double room, bed, locker, Air-Conditioned


Aung Yadanar

Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa

Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa

Type(C): Single room Air-Conditioned, Fridge, TV, en-suite bathroom


Bahosi

Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, locker


Type(C): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom



Type(A, B ): Deluxe suite

VIP Hall: Air-Conditioned, Fridge, TV


Maha Myine

Type(A): Single room, bed chair, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa

Type(B): Single room, bed chair, Air-Conditioned, Fridge, TV, en-suite bathroom

Type(C):


Pin Lon

Type(A): 2-room, Extra Bed, Air-Conditioned, Fridge, 2 TVs, en-suite bathroom, sofa, breakfast-

included, wardrobe

Type(B): 2-room, Extra Bed, Air-Conditioned, Fridge, 2 TVs, en-suite bathroom, sofa, breakfast-

included, wardrobe

Type(C): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa,

breakfast-included

Hall: Air-Conditioned, Fridge, TV

Pun Hlaing Hospital

Type(A): Deluxe suite

Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, 2 TVs, en-suite bathroom, sofa, food-

support

Type(C): Double room, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, food-support

Hospitals in Yangon

March 25, 2019 39

Type (D): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, food-

support


Sakura

Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom


Type(C): bed, chair, locker, Air-Conditioned

Hall: bed, chair, locker, Air-Conditioned

Shin Par Ku

Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom


Type(C): Double room, Air-Conditioned, TV, en-suite bathroom

Hall: TV, chair

Shwe La Min

Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, water-

cooler

Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, water

Cooler

Type(C): Single room, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, water Cooler

Hall

SSC

Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa


Type(C): bed, locker, Air-Conditioned


Thuka Gaba

Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, locker


Type(C): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom

Witoriya

Type(A): Deluxe suite

Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, food

Type(C): Single room, Air-Conditioned, Fridge, TV, en-suite bathroom

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