Asia: Rise of Consumers as Self-Appointed GPs

Unprecedented access to information and increasing personal wealth across Asia-Pacific is empowering patients to influence their healthcare treatment decisions during doctor consultations, through government lobbying and even in where they seek treatment. At the same time, the aging population and changes in lifestyle will create a chronic disease epidemic that will cause patient numbers to swell thereby amplifying the impact of patient power.

The rise in consumer power will ultimately change how doctors interact with their patients, how governments seek to manage burgeoning healthcare costs; while companies looking to drive healthcare product sales will need to reassess their marketing activities in light of the changing dynamics.

Access to Information Drives Change

Consumers today are bombarded with medical messages from their friends and relatives, in the office, through the media, on billboards and even on the side of buses. Health messages are all around us. And, for those seeking help the Internet has revolutionized the type of information that people can access.

For the millions of people in Asia with access to the Internet there are no longer any boundaries to the type of information they can find. Details of prescription-only medicines are readily available to anyone with a computer. Access to information from patient organizations or companies themselves, in the US, has effectively removed the regulatory control that governments in much of Asia-Pacific still seek to prevent through laws that prohibit companies from communicating directly with patients about prescription-only medicines.

Clinical trials are no longer conducted behind closed doors. Patients are sharing their own personal stories of success and woe and they are finding sole-mates and communities around the world with whom they can talk in a way that is often not acceptable in their own culture.

This access to information is already changing the dynamics between patients and doctors. Today, patients are more likely to ask questions of their doctors and challenge their decisions in a way that would have been impossible before the advent of the Internet.

Yet the full effect of the Internet has not been felt in Asia. One-third of the world's Internet users may be in the region but only 10% of China's population and 4% of people in India are currently online - leaving millions of people who are still to gain access to healthcare information through this medium.

Increasing Wealth - Increasing Choice

According to UN-WIDER World Distribution of Household Wealth Report, individuals living in rich countries in the Asia- Pacific region hold 24% of the world's wealth and the wealthy of China and India own 3% and 1% respectively. There is definitely a large gap between those with and without money, but for those who are wealthy, they are experiencing a period of unprecedented choice and this continues when it comes to managing their healthcare expenses.

World Bank Statistics say more than half of all patients in the Asia-Pacific region have to pay for their own healthcare expenses and, while for many, healthcare expenses are still overwhelming - some 30% of poor households attribute their poverty to health related expenses in China, reports Pharma- Handbook in 2006 - for those individuals in the upper income brackets in each country their relative affluence affords greater choice in healthcare treatment decisions.

Medical tourism centers in Malaysia, Thailand, Singapore and most recently India are growing year-on-year and they have international reputations for clinical excellence. And while the US, Europe and the Middle East are still target markets, hospitals are now advertising in other Asian countries as they recognize the growing ability of people in the region to be able to choose when, where and how they are treated. Growing numbers of people are enrolling in private healthcare insurance schemes, which give them greater flexibility and choice in which doctors they can see, within the context of their providers' guidelines, and when they can get treatment.

Desire for luxury brands is increasing across the region and more than half the world's sales come from this part of the world. Every country, from India to Indonesia, has a group of affluent consumers -no matter how small - that are willing to pay high prices for brand names and it is not too much of a leap to believe that this desire for high quality products may begin to extend to healthcare treatment choices. The newspapers are filled with horror stories of deaths associated with taking counterfeit drugs and generic drugs can be perceived to be "older", low quality products. In this environment people with more money may well start to demand newer branded products to treat conditions they are living with.

The Patient Explosion

As patient influence is on the increase, so too is the actual number of patients. The population is aging and chronic diseases such as diabetes, heart disease and stroke will be responsible for the vast majority of deaths in the next 10 years across all countries in Asia; while communicable diseases are generally predicted to decrease says World Health Organization. The number of people who are becoming patients from all walks of life will mushroom - amplifying the impact of empowered patients and causing problems for governments trying to manage healthcare budgets. But managing this emerging health crisis will need the active involvement of every man, woman and child in the region if the predictions are to be thwarted.

Lifestyle factors such as an unhealthy diet, lack of physical activity and smoking are the three most important, preventable risk factors for chronic disease. As more people move from rural communities in to cities to engage in office work, physical activity levels are dropping. The demand for "western" style fast good restaurants and high-fat diets is growing and obesity levels are soaring. Meanwhile, smoking is still socially acceptable in countries such as China, Korea, Vietnam and Japan.

People will need to understand the impact of their actions on health years before they need to see a doctor if the chronic disease predictions are to be prevented. Unless consumers can be engaged to change their lifestyles the healthcare system will be facing a crisis in the next few years.

Consumers are Driving Change

Patient influence is here to stay and its impact will only escalate in the coming years. For those individuals and organizations operating in this area, patient power will demand changes in how those in the healthcare sector relate to them.

Doctors, just like bankers, opticians, travel agents and real estate agents before them, will need to adapt how they practice medicine. Consumers will demand more respect, outstanding service, convenience and greater transparency in their dealings with their doctors. The rising numbers of people living with chronic diseases such as diabetes and high blood pressure, who are not house-bound or unable to work, will also change when and where people choose to see their doctors. Finally, as patients begin to exercise greater selectivity in which doctors to see and what treatments they are prepared and able to pay for, doctors who derive their income directly from patients will need to become more commercially orientated.

While individual circumstances and expectations will drastically change how doctors operate in countries with largely self-pay healthcare systems; in countries with national healthcare systems, consumers will have the greatest impact on government decisions.

Governments across the Asia-Pacific region face a difficult short and long-term future as they try to balance the needs of increasingly vocal and demanding patients with the needs of the aging population facing years of treatment for chronic diseases. In managing patient treatment needs, governments will need to closely engage with patient organizations, doctors and even patients themselves in making decisions about what should and should not be available to treat different diseases in their countries. Just as crucially, governments across the region need to conduct widespread consumer education and prevention activities to try to halt the predicted increase in lifestyle dependant chronic diseases.

Embracing the increasing role of patients in determining treatment decisions will require a fundamental change in how pharmaceutical companies in the region appear to be conducting marketing and communications activities. Just as in Europe, where direct-to-consumer activities are prohibited, consumer activation is a routine part of the marketing mix through public and advocacy relations activities, so too will companies in Asia will need to embrace these techniques.

Summary

Consumers, not doctors, will begin to drive healthcare treatment decisions and change the way that the medical community operates across the Asia-Pacific Region. Unprecedented access to information and increasing personal wealth across the region will empower patients to influence their healthcare treatment decisions and necessitate changes among doctors, governments and companies looking to realize the potential of this region.