Indonesian Travels Overseas For Healthcare

Getting top-notch medical treatment in Indonesia is complicated, even though universal healthcare covering everything from physiotherapy to cancer treatment reaches 80 per cent of the country's 260-million population. Premiums are also modest, and a married couple with a child pay on average 240,000 rupiah (S$24) a month.

Universal healthcare is expected to add 2.9 years to average life expectancy from 71 years now when it is fully rolled out. It saves 1.2 million from penury every year because the less well-off will no longer need to exhaust their savings or rack up debts to pay hospital bills.

However, most people who can afford to still either use their private insurance or travel abroad for care.

"The perception of care is bad," said Mr Hasbullah Thabrany, who helped draft the 2005 law on universal health insurance benefit. And while private hospitals are considered a safer bet than the public option, they pale in comparison to care in Malaysia or Singapore.

"If the rich are paying for a service they don't use they will have the incentive to seek cuts in funding," he said.

Resentment among the moneyed classes could rise as early as January when premiums double to help close the US$2 billion ($2.7 billion) deficit the insurance programme is expected to run this year.

While BPJS Kesehatan, which administers the insurance plan, is expected to be able to close the gap with the higher premiums, it leaves little to improve services, Mr Hasbullah said, and Indonesians will still continue to go abroad.

"That's money going overseas that could be spent here," he noted.

Indonesia has some of the lowest doctor-patient ratios in Asia. There are on average four doctors for every 10,000 people, according to the World Bank. That is slightly behind Laos, which has five, and well behind Malaysia, which has 15.

A visit to a doctor in Indonesia involves long waits culminating in a brief consult with an overstretched physician. Errors are common.

During the 10 years to 2016, there were 317 malpractice suits levelled against Indonesian doctors, according to data collected by the Indonesian Honorary Council of Medical Discipline and media reports.

And while the government of President Joko Widodo is courting investment in the healthcare system, its ranks of doctors face little competition from foreign practitioners. Foreign doctors must get local accreditation, speak Indonesian and be admitted to the Indonesian Doctors Association.

Richer Indonesians seek treatment elsewhere. The country is the biggest source of medical tourists for Malaysia. Last year, half of the 1.2 million or so expatriates travelling to Malaysia to see a healthcare professional were from Indonesia, data from the Malaysian Healthcare Travel Council shows.

Medical services offered in Malaysia, Thailand and Singapore were worth US$9 billion last year, according to consultancy Patients Without Borders.

Universal coverage has made care available to the bottom of the pyramid that did not have access to healthcare. However, this has not translated into preventing medical tourists from travelling abroad. Nevertheless, many are happy with the calibre of care they get at home. Ms Dewi Komala, a Jakarta-based interpreter, sought a second opinion in Singapore to ensure a lump in her breast was benign. The Singapore doctor was so aloof and brusque that Ms Dewi came back to Jakarta to consult another doctor.

"This was the biggest concern of my life and he didn't seem to care," said Ms Dewi.

Mr Sabnis said Indonesian hospitals are lifting their game and will eventually do a better job holding on to their moneyed clients.

But Mr Hasbullah said it is only when the flow of patients is reversed that Indonesia's medical sector will be on a level footing. "When the Thais come here, then we'll know we've got a good system."

Zurich Completed Aquisition On Adira

Zurich Insurance Group has completed its acquisition of an 80% stake in PT Asuransi Adira Dinamika Tbk (Adira Insurance). According to a statement by Zurich, the stake was purchased from Bank Danamon Indonesia and a minority investor, resulting in the creation of the largest property & casualty (P&C) insurer in Indonesia.

The transaction also includes two separate long-term distribution agreements with Bank Danamon and PT Adira Dinamika Multi Finance Tbk (Adira Finance). The former also remains a minority shareholder in Adira Insurance.

The deal is worth IDR6.15 trillion (around US$414 million), with potential future incremental payments subject to business performance.

“This transaction is fully aligned with our growth strategy in Indonesia,” said Chris Bendl, country manager for Zurich Indonesia and president director of PT Zurich Topas Life. “As the largest international P&C insurer, we are in a great position to play an active role in the continued development of Indonesia’s insurance industry. Through Adira Insurance and our other Zurich businesses including our life company, we are committed to helping our customers manage their risks and achieve financial success in the long term.”

Myanmar Opens-up Insurance Industry

The Financial Regulatory Department today awarded licences to five foreign insurers and half a dozen joint ventures to operate in the Myanmar market.

British Prudential, Japanese Dai-ichi Life, Hong Kong AIA, US Chubb and Canadian Manulife have been permitted to issue life insurance policies in Myanmar with their fully-owned subsidiary, more than half a year after the five insurers were granted provisional licences.

The approval marked Myanmar’s first-ever licencing to foreign fully-owned life insurers.

The Department also granted licences to three life and three non-life joint ventures between foreign and local firms. Three JVs for non-life insurance are between AYA Myanmar General Insurance and Sompo Japan Nipponkoa Insurance; Grand Guardian General Insurance and Tokio Marine & Nichido Fire Insurance; and IKBZ Insurance and Mitsui Sumitomo Insurance. Another three life JVs are between Capital Life Insurance and Taiyo Life Insurance; Citizen Business Insurance and Thai Life Insurance; and Grand Guardian Life Insurance and Nippon Life Insurance.

Insurance liberalisation is a flagship reform of Daw Aung San Suu Kyi’s government, albeit one tarnished by repeated delays, executives say. Her administration had initially committed to opening up the insurance market in the first quarter of 2017 and pressure was building for the ministry to follow through the pledge.

The finance ministry announced it would grant up to three life insurance licences to foreign companies a day after it that Samsung Life Insurance had shut down its Myanmar subsidiary. In April, it awarded provisional licences to five instead. 

Despite the delays, international insurers remain keen to tap into a market where current insurance penetration is among the lowest in the world.

Local insurer IKBZ Insurance, which has formed a joint venture with Mitsui Sumitomo Insurance Group, released a report in July showing that less than 4 percent of the population have any sort of insurance coverage. The report also indicated that the industry has the potential to grow into a K4 trillion market in 10 years. 

Insurance in Myanmar, historically monopolised by the state firm, was opened up to local private operators in 2013, with 11 Myanmar licenced firms currently operating. More than a dozen foreign insurers have set up representative offices in Yangon.

The government has also approved six joint-venture (JV) proposals between foreign and local partners.

Three joint ventures for non-life insurance are between AYA Myanmar General Insurance and Tokyo-based Sompo Japan Nipponkoa Insurance; Grand Guardian General Insurance Co and Tokyo-based Tokio Marine & Nichido Fire Insurance; and IKBZ Insurance and Mitsui Sumitomo Insurance.

And another three life insurance JVs are between Capital Life Insurance and Tokyo-based Taiyo Life Insurance Co; Citizen Business Insurance and Bangkok-based Thai Life Insurance; and Grand Guardian Life Insurance Co and Osaka-based Nippon Life Insurance. 

The Financial Regulatory Department (FRD), under the Ministry of Planning and Finance,  authored a proposed Insurance Business Law which is currently under public consultation. As reported by The Myanmar Times, the draft legislation as it stands will exempt the insurance market from the Competition Law.

Under the new law, state-owned Myanma Insurance is also exempted from provisions regulating governance, liquidation and licencing.

Rare Earth Kills

Sahabat Alam Malaysia (SAM) has expressed shock that the Perak government and Putrajaya have inked a deal with a Chinese company to undertake the exploration of rare earth minerals in the state.

SAM president Meenakshi Raman said Perak has not learnt the "tragic lessons" of the Asian Rare Earth (ARE) plant that resulted in serious radioactive poisoning in the Bukit Merah community.

"There were high incidences of deaths among children who suffered from leukaemia and cancer, children with elevated levels of lead in their blood and above normal rates of miscarriages among pregnant women," she said in a statement.

Meenakshi warned that just adding the word "sustainable" to rare earth mining and processing does not make an inherently dangerous and risky activity safe.

"Especially if we are talking about radioactive thorium and uranium wastes that remain hazardous in the environment for generations to come. It is most irresponsible of the Perak government and Ministry of Water, Land and Natural Resources to promote environmentally unsound investments in rare earths, despite the ARE lesson and the controversial Lynas rare earth operations in Gebeng, Pahang," she said.

Meenakshi was referring to a memorandum of understanding signed between the Perak government and a Chinese company, Chinalco GXNF Rare Earth Development, to undertake the exploration of rare earth minerals in Perak.

This was announced on Nov 16 by the Water, Land and Natural Resources Ministry, which described the initiative as a “positive move”. The move comes amid dissatisfaction from environmental and health-conscious citizens over Mara's deal with Lynas Malaysia Sdn Bhd "to catalyse Malaysia's downstream rare earth industrial, research and technological capabilities".

Meenakshi said clearly, the exploratory work would be the first step in embarking on rare earth mining in the state, adding that SAM viewed this development with utmost concern.

She reminded that Perak is already home to a radioactive permanent waste facility in the Kledang Range that contains "dangerous and harmful wastes" of thorium and uranium inherited from ARE plant which operated in Bukit Merah, Ipoh during the mid-1980s to 1990s.

"These wastes will remain radioactive for billions of years and pose high risks to the people of Perak," she said.

Meenakshi urged the Perak government and the ministry to act responsibly to halt investments that bring huge profits for companies in the short-term but leave behind toxic, radioactive and hazardous legacies of waste dumps for generations to be burdened with.

"Do not to embark on any rare earth mining activities in the state. The Water, Land and Natural Resources Ministry should not be promoting such rare earth mining with the dubious label of sustainable mining.

"Instead, we should be promoting environmentally sound investments that benefit the public and the environment both in the short and long terms," she said.

Diabetes - Top Killer In Malaysia

Diabetes mellitus is one of the ten principal causes of death in 2018, according to the Malaysian 2019 social statistics bulletin. Commenting on the report, chief statistician Mohd Uzir Mahidin (photo) said hypertension (hypertensive diseases) recorded the highest increase of 73.2 per cent.

“This is followed by chronic lower respiratory diseases (59.5 per cent) and malignant neoplasm that affects the colon, rectum and anus (39.7 per cent),” he said in a statement today.

The social statistics bulletin displays selected social statistics, which are the key indicators for measuring the quality of life and well-being of the people.

Meanwhile, Mohd Uzir said death from road accidents in 2018 recorded a decline of 2.4 per cent to 4,391 deaths from 4,499 deaths in 2017. He said there were 548.598 of road accidents reported to the police in 2018 and only 1.1 per cent involved fatalities.

“Selangor recorded the highest death rate of 1,046 cases while Kelantan recorded the highest number of road accident injury cases with 1,626 cases. Putrajaya recorded the lowest number of injury cases and deaths, namely 10 and seven cases respectively,” he said.

According to Mohd Uzir, new motor vehicle registrations recorded an increase of 8.2 per cent in 2018 to 1.22 million compared to 1.13 million in 2017.

“The increase was contributed by public transport (48 percent), followed by commercial vehicles (15.3 percent) and motorcycles (11.5 percent)," he said.

In terms of education, the bulletin shows there are 4.92 million primary and secondary school students and 416,886 teachers in 10,486 schools nationwide.

Thailand Life Insurer - Low Interest Rate Environment

The Thai Life Assurance Association (TLAA) has called for the Office of Insurance Commission (OIC) to relax rules to broaden investment opportunities for life insurers, enabling them to cope with a prolonged low-rate environment. The association has requested the regulator widen investment scope and raise flexibility based on the risk acceptance of each insurer, said president Nusara Banyatpiyaphod.

If investment risks remain the OIC's largest concern, the regulator may gradually ease the regulations, raise the ceiling limit or provide permission on a case-by-case basis, she said.

Life insurance companies are scrambling for higher returns to match their promised yields to policyholders -- particularly those who take out insurance products with savings features -- and avoid losses amid falling bond yields and low interest rates.

Over the past few years, life insurers have adjusted by lowering the minimum guarantee to policyholders and focusing on unit-linked or investment insurance products for which customers have to accept risks themselves.

Some firms have diversified to invest in property offering higher returns than bonds but producing a steady income stream and launched participating policies that guarantee a minimum return to policyholders and with which they can earn additional returns if the insurers' investment yields a better return.

Mrs Nusara said the TLAA, according to the proposals, asked the regulator to allow local life insurers to allocate more assets to foreign markets.

"The low-interest-rate environment for an extended period is the biggest challenge for life insurance business that needs to be addressed," she said. "The challenge is seen not only in Thailand, but also other countries including Indonesia and Vietnam where interest rates once stayed at a high level."

Abolishing the minimum investment requirement of 500 million baht in each property project to mitigate risk and diversifying to invest in other types of real estate are also among the TLAA's proposals, Mrs Nusara said.

At present, life insurers are restricted to investment in office buildings.

Property yields attractive returns amid record-low interest rates as investors earn returns from rentals and capital gains from higher property prices, Mrs Nusara said.

"The nature of property investment is complemented by the insurance business, as both are long-term commitments," she said. "The long-term investment is enough to achieve the target in the event that short-term returns from investment fall short of the goal."

GoBear - Updates 2019

Fintech firm GoBear has reportedly had a shuffle with two of cofounders stepping down, and the company having to shut its Indonesian comparison business. In a statement to Marketing, GoBear CEO Adrian Chng confirmed that the company did recently make changes within the organisation. He added that such changes are not uncommon for a growth stage company in a rapidly evolving marketplace.

As for its Indonesian operations, he said GoBear’ shifting from to a content model to drive financial education locally. He said, “GoBear’s purpose is to improve financial health across Asia Pacific. Financial literacy is a key challenge in Indonesia and GoBear’s online presence within this market is shifting to a content model to drive critical financial education.”

Meanwhile, the company is said to be focusing on long-term growth in Asia Pacific, “following successful funding rounds.”

“We are actively expanding our operations across the region and are committed to achieving our mission of improving financial health,” he said. The company was launched in early 2015, and offers over 1,800 financial products such as travel, health and car insurance, credit cards, and personal loans. It has a presence in markets such as Singapore, Hong Kong, Malaysia, the Philippines, Thailand, and Vietnam, with Indonesia taking off a year ago.

Malaysia Number One Killer Disease Of Woman

Breast cancer cases in the country are at an alarming level, as 31.1 in every 100,000 people are suffering from the number one killer disease of women, says Health Minister Datuk Seri Dzulkefly Ahmad.He said 43% of those who had breast cancer screening were in the critical stages. 

“The government is committed to dealing with breast cancer cases. In Budget 2020, the government has allocated RM216.9mil for cancer treatment.

“The fight against breast cancer needs to involve not only the government and corporations but also the whole community including NGOs and individuals, ” he told reporters after launching the third phase of the Etiqa Free Mamogram Programme in collaboration with the National Cancer Society Malaysia here yesterday.

The programme, which is being carried out in selected hospitals in Peninsular Malaysia with an allocation of RM2mil, provides 6,000 free breast cancer screenings for underprivileged women aged 40 and above.

The first and second phases of the programme have benefited 11,000 underprivileged women in the peninsula.

Macau Scam Increasing

Scammers have cheated Malaysians of more than RM769 million in the past three years, making it one of the most lucrative illegal business schemes around. In 2017, 13,580 police reports were lodged, with losses amounting to more than RM214 million.

There was an increase of 15,533 cases last year, with losses totalling RM354 million. Betweeen January and September this year, 9,225 cases were reported with losses amounting to more than RM199 million.

Bukti Aman Commercial Crime Investigation Department’s Commissioner Datuk Seri Mohd Zakaria Ahmad claimed that non-existent loan schemes topped the list of cases in the first nine months of this year. He said Macau and African scam victims suffered the most losses in the period under review, despite a low number of cases reported.

“A total of 3,667 cases lodged were related to non-existent loan schemes with losses amounting to RM34,395,846.05. Macau scams recorded 1,666 cases from January to September this year with losses amounting to RM81,550,612.87, followed by African scams with RM62,977,518.01 in losses from 1,164 cases.”

Zakaria said online scams were rampant with 2,637 cases recorded this year, with losses of RM19,951,859.83, while 91 cases were lodged for short messaging system scams amounting to RM1,025,294.30 in losses.

He said the figures showed that Malaysians were desperate for cash. He added that the police had been working hard to create awareness about such scams.

“Scams can be prevented if the public know the modus operandi of the perpetrators.”

Zakaria said people must not fall prey to scammers and must be alert when they were falsely accused of a crime. The victims must contact the police or Bank Negara Malaysia immediately for verification.

Deputy Home Minister Datuk Mohd Azis Jamman had, on Nov 6, said in the Dewan Rakyat despite campaigns by the authorities, it ultimately boiled down to the people’s attitude.

He said the police had set up an Internet Banking Task Force Group and a Cyber Crime Technical Committee to address online cheating cases, and as well as the http://ccid.rmp.gov.my/semakmule portal to allow members of the public to check the telephone and bank account numbers used by syndicates.