Increasing demand for laboratory technology in the ASEAN region

In the ten ASEAN countries (Brunei, Indonesia, Cambodia, Laos, Malaysia, Myanmar, The Philippines, Singapore, Thailand and Vietnam) the potential for laboratory technology is greater than elsewhere for climatic reasons: Infectious diseases of all kinds find the best conditions to spread on site. In addition, there are often hygiene deficiencies and sometimes high population densities. Dengue fever, malaria, tuberculosis and numerous other diseases still pose a major threat to the population today. Most pathogens can only be detected with the help of modern laboratory technology.

Even more decisive for the increasing demand for laboratories and laboratory technology is the establishment or further expansion of health systems. At least in the economically better positioned national economies of the region, health service providers are increasingly having to take care of preventive benefits and the diseases of civilization affecting aging populations.

The current supply options in the ASEAN countries could not be more different: Singapore has world-class laboratories and corresponding equipment, research and training. The majority of the population in Malaysia and Thailand now has access to modern laboratory technology. Meanwhile, there are Myanmar, Laos and Cambodia which are only at the very beginning of building a health system.  

Indonesia: Around 1,300 laboratories for 270 million inhabitants 

Indonesia has the largest laboratory market in the region, if not necessarily in terms of the standard of technical equipment and more towards volume. Thanks to the introduction of a general health insurance in 2014, more than 220 million Indonesians are now entitled to health care that also includes laboratory tests. Soon, all 270 million inhabitants of the archipelago should be able to benefit.

The Indonesian state health insurance includes standard blood tests such as hemoglobin, thrombosis or blood sugar tests, as well as simple stool and urine tests. More specific tests are also covered by health insurance if a doctor prescribes them. Time and again, however, it is reported that patients in the hospitals are asked to pay for corresponding examinations because the facilities fear that the costs will not be reimbursed by the insurance company. In fact, the general health insurance is at a high deficit and is dependent on government subsidies. The monthly contribution for the insured is between US$1.80 and just under $10. Around 100 million poor people even get it free of charge. The service catalog is therefore constantly checked. The middle class can afford examinations and laboratory tests in private hospitals beyond insurance. And those who are wealthy have major interventions carried out in Singapore or Malaysia.

The backbone of the Indonesian health system is the 10,000 so-called Puskesmas (Pusat Kesehatan Masyarakat – Public Health Center) scattered across the archipelago. These state health centers provide basic services to the poorer sections of the population. However, they have a different level of quality. In the more rural areas, the available care is limited to bandages and disinfectants. In larger cities like Jakarta, several doctors work in the Puskesmas with electrical diagnostic devices and their own laboratory technology. All Puskesmas have access to a laboratory where samples can be sent. And all laboratories can do simple standard tests. The large Puskesmas are also equipped for specialized tests in microbiology and immunology.

Of the almost 2,900 hospitals in Indonesia, many, but by no means all, have their own laboratories. Usually these belong to the hospital or the hospital chain itself. In other cases they are service providers for laboratory groups. With 142 of its own medical laboratories in 126 cities, Prodia is the largest laboratory company in the country.

According to the Ministry of Health, there are around 1,300 medical laboratories in Indonesia, 80 percent of which are private. Laboratory employees are mostly trained at polytechnic universities. In-house training is mandatory at least for state laboratories.

China is the largest supplier of laboratory technology in Indonesia - mainly for products such as glass and ceramic-based medical devices, but also simple electronic devices. Specialized technical equipment is imported on a large scale from the USA, Japan or Germany.

Modern laboratory technology in Thailand and Malaysia 

While the interim goal in Indonesia is to offer large sections of the population access to basic medical care including laboratory tests, Malaysia and Thailand are already a step further. Both countries already have efficient public and private health facilities that offer most residents more than basic care.

There are around 750 accredited medical laboratories in Malaysia, almost 600 of which are privately owned. According to official information, there are 6,400 laboratory technicians who are well trained in regional comparison. The laboratories benefit from the healthcare system's shift towards preventive medicine, an aging population and medical tourism, which is economically important for Malaysia. While the orders of the hospitals remain the core business of the laboratories, at least the private laboratory facilities are increasingly aligning their services to preventive examinations of private patients.

There are around 650 medical laboratories in Thailand, but most of them are state-run. Their employees have degrees as laboratory technicians or in biomedical fields. The laboratories receive their equipment mainly from the USA, Germany, China, Japan and Malaysia. In addition to all the standard tests, at least the larger municipal institutions offer hundreds of more sophisticated molecular biology tests, which are mainly accessible to wealthy customers. The leading private hospitals in Thailand have an excellent reputation and attract foreign medical tourists from the region - including expats from neighboring countries. There is a wide range of medical laboratories in Bangkok. However, the prices of private hospitals for special laboratory tests are high. In some cases, the examinations even cost a multiple of comparable services in Germany. A price comparison among the providers is therefore worthwhile for customers. The prices of the state general hospitals are slightly lower. You have two price lists: one for Thais and one for self-paying foreigners with significantly higher prices. During the corona pandemic, the Thai government equipped 50 medical laboratories for Covid-19 tests, with a capacity of one million tests every six months.

Vietnam is a growth market 

As a socialist country, Vietnam has geared its health system to availability for broad sections of the population. In terms of performance, however, it still lags far behind much wealthier countries such as Singapore, Malaysia and Thailand. 122 medical laboratories are accredited by the Vietnamese Ministry of Science and Technology. Of these, exactly 48 laboratories were able to carry out Covid-19 tests as of summer 2020. Wealthy Vietnamese bypass the state health system and have the necessary examinations done directly by private medical laboratories. Due to the high economic growth rates and the comparatively high level of education in Vietnam, a rapid expansion of the laboratory market is to be expected there. 

Myanmar, Laos and Cambodia first have to build up laboratory capacities 

In economic terms, Myanmar, Laos and Cambodia lag far behind the neighboring countries of the ASEAN region. The economic output per capita of the three countries taken together is hardly more than half that of Thailand. The supply situation with medical laboratories is correspondingly rudimentary. The countries do not manufacture any laboratory equipment worth mentioning and can hardly afford to import expensive diagnostic equipment. There is also a lack of trained specialist staff. The equipment of the health systems therefore depends to a large extent on international development aid.

In Myanmar there are said to be 169 laboratories. However, only four percent of the population have private health insurance. The Burmese often have to pay for laboratory tests themselves because the insurance does not cover them. The existing laboratory technology comes from Europe, the USA and India.

In the Laotian capital Vientiane, the Rodolphe Mérieux Laboratory of the French foundation of the same name is one of the most famous institutions. According to its own information, it specializes in examinations that do not exist in the rest of the country, including HIV / AIDS and hepatitis B and C. In addition, with its Lab Kham project, the foundation supports the expansion of local laboratories and, above all, the training of employees in the central Lao province of Khammouane. 

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GTAI is the foreign trade and inward investment agency of the Federal Republic of Germany. The organization advises foreign companies looking to expand their business activities in the German market. It provides information on foreign trade to German companies that seek to enter into foreign markets.