Wound Care Around The World: Malaysia

More often than not, the wound care industry’s most influential executives who oversee the commercial planning and execution for the industry’s most lucrative products are based in corporate offices located in established markets. Yet, they retain responsibility for their brands across large geographies, including entire continents. True, many of these individuals may indeed visit these markets frequently, such as to attend company-sponsored events or industry conferences and/or to meet with distributors. And, true, they are typically well-educated, experienced, and accomplished executives from across the scientific, biomedical, healthcare, and commercial spectrum. But do they truly understand where and how their wound care solutions are evaluated and used by their stakeholders in such markets?

Unfortunately, if they have not really invested the time and resources on the ground (in actual patient care settings), the answer is usually, “no.” The opportunities and challenges for emerging-market wound care are well documented. Increasingly, both clinicians and industry professionals have been gaining interest in these regions. I recently spoke on this topic at the Symposium on Advanced Wound Care Fall conference in Las Vegas, NV, and often present on this topic in developing markets as well. Yet, overall, most outside stakeholders are still lacking a true grasp of how to offer solutions to wound care needs in such regions.

Not too long ago, I visited with Dr. Mogan Naidu, a very passionate wound care provider who serves as head of MediAsia^TM Advance Wound Care & Tissue Repair Center in Penang, Malaysia, and is the founding chairman of the Malaysian Diabetic Limb Salvaging Society, a group of professionals who seek to reduce the incidence of lower limb amputations among diabetic patients in Malaysia. Our conversations canvassed a variety of wound care products and services, including a new private wound care hospital that is planned for the region, which aims to service both the local population and medical tourists. Although Malaysia is just one of many emerging markets, and each market is unique, many of the themes and lessons that we discussed can be applied to other regions. The following notes represent some key takeaways from the discussions (The full interviews are available on video by accessing Part 1 here and Part 2 here):

• Value-Based Healthcare: Patients & Pricing: Despite all the talk about moving to value-based healthcare in the developed markets, in many ways Dr. Naidu and his team have already implemented a version of it. The patients are directly involved in the cost of care, but the pricing is determined by the severity level of the wound (which they divide into zones: red, yellow, green). Rather than charging the patient for each piece of product or procedure, they bill based on zones, which in many ways better aligns the incentives of the parties than either traditional fee-for-service or socialized public healthcare. 

• Advanced Wound Care Products: Although resources in this environment are lacking, there is indeed access to most categories of advanced wound care therapies (foams, cleansers, debridement, etc.). This is consistent with what I have seen across most emerging markets, especially in the Asia-Pacific. 

• Holistic Healthcare: Not only based on what I learned in the interview, but from the entire two days I spent with the MediAsia team members, it is apparent that they do an excellent job of addressing holistic factors in patient care, such as diabetes management, cardiopulmonary status, kidney function, offloading, nutrition, and even the psychosocial status of the patient. They give more attention to these critical healing factors than the majority of wound care facilities that I have visited – and that statement includes countless facilities across North America and Europe.

• Access to Care: True, their patients cannot easily access certain technologies and specialists, for example, care related to vascular imaging/interventions and hyperbaric oxygen therapy when compared with markets with a more developed healthcare infrastructure. This is especially true for financially challenged patients, a category that includes many patients living with difficult-to-heal wounds. Patients may turn to traditional healers first, which can further delay their arrival to a specialty wound care center (if they go at all) and will often exhaust patients’ funds that otherwise might be used for specialized wound care. This is consistent with the practice of wound care in many other markets, including Latin America, Africa, and across Asia (and even among some medical tourists and immigrants to the United States, Europe, and Oceania).

• New Innovations: However, many of these are precisely the scenarios and opportunities that innovations such as hemoglobin oxygenizers, disposable negative pressure wound therapy, mobile assessment and analytics platforms, and many more, are able to address and that result in potentially fast adoption in such regions, where leapfrogging entire generations of technology is already the norm.

• Wound Care Services & Future Plans: While we opened the interview with a focus on wound care product price points, adoption, and usage in Malaysia (and developing markets in general), we shifted to the wound care services ecosystem, the patient journey, challenges, telemedicine/mobile health (mHealth), and investment opportunities. Dr. Naidu also shared with me his team’s plan for a private wound care hospital to treat patients from Malaysia and the surrounding region (Indonesia, the Philippines, and others). I even got a chance to tour the site (the land has already been purchased), and they took me on a buggy tour of the grounds and surrounding village. Although the conversation centered on wound care in Malaysia, many of the needs articulated by Dr. Naidu also exist across the emerging and developed markets. Although advanced wound care in developing markets does not yet have the same level of awareness or infrastructure as in developed markets (which is not very high either), the patient volumes at specialty care settings such as MediAsia (and other wound centers in this part of the world) are on par with the top 10% of U.S. and Europe-based wound care centers.

• Digital Health: Due to the distances traveled for wound care, as well as the international medical tourism component, there are opportunities for telemedicine and mHealth that are equally, if not more attractive, than those in the developed markets. Wound care patients (international and domestic) in the emerging markets are prepared to spend cash when they travel to receive treatment, which gives providers some more flexibility in terms of the therapies and payment models incorporated.n

Rafael Mazuz is managing director of Diligence Wound Care Global LLC, a leading advisory firm providing executives, investors, and specialists confidence in their wound care business decisions. He previously opened and led award-winning wound care centers for the world’s largest provider of wound care management services and actively advises wound care product and services stakeholders in both the developed and emerging markets. He can be reached at rafael@diligencewcg.com