Advances in healthcare technology have resulted in millions of people living longer, but the growing number of elderly people is also testing the limits of the system. Overcrowded hospitals, long waits for specialist treatment, a limited number of caregivers and high cost of essential medications are facts of life in many countries.
Can society adapt to a new era in which living to 90 or 100 will become normal, and can it afford the cost of keeping everyone healthy for longer? Research and technology will help to provide the answer. But if the focus of the past century was on treatment and cure, the focus today is on prevention, monitoring and smarter use of resources to keep healthcare costs manageable.
"Pharmaceutical companies and the healthcare profession are tasked with continuously innovating, discovering and bringing to market new and better therapies for patients across different diseases, across chronic diseases, and particularly as we have an ageing population," says Riaz Buksh, general manager of the pharmaceuticals division of Bayer Thai, with responsibility for Cambodia, Myanmar and Laos as well.
By 2050, one out of every four people in Asia Pacific will be over 60 years old, according to the World Bank. For the pharmaceutical industry, that means introducing new drugs and helping healthcare professionals to better deliver the improvements those drugs can bring to patients through compliance and adherence.
One of the major challenges, especially among elderly people, is remembering to take medications as instructed by doctors. As people age, they tend to forget things. As well, as we get older we tend to have more than one health condition at a time, and some are likely to be chronic diseases.
If patients do take their medicines correctly, their condition will improve and eventually they will require fewer medicines, leading to lower costs for themselves and for government programmes that help the elderly.
"As a result of getting older and facing higher risk from chronic diseases, we are likely to be on multiple medications for different conditions at the same time and that leads to complexity," said Mr Buksh. "Unfortunately, as it gets more complex, it leads to poor adherence in terms of patients' ability to take their medications."
The result? Up to 50% of patients in Asia Pacific do not adhere to long-term treatments consistently, according to the most recent World Medicines Situation report by the World Health Organization.
NEW-AGE SOLUTIONS
It's no surprise, then, that technology to improve patient compliance is an important focus of researchers. Encouraging that work is the focus of Grants4Apps, which recently staged an innovation challenge in Singapore, sponsored by Bayer and NUS Enterprise, an arm of the National University of Singapore.
PillPocket, a Thailand-based startup, was one of three winners chosen from among 80 participants in the first round of the challenge. The other two were EyeDEA and GlycoLeap by Holmusk, both based in Singapore.
PillPocket is an integrated solution that provides personal assistance from pharmacists for patients with high blood pressure, high blood cholesterol and diabetes. The mobile application component features a chatbot linked to pharmacist services for follow-up care, medication refills and home delivery, and free patient case management. This is especially helpful for patients in remote areas where healthcare providers are limited and transport difficult.
"Some patients have to wake up very early and travel a long way to go and wait for medicines at the hospital and sometimes by the time they get there, the medicines have already run out. This means the patient has wasted the whole day while ending up receiving only some or none of the medications they require to get better," PillPocket co-founder Krittin Tipsang told Asia Focus.
PillPocket also has a medication reminder function that triggers alerts via chat and a component that helps the user keep track of his or her general health condition.
EyeDEA, meanwhile, is developing a two-in-one medication card and wearable device to improve elderly glaucoma patients' compliance with essential eye drop usage. The personalised wallet-size medication card presents the medications in easily understood visuals.
The customised wearable has an alarm that reminds glaucoma patients when to use their eye drops and it can also track usage. The data can be shared automatically with physicians and caregivers and is a smart solution for elderly people who have poor vision and do not like smartphones.
Wearable devices connected to smartphones are potential game-changers in the healthcare industry because the data collected -- heart rate, blood pressure, stress levels and other vital signs -- can be monitored in real time and easily shared with the appropriate care providers.
While apps can never address all the issues associated with ageing, they are a step in the right direction, Mr Buksh said. However, developing an in-house application might not be an option for many conventional healthcare businesses.
Another option is an inorganic growth strategy via mergers and acquisitions. But the companies pursuing this approach are not necessarily traditional healthcare providers.
Tencent, one of China's largest internet companies, has already invested in more than 60 startups through its investment arm, Tencent Exploration, and around 40% of them are related to health and wellness.
Along with its other big Chinese peers Alibaba and Baidu, Tencent now has a team in Israel looking for healthcare startups to tie up with, Levi Shapiro, founder of the non-profit organisation mHealth Israel, told the Nikkei Asian Review earlier this month.
DATA DOCTORS
SoftBank Group, Japan's leading internet and telecoms firm, has teamed up with TechMatrix to establish ways for hospitals to share medical data such as X-ray, CT and MRI images.
Radiologists who examine these images look for shades or colours that indicate the presence of abnormal or cancerous tissue and other conditions. But in the future a doctor will also be able to look at a patient's statistics and use an algorithm to compare them to other similar patients, said Reenita Das, a partner with Frost & Sullivan, a California-based consultancy.
According to KPMG, venture capital firms made 97 investments worth around US$1.37 billion -- double the figure of five years earlier -- in Asian healthcare, pharmaceutical and biotech ventures last year. The increase reflects rising interest in the potential of the healthcare market, which in Asia excluding Japan will be worth $800 billion by 2025 compared with $300 billion in 2016, according to Frost & Sullivan.
In Japan, the only Asian country with life expectancy above 80 years, the healthcare market is worth $180 billion and is expected to reach $200 billion by 2025.
Discovering and developing new drugs is extremely expensive, but new technology is already driving down spending on treatment because most of the treatments that can be found have now been found, says Mr Buksh. The shift in spending is now moving toward prevention.
Frost & Sullivan has projected that spending on treatment will shrink to 51% of total healthcare costs by 2025 compared with 70% in 2007. Spending on monitoring, prevention and diagnosis will, however, grow to 49% from 30%.
McKinsey & Company forecasts that use of Big Data and a greater focus on prevention could reduce US healthcare spending by between $300 billion and $450 billion, or 12-17% of the $2.6 trillion the country spent in 2011. Online scheduling, digitally stored health data and electronic payments could also reduce administrative costs, which account for 16% of spending in the US healthcare system.
McKinsey has also estimated that proper use of Aspirin by people at risk of heart disease, combined with early cholesterol screening and smoking cessation, could reduce the total cost of their care by more than $30 billion. Advanced data analysis can help by providing faster identification of high-risk patients, more effective interventions and closer monitoring.
Some of the new monitoring devices include a GPS-enabled tracker that records inhaler usage by asthmatics, developed by Asthmapolis. The data can help physicians develop personalised treatment plans and spot prevention opportunities.
Another example is a mobile app being developed by Ginger.io that assists with behavioural-health therapies. Data that patients agree to share with therapists -- such as calls, texts, location and physical movements -- can tell the care provider if a patient feels physically unwell or anxious because they can see the patient is not moving around as much or sleep patterns are irregular.
HUMAN TOUCH
Applications, chatbots, wearable technology and Big Data are clearly part of a healthcare future in which patients will spend less time at hospitals while professionals can monitor them from anywhere in real time. However, Mr Buksh believes the judgement of medical professionals is still irreplaceable.
"At least in my lifetime, I don't think we will see a replacement of human medical professionals with artificial intelligence in its entirety, but what we are going to see is continuous growth in the utility of technology to try and improve the quality of healthcare that is being provided, and that can only be a good thing," he said.
One area where the human touch remains indispensable is in guarding against the danger of self-medication, especially with prescription drugs, where the direct supervision and instruction of a qualified professional is critical.
"We are all hoping that we will have a job by the time we finish innovating," Prof Wong Tien Yin of the Singapore National Eye Center observes wryly.
"It is true that there is some concern but it is a little bit misplaced because most physicians now realise that the skills that we have learned cannot be easily replaced and those skill sets are involved with the human touch," he said at Innovfest Unbound 2017, a seminar organised by NUS Enterprise this month.
"This includes empathy, listening to patients, caring for patients, and it is about understanding their needs and all those things are not that simple to replace."
However, there are a lot of things that physicians do not want to do and Prof Wong hopes this work can be delegated to technology. This includes dealing with data where doctors have to order a lot of tests and then spend a lot of time analysing them.
"Why do we need to do this when we can ask a computer? When you go to search for something on Google you don't want to know the algorithm or how it works, you just want to know the answer," he said.
