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August 6, 2017
Hospitals in Yangon Industry Survey
Author
Thidar Soe
Tel: (95) 9 42 112 6155
Tel: (95) 9 79 589 0758
First Rangoon Corporation
148 A1 Street
Yangon, RGN 11061
Myanmar
As Myanmar undergoes political and economic openings,
healthcare industry is witnessing profound changes. Our
analysis suggests that there are significant demand and
spending power in Myanmar for quality healthcare and
medical products.
In recent years, public outcry has led to increases in government
health budget, and economic liberalization has led to Burmese
individuals and businesses looking abroad for better products
and services.
This is the second of three reports that First Rangoon has
compiled to analyse the healthcare sector in Myanmar. The first
report provided a general overview of history and current
condition of Myanmar's healthcare sector. This second report
will be an industry analysis on hospitals in Yangon, followed by
a third report on pharmaceutical and medical equipment market
in Myanmar. These segments are identified as areas where
there are large needs and ample opportunities.
There are not enough quality providers of healthcare in
Myanmar. By 2030, Myanmar will need to build around 140
hospitals and spend up to $3 billion on building new hospitals
and acquiring quality medical facilities and instruments.
Emerging middle class is accustomed to paying for
healthcare services out-of-pocket. By 2030, annual private
healthcare spending is expected to reach $7.8 billion – growth
of 17.5% annually.
Public and private sector demand for pharmaceutical
products is increasing. The government has increased
procurements, and customers are moving upmarket; annual
imports of medicines will reach $1.3 billion by 2020.
There is a shortage of qualified specialist doctors
presently. Number of doctors, nurses, and dentists per capita
is low, and waiting periods to see specialists are long. In-country
and overseas further education is much in demand.
Hospitals in Yangon
March 25, 2019 2
Contents
Hospitals in Myanmar Survey .......................................................................................................... 3
Medical Departments ................................................................................................................. 11
Medical Staff ............................................................................................................................... 14
Revenues and Costs .................................................................................................................. 20
Medical Travel ............................................................................................................................ 27
Data Envelopment Analysis ........................................................................................................... 28
Medical Agencies in Myanmar Survey........................................................................................... 30
Cost of Medicare Abroad............................................................................................................ 34
Medical Agency Staffing ............................................................................................................. 36
Prescription Filling ...................................................................................................................... 37
Appendix I: Hospital Room Amenities ........................................................................................... 37
Hospitals in Yangon
March 25, 2019 3
Hospitals in Myanmar
Major hospitals in cities such as Yangon and Mandalay already have a large pool of middle-class
consumers. Yet, as the consumer class grows, they will look for more sophisticated healthcare
services. The recent relaxation of laws governing foreign investment in healthcare, coupled with
current lack of high-quality government healthcare facilities, may provide opportunities for foreign
healthcare providers.
Multinational companies and regional companies across ASEAN, have invested in Myanmar’s
healthcare sector, especially in provision of medical equipment, and hospital operation. First
Myanmar Investments Co Ltd (FMI) and Indonesian conglomerate Lippo Group has a healthcare
joint venture which planned a $420 million national roll of 20 hospitals within the decade. In the
initial phrase, Pun Hlaing Siloam Hospital in Yangon underwent a $10-million upgrade of
equipment, systems and services. Thonburi Hospital Group (THG), Thailand’s third-largest private
hospital group, is working with Ga Mone Pwint company (GMP Group) to build two hospitals in
Yangon, worth $100 million. Malaysian firm IHH Healthcare is building a US$70 million 250-bed
hospital in Yangon through a Singaporean subsidiary; the new Parkway Yangon Hospital is
expected to open in 2020.
In July 2017, a questionnaire containing twenty-seven questions was surveyed at fourteen
hospitals, all of them located in the Yangon region. The full questionnaire is included in Appendix
II.
The surveyed hospitals, in alphabetical order, are:
Name Township Location
Academy Ahlone
Asia Royal Sanchaung
Aung Yadanar Thingankyun
Bahosi Lanmadaw
Grand Hantha International Kamaryut
Maha Myine Sanchaung
Pin Lon North Dagon
Pun Hlaing Hlaing Tharyar
Sakura Sanchaung
Shin Par Ku Tamwe
Shwe La Min Lanmadaw
SSC Bahan
Thuka Gaba Kamaryut
Witoriya Mayangone
Before the questionnaire is conducted, the surveyor is required to ascertain the cleanliness of the
hospital visually. This is done so in order for First Rangoon to establish a proxy for patient
satisfaction and an additional proxy input for data envelopment analysis. It should be noted that
cleanliness variable can also be used as a baseline to categorize whether a hospital is “Tier-1”,
“Tier-2”, or “Tier-3”, but we haven’t done so in the following pages, as the sample size is small.
Surveyor is asked to rank the hospitals on a scale of one to ten, with one being bad, and ten being
excellent.
Apart from one hospital, Aung Yadanar in Thingankyun township, the rest scored above 7 on visual
cleanliness inspection. Only one, Pun Hlaing hospital, scored the perfect score of ten.
Hospitals in Yangon
March 25, 2019 4
List of Figures
Figure 1: How many Beds do you have in the Hospital? ........................................................................ 5
Figure 2: What is the average daily occupancy? .................................................................................... 6
Figure 3: What percentage of beds is used by surgery patients?........................................................... 7
Figure 4: What types of rooms do you have in your hospital? ................................................................ 8
Figure 5: How many out-patients do you received daily? ....................................................................... 9
Figure 6: How many X-rays do you perform daily? ............................................................................... 10
Figure 7: Percentage of Hospitals with the Following Departments ..................................................... 11
Figure 8: Do you offer the following services? ...................................................................................... 12
Figure 9: How many operation theatres do you have? ......................................................................... 13
Figure 10: How many administrative staff do you have?? .................................................................... 14
Figure 11: How many doctors (non-specialists) do you have?? ........................................................... 15
Figure 12: How many nurses do you have?? ....................................................................................... 16
Figure 13: Number of Staff Per Bed ...................................................................................................... 17
Figure 14: Average Number of Specialists by Department ................................................................... 18
Figure 15: Average Number of Technicians by Service ....................................................................... 19
Figure 16: How many duty shifts do you have per day? ....................................................................... 20
Figure 17: Hospital Manpower by Shift ................................................................................................. 20
Figure 18: What is the price of walk–in consultation with General Practitioner (Non-Specialist)? ....... 21
Figure 19: What are the prices of rooms and overnight stays at the hospital? ..................................... 22
Figure 20: Specialists’ Commission ...................................................................................................... 23
Figure 21: Specialists’ Salaries ............................................................................................................. 24
Figure 22: Doctors’ Salaries .................................................................................................................. 25
Figure 23: Nurses’ Salaries ................................................................................................................... 26
Figure 24: Nurses’ Shift Salaries .......................................................................................................... 26
Figure 25: Which countries do your patients typically go? .................................................................... 27
Figure 26: Efficiency Levels Based on DEA ......................................................................................... 29
Figure 27: How many patients do you have in the Hospital? ................................................................ 31
Figure 28: What are the diseases/procedures for which patients go abroad? ..................................... 32
Figure 29: Hospital Room Rates Per Night ........................................................................................... 34
Figure 30: Cost of Medical Treatment Abroad ...................................................................................... 35
Figure 31: Days Needed to Fill Foreign Prescriptions .......................................................................... 37
Hospitals in Yangon
March 25, 2019 5
Average number of beds varies from 70 to 200, with mean of 140 (and median of 150). Grand
Hantha International Hospital noted that it will be expanding from 200-bed to a 700-bed hospital,
which will make it the largest hospital in Yangon.
Figure 1: How many Beds do you have in the Hospital?
Source: Survey Data
0 20 40 60 80 100 120 140 160 180 200
Thuka Gaba
Shin Par Ku
Academy
Maha Myine
Witoriya
Pun Hlaging Hospital
Aung Yadanar
Sakura
Shwe La Min
Bahosi
SSC
Asia Royal
Grand Hantha International
Pin Lon
Hospitals in Yangon
March 25, 2019 6
Average daily occupancy varies from 60% to 100%, with mean of 82.5% (and median of 80%).
From these two questions, we can note that of 1,964 beds surveyed, 1,604 beds are occupied.
Figure 2: What is the average daily occupancy?
Source: Survey Data
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Maha Myine
Grand Hantha International
Pin Lon
Sakura
Academy
Shwe La Min
SSC
Witoriya
Asia Royal
Bahosi
Thuka Gaba
Shin Par Ku
Aung Yadanar
Pun Hlaing Hospital
Hospitals in Yangon
March 25, 2019 7
Of 1,604 occupied beds, 1,041 beds are taken up by patients awaiting/recovering from surgeries.
This suggests that around 65% (mean of 64%, median of 70%) of beds are used for surgery.
Standard deviation is 27.6%.
Therefore, if there is a need for imposing a protection level to reserve capacity for surgeries, the
hospitals should use mean of 64% and standard deviation of 27.6% along with critical fractile score
of net contributing margin per procedure.
Figure 3: What percentage of beds is used by surgery patients?
Source: Survey Data
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Hospitals in Yangon
March 25, 2019 8
Of these beds, some hospitals reserve some in private rooms and double rooms. (Hospitals
where there are double rooms are designated with an asterisk below).
The percentage of private rooms vary from a fraction in some hospitals to totality in others. For
instance, at SSC and Witoriya, all rooms are private single rooms.
Figure 4: What types of rooms do you have in your hospital?
Source: Survey Data
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Witoriya
SSC
Shin Par Ku*
Sakura
Pun Hlaing Hospital*
Pin Lon
Maha Myine
Grand Hantha International
Aung Yadanar
Asia Royal*
Academy
Private Deluxe Private Special Private Single/Double* Beds in Hall
Hospitals in Yangon
March 25, 2019 9
Average number of patients daily ranges from around 100 at Pun Hlaing hospital to up to 2,000
at four hospitals.
Median figure is 1,000, and mean is 983, with standard deviation of 497 patients.
In addition of these patients who are local, the hospitals also receive a very small number of foreign
patients. At Asia Royal Hospital, they receive up to five foreign patients per day, due to their
affiliation with SOS International, but at other hospitals it varies from 1-3 foreign patients per day
to as few as one per week.
Figure 5: How many out-patients do you received daily?
Source: Survey Data
-
500
1,000
1,500
2,000
2,500
Nu
mb
er o
f P
atie
nts
Dai
ly
Low High Average
Hospitals in Yangon
March 25, 2019 10
We also surveyed how many X-rays each of these hospitals perform daily. This is a measure which
can be used as a proxy for laboratory and testing services usage, as in Myanmar, general
practitioners and private clinics refer patients to larger hospitals for these services.
As noted below, hospital’s radiology departments are not strongly utilized in Myanmar, with even
bigger hospitals only performing 2-3 X-rays per day, compared to over 1,000 patients they see
each day.
Figure 6: How many X-rays do you perform daily?
Source: Survey Data
0 1 2 3 4 5
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Hospitals in Yangon
March 25, 2019 11
Medical Departments
In hospitals in Yangon, the most common medical departments are Accident & Emergency
(A&E)/Casualty, Anesthetises, Ear Nose and Throat, Surgery, Gynaecology (OG), Nephrology,
Neurology, Paediatrics, Radiology/Radiotherapy and Urology. All the surveyed hospitals have
them.
The least common department is plastic surgery department. Only Pun Hlaing hospital and Grand
Hanthar have a dedicated department to plastic surgery.
Figure 7: Percentage of Hospitals with the Following Departments
Source: Survey Data
All hospitals have diagnostic imaging services in location, and in other locations affiliated with the
hospital. Two hospitals, Witoriya and Pin Lone also serve as partner hospitals to which other two
hospitals, Sakura and SSC respectively, refer diagnostic imaging patients.
All percent of hospitals have laboratory services in location, and in other locations affiliated with
the hospital. Three clinics -- Ni Ni Lab, NHL, Parami – are used for some laboratory services.
All of the hospitals surveyed have ambulance services.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Accident & Emergency (A&E)/Casualty
Anesthetises
Cardiology
Critical Care
Dental Care
Ear Nose and Throat
Gastroenterology
Surgery
Gynaecology (OG)
Haematology
Maternity Ward
Nephrology/Kidney Department
Neurology
Oncology/Cancer
Ophthalmology/Eye care
Orthopaedics + Rheumatology
Physiotherapy
Paediatrics/Childcare
Radiology/Radiotherapy
Urology
Dermatology
Chest
Psychiatric Care
Liver
Plastic Surgery
Hospitals in Yangon
March 25, 2019 12
All of the hospitals surveyed have pharmacy attached to the hospital.
In hospitals in Yangon, the most common technical service are Ultrasound, General Radiography,
and Annual Medical Check-ups. All the surveyed hospitals offer them. The least common are
pacemaker insertion and mammograms.
Figure 8: Do you offer the following services?
Source: Survey Data
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%
Annual Medical Check-up
Breast Screening/Mammogram
Electrocardiogram (ECG)
Pacemaker Insertion
Echocardiogram
General Radiography (X-ray)
Ultrasound
Angiography
CT Scan
MRI Scan
Endoscopy
Hospitals in Yangon
March 25, 2019 13
Yangon hospitals have on average 6.4 operation theatres (with standard deviation of 3.6).
Median value is 6, and Grand Hantha Hospital is an extreme outlier – with 17 operation theatres.
Figure 9: How many operation theatres do you have?
Source: Survey Data
0 2 4 6 8 10 12 14 16 18
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Hospitals in Yangon
March 25, 2019 14
Medical Staff
Number of administrative staff varies from 160 in Shin Par Ku to 1500-2000 at Pun Hlaing hospital.
Median value is 1,000, with mean of 897 and standard deviation of 496.
Figure 10: How many administrative staff do you have??
Source: Survey Data
0 200 400 600 800 1000 1200 1400 1600 1800 2000
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Hospitals in Yangon
March 25, 2019 15
Number of non-specialist doctors varies from 25 to 300.
Median value is 100; with mean of 145 and standard deviation of 98.
Number of foreign doctors is still extremely limited – only 27 doctors across all hospitals surveyed.
Pun Hlaing has 14 foreign doctors, and three other hospitals have foreign doctors (Foreign doctors
are excluded from mean-value calculations).
Figure 11: How many doctors (non-specialists) do you have??
Source: Survey Data
Median value of nurses is 150; with mean of 275 and standard deviation of 253.
Asia Royal Hospital is the extreme outlier – with 1,000 nurses. Excluding Asia Royal, mean is 219,
with standard deviation of 160.
0 50 100 150 200 250 300 350
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Local Doctor Foreign Doctors
Hospitals in Yangon
March 25, 2019 16
Figure 12: How many nurses do you have??
Source: Survey Data
0 200 400 600 800 1000 1200
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Hospitals in Yangon
March 25, 2019 17
In addition to numerical values, we should also pay attention to staffing levels on per bed basis.
Our analysis suggests that the staffing levels are as follows, on per bed basis:
Beds Admin Doctors Nurses
median 6.3 0.9 1.5
mean 6.3 1.0 1.8
st dev 3.1 0.5 1.2
Figure 13: Number of Staff Per Bed
Source: Survey Data
- 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Nurses Doctor Admin
Hospitals in Yangon
March 25, 2019 18
Specialist staffing differs dramatically from department to department. Gynaecology departments
are the best staffed – with average of 17.4 doctors per hospital (with max of 42), followed by
maternity wards and A&E.
Dermatology, haematology, and psychiatric care departments are least staffed.
Note: the figures include On-Call Doctor figures, and foreign specialists who flew in from time to
time.
See the raw data for more details, and breakdown by hospital.
Figure 14: Average Number of Specialists by Department
Source: Survey Data
In addition to specialists, there is a small group of supporting technical staff.
This staff can be as few as 11 or as many as 102. Mean-value is 58 persons, with standard
deviation of 27.5.
- 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0
Chest
Haematology
Psychiatric Care
Dermatology
Neurology
Ophthalmology/Eye care
Liver
Oncology/Cancer
Ear Nose and Throat
Plastic Surgery
Physiotherapy
Urology
Gastroenterology
Nephrology/Kidney Department
Radiology/Radiotherapy
Cardiology
Orthopaedics + Rheumatology
Dental Care
Paediatrics/Childcare
Anesthetises
Critical Care
Surgery
Accident & Emergency (A&E)/Casualty
Maternity Ward
Gynaecology (OG)
Min Average Max
Hospitals in Yangon
March 25, 2019 19
General Radiography and Ultrasound are the best staffed on average – with average of 8.6 and
7.9 technicians per hospital respectively (with max of 15).
Seven other services are staffed at a maximum of ten per service, with endoscopy having the least
amount of dedicated technicians – just 5.6 average across just seven hospitals which offer it.
Figure 15: Average Number of Technicians by Service
Source: Survey Data
0 5 10 15 20 25
Endoscopy
Echocardiogram
Breast Screening/Mammogram
CT Scan
Pacemaker Insertion
Angiography
MRI Scan
Annual Medical Check-up
Electrocardiogram (ECG)
Ultrasound
General Radiography (X-ray)
Min Average Max
Hospitals in Yangon
March 25, 2019 20
Typically, hospitals in Yangon have 2-3 duty shifts, with dual shifts being more common.
In dual shift hospitals, the shift times normally run from 7 am – 7 pm, and from 7 pm to 7 am.
In triple shift hospitals, the shift times are normally from 7 am – 1 pm, 1 pm – 7 pm and from 7 pm
to 7 am.
Manpower (both doctors and nurses) is almost always equally divided between shifts. Outliers are
Pun Hlaing hospital and Shwe La Min hospital, which have slight fewer doctors and nurses during
morning shifts.
Figure 16: How many duty shifts do you have per day?
Source: Survey Data
Figure 17: Hospital Manpower by Shift
Source: Survey Data
Revenues and Costs
The price of walk–in consultation with General Practitioner (Non-Specialist) has median value of
10,000. (Mean of 13,750 kyats, with standard deviation of 7322).
Price of walk-in consultation varies with time, with evening/night visits costing around 10,000 kyats
more.
71%
29%
2 shifts
3 shifts
0 10 20 30 40 50 60 70
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Nurses Doctors
Hospitals in Yangon
March 25, 2019 21
The diagram below are prices for locals. For foreigners, walk-in consultation fees vary from $30 -
$55.
Figure 18: What is the price of walk–in consultation with General Practitioner (Non-Specialist)?
Source: Survey Data
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
Hospitals in Yangon
March 25, 2019 22
The price of over-night stay in a hospital room varies from 200,000 kyats to 25,000 kyats. Overnight
stay at a hospital hall has minimum value of 7,000 kyats.
Yangon region therefore has maximum overnight cost of 200,000 kyats, minimum of 7,000 kyats,
median value at 45,000 kyats, and mean of 55,069 kyats (with standard deviation of 43,592 kyats).
For room types and amenities, please see Appendix I, or raw data.
Figure 19: What are the prices of rooms and overnight stays at the hospital?
Source: Survey Data
Hospitals in Yangon
March 25, 2019 23
Apart from Pun Hlaing hospital, all other hospitals paid specialists commission based on the
number of patients they see.
This commission ranges from 50% to 100% of the consulting fees – ten hospitals paid the
specialists the full 100%.
Figure 20: Specialists’ Commission
Source: Survey Data
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Hospitals in Yangon
March 25, 2019 24
The specialists’ salaries are based primarily on their commission payments. However, the range
can differ dramatically based on the hospital’s footfall.
Mean-value is 1.28 million kyats – with standard deviation of 0.48 million.
Figure 21: Specialists’ Salaries
Source: Survey Data
500,000
1,000,000
1,500,000
2,000,000
2,500,000
Hospitals in Yangon
March 25, 2019 25
Doctors’ salaries vary from 500,000 kyats to 1 million kyats, with the salary band between
800,000-1,000,000 kyats being most common.
Mean-value is 789,286 kyats – with standard deviation of 181,441.
Figure 22: Doctors’ Salaries
Source: Survey Data
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
1,100,000
Hospitals in Yangon
March 25, 2019 26
Nurses are either paid for by the hospital or engaged by the patient.
Nurses’ salaries from hospital vary from 300,000 kyats to 1 million kyats. Mean-value is 462,857
kyats – with standard deviation of 138,844. Nurses engaged by the patient are paid from 3,000
kyats to 35,000 kyats per shift. Mean-value is 10,786 kyats – with standard deviation of 6,149. In
both scenarios, Asia Royal is an extreme outlier.
Figure 23: Nurses’ Salaries
Source: Survey Data
Figure 24: Nurses’ Shift Salaries
Source: Survey Data
200,000
400,000
600,000
800,000
1,000,000
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Hospitals in Yangon
March 25, 2019 27
Medical Travel
All hospitals indicated that they refer serious patients to Yangon General Hospital (YGH). However,
nearly all respondents indicated that patients prefer to go abroad.
Patients primarily go to Thailand (67%) and Singapore (26%), followed by Malaysia, India, and the
US.
Figure 25: Which countries do your patients typically go?
Source: Survey Data
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yangon Total
Witoriya
Thuka Gaba
SSC
Shwe La Min
Shin Par Ku
Sakura
Pun Hlaing Hospital
Pin Lon
Maha Myine
Grand Hantha International
Bahosi
Aung Yadanar
Asia Royal
Academy
Thailand Singapore Malaysia India USA
Hospitals in Yangon
March 25, 2019 28
Data Envelopment Analysis
The data envelopment analysis (DEA) method can be used to determine whether a hospital is
operating efficiently. Specifically, DEA is used by inefficient organizations to benchmark efficient
and best-practice organizations.
In a general DEA analysis, a hospital’s inputs and outputs are first be defined. Then for each input
or output, a unit of measurement must be selected. Neither of these is necessarily an easy task,
because organizations such as hospitals consume a variety of inputs and produce a variety of
outputs that can be measured in alternative ways.
To keep the model small, we assume that each hospital uses three inputs to produce three outputs.
The inputs are:
• input 1: capital (measured by hundreds of hospital beds)
• input 2: high-cost labor (measured by number of doctors per shift)
• input 3: low-cost labor (measured by number of nurses per shift)
The outputs produced by each hospital are
• output 1: out-patients (measured by average daily number of out-patients)
• output 2: in-patients (measured by average daily occupancy of beds)
• output 3: cleanliness (measured visually by surveyor)
DEA shows that in efficient hospitals, inputs and outputs can be priced in such a way that this
hospital gets out all of the value that it puts in. The pricing scheme depends on the hospital.
Each hospital tries to price inputs and outputs to put its operations in the best possible light.
If DEA finds that a hospital is inefficient, there is no pricing scheme where that hospital can
recover its entire input costs in output values. Thus, inputs are wasted or hospital will have to
increase output prices and hence become uncompetitive among its peer group. DEA simply shows
that if a hospital is inefficient, then a combination of the efficient hospitals can be found that uses
no more inputs than the inefficient hospital, yet produces at least as much of each output as
the inefficient hospital. In this sense, the hospital is inefficient.
Hospitals in Yangon
March 25, 2019 29
Figure 26: Efficiency Levels Based on DEA
Efficiency Score
1 Academy 86.4%
2 Asia Royal 86.9%
3 Aung Yadanar 100.0%
4 Bahosi 91.2%
5 Grand Hantha International
75.6%
6 Maha Myine 82.4%
7 Pin Lon 80.0%
8 Pun Hlaing Hospital 100.0%
9 Sakura 75.0%
10 Shin Par Ku 100.0%
11 Shwe La Min 81.5%
12 SSC 88.1%
13 Thuka Gaba 100.0%
14 Witoriya 86.4%
Source: Survey Data
Using above three inputs and three outputs, we find four hospitals are DEA-efficient – i.e., their
output levels are priced-justified by their input levels.
It should be noted that Aung Yadanar, which scored low on cleanliness, is DEA-efficient. This is
because it enjoys high occupancy and footfall, while maintaining low staffing levels. On the
opposite end, Pun Hlaing hospital also scored 100%, based on high occupancy and cleanliness
but has low footfall. These two examples show different efficient frontiers possible in health
services sector in Myanmar.
For inefficient hospitals, they can increase their score by reducing inputs or increasing outputs. For
instance, Pin Lon hospital, which scored 80%, can increase their outputs by 20% or decrease their
inputs by 20% to approach the efficient frontier.
Disclaimer: DEA-efficient hospitals can be found inefficient, and vice versa, if different
inputs/outputs are used to measure them.
Hospitals in Yangon
March 25, 2019 30
Medical Agencies in Myanmar Survey
Due to the lack of international quality healthcare services currently available in Myanmar, many
affluent Myanmar citizens and foreign expatriates prefer to fly to neighbouring countries, such as
Thailand, Malaysia, India and Singapore, to receive medical treatment. Thailand is the preferred
choice due to its proximity, similar culture, low costs, and the fact that it offers visa exemption to
Myanmar nationals. Many Myanmar citizens are interested in foreign healthcare treatments;
however, lack of information on foreign companies and concern over language barriers limit their
ability to access these foreign treatments. To attract this customer group, many foreign hospitals
have now established subsidiary offices in Myanmar.
Some foreign-partnered hospitals in Myanmar, mostly from Thailand, are as follows:
• Bangkok Hospital (Thailand)
• Bumrungrad Hospital (Thailand)
• Chaophya Hospital (Thailand)
• Praram 9 Hospital (Thailand)
• Samitivej Hospital (Thailand)
• Vejthani Hospital (Thailand)
• Vibhavedi Hospital (Thailand)
• Yanhee Hospital (Thailand)
• Parkway Hospital (Singapore)
• Raffles Hospital (Singapore)
• Singapore General Hospital (Singapore)
• Tan Tock Seng Hospital (Singapore)
• Amri Hospital (India)
• Apollo Hospital (India)
• Mahkola Hospital (Malaysia)
In July 2017, a questionnaire containing twenty-seven questions was surveyed at five medical
tourism agencies, all of them located in the Yangon region. The full questionnaire is included in
Appendix III.
The surveyed agencies are:
Name Township Location
Sea Lion Group Botataung
Nakornthon healthcare San Chaung
Bangpakok Kamayut
Pacific Medical Center Bahan
Enquiry Ulink Myanmar Botataung
As the survey sample size, as indicated by the client is small, we have tried to have a diverse
group of respondents.
Sea Lion Group is a large medical agency – with 11 branches throughout Myanmar. The other four
are single outlet small medical agencies. Altogether, they are partnered with 12 hospitals in three
countries. Broadly speaking, three of them send patients mainly to Thailand, and the other two
send patients to Singapore and India respectively. This mix is chosen in accordance with the
answers from a previous questionnaire in Chapter 2. (It should be noted that all the surveyed
agencies sent out their patients to Thailand for surgery).
Hospitals in Yangon
March 25, 2019 31
Of the firms surveyed, one firm – Bangpakok – operates on a clinic model, where locals can also
see specialists and doctors in Yangon.
As the sample size is small and respondents are varied, it is instructive for the client to refer directly
to the raw data in certain cases.
Sea Lion agency receives around 500 patients per month – 45 patients per branch.
Smaller agencies receive around on average 7.75 patients per month, and they manage to send
out 5.5 patients per month abroad.
72% of all these patients sent out are in-patients, and others are out-patients.
No foreigner usage is detected in the surveyed sample.
Figure 27: How many patients do you have in the Hospital?
Agency New Patients Per Month (A)
Patients Sent Out Per Month (B)
Of (B), in-Patients
Of (B), out-Patients
Sea Lion Group 500 500 N/A N/A
Nakornthon Healthcare 6 2 0 2
Bangpakok 10 8 8 0
Pacific Medical Center 10 7 5 2
Enquiry Ulink Myanmar 5 5 3 2
Source: Survey Data
Among those who go abroad, the main purpose is for surgery – 24% of all those who go abroad
for medical treatment go for surgery. This is followed by Annual Medical Check-up at 22.0%,
Kidney diseases at 17%, and Cancer treatments at 12%, Cardiology at 8%, and Dental Care at
4%.
Other twelve procedures make up the remaining 13%.
For seven treatments, patients do not go abroad. They are anaesthesiology, A&E, cardiology,
maternal care, psychiatry, radiology, and urology.
Hospitals in Yangon
March 25, 2019 32
Figure 28: What are the diseases/procedures for which patients go abroad?
Source: Survey Data
Note: In the survey in Chapter 2, we found that patients primarily go to Thailand (67%) and
Singapore (26%), followed by Malaysia, India, and the US. Weighed by the treatment, in our
surveyed sample, 66.2% of patients go to Thailand, 15.4% of patients go to Singapore, and 18.4%
of patients go to India. Using this market share, we can survey-adjust the preceding data.
With market share adjusted, surgery patients are 27% of all those who go abroad. This is followed
by Annual Medical Check-up at 20.5%, cancer treatments at 15%, and kidney treatments at 10%,
Cardiology at 9% and Dental Care at 4.9%.
Surgery24%
Annual Medical Checkup
22%
Nephrology/Kidney Department
17%
Oncology/Cancer12%
Cardiology8%
Dental Care4%
Others13%
Hospitals in Yangon
March 25, 2019 33
The reasons patients go abroad are listed below:
Agency 1
• Medical check-up results are more trustworthy than in Myanmar
• Medical treatment is fast & good
• More trust
Agency 2
• Seeking better services
• Trust the quality of foreign hospital/medical personnel more than local ones
• Unavailability of some services (e.g. artificial insemination) in local ones
Agency 3
• Weak technologies in local hospitals
• More perfect medicine and medical equipment
• Wealth enables patients to go abroad
Agency 4
• lower cost than other alternative countries to go
• Better treatment
• Food & services support are better than in Myanmar
Agency 5
• Better Care
• Better Technology & Treatment
• Medical services are better
Hospitals in Yangon
March 25, 2019 34
Cost of Medicare Abroad
Medical Package costs vary from $300 to $30,000, depending on the procedures involved.
Agency Cost
Sea Lion Group $300-$1435
Nakornthon Healthcare $300
Bangpakok $2000-$30000
Pacific Medical Center $1500-$25000
Enquiry Ulink Myanmar $1500-30,000
Hospital Room Rates abroad vary from $50 to $700, with average of $210. Median is $200, with
standard deviation of 133.33.
Figure 29: Hospital Room Rates Per Night
Source: Survey Data
Transportation costs for patients to go abroad vary from $100 to $300.
US$ Thailand India Malaysia Singapore
Average 191 240 250 250
Median 180 200 250 300
StDev 49 49 41 71
0
100
200
300
400
500
600
700
800
USD
Hospitals in Yangon
March 25, 2019 35
Medical Procedure Costs are varied and depends on the detailed procedure. However, a
generalized cost structure is produced below for the most common ailments.
Most expensive treatments are for Cardiology and Oncology/Cancer – two ailments for which large
number of Burmese people go abroad.
Average cost of cardiology treatment is $60,875 – with minimum at $15,000 and maximum at
$200,000. Average cost of oncology treatment is $100,000 – with minimum at $10,000 and
maximum at $200,000.
For others, the cost structure is as follows:
Figure 30: Cost of Medical Treatment Abroad
Source: Survey Data
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
US$
Min Max Average
Hospitals in Yangon
March 25, 2019 36
Medical Agency Staffing
Medical Agency staffing varies from company to company. Sea Lion which has 11 branches has
only one doctor per branch, while Nakornthon Healthcare, affiliated with the hospital of the same
name in Thailand, has 30 doctors working for them.
Two of five firms have foreign specialists working for them in Yangon; and one firm has one foreign
specialist visit from abroad per month.
Number of Doctors
Number of Foreign
Specialists
Number of Foreign
Specialist Visits from Abroad per
month
Sea Lion Group 11 No No
Nakornthon Healthcare 30 No No
Bangpakok 2 2 1
Pacific Medical Center 4 No No
Enquiry Ulink Myanmar 5 3 No
Hospitals in Yangon
March 25, 2019 37
Prescription Filling
Another business for medical agencies is prescription filling – import of medicine when a patient
orders prescription medicine (prescribed by doctors at hospitals abroad). On average, it takes two
weeks for medical agencies to fill foreign prescriptions.
Figure 31: Days Needed to Fill Foreign Prescriptions
Source: Survey Data
0
5
10
15
20
25
30
35
Sea Lion Group NakornthonHealthcare
Bangpakok Pacific Medical Center Enquiry UlinkMyanmar
Nu
mb
er o
f D
ays
Hospitals in Yangon
March 25, 2019 38
Appendix I: Hospital Room Amenities
Academy
Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa.
Type(B): Single room, Bed chair, Air-Conditioned, Fridge, TV, en-suite bathroom,
Hall: Air-Conditioned
Asia Royal
Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, water-
cooler
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Special (C): Double room, bed, locker, Air-Conditioned
Hall: Air-Conditioned
Aung Yadanar
Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa
Type(C): Single room Air-Conditioned, Fridge, TV, en-suite bathroom
Hall: Air-Conditioned
Bahosi
Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, locker
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Type(C): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Hall: Air-Conditioned
Grand Hantha International
Type(A, B ): Deluxe suite
VIP Hall: Air-Conditioned, Fridge, TV
Hall: Air-Conditioned
Maha Myine
Type(A): Single room, bed chair, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa
Type(B): Single room, bed chair, Air-Conditioned, Fridge, TV, en-suite bathroom
Type(C):
Hall: Air-Conditioned
Pin Lon
Type(A): 2-room, Extra Bed, Air-Conditioned, Fridge, 2 TVs, en-suite bathroom, sofa, breakfast-
included, wardrobe
Type(B): 2-room, Extra Bed, Air-Conditioned, Fridge, 2 TVs, en-suite bathroom, sofa, breakfast-
included, wardrobe
Type(C): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa,
breakfast-included
Hall: Air-Conditioned, Fridge, TV
Pun Hlaing Hospital
Type(A): Deluxe suite
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, 2 TVs, en-suite bathroom, sofa, food-
support
Type(C): Double room, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, food-support
Hospitals in Yangon
March 25, 2019 39
Type (D): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, food-
support
Hall: Air-Conditioned
Sakura
Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Type(C): bed, chair, locker, Air-Conditioned
Hall: bed, chair, locker, Air-Conditioned
Shin Par Ku
Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Type(C): Double room, Air-Conditioned, TV, en-suite bathroom
Hall: TV, chair
Shwe La Min
Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, water-
cooler
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, water
Cooler
Type(C): Single room, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, water Cooler
Hall
SSC
Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Type(C): bed, locker, Air-Conditioned
Hall: Air-Conditioned
Thuka Gaba
Type(A): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, locker
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Type(C): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom
Witoriya
Type(A): Deluxe suite
Type(B): Single room, Extra Bed, Air-Conditioned, Fridge, TV, en-suite bathroom, sofa, food
Type(C): Single room, Air-Conditioned, Fridge, TV, en-suite bathroom