To many Asian hospitals, benchmarking is a new concept, as novel as such Western imports as line dancing and gourmet coffee bars.
When U.S.-based consulting firm Arthur Andersen undertook last year what it believes is the first East Asian hospital benchmarking survey, some hospitals had to be persuaded to complete a 25-page questionnaire that was designed to capture basic operating data.
The survey included about 100 facilities, mostly in Malaysia, Indonesia and Thailand.
"(Administrators) were saying to us, `I'm not used to sharing information. Why should I give you something?' " says Darryl Hadaway, Asia-Pacific director of Arthur Andersen's healthcare practice.
That was just the first obstacle in an ongoing effort to bring service improvements and cost efficiencies to countries with developing healthcare systems-an effort that Arthur Andersen started five years ago and hopes will pay off as those nations devote more resources to healthcare.
While countries such as Singapore and Japan have extensive access, strong quality control and cutting-edge information systems, others, including Indonesia, Malaysia, the Philippines, Thailand and South Korea, do not. Yet those developing nations have booming populations and-at least until the economic crisis hit in 1997-a growing middle class.
"Until seven or eight years ago, there wasn't much wealth in these countries. What you had was government mainly providing healthcare," says Hadaway, a native of Australia who moved to Indonesia 41/2 years ago. Quality and efficiency were on the back burner.
As a result, hospitals in the survey often couldn't provide such basic data as full-time-equivalent employees, patient case mix, length of operating procedures, readmission rates and infection rates.
Activity-based costing isn't generally practiced, which means that most hospitals don't know the profitability of various procedures, Hadaway says.
Despite the limited data, the first survey was an eye-opener for many participants. For example, hospitals in Indonesia saw dramatic cost differences between ward-style nursing and a model in which nurses were assigned to specific patients. In Malaysia, the survey revealed a 25% annual turnover rate in hospital staff, underutilization of operating rooms, and low productivity in clinical and nonclinical support areas.
The survey was published in July 1997, just before the financial crisis hit the region last year.
The crisis has sucked resources from healthcare, threatening the ability of hospitals to provide basic care and diminishing the prospects for healthcare development.
Before the downturn, healthcare had begun to evolve toward private hospitals and multihospital systems. Foreign investors were active in healthcare markets throughout Southeast Asia, according to Annapolis, Md.-based Taylor Associates International, which published a July 1997 study on international healthcare economic activity by the International Finance Corp., the lending arm of the World Bank, to the private sector.
At the time, Taylor rated India, Indonesia, the Philippines and Thailand as good climates for private- sector healthcare investment. According to Taylor, the four countries were developing middle-income, market-oriented economies with moderate to good growth prospects. Other pluses were considerable growth in the private healthcare sectors, a plentiful supply of well-trained physicians and nurses, and a growing market for private healthcare insurance.
Today, all of those countries would be in the poor-to-moderate category, says the firm's president, Robert Taylor. "Some projects that were in line (for development) are being held back until the financial future is more clear," Taylor says. "At best, it's a wait-and-see situation."
But Arthur Andersen says it is persevering with its benchmarking survey, and expects to triple the number of participants in a second, more detailed survey being prepared this fall, which will include hospitals in China, Japan and South Korea.
Rather than reduce interest in benchmarking, the current economic downturn in some ways enhanced it, Hadaway says. Hospitals are forced into tough choices about where to spend extremely limited capital, and governments want better data as more citizens turn to publicly funded care.
Hadaway predicts that some Asian governments may privatize groups of hospitals in the next 12 months, creating opportunities for foreign investment. "They need someone to help take away the pain," Hadaway says.