MR DAN Snyder sometimes lapses and refers to his favourite airline as 'Singapore Air'.
But there is no mistaking his desire to emulate Singapore Airlines.

'We want Parkway Holdings to be the Singapore Airlines of health care,' said the 51-year-old American.

Mr Richard Seow wanted to achieve the same thing too. That was why one of the first things he did when he was appointed chairman 20 months ago was to lead a six-month headhunt that last June snagged Mr Snyder as group vice-president and chief operating officer.

Mr Seow, a former investment banker whose resume includes stints in the world's most robust financial institutions like Citibank, Goldman Sachs and JP Morgan, says he saw a chance to turn Parkway into more than a regional brand for quality health care.

He saw a huge opportunity to create a global leader in integrated quality health care. Why? Because there isn't one now.

The time is right for Parkway, he said, but the timeline to achieve his target is tight.
Growth in medical travel is expected to hit the roof within the next five years. But every health-care group worth its salt here and abroad wants a piece of the action too.

For Singapore, the massive push in ramping up foreign patient numbers is a result of a government-inspired drive to attract a million medical travellers in 57 months.

That's 21/2 times more than the estimated number who came here last year.

Barring an unforeseen crisis, achieving goal 2012, which began three years ago, seems possible.

The official figures are not in yet, but industry experts are guessing that more than 400,000 foreigners visited Singapore for health care last year, maintaining the steady clip of an average of 20 per cent growth in numbers over the past few years.

Attracting one million medical travellers will mean $3 billion more for the Singapore economy, and 13,000 new jobs.

By 2012, the Ministry of Health (MOH) estimates the medical travel and tourism market alone may be worth some $7 billion.

The leading drivers in Singapore are private health-care groups like Parkway Holdings and Raffles Medical Group, first and second respectively in the foreign patient stakes.

Foreigners make up as much as 60 per cent of Parkway's patient load while Raffles sees 35 per cent.

To be sure, the public health-care sector sees foreign patients too who pay the full, unsubsidised rates.

The SingHealth cluster's institutions includes Singapore General Hospital, Changi General Hospital and KK Women's and Children's Hospital while the National Healthcare Group (NHG) counts Tan Tock Seng Hospital, Alexandra Hospital and the National University Hospital in its fold.

SingHealth group director for business Edmund Oh says the group expects to attract some 10,000 foreign patients more annually in the next two years while NHG says it expects to see some 64,000 foreigners in its current financial year.

MOH said that relative to total patient population, foreigners make up just 2 per cent of the public health-care clusters' patient load, based on hospital admissions.

Health Minister Khaw Boon Wan told Parliament recently that the primary aim of SingHealth and NHG is to serve Singaporean patients by offering quality medical care at competitive prices.

'But if our standard is high and our prices reasonable, Singapore is bound to attract many foreign patients, as we always do,' he noted.

By contrast, Parkway and Raffles, which receive no state subsidies and must be more aggressive in ratcheting up profits and revenue, are heavily dependent on foreign patients.

Parkway is Singapore's and the region's leading private health-care group with three hospitals here and 11 others in the region, including in Malaysia, Brunei and India.

An average of more than three in five patients at its three Singapore hospitals - East Shore, Gleneagles and Mount Elizabeth - are foreigners, said a spokesman.
That proportion may be higher, about 80 per cent, for a significant number of its accredited specialists, who set up shop at the medical centres adjoining its hospitals.

But achieving the company's aim of taking it to the next level - which is to transform itself into the region's central magnet for quality health care for everyone, everywhere - will not be an easy task.

Rival hospitals like Thailand's Bumrungrad, whose claimed numbers suggest that it may have treated as many foreign patients last year as all of Singapore's hospitals combined, and India's Apollo Hospital chain, are threatening to widen their lead in attracting medical tourists with the minutest service detail or the cheapest rates.

To achieve its aim, Parkway's hospitals and medical centres must change, said Mr Seow.

One change saw the hiring of foreign talent to reinforce current staff. Mr Snyder was offered the job because he belongs to a small band of experts who run champion hospitals, according to Mr Seow.

Mr Snyder's lifelong connection to health care began when he signed up with the United States Navy as a medic to pay for his schooling. After the navy, he worked his way towards the upper reaches of health-care administration.

Prior to Parkway, he led two large hospital groups which were consistently ranked among the top five in the US for integrated health care.

The fact that Mr Snyder is an American helps, because the US looms large in a plan to change the way Parkway operates its hospitals and in how it relates with some 1,500 accredited specialists.

Parkway wants more US patients to come to Singapore and if Mr Snyder's efforts succeed, it may signal the group's great leap forward towards becoming a first-class, world-
renowned destination for medical travellers far away.

So far, the Asia-Pacific footprint - Asean, South Asia and East Asia - the Middle East and Russian states and cities closer to Asia, like Vladivostok and Khabarosk, are the traditional and emerging markets most health-care groups here and in the region are targeting.

Indonesia and Malaysia will remain at the core of the Republic's traditional patient base. But Singapore Medicine, the government agency coordinating the drive to help build a medical hub here, reports that Indochina, South Asia, the Middle East and China are growing swiftly.

These are the seams of foreign patients that most, if not all, health-care groups here and in the region are winning over.
Mr. Snyder calculates that Parkway needs to raise the number of its foreign patients to 750,000 a year in 57 months if the company wants to keep its status and share.

It means expanding beyond retaining its market share from Indonesia, Malaysia, expatriates within the region as well as the fast-growing clusters in South Asia like
Bangladesh and the Middle East.

Enter America. A key role for Mr Snyder is to convince really large numbers of fellow Americans that Singapore is a cheaper sick bay that is worth traversing half a world to, for as safe and effective a cure as they can find at home.

One key aspect of his road trip is to suss out possibilities with health-care insurers about considering Parkway as an overseas treatment option when they offer their menu of insurance plans to companies and individuals.

For a start, Parkway wants to attract tens of thousands through the health insurance firms and other medical travel agencies that underwrite and promote health care in America.

Just as important, it wants to attract them constantly and consistently.
The US is the most significant new market for outsourcing health care for several reasons.

First, health-care cost there is a largely individual, rather than state, responsibility. Slightly more than 200 million Americans, or two in three, are cushioned from the full blast of health-care costs by government programmes, company health-care benefits or insurance.

Unlike Singapore, there are virtually no state-subsidised quality public sector hospitals or outlets that offer affordable health care to the public. Health care is a virtual monopoly of private enterprise.

Second, medical inflation is growing two to three times faster than general inflation in the US, according to a report last week by global management consultancy McKinsey.

This is quickening the rate of unaffordability and US employers are increasingly passing on more of the burden of health-care costs to their workers.

Third, the revenue potential is huge. Mr Josef Woodman, who has written a consumer guidebook, Patients Beyond Borders, to help Americans seeking treatment abroad, estimates that the growth potential of medical travel may double from last year's figure to US$40 billion (S$60 billion) in 2010.

Increasingly, employees, rather than companies, are deciding on their health plans. And they are becoming more informed about solving their needs outside America.

Parkway hopes to establish itself as a cost-effective, high-quality health-care destination for Americans that is as good as any premium US health-care establishment.

In fact, the outsourcing from the US has begun. Half a million Americans now travel abroad yearly to seek cheaper treatment.

This amounts to only a trickle from the US, but that number is already more than any other nationality crossing borders for medical treatment. And the number will only grow because health-care policy and costs have created a new class of medically homeless Americans.

The New England Journal Of Medicine describes this group as 'medical refugees' who cannot afford health care at home. They must flee to cheaper places for treatment or sink into poverty by sacrificing their homes and their middle class lifestyle to pay for treatment at home.

One study says there are as many as 46 million uninsured Americans for whom the price of medical treatment becomes a question of financial survival.

Hence the tales of uninsured American professionals and blue-collar workers travelling to India, Thailand and Malaysia seeking the cheapest medical procedures they need but cannot afford in the US.

But that is not the group Parkway hopes to attract.

Instead, it is eyeing the motherload of 165 million potential American patients who are covered by their companies, or by health insurance bought personally.

Already, overseas treatment options have begun to be included in insurance plans there and choosing them usually means lower premiums.

Pursuing this group is new ground for Parkway and Singapore health-care groups, but rival clusters in Asia and elsewhere are also in the race.

One report indicated that at least 40 employers have signed on to an overseas health-care plan within six months of its introduction by United Group Programs, a health insurer in Florida. Already, reports say, Thailand's Bumrungrad has managed to lock into that plan.
Apart from the competition, attracting American patients is not a sure thing for other reasons.

For some, the distance to Asia will remain an obstacle.

For others, it may be too daunting to seek treatment abroad if it means forgoing hospital visits by family and friends and being in the hands of strangers in a foreign country.

Still, the prize is too attractive to ignore and getting in early may be the key to profitability and health-care renown.

Parkway is banking that these patients will not mind making the 22-hour flight to its hospitals and specialist partners here if they know that Singapore's reputation is benchmarked by medical excellence that is unattainable among rivals elsewhere - and at a quarter of the cost in the US, or less.

March 23, 2007