After an experience managing medical clinics, Maran Virumandi saw fundamental challenges in the Malaysian healthcare that could be resolved through innovation and technology. In 2017, he launched DoctorOnCall, a digitalhealth platform that offers affordable telehealth consultation and online pharmacy. Recently, the Ministry of Health established a partnership with DoctorOnCall to develop digital health solutions in the battle against COVID-19.
This interview has been edited for brevity and clarity.
KrASIA (Kr): What inspired you to start DoctorOnCall?
Maran Virumandi (MV): I stumbled upon healthcare, and saw that operators are vastly under-invested and under-focused in terms of coming up with new management practices and technology innovation.
A classic case would be the fee-for-service model in Malaysia. If you talk to any hospital or clinic, medical consultations are not as insured for patients as see in other countries. For patients, the more complex the practitioner makes it out to be, the more expensive the treatment options are. That has created a negative perception of doctors, specialists, and pharmacists in Malaysia. There is a lack of separation between prescribing and dispensing, so doctors hold a monopoly on prescribing medications. You typically get a case of over-prescribing or unnecessary prescriptions being made.
At government hospitals, there are no computers, but massive files of patient records, and patients usually wait two to four hours for a five-minute consult. You don’t do that when you go to a bank. Actually, when was the last time you went to a bank? 99% of the transactions are all done online. The same happens with telcos or movie tickets bookings. We see how folks who have the means can easily go to nearby private hospitals, but the rest of the population is stuck with poor healthcare options.
We said, “what if we get everyone on a single platform with shared health records, and give doctors the opportunity to sell and advertise their services responsibly while patients have the power to make their decisions?” We want to have the continuation of accessibility and affordability when it comes to medical services. Doing it properly, in a regulated manner, is what is inspiring us right now.
Kr: What are some issues of healthcare accessibility and infrastructure in Malaysia?
MV: I’ll use some simple statistics. In Klang Valley, Kuala Lumpur, the doctor to patient ratio is about one to over 200. In the east coast of Malaysia, it’s close to one to 1500. The World Health Organization (WHO) standard is one to 400. It is a tale of two Malaysias.
Malaysia is consistently ranked at the top of the healthcare ladders from private healthcare facilities. There are droves of Indonesians, Chinese and Middle Easterners who come down to Malaysia because our doctors are educated in Australia and the UK, the world’s premier locations. They come back to practice in the major metros of Penang, Klang, and Johor Bahru. However, healthcare outcomes are poor in public hospitals because we don’t have a national insurance system. Even though we have a public healthcare system that caters to the majority of low-income populations, Malaysia is no more an egalitarian society where everyone gets access to the same standards of education or healthcare.
A digital healthcare platform needs to go hand-in-hand with the national insurance scheme. What we can do is allow better choices, visibility of inventory, price transparency, and then, allow the market forces to try to shape the demand and supply better. By getting the entire country wired up, you could solve some basic issues. If you have health records wired up, you could switch hospitals with ease if you have to, and then keep going on with your treatment. Ten insurers have switched hundreds of thousands of their members to our platform because of our price transparency.
A lot of the accessibility issues are due to the manual system that we have right now. One of the ways to resolve that problem is to break those thick rules that have been built into the old system.
Kr: Do some of these same issues exist in other Southeast Asian markets? If they do, do you think DoctorOnCall can help in these markets?
MV: The short answer is yes, but to a varying extent. Malaysia’s tale of two cities is going to be amplified if you move to vast geographies like Indonesia. In social economies like Vietnam, it would be more unified. There are countries that we would give a lot more utility if we move there, specifically Indonesia and Thailand. Other countries, like Thailand or the Philippines, are experiencing healthcare issues as part of their growth curve, and these would curb somewhat with growth. Digitizing healthcare and allowing for benefits across the Southeast Asian geographies is something that we are aspiring to do. Malaysia is a sweet spot to start off from. Singapore wouldn’t be the right model to perfect it, and Indonesia already has a couple of players.
Kr: DocPods are your mobile clinics. Were they created to address healthcare issues in rural areas?
MV: The director general of the Ministry of Health, Dr. Noor Hisham, challenged us to provide digital help beyond the major metros to rural folks. Mobile phones are not intuitive to them. One fundamental issue with rural clinics is that a significant number of them lack doctors. There are physical clinics with no doctors. On the flip side, there are plenty of doctors in Malaysia. One challenge would be that patients would get served by a nurse who’s not capable of diagnosing a patient, but can work as a pharmacist. To bridge that divide, we figured that a DocPod could be positioned in rural areas with video facilities. An educated user could use them independently, while rural folks would need a nurse to guide them, consult with them, and manage that doctor-patient ratio. These nurses are already present there.
Kr: COVID-19 has driven a change in telehealth behaviours out of necessity. Do you think some of these changes will stick around post-COVID?
MV: We were growing 20% month-on-month pre-COVID, and have skyrocketed past during the height of it. Even before COVID, there was pent-up demand for connecting to a doctor for everyday conditions like the flu and fever. Conversely, in terms of bigger treatments, users want to have transparency in options.
COVID is currently beyond control in Malaysia and Southeast Asia. In Singapore, the vaccination rollout is going to take anything from 18 to 36 months. China has completely kicked it down, but they’re having sporadic waves. This means that COVID’s effects are going to be sustained for long, and people will get into a certain mindset.
We’ve already seen a huge surge when it comes to e-commerce and food delivery in Malaysia and Southeast Asia. People are realizing they don’t need to go back to the old ways even for simple matters. There’s going to be a large degree of people who will switch to telehealth permanently if healthcare keeps growing at the same.