This article first appeared in The Edge Malaysia Weekly on December 19, 2022 - December 25, 2022

OVER the next few years, Institut Jantung Negara Sdn Bhd (IJN) plans to expand its reach by setting up cardiac centres outside Kuala Lumpur to improve healthcare access and establishing a chain of retail pharmacies. At the same time, IJN, which is also known as The National Heart Institute, will be expanding its existing medical facility in Jalan Tun Razak and is working on attracting more foreign patients to improve its revenue base.

Touted as Southeast Asia’s largest independent cardiac centre, IJN is currently at an advanced stage of negotiations for potential openings in Johor and Penang. A branch hospital may be operational as early as 2026. The setting up of branch hospitals to provide patients outside the city with greater access to its specialist care has been a long-term goal of the 30-year-old institution.

“This expansion is a significant part of our medium-term plan in our pursuit of improving healthcare access and widening our patient base,” IJN CEO Datuk Dr Aizai Azan Abdul Rahim tells The Edge in a recent interview.

“We are keen to expand our services to encompass the east coast, southern and northern regions,” he says, adding that it is in discussions with several interested parties, including state governments/agencies, to set up hospitals. Private companies are also courting IJN in hopes of establishing a partnership.

While Aizai is unable to divulge details of the exact location or who the partner might be, he says it may sign a deal next year and the hospital may be ready in 2026. The deal could be a hospital management contract or IJN may manage and take a stake in the hospital. It is worth noting that a 2018 plan to open a cardiac centre in Johor in partnership with Permodalan Nasional Bhd never materialised.

For a start, IJN has embarked on a collaboration with Universiti Sultan Zainal Abidin (UniSZA) in Terengganu. UniSza has built Hospital Pengajar Universiti Sultan Zainal Abidin, which will be operational in stages beginning mid-2023. IJN will operate the cardiac clinic in the hospital. Aizai points out that such collaborations enable IJN to leverage the strength of the partner institutions to assess local market demands and needs.

IJN will also be setting up a chain of retail pharmacies. In February, it launched its first store called IJN First Pharmacy, which is accessible to the public, at its current hospital. It plans to open two outlets in the Klang Valley in 2023 and one in Terengganu in 2024.

The existing facility will also be expanded. IJN plans to build two new blocks in two phases, with Phase 1 to be completed in 2Q2023 and Phase 2 in 2027.

Phase 1 involves expanding the patient car park facility by 600 bays, building a rooftop surau, a new kitchen and a childcare facility for the families of the staff. The investment in this phase, which will add 30,765 sq m, is an estimated RM74.5 million.

“Once that is completed, we plan to start our second phase of expansion to further increase our bed capacity, as well as [build] additional adult and paediatric clinics, operating theatres and invasive cardiac catheterisation laboratories. This will cater to new patients and help enhance the patient experience,” Aizai says. Investment in the second phase, for which a tender will be called next year, is expected to be “a few hundred million ringgit”. The 11-storey building, scheduled for completion in 2027, will have an initial capacity of 120 beds.

IJN sits on a 15.8-acre parcel and once Phase 2 (involving 3.25 acres) is completed, it will have 0.7 acres of land remaining. It also owns a 0.3-acre plot in Section 6, Peta­ling Jaya, with the potential of building a satellite clinic there in the future.

Officially launched on June 12, 1993 by Tun Dr Mahathir Mohamad, IJN started with 275 beds and 298 staff including 13 specialists. By 2009, it had 461 beds. Now, it operates the hospital with 67 specialist clinics and 174 doctors in total. Over the past three decades, IJN has treated over five million patients, performing 101,408 cardiac surgeries and over 266,557 invasive and interventional cardiology procedures.

While IJN will continue to focus on treating cardiovascular and heart-related patients, it plans to expand its multidisciplinary hospital and integrated disease services. Some of the areas where it has already expanded into include speciality diabetic services, respiratory disease services, a renal care centre, heart failure and cardiovascular risk reduction clinics, and smoking cessation services.

IJN is wholly owned by IJN Holdings Sdn Bhd, which in turn is wholly owned by Ministry of Finance Inc. A search on the Companies Commission of Malaysia website reveals that in the financial year ended Dec 31, 2021, IJN posted RM795.48 million in revenue and RM68.24 million in net profit. As at Dec 31, 2021, total assets amounted to RM1.14 billion and total liabilities RM245.43 million, of which RM198.17 million was current. IJN also has an accumulated profit of RM494.59 million.

“We hold some of our retained earnings for investment purposes and the remainder is used to continuously upgrade our facilities with building expansion and renovation projects, enhance our services with digital transformation initiatives such as a total hospital information system and invest in the latest leading-edge medical diagnostic and therapeutic technology and devices in the field of cardiology and thoracic services,” Aizai explains.

He emphasises that as a referral centre for cardiovascular and paediatric cases, IJN primarily caters to Malaysians. “Almost 99% of our patients are locals, with the remaining 1% comprising international patients. These numbers are reflected in our revenue as well, with the bulk coming from local patients. Of our local patients, around 70% are those sponsored by the Ministry of Health, including pensioners,” he points out.

Malaysians who are not sponsored by MoH are charged fees based on the 13th schedule released by the Malaysian Medical Association, which provides a minimum and maximum fee chargeable for consultation and procedures. “IJN positions its fees competitively and not at the maximum rate for cardiac-related surgeries or procedures,” Aizai says.

Going forward, IJN is keen on widening its revenue base to include medical tourism.

“While our fellow Malaysians are a priority, we are very much on board with the country’s push to be at the forefront of medical tourism,” he says. As IJN is Southeast Asia’s largest independent cardiac centre, it has been catering to international patients for some time now and helps train medical personnel from other countries.

“We work closely with the Malaysia Healthcare Travel Council (MHTC) in their bid to turn Malaysia into a major player within the medical tourism space.” IJN, Aizai adds, is leading the MHTC’s goal of turning Malaysia into a cardiology hub within Asia-Pacific and is confident that it will be “able to make this dream a reality in the coming years”. He believes the IJN brand and generally lower cost of medical treatment in the country will help it attract more foreign patients.

In 2019, foreign patients contributed RM17 million, or 2% of total revenue. The travel restrictions during the pandemic resulted in a 60% to 70% drop in revenue in 2020 and 2021. However, since the reopening of borders this year, international patient numbers have been improving.

IJN’s foreign patients are mostly from Indonesia, Myanmar, Vietnam, Bangladesh and countries in the European Union. The treatment they seek usually involves complex procedures that are not available in their country. These procedures include coronary artery bypass graft surgery and valve repair and replacement surgery, complex percutaneous coronary interventions, trans­catheter aortic valve implantation, endovascular aneurysm repair and thoracic endovascular aortic repair.

In the next five years, together with MHTC, IJN hopes to be recognised as the flagship hospital for cardiovascular and thoracic care in the country, in support of the government’s goal of making Malaysia the preferred destination for medical tourism.

As the country’s only discipline-specific heart specialist facility, IJN is also a training centre of excellence for cardiology experts in Malaysia and Asean. “As a tertiary referral centre, our cardiology services span the spectrum of the speciality. As the country’s pioneering heart specialist, it’s in our interest to offer a comprehensive range of services and treatments.

“This includes diagnostics and interventional cardiology procedures, peripheral vascular disease intervention, cardiothoracic surgical services, structural heart disease procedures, pacemaker implantations and radiofrequency ablation for arrhythmias, heart and lung transplantation, mechanical heart devices such as ventricular assist devices (VAD) and non-invasive treatment modalities,” says Aizai.

He adds that IJN is also Malaysia’s only centre at the forefront of providing complex treatment as well as established services for paediatric heart rhythm problems and is the go-to centre for complex heart surgery for children.

What’s next? IJN plans to implement the Strategic Information System Plan (SISP) to digitise healthcare as the Covid-19 pandemic revealed gaps in its current services and the need to embrace technology and innovation to be able to continue servicing patients’ medical and surgical needs and protecting its staff.

IJN will be upgrading its hospital management system to a Total Hospital Information System (THIS) that will integrate the Electronic Medical Record system with medical imaging, radiology and laboratory information systems that have features like automated drug dispensing, billing and accounting. Patients will be able to use mobile apps to communicate with IJN and even access their own medical records.

Its research department is also developing its own digital databank on cardiovascular diseases (CVD) based on information collected over the past 30 years. The CVD data, which can be analysed using artificial intelligence and machine learning, will allow data-driven decisions to be made to improve patient care, predict outcomes, recommend the best treatment and will play a key role in personalised or precision medicine. Aizai says it may also be a potential source of revenue for IJN. “The possibilities are endless,” he adds.

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