Historical and Estimated Healthcare Expenditure (HE) per Payor (in $ millions) GuamUSA 10-year HE CAGR4.4%6.8% 9-year GIP CAGR3.1%4.0% Health Expenditure / GDP Guam 8.8% USA17.4% World 9.7% 395 Guams healthcare spending per capita and as a % of GDP is quite low compared to U.S. and World averages – pointing to room for further growth. 256 Source: GHDI and FCCM estimates; US Department of Commerce - Bureau of Economic Analysis; National Health Expenditures Report, 2009; World Bank Report, 2009
Guam authorities project Population CAGR at 1.18% from 2010 to 2020. The number of persons over 65 is expected to approach 10% of the total population by 2030, from 7% today. Guams population growth rate is higher than that of the U.S. and the World average. Guams median age exceeds World averages and is rising geometrically.
Guams disease burden is more severe than U.S. averages. Diabetes, heart disease and cancer are particular areas of concern. As of 2009, at least 40,000 people on Guam have diabetes (close to 25% of the population) Diabetes incidences Cancer Incidences and Mortality* 100%73% Poor oncology services on Guam may be a factor for the significant increase in mortality rates, even as incidence rates remained steady. Mortality Incidence In the United States, only 8% of the population have diabetes (less than one in ten) Heart disease228.4190.9 Malignant neoplasms122.3178.4 Cerebrovascular disease50.142.2 Diabetes mellitus44.022.5 Suicide16.011.3 Motor vehicle accidents16.014.4 All other accidents and adverse events26.240.0 Fibrosis and cirrhosis of the liver18.99.1 Chronic obstructive pulmonary disease23.240.8 *Age-adjusted incidences/deaths per 100,000. The age-adjusted rates are rates that would have existed if the population under study had been distributed by age the same way as in the US population. Top leading causes of death (2007) Guam* U.S. Sources: Guam Cancer Facts and Figures 2003-2007 (June 2009), National Vital Statistics Report US Department of Health and Human Services 2007. CDC National Diabetes Fact Sheet 2007. Department of Health and Senior Services – Missouri.
Majority of Guams population have the capacity to pay for healthcare through third party private and public payors.
Guam suffers from a severe shortage in hospital beds. Specialized care and services are likewise deficient. 8 Source: GHDI estimates based on the World Health Organizations recommended 1:500 bed-to-population ratio, Guam Bureau of Statistics and Plans 2008 Guam Statistical Yearbook Many healthcare services needed to address Guams growing disease burden are not available on-island. Limited number of MD Specialists Only 1 operational MRI No regular Cardiac Catheterization service Old Linear Accelerator Required Beds = 360
15,000 Estimated number traveling off-island every year to receive specialized and higher quality healthcare. $ 58.2M Estimated total off-island healthcare spending in 2010 As a result of deficiencies in the local health sector, many citizens of Guam have to travel abroad for healthcare. 9
Neighboring Pacific Islands and growing tourism sector present additional demand for healthcare services. 10 *FCCM estimates based on World Bank 2008 population figures Commonwealth of the Northern Mariana Islands Guam Republic of Palau Federated States of Micronesia Republic of the Marshall Islands CountryPop. (2009) Guam**178,287 Commonwealth of the Northern Mariana Islands63,112 Federated States of Micronesia107,973 Republic of the Marshall Islands61,300 Republic of Palau20,397 Total431,069 Guam Visitors1,215,180 *Based on World Bank population figures ** Population estimates excludes the impact of the military build-up Sources: Guam Statistical Yearbook 2008, World Bank
Components of Project Cost (USD MMs)Total Hospital building127.9 Equipment26.3 Furniture and Fixtures5.1 IT5.5 Land and Site Preparation4.0 Start –up Costs13.4 Financing Costs20.8 Contingency13.0 Total Project Cost216.0 LocationDededo, Guam Bed Capacity130 Beds Floor Area266,785 Square Feet Project CostUS$216 Million Target Date of OperationJune 2014 GRMC, the only private hospital on Guam, is scheduled for operation in June 2014, with total project cost estimated at US$ 216 million. Project Summary
US Naval Station 420-768 249-419 155-248 85-154 GRMC will be strategically located in the most densely populated area of the island, Dededo, and within reasonable proximity to major tourist areas in Tumon Bay and US military bases. Tumon Bay Guam Regional Medical City Andersen Air Force Base Guam Memorial Hospital Naval Hospital Guam population density map Number of Households 39-84 13-38 0-12 Close to 70% of the island population live in the Northern part of Guam Source: Guam Statistical Yearbook 2008 Guam Regional Medical City
Operates the largest healthcare network under a single trade name in the Philippines, including a world-class 500-bed tertiary flagship hospital, 3 provincial hospitals and 20 outpatient clinics. Serves some 40,000 inpatients and 1.2 million outpatients every year. Engages 2,700 employees and 1,500 medical staff. Has been accredited and re-accredited by the Joint Commission International, the most prestigious accrediting body of healthcare organizations. In its accreditation surveys, TMC has received perfect scores in key standards on service quality and patient safety. With Centers of Excellence in Wellness, Cancer, Cardiovascular and Regenerative Medicine that are well-aligned with healthcare needs of Guam and the rest of Micronesia. Has had a medical coordination office in Guam since 2008 to support the large and growing number of patients from Micronesia receiving care in its Manila site. GRMC will be operated by PSI / TMC, a Joint Commission accredited organization with an established track record in healthcare quality, safety and innovation.
GHHDF, a long-time champion of the hospital project, serves as a vital link between the developers and the local community. The Foundation has developed key relationships : Local and federal government agencies Military and veterans groups Medical and allied medical organizations Insurance companies Educational institutions Business and community leaders Peter R. Sgro, Jr. J.D. President & Board Chairman Frank Arriola M.S.S.M: Vice-President Frances Taitague-Mantanona M.H.A; Secretary John Onedera CPA; Treasurer Peter R. Sgro, Jr. J.D. President & Chairman, International Group, Inc. Katherine Calvo Sgro M.B.A.. EVP & Chairman, Payless Markets, Inc. Ruth Gurusamy R.N., M.N. Administrator, Health Services of the Pacific John Onedera CPA. Partner, Ernst & Young Art Mesa: Veterans Advocate, Small Business 2010 Veteran of the Year. Mayor Roke Blas. Mayor, Municipality of Sinajana Richard Lai: Director of the Chinese Chamber of Commerce. Frank Arriola M.S.S.M; CEO of Pacific Rim Brokers, Inc. Mary Torre. President, Guam Hotel & Restaurant Association Hidenobu George Takagi. President. Takagi & Associates Larry Lizama M.D. Internal Medicine Kia Rahmani M.D. General, Vascular and Oncologic Surgeon Frances Taitague-Mantanona. Masters in Health Administration Thomas Shieh, M.D. Fellow American College of Obstetricians & Gynecologists John Ray Taitano M.D. MSS FACP Internal Medicine David Silva, EMBA. General Manager, Century Insurance Guam Ernesto V. Espaldon, Jr. President, Sun Foods Intl dba Lina Leon Guerrero: General Manager of Marianas Physicians Group GHHDF Officers GHHDF Board of Directors
Cardiology Oncology Endocrinology Pulmunology Neurology Laboratory Radiology Pharmacy Physical Therapy Emergency Medicine Services Orthopedics Ophthalmology ENT General Surgery Anesthesia Gastroenterology Nephrology Infectious Disease Pediatrics/ Neonatology OB-Gynecology GRMC will augment bed capacity and deliver world-class healthcare services that respond to the specific needs of the Region. Hospital Beds 158 130 361 380 43 Emergency 2 Triage Rooms 9 Exam Rooms 1 Trauma Room 6 Observation Units Delivery 6 LDRs 4 IMUs 13 NICU Facilities Surgery 4 Major ORs 5 Minor ORs 12 PACU/RR Intensive Care 10 ICUs 4 Isolation
Project development and construction will proceed from 2011 to 2014. Hospital operations will commence mid-2014. Project Development 2011 Hospital Build Out 2012 - 2013 Hospital Operation 2014 Onwards
Peak employment during construction will number 290. Some 75% of staff will be sourced on-island.
At full operation, GRMC will employ 58 hospitalists and 396 allied medical and support staff. In addition, GRMC will credential some 250 medical staff across all clinical services. Rural hospitals provide a source of high-tech jobs for young people who might otherwise leave communities heavily dependent upon natural resource-based industries and tourism. Rural hospitals also provide an anchor for other health care jobs, such as physicians and pharmacists that, in the absence of the hospital, may not be available. Healthy Hospitals. Healthy Communities. The Economic Impact of Wisconsins Hospitals, 2008.
GRMC will generate multiplier effects conservatively estimated at $585 million during the construction period and $210 million per year during full operation. * Healthcare Spending Retained On-island $58 Million x 65% = $38 Million per Year
GRMC will likewise produce substantial incremental (albeit unquantifiable) economic and social benefits. Enhanced quality and retention of hospital staff from investments in staff and organizational development More attractive environment for business and industry Growth in tourism, retirement and other economically- beneficial sectors Larger Social Security, Medicare and other inflows from the Federal government Improved disease prevention and health promotion Healthier, more productive, population