Ms. Margaret Bengzon
President and Chief Executive Officer,
Guam Healthcare Development Inc – Guam
Regional Medical City
Opportunities for Health Human
Resources in Guam and Micronesia
14 March 2012
Presentation Outline
Demand for Healthcare
Available Healthcare Human Resources
The Guam Regional Medical City
Opportunities Presented by GRMC
Conclusions
Demand for Healthcare
Guam’s 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.
Historical and Estimated Healthcare Expenditure (HE) per Payor (in $ millions)
395
256
Health Expenditure / GDP
Guam
USA
World
8.8%
17.4%
9.7%
Guam
USA
10-year HE CAGR
4.4%
6.8%
9-year GIP CAGR
3.1%
4.0%
Source: GHDI and FCCM estimates; US Department of Commerce - Bureau of Economic Analysis; National Health Expenditures
Report, 2009; World Bank Report, 2009
Guam’s population growth rate is higher than that of the U.S. and the World
average. Guam’s median age exceeds World averages and is rising geometrically.
Comparative Population Statistics : Guam, USA, World Population
Guam
USA
Population Growth Rate (%)
1.31%
0.96%
Median Age (in years)
Total
29.40
36.90
Male
29.00
35.60
Female
29.80
38.20
Source: CIA estimates, CIA World Factbook 2011
World
1.09%
28.40
27.70
29.00
 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.
Guam’s disease burden is more severe than U.S. averages. Diabetes, heart
disease and cancer are particular areas of concern.
Top leading causes of death (2007)
Heart disease
Malignant neoplasms
Cerebrovascular disease
Diabetes mellitus
Suicide
Motor vehicle accidents
All other accidents and adverse events
Fibrosis and cirrhosis of the liver
Chronic obstructive pulmonary disease
Guam*
U.S.
228.4
122.3
50.1
44.0
16.0
16.0
26.2
18.9
23.2
190.9
178.4
42.2
22.5
11.3
14.4
40.0
9.1
40.8
Cancer Incidences and Mortality*
100%
2003-2007
263 264
201
117
100
68
Diabetes incidences

73%
329
*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.

1998-2002
394
As of 2009, at least 40,000 people on
Guam have diabetes (close to 25% of
the population)
In the United States, only 8% of the
population have diabetes (less than
one in ten)
Males
Females
Mortality

Males
Females
Incidence
Poor oncology services on Guam may be a factor for
the significant increase in mortality rates, even as
incidence rates remained steady.
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 Guam’s population have the capacity to pay for healthcare
through third party private and public payors.
Estimated Guam Population by
Healthcare Coverage (2010)
Estimated Breakdown of Guam Health
Expenditures by Payor (2010)
Medicare
7%
Self-Pay
28%
Self-Pay
12%
Medicaid
17%
Medicaid
8% MIP
6%
Medicare
12%
Tricare
7%
MIP
7%
Private
Insurance
Private
Insurance
34%
41%
Tricare
21%
Neighboring Pacific Islands and growing tourism sector present additional
demand for healthcare services.
Commonwealth of the
Northern Mariana Islands
Guam
Republic of Palau
Republic of the Marshall Islands
Federated States of
Micronesia
Country
Guam**
Commonwealth of the Northern Mariana Islands
Federated States of Micronesia
Republic of the Marshall Islands
Republic of Palau
Total9
*Based on World Bank population figures
** Population estimates excludes the impact of the military build-up
Sources: Guam Statistical Yearbook 2008, World Bank
Guam Visitors
*FCCM estimates based on World Bank 2008 population figures
Pop. (2009)
178,287
63,112
107,973
61,300
20,397
431,069
1,215,180
Available Health Human Resources
Guam has been designated a Medically Underserved Area due to deficiencies
in the number of health professionals relative to the population served.
Staff Metrics
Physicians
Physician - Population Ratio
Registered Nurses
Nurse - Population Ratio
Guam
283
16
800
44
Source: Office of Guam Medical Examiners, Kaiser Family Foundation Website, 2010 Data
* Population Ratios Per 100,000 Population
USA
811,533
27
2,655,020
87
Gaps in specialized care, especially in relation to the Island’s disease
burden, have also been observed.
Leading Causes of Death
Heart Disease
Malignant Neoplasms
Cerebrovascular Disease
Diabetes Mellitus
COPD
Fibrosis and Cirrhosis of the Liver
Age-Adjusted
Death Rate*
Subspecialists
228.4 1 Cardiologist
122.3 5 Oncologists
50.1 2 Neurologists
44.0 2 Endocrinologists
23.2 1 Pulmonologist
18.9 0 Gastroenterologists / Hepatologists
Source: National Vital Statistics Report US Department of Health and Human Services 2007 ; Guam Subspecialists compiled by GHDi.
* Per 100,000 Population
The Guam Regional Medical City
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
Location
Dededo, Guam
Bed Capacity
130 Beds
Floor Area
266,785 Square Feet
Project Cost
US$216 Million
Target Date of Operation
June 2014
Components of Project Cost (USD MMs)
Total
Hospital building
Equipment
Furniture and Fixtures
IT
Land and Site Preparation
Start –up Costs
Financing Costs
Contingency
Total Project Cost
127.9
26.3
5.1
5.5
4.0
13.4
20.8
13.0
216.0
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.
Andersen Air Force Base
Close to 70% of the island
population live in the Northern
part of Guam
Guam Regional Medical City
Tumon Bay
Guam Memorial Hospital
Naval Hospital
US Naval Station
Guam
Regional
Medical City
Guam population density map
Number of Households
420-768
249-419
155-248
85-154
39-84
13-38
0-12
Source: Guam Statistical Yearbook 2008
GRMC will be operated by PSI / TMC, a Joint Commission accredited organization
with an established track record in healthcare quality, safety and innovation.
 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.
GHHDF, a long-time champion of the hospital project, serves as a vital link
between the developers and the local community.
GHHDF Officers
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
GHHDF Board of Directors
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 Int’l dba
Lina Leon Guerrero: General Manager of Marianas Physicians Group
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
GRMC will augment bed capacity and deliver world-class healthcare
services that respond to the specific needs of the Region.
Hospital Beds
Facilities
380
361
Emergency
Surgery
Intensive Care Delivery
2 Triage Rooms
4 Major ORs 10 ICUs
6 LDRs
9 Exam Rooms
5 Minor ORs 4 Isolation
4 IMUs
1 Trauma Room 12 PACU/RR
130
43
158
13 NICU
6 Observation Units
Services
Cardiology
Gastroenterology
Orthopedics
Laboratory
Oncology
Nephrology
Ophthalmology
Radiology
ENT
Pharmacy
General Surgery
Physical Therapy
Anesthesia
Emergency Medicine
Endocrinology Infectious Disease
Pulmunology Pediatrics/ Neonatology
Neurology
OB-Gynecology
Project development and construction will proceed from 2011 to 2014.
Hospital operations will commence mid-2014.
Project
Development
2011
Hospital
Build Out
Hospital
Operation
2012 - 2013
2014 Onwards
Opportunities Presented by GRMC
Peak employment during construction will number 290. Some 75% of staff will be
sourced on-island.
Position
Office Quality Control Manager
Field Quality Control Manager
Electrical Engineer
Mechanical Engineer
Cost Controller
Assistant Supervisor
Field Foreman
MEP Superintendent
Finishes Superintendent
Administrative Assistant
Equipment Operators
Laborers
Carpenters
Concrete Finishers
Masons
Drywall Hangars
Painters
Mechanics/Sheet Metal
Plumbers
Electricians
Total
Source
Guam
Other
1
1
1
1
Total
Peak
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
10
15
15
15
6
30
15
48
25
30
5
5
5
4
10
5
17
10
10
10
20
20
20
10
40
20
65
35
40
218
72
290
1
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.
Service
Internal Medicine
Surgery
OB-Gyn
Pediatrics
Anesthesia
Ophthalmology
Otolaryngology
Radiology
Pathology
Physical Medicine
Emergency
Intensive Care
Neonatal Intensive Care
TOTAL
Consultants Hospitalists
90
12
35
6
25
4
70
6
7
3
5
3
5
3
6
6
4
3
6
6
3
250
58
Service
Nursing
Ancillary Services
Administration and Support
TOTAL
Staff Count
158
134
104
396
“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 Wisconsin’s Hospitals, 2008.
GRMC will provide an attractive platform for staff to advance personal and
professional aims.
Research
Teach
Professional
Standing
Learn
Financial
Security
Personal
Fulfillment
Practice
GRMC has made provisions for a competitive salary package to attract and
retain qualified medical staff.
Physician Staffing for GRMC
Salary Benchmarking
396,141
GMH
Guam
US Mainland
324,330
261,960
234,277
130,000
25th Percentile
 Number of Hospitalists = 58
 Number of Credentialed Consultants = 250
160,021
Average
75th Percentile
 Budget of US$300,000 per hospitalist per year is
competitive relative to island and mainland salary
levels
Sources: Guam Memorial Hospital Staffing Pattern as of May 2011, Medical Group Management Association 2009
Recruitment efforts will be directed at medical and allied medical
professionals in Guam, the U.S. mainland and the Philippines.
U.S. Professionals
Philippine (U.S.
Boarded)
Professionals
Guam Professionals
 Better income-  Access to top quality
facilities and services
generating

Opportunities for
potential
 Robust practice professional capacity
development,
platform but
teaching/mentoring
closer to the
and research
Philippines
Estimated
number: 1,500
Estimated
number: 283
Recent Graduates
Established Practice
With Guam Ties
With
Philippine Ties
 Access to student loan  Improved quality of
repayment programs
life, given challenges
and other incentives
of practice in the
directed at medically
mainland U.S.
underserved locations  Rising costs of living
in the mainland U.S.
 Prospect of
practice at home
in a world‐class
hospital complex
 Prospect of
practice in a
U.S. setting
but closer to
the
Philippines
Total Graduates (2010):
16,8381
Pacific Islander / Other Minority
Races Non-Federal Physicians
(2008): 20,263
Sources: Association of American Medical Colleges, American Medical Association,, Guam Board of Medical Examiners, The Medical City, The Economist.
In partnership with Regional providers, GRMC will facilitate access to federal
incentives to practice in medically-underserved locations, as well as advocate for
the institution of parallel programs at the local level.
Federal Government
Local Government
Scholarships
Loans
Research Grants
Loan Repayment Programs
Matching of State-Funded Programs
Visa Waiver Programs
Preferential Reimbursement Rates
Tax Credits
Locum Tenens
GRMC will leverage its existing network of educational institutions, as well as
develop linkages with the University of Guam, to provide professional staff with
extensive opportunities for capacity building, teaching/mentoring, and research.
In conclusion ,
”Field of Dreams”
”Anonymous”