The Prospects for Healthcare in LVMC Bangkok Dusit Medical Services PCL

Transcription

1 The Prospects for Healthcare in LVMC Bangkok Dusit Medical Services PCL Dr. Chatree Duangnet, M.D., FAAP. Chief Operating Officer Medical Affairs and Vice President Bangkok Dusit Medical Services Public Co., Ltd.(BGH) Chief Executive Officer, Bangkok Hospital Medical Center 29 August 2013

2 Disclaimer Copyright 2013 Bangkok Dusit Medical Services PCL All rights reserved. Any unauthorized use or disclosure is prohibited. The information contained in our presentation is intended solely for your personal reference general information purpose only. The information herein was obtained from various sources and is subject to change without notice. We do not guarantee its accuracy or completeness. Neither the information nor any opinion expressed constitutes an offer, or an invitation to make an offer, to buy or sell any securities or any options, futures or other derivatives related to such securities. In addition, this presentation includes statements of future expectations, projections or other forward-looking statements, which reflect our current views with respect to future events and are not a guarantee of future performance. A number of important factors, risks and uncertainties could cause actual results or outcomes to differ materially from those expressed in any forward-looking statement. Investors should seek financial advice regarding the appropriateness of investing in any securities or investment strategies discussed in this presentation and should understand that statements regarding future prospects may not be realized. Accordingly, we caution you not to rely unduly on these forward-looking statements. Past performance is not necessarily a guide to future performance. 2

3 LVMC Snapshot Myanmar Population (mm) 63.7 Median Age 29 Urbanization (% total pop.) 33% GDP per capita (PPP) 1,405 GDP (PPP) (Intl. $ Bn) 89.5 GDP Growth (CAGR 12 15E) 7% Vietnam Population (mm) 90.4 Median Age 29 Urbanization (% total pop.) 32% GDP per capita (PPP) 3,548 GDP (PPP) (Intl. $ Bn) GDP Growth (CAGR 12 15E) 5% Laos Cambodia Population (mm) 6.4 Median Age 22 Urbanization (% total pop.) 35% GDP per capita (PPP) 3,011 GDP (PPP) (Intl. $ Bn) 19.2 GDP Growth (CAGR 12 15E) 8% Population (mm) 15.3 Median Age 23 Urbanization (% total pop.) 20% GDP per capita (PPP) 2,405 GDP (PPP) (Intl. $ Bn) 36.6 GDP Growth (CAGR 12 15E) 7% Source: World Bank, IMF and World Health Statistic

4 Key Indicators LVMC Population Still Lack Sufficient Healthcare Selected Healthcare Indicators (1) Indicator Laos Vietnam Myanmar Cambodia Thailand ASEAN America Europe World Life expectancy after reach the age of 60 (years) Under-five mortality rate (per 1000 live births) Maternal mortality ratio (per 100,000 live births) Prevalence of tuberculosis (per 100,000 population) Prevalence of HIV (per 100,000 population) Incidence of malaria (per 100,000 population) 1, ,180 1, , n.a. 4,082 (1) Source: World Health Organization 4

5 Better Standard of Living Growing Urban Population Percentage of Urban Population (1) Estimated CAGR E 3.1% 2.0% 1.7% 0.9% 1.1% 1.3% 0.3% 0.3% 0.9% 80% 80% 81% 74% 74% 75% % 52% 53% 38% 35% 33% 34% 32% 33% 35% 30% 32% 21% 20% 20% 34% 34% 35% 32% 33% 34% Laos Vietnam Myanmar Cambodia Thailand ASEAN America Europe World (2) (1) Source: World Bank, United Nations, World Health Organization (2) Consists of only North America 5

6 Better Standard of Living (Cont d) Growing GDP per Capita GDP Based on PPP per Capita in Thousand Current International Dollar (1) Estimated CAGR E 8.5% 6.1% 6.2% 7.9% 5.7% 5.9% 3.6% 3.1% n.a n.a. Laos Vietnam Myanmar Cambodia Thailand ASEAN America Europe World (2) (1) Source: IMF and World Bank (2) Consists of only North America 6

7 Demand Health Expenditures in LVMC Relatively Low Health Expenditure per Capita in Current USD (1) CAGR % 15.3% 24.0% 10.0% 12.9% 11.8% (2) 5.0% (3) 5.5% 6.9% 8,608 8,233 7, ,958 3,736 4,593 4,310 4, (1) Source: World Bank (2) CAGR (3) CAGR (4) Source: World Health Organization, subjected to slightly different data collection methodology Laos Vietnam Myanmar Cambodia Thailand ASEAN Japan US OECD n.a. (4) n.a. 7

8 ASEAN Australia Europe America Demand (Cont d) Comparison of Healthcare Expenditure Total Healthcare Expenditure as % of GDP (2011) Healthcare Expenditure (USD) Gap with OECD Average Laos 67 3,269 USA 17.6 Vietnam Myanmar ,120 3,310 Canada France Germany Cambodia 132 3,204 New 10.7 Thailand 331 3,005 Australia 9.0 Indonesia Malaysia ,213 2,691 Vietnam Malaysia Thailand Philippines 164 3,172 Indone 2.8 OECD Average = 9.5% Source: World Health Statistics, WHO 8

9 Payor Small Government Contribution in Healthcare for LVMC Nations Breakdown of Total Healthcare Spending (1) Non-Government Spending Government Spending % 64.9% 53.5% 69.1% 62.9% 86.5% 87.9% 79.6% 78.5% 35.1% 46.5% 30.9% 37.1% 13.5% 12.1% 20.4% 21.5% 43.9% 25.0% 56.1% 75.0% Laos Vietnam Myanmar Cambodia Thailand 68.0% 65.3% 54.9% 50.2% 26.1% 25.6% 40.6% 41.1% 32.0% 34.7% 45.1% 49.8% 73.9% 74.4% 59.4% 58.9% ASEAN America Europe World Government Policy Aiming Towards Better Healthcare (1) Source: World Health Organization 9

10 Supply (1) Physicians per 10,000 Population (2) Laos Vietnam Myanmar Cambodia Thailand ASEAN America Europe World Hospital beds per 10,000 Population (1) Nursing personnel per 10,000 Population Hospitals per 10,000 Population (3) Laos Vietnam Myanmar Cambodia Thailand ASEAN America Europe World Laos Vietnam Myanmar Cambodia Thailand ASEAN America Europe World n.a n.a. n.a. n.a. n.a. Laos Vietnam Myanmar Cambodia Thailand ASEAN America Europe World Source: WHO Statistics 2013 Notes: (1) Latest Figure Available; due to variability of data sources and national occupation titles, the figures provided may not always be comparable or comprehensive (2) Physician includes generalist and specialist medical practitioners - derived from WHO Global Health Workforce Statistics (3) Hospitals include district, rural, provincial, specialized, teaching and research hospitals; derived from the WHO Baseline country survey For specific country details: 10

11 Providers Laos Myanmar (as of 2010) n.a. n.a. n.a. n.a. District/first level hospitals General hospitals Private hospitals Specialized hospitals District/first level hospitals General hospitals Private hospitals Specialized hospitals Vietnam Cambodia (as of 2009) (as of 2010) District/first level hospitals General hospitals Private hospitals Specialized hospitals District/first level hospitals General hospitals Private hospitals Specialized hospitals Source: World Health Organization 11

12 Foreign Participation Myanmar July, 2013 Vietnam Hoan My June, 2013 Laos Cambodia First quarter, 2014 January, 2013 Chinese International Hospital, Luang Prabang Source: World Health Organization and Local news articles 12

13 Appendix

14 AEC Regulations

15 Low Barriers to Expand to Regional Market 1. Free flow of Goods: AEC 2015 Blue Print ASEAN-6 has reduced tariff down to 0% since CLMV (Cambodia, Laos, Burma, and Vietnam) targeted to eliminate tariff by Tariff reduction doesn t apply to sensitive items (mostly agricultural products) Ultimate objectives beyond zero tariffs to eliminate non-tariff barriers altogether 2. Free flow of Service (AFAS) Remove substantially all restrictions on trade in services for 4 priority services sectors, Airlines, ICT, Healthcare and Tourism, by 2010 Allow up to 70% of foreign (ASEAN) ownership in all sectors targeted by Liberalization of cross border investments (ACIA): Free flow of capital among ASEAN countries National treatment of investors Eliminate restrictions on investments and investments types 4. Free flow of capital Remove or relax restrictions, where appropriate and possible, to promote foreign direct investment and development of capital market ASEAN-6 comprises of Brunei Darussalam, Indonesia, Malaysia, the Philippines, Singapore and Thailand 15

16 Low Barriers to Expand to Regional Market (Cont d) Type of Services Modes Laos Vietnam General commitments to all services Additional commitments For Private Hospitals Additional commitments For Medical Services Additional commitments For Nursing Services Commercial presence Foreign service supplier shall be subject to approval JV is jointly owned and operated by at least one international and domestic investor, a minimum portion 30% of the total equity investment in that venture shall be made Wholly foreign-owned / branch or representative office must be subjected to laws and regulations and conform with laws Natural persons Right to employ skilled and expert foreign personnel when necessary and with approval Subjected to pay to the Lao Government personal income tax Commercial presence Joint-venture with Lao services suppliers 100% foreign owned Natural persons Unbound, except intra-corporate/hospital transferees] OR [intra-corporate/hospital transferees only Commercial presence Joint-venture with Lao services suppliers and foreign equity participation limited to 49% In accordance with domestic laws and regulations Allowed to establish business co-operation contract, joint venture enterprise or 100% foreign-invested enterprise Shall be permitted by authorities to lease the land to carry out their investment projects Representative offices are permitted to be established, but they shall not engage in direct profitmaking activities At least 20% of managers, executives and specialists shall be Vietnamese nationals, with a minimum of 3 None (same as General Commitments to all service) None Natural persons Unbound (same as General Commitments to all service) Commercial presence - None Natural persons - (same as General Commitments to all service) 16

17 Low Barriers to Expand to Regional Market (Cont d) Type of Services Modes Myanmar Cambodia General commitments to all services Additional commitments For Private Hospitals Commercial presence 100% Foreign investment JV with minimum of 35% equity for domestic citizen/enterprise Subject to withholding tax and certain tax for foreign resident Services activities are restricted, but may be permitted by cabinet Natural persons Foreign workers are required Visa Require registration of oversea workers. Registration are subjected registration fee and duration of registration is six months Commercial presence Permitted in accordance with certain laws JV with 51% foreign equity is permitted Not allowed to own land Land may be acquired form government in long term lease basis May lease but not own land Provide adequate and consistent training to Cambodian staff, including for promotion to senior positions Unbound except business visitors, persons responsible for setting up of a commercial establishment and Intra- Corporate Transferees One director for technical matters must be Cambodian Natural persons Unbound (same as General Commitments to all service) Additional commitments For Medical Services Additional commitments For Nursing Services Commercial presence (same as Additional Commitments for Private Hospitals) Permitted through a joint venture with Cambodian juridical persons Natural persons Unbound (same as General Commitments to all service) Commercial presence (same as Additional Commitments for Private Hospitals) Natural persons Unbound

18 Attractiveness of ASEAN

19 Global Healthcare Indices ASEAN Hospitals Index Outperforms the Rest of the World Rebased to Performance Since January ASEAN Hospitals (1) 226% 167% 64% 16% Australian Hospitals (4) 217% 94% 79% 26% Indian Hospitals (2) 149% 81% 66% 13% South African Hospitals (3) 163% 122% 94% 24% Russian & Middle East Hospitals (6) n.a. n.a. 73% (7) 74% EU Hospitals (5) 3% 13% 26% 19% 0 Jan-10 Jul-10 Jan-11 Jul-11 Jan-12 Jul-12 Jan-13 Jul-13 Emerging Markets Continue to Outperform Western Markets Source: Bloomberg as of 22 August, (1) Index includes Bangkok Dusit, Bumrungrad, Bangkok Chain, IHH Healthcare, Raffles, KPJ (THB denominated). (2) Index includes Apollo and Fortis (INR denominated). (3) Index includes Life Healthcare, Medi-Clinic, Netcare (ZAR denominated). (4) Index includes Ramsay (AUD denominated). (5) Index includes Athens Medical Centre, Euromedica, Générale de Santé, Hygeia, Iaso, MediClin, Rhön Klinikum (EUR denominated). (6) Index includes MD Medical Group, NMC Health (GBP denominated, London listed). (7) Since NMC Health IPO on 2nd April,

20 Thailand Listed Hospitals Price Performance Rebased to BGH 476.3% NEW 482.0% MCHAI 400.0% AHC 377.9% KDH 371.9% SETHEALTH 310.5% VIBHA 284.9% CMR 280.0% RAM 257.5% SKR 195.0% BH 179.7% VIH 164.0% NTV 119.6% SET 93.4% BCH 94.7% THN 63.4% CHG 66.7% 0 Jan-10 Apr-10 Jul-10 Oct-10 Feb-11 May-11 Aug-11 Dec-11 Mar-12 Jun-12 Sep-12 Jan-13 Apr-13 Jul-13 Source: Bloomberg as of 2 August,

21 Forecast Points Out Continuous Growth for the Region Strong Sales Growth Looking Forward Strong EBITDA Growth Looking Forward 12.6% Median Sales CAGR 12-14F Median EBITDA CAGR 12-14F 12.5% 15.2% 15.4% 4.8% 4.8% 1.8% 4.0% 4.6% 6.3% Other Emerging US -3.7% South Africa Europe Australia and NZ ASEAN Other Emerging US -2.6% South Africa Europe Australia and NZ ASEAN Top Percentile EBITDA Margin Region Other Emerging (1) 22.9% 20.0% 15.2% 21.1% 20.0% 23.3% 17.4% US 17.6% 17.0% 15.3% 14.6% 14.3% 15.0% 15.7% South Africa 28.8% 26.4% 22.5% 22.5% 21.2% 21.3% 22.7% Europe (2) 6.1% 6.2% 6.3% 5.2% 7.6% 11.7% 12.0% Australia and NZ 28.1% 24.2% 10.0% 20.8% 21.8% 20.1% 24.5% ASEAN 26.1% 24.5% 20.5% 20.2% 21.4% 26.9% 28.4% Percentile 60.0% 80.0% 60.0% 40.0% 80.0% 100.0% 100.0% Source: Bloomberg as of 22 August, Note: (1) Other Emerging includes Russia India and UAE (2) Europe includes Greece France and Germany 21

22 Regional Player s Performance Thailand Thailand Thailand Malaysia Singapore / Malaysia Singapore Philippine # of Hospitals # Licensed beds 5, ,620 2,709 More than 5, ,806 ADC (Beds/Day) 2, n.a. 315 OPD (Patients/Day) 20,744 3,017 6,618 6,582 n.a. n.a. 4,214 Profit & loss Revenue (USD mm) Revenue per Operating Bed (USD 000) Revenue Revenue / Bed 2,260 1,189 1, ,401 1, , '10 '11 '12 '10 '11 '12 '10 '11 '12 '10 '11 '12 '10 '11 '12 '10 '11 '12 '10 '11 '12 CAGR 39.8% 15.7% 2.1% 14.9% 27.0%. 19.2% 31.6% MK Cap (USD mm) 6, , , ,961 / 10,124 SG / MK 1,329.6 n.a. Analyst Consensus n.a. Buy Hold Sell Source: Bloomberg as of 22 August, 2013 and Company filings for year ended

23 Shifting Demographics Drives ASEAN Growth ASEAN Elderly Population Continues to Grow (1) Million people F Cambodia Indonesia Laos Malaysia Myanmar Philippines Singapore Thailand Vietnam ASEAN OECD F CAGR 4.0% 3.9% 3.5% 5.4% 4.4% 4.7% 4.9% 4.1% 5.2% 4.4% 2.2% As People Age, the More Frequent they visit the Hospital (2) OPD visit within one month as % of survey group IPD visit within one month as % of survey group 63.8% 34.7% 19.8% 4.8% 1.1% 28.1% 13.1% 6.7% 4.9% 8.3% 0-4 Years Old 5-14 Years Old Years Old Years Old Over 60 Years Old (1) Source: Euromoniter, elderly is defined as people over the age of 60 (2) Source: Ministry of Public Health 23

24 ASEAN Population are Starting to Spend More USD thousands Disposable Income per Capita in ASEAN Continues to Grow (1) F F CAGR Indonesia Malaysia Philippines Singapore Thailand Vietnam ASEAN OECD 10.6% 6.7% 7.4% 3.5% 6.3% 14.3% 8.6% 3.2% ASEAN Total Healthcare Rising Fast (2) Increasing Private Thai Healthcare Consumption (1) Total Healthcare Expenditure as a % of GDP Year Years CAGR 12.3% THB Trillions 2.7% 1.6% 2.2% 3.6% 4.1% 4.6% 4.1% 4.7% 1.3% 6.8% 3.0% 1.9% 2.3% Indonesia Malaysia Philippines Singapore Thailand Vietnam OECD (1) Source: Euromoniter (2) Source: World Bank Database

25 Shift in Healthcare Financing Agents Example: Thailand THB millions Increase in Government and Private Insurance Healthcare Payers in Thailand (1) 360, ,226392,368 14% 15% 303,854 15% 274,056 10% 11% 9% 251,695 14% 17% 9% 201, ,958228,040 27% 10% 26% 27% 27% 8% 9% 9% 9% 76% 74% 75% 76% 72% 63% 64% 65% 64% Shift in Healthcare Policy from the Government In 2001 a Universal Healthcare Scheme was introduced to increase access for the poor Prior to its implementation up to 20% of the population had no coverage Now c.95% of population is covered by public health insurance There are 3 main types of public healthcare financing schemes: Civil Servants Medical Benefit Scheme (CSMBS), Social Security Scheme (SSS) and Universal Coverage Scheme (UCS) Increase in Healthcare Coverage from the Government (2) % Coverage Government Private Insurance Out-of-pocket Others (1) Source: National Health Accounts of Thailand , IHPP Thailand (2) Source: Independent Assessment of first 10 years UCS by Health Systems Research Institute Civil Servant Medical Benefit Scheme Social Security Scheme Private insurance Others Medical Welfare Scheme Voluntary Health Card Scheme Universal Coverage Scheme 25

26 Attractive Medical Tourist Destination Overview Increasing Number of Medical Travelers (1) Thailand is the leading Asian medical travel destination for patients from the Middle East Over 50% of Thai international patients are from UAE, Qatar and Oman Added benefit of being a post-surgery holiday destination Medical tourists visiting Thailand are expected to grow by 3.5% CAGR to 2016 Key competitive advantages Thai hospitals have over their regional peers are higher service quality and cheaper treatment costs 17 hospitals in Thailand are JCI accredited In addition Thai medical personnel are highly qualified Popular treatments in Thailand are generally cosmetic and non-essential surgeries Thai Cost Advantage over US and Singapore: Procedure ($US) USA Thailand Singapore Thailand/ USA Thailand/ Singapre Heart bypass 130,000 11,000 18,500 8% 59% Heart valve 160,000 10,000 12,500 6% 80% replacement Angioplasty 57,000 13,000 13,000 23% 100% Hip replacement 43,000 12,000 12,000 28% 100% Hysterectomy 20,000 4,500 6,000 23% 75% Knee replacement 40,000 10,000 13,000 25% 77% Spinal fusion 62,000 7,000 9,000 11% 78% (k) (USD mm) 1, F 2011F 2012F 2013F 2014F 2015F 2016F Increasing Medical Travel Market Size 1,087 1,050 1,145 1,156 1,216 1,280 1,346 1,417 1,482 1,551 Source: Frost & Sullivan, Equity Research Note: (1) The numbers of medical travelers include tourists receiving treatment and exclude expatriates. Any incidental tourism expenses incurred during travel are also considered 1,500 1, F 2011F 2012F 2013F 2014F 2015F 2016F 26