Bumrungrad Hospital Public Company Limited (BH) Earnings Call Transcript & Summary

[Foreign Language] Welcome to the Second Quarter 2022 Analyst Presentation for Bumrungrad Hospital Public Company Limited. Thank you for listening in. We had an excellent second quarter, and I'd like to give you a bit of color as to what drove that performance and what we can expect going forward, given what we've seen so far. We can clearly see there was very strong performance on the international business side, and the key markets were performing very, very solidly, including Myanmar, Bangladesh, Kuwait and the UAE, our core markets. In addition to this, if you compare it with 2019 levels, which you can see in the graph there, you will -- you can immediately notice that we exceeded our 2019 or pre-COVID levels. This is a testament to how strong the quarter was and how rapid the business recovery was as well. And if I recall in our internal discussions, we had expected a time frame that was a little longer dated than what we have achieved thus far, so this is excellent news for us. If you also recall, in Q2 of 2019, there was a one-off charge for provision for long-term employee benefits. And it really -- if you were to exclude that charge, we still exceeded the net profit levels for even that quarter. So that also once again indicates to you how strong the quarter was. Comparing the Thai, the expat, the international business to 2019 levels, we actually exceeded across all 3 segments, for the Thai side, we were 27% above 2019 levels. We were 41% above on the expat side, 2019 levels, and we were even 1% above on the international side, the 2019 levels. In addition to the volume growth, there was also a case mix uplift. Revenue intensity on average increased due to stronger growth among the more profitable specialties within the hospital. That includes cardiology, digestive diseases, general surgery and neurology, even checkup, which typically is a low margin or even a loss leader for us, benefited from lower discount rates. The last -- if you recall last year, we sold Buy 1 Get 1 free packages, which have a higher discount than what we sold at the current health fair, where we only offered a 30% discount. So this reduction in discount benefited the margin as well to the benefit of the hospital. Moreover, although COVID-related revenue amounted to 5% of total revenue, it was still lower than in relative terms compared to the previous quarter despite the fact that there was a Q-on-Q and year-on-year jump of 17 -- of 9% and 17%, respectively. And in addition to this, we benefited from a lower contribution of vaccination revenue in the mix, which is, if you recall in the previous quarter, rather margin diluted for us. So overall, that benefited us as well. Prudent cost management was a key factor in determining how strong our growth was as well for the quarter. In fact, if you take a look at medicines and supply costs as a percentage of revenue in relative terms, it fell by 140 bps and 260 bps in year-on-year and Q-on-Q terms. That is a very strong uplift in margins. In particular, a benefit of this is in driving up the revenue intensity margin of our business as well. If you recall in the previous few quarters that we talked about, cost management was a key aspect of what we were focusing on during the COVID years, and this really has provided that benefit, relatively long term as well. And this is what you see right now. On the [ SW&B ] costs, although it grew at a lower rate -- it grew at a lower rate in year-on-year terms, because of the economies of scale we highlighted to you in the previous quarter as well as good FTE and contract management. In Q-on-Q terms, there was a reduction in SWB because we paid off a one-off loyalty awarded to staff in the first quarter of 2022. So that's a one-off which will balance out heading towards the latter part of the year. Looking forward, we continue to see sustained high volumes of inquiries and appointment requests which are a compelling forward indicator of the business strength in the second half of this year. Internally, we, in fact, revised upwards our daily census targets for inpatients, having nearly reached our target for the Middle Eastern segment, which is typically much higher margin, much more revenue intense. So again, a positive outlook currently. The continued discount reduction and the international business expansion that we expect in the second half as well as among not only the core markets that we talked about, but even the lesser developed markets that we haven't touched upon, namely markets such as Vietnam or Oman or even Saudi Arabia are expected to benefit performance going forward. And although there might be some offset with higher SW&B expenses due to inflationary adjustments, and the higher recruitment of additional head count of staff, we do expect a positive outlook in the overall business performance going forward as well. On the discount rate development, we talked in the previous quarter about the expectation of it coming down. It in fact has come down from 13.7% to 13%. That was the continued -- discontinuation of the Loyalty program and the steeply discounted birth delivery packages that we provided last year. The reduction, although relatively slower than what it was in the first quarter, was mainly due to the fact that we had the health fair in the second quarter, which sold although less discounted packages, did slow down the rate of reduction, but this effect is expected to taper, and we do expect the discount rate to continue to fall in the second half of 2022. We haven't touched upon new patient growth and patient retention. And I want to show to you this graph which indicates to you the strength of the quarter and the performance that we have done so far. This is really a testament to the good planning and good management and foresight that we have enacted over the COVID years and really are reaping the fruits of that now. If you take a look at the top chart there, you can see for new HNs, it comprised of 31% of our overall patient episodes for the first half of 2022. You compare that with a significant growth in the second half -- sorry, in the first half of 2021 and even the first half of 2019, it looks very favorable, especially when you factor in the overall number of patients also increased, meaning that not only did we grow new patients, we also had effective patient retention, which allowed us to benefit from the strong performance that we were talking about in the previous slides. If you look at by segment, you can see across the board, very strong growth in the Thai, the expat and the international market as well. And that really is rather broad-based. We do expect to continue to perform in a strong way going forward as well. Now I'd like to hand the presentation over to Neil Sorrentino, our Chief Global Strategist, who will talk further about developments of the quarter, diving specifically into the performance of the individual markets and the company as a whole. Thank you.

[Foreign Language] And I too welcome you to Bumrungrad Hospital Public Company Limited quarter 2 and 1H 2022 analyst presentation. You're going to hear a lot of comments during this analyst presentation from a number of people about the specifics to the spectacular quarter that we had. And in fact, it was dramatically spectacular by any measure especially when you consider that we came from Q3 to Q4 2021 at 33% revenue growth delta. And then from Q4 to Q1, there was an additional of 5-plus percent increase in revenue. And then in Q2, we showed a 19.5% increase in revenue growth over Q1 2022. And this, I would remark that this was done without any price increases whatsoever. So it goes to the question of why is it that we're having these kinds of dramatic returns and performance for this company. In the quarter, I and Khun [ Lang ], our hospital CEO and Daniel Kastner, sat for an interview with the Bangkok Post, which was published in the Bangkok Post in quarter 2. And in that interview, I spoke at some length about the customer experience. I spoke at great length about the value proposition as to why people select Bumrungrad. And a lot of those things I spoke about had to do with the performance of Q2. So if you take a look at what I put together for you in the way of quarter 2 takeaways, I talk about global competitive advantage and pricing power. What are they? What does it mean by that when I talk about that with respect to Bumrungrad Hospital? Durable competitive advantage. That means to say that when customers, clients, patients make a choosing about where they seek their health care, there's a sustainability about why they make these selections. Why is it that the country has opened up so dramatically, and we have jumped our performance so dramatically in kind, when it was clear that during the pandemic, there was a lot of questions about whether or not the international business would return? Well it returned with a vengeance to the benefit of our institution. And we had that confidence that it would. And the reason was is that this institution 42 years young and 42 years old has this kind of market power, has this kind of brand image and this kind of brand equity. When I speak about pricing power, I am not talking about -- and I will say again, I'm not talking about raising prices. I'm talking about customers, patients, clients who look at Bumrungrad and say, am I getting value for my money? Is the pricing power of this organization, something I'm willing to pay to go to Bumrungrad amongst all others in Bangkok? And clearly, when you look at Q4, Q1, Q2 of 2022, our customers made that decision in saying, you know what, that value proposition is there for us. We want to go back there. When I go through the numbers for Q2, you will see some very specific and dramatic returns from various elements around the world, supporting Bumrungrad Hospital. These are countries and these are patients that have been here before, many returning again for that value proposition that they see as important. Next slide. We track as a company, we track customer loyalty. And while many, many companies do this, it's an imperfect science. Many, many companies do this, but as they do this, they're looking to get feedback from their clients to continue to deliver that value proposition I've referred to. If you look at this slide, and you can look at it at your leisure, you will see there are 3 main characteristics we look at: Overall patient satisfaction; would the customer, would the client, would the patient return to Bumrungrad in the future based upon their experience; and how likely is that they would recommend this institution to their family and friends. And look at the tracking of the data that we're getting from our patients, it validates what I've talked about in the Bangkok Post interview, which is the value proposition that is Bumrungrad is unique in Thailand. And if not in Thailand, in Southeast Asia. And it's the reason why we've had such fundamental increases in our business returns for Q1 and Q2 now. And if you look at 1H in comparison to 1H 2021, and I'll go through that with you, that detail for a moment, you'll see the dramatic increase. And it didn't have to be that way simply because the pandemic ended. It's that way because people want to come to this institution. Next slide. So digging deep now into the numbers. I've shown you this over the last several quarters, and it's still a very, very revealing slide presentation, and it shows you the jump in revenue, EBITDA and NOPAT. And take a look at 4Q '21, 1Q '22, 2Q '22. It's what I've been talking about, and it's what others will be talking about when they talk about Bumrungrad Hospital. Our Dr. Narinthorn, who's our Chief Operating Officer for VitalLife Corporation will be talking about his performance in his business unit, making a contribution to this. VitalLife as an example, we've been quiet about it because it really has been a company 22 years in its duration and continues to grow. It wasn't that long ago that VitalLife was about 4% of our total consolidated earnings for the company. Now it's about 5.5% with the base growing, and he will talk a little bit about that in detail in the next presentation. But have a look at Q1 versus Q2 THB 4.1 billion versus THB 4.954 billion in growth in total revenue, EBITDA, very, very strong growth. Net profit, not only the net profit grew, but the margins associated with EBITDA and net profit were quite dramatic for the quarter. And I would add further that as we look into 2H, which we're now in the middle of, absent some kind of an uncontrollable circumstance, we are seeing tremendous demand from around the world for our products and services for our company. And I won't predict whether or not these kind of performances will replicate themselves in Q3 and Q4, but I'm very positively optimistic about where we go in 2H. I'll talk a little bit more about guidance in a moment. Next slide. This slide is quite revealing for you because it shows a very interesting trend. As you look at the brown area, which is international and go back to 1Q 2021 from 25% grew to 49%, almost double the revenue from 1Q 2021 to 2Q 2022. In the same way, we add these 2 numbers up 49% and 13% that represents 62-something percent of total international business, which includes expat as well as all other international business. That's important for us as a marker, it tells us that we are fast approaching our record high of revenue of 66% of international business against the total revenue. And that didn't happen until 2015 and then again, 2019. Correspondingly, if you look at the blue segments, you will see that is the Thai business. It has gone from 54% down to 38% by revenue. Although a lot of this was intentionally manufactured by our company, as a result of in the early days, meaning 1Q 2021 when the pandemic was around, we were trying to incentivize locals because that's all that would come to any hospital in Thailand, including ours. We tried to incentivize them to come and use services here at Bumrungrad. We provided a lot of promotional opportunities for them, and you can see that it worked. When Daniel speaks to you later about our percentage of discounts, in these days, 1Q 2021, 2Q 2021, our discounted rate was pushing 16%, 17%. It is now, I think, for the quarter 13%, a little over -- an inch over 13%, dropped 4 percentage points on that base of revenue. It's fairly, fairly dramatic. This is the orientation that I like to see from a strategic standpoint as we continue to build this platform of this company internationally. Next slide. So for the segments, the market segments themselves, I mentioned earlier that the revenue grew almost 20% quarter-on-quarter. And if you think about 5-plus percent before that, and if you think about 33% before that quarter, meaning Q4 over Q3, you can understand, well, what is driving this in terms of marginal contribution. And the answer is very, very clear, what's driving it is our international business. I've just shown you how it has changed over the quarters. When I look at profitability by markets, I won't go into which markets have the higher profitability or not because that's proprietary information. But it's fairly self-evident when you look at the volume changes in our international business that the international is driving, not only high revenue intensity. And we go back now to my earlier point with respect to pricing power, where patients continue to come here from all over the world when there are assets in those countries that they could go to, but they choose this asset to the extent that you've seen this change in performance. And obviously, year-over-year, the numbers are really not relevant because one is during the pandemic and 2022 is absent the pandemic for the most part. So that's the net patient revenue overall. Very strong quarter. Next slide. On the Thai business, it grew slightly. We weren't just pleased with the growth in the quarter. Look down here though, where you look at the quarterly revenue trend, this green line here, you'll see the variation between this slope difference right here, Q1, Q2, that's 2022. You'll see that it's higher in terms of overall revenue. And what drove that overall revenue growth, but not very, very much volume growth was revenue intensity, meaning as Thai people came to this hospital, they were sicker in the quarter. Their revenue -- their resource consumption was higher. And this is what drove this revenue trend, not so much volume, more resource consumption. Of course, year-over-year, not relevant. Next slide. The same story for expat. You'll see that it grew slightly, up by 1% -- 0.8%. But what did grow was the revenue change, this slope line here change, same story with expats as well as Thai patients. And that related to revenue intensity, meaning sicker patients coming to Bumrungrad during the quarter. Next slide. Now we get to the meat of the quarter, this is where there's a lot of meat on the bone about what happened in the quarter. I much rather prefer to have explain to you why rather than just show you these numbers. The numbers are self-evident. But in the quarter, you see that the change was almost 48% all international. So mind you, that's expat, which are foreign nationals. They're considered international as well as Middle Eastern, Indochina, et cetera. That number grew almost 48%. And this slope line here, this rising slope line Q1 over Q2, you can see how dramatic it was. Next slide. Here are the international countries that grew by percentage, and I'll take a few moments to tell you the delta revenue changes for these countries without getting into the gross revenues by country. But you can see the top 5 countries that drove a high increase quarter-over-quarter, led by Myanmar in our Indochina country sleeve, followed by Kuwait, Qatar, Cambodia and Bangladesh. And interestingly, over the last 2.5 quarters, we spent a lot of time with our sponsors and partners in the UAE, and that business has dramatically grown for us at Bumrungrad. This is a market that used to be ours before the pandemic. And then the pandemic came and a lot of these patients were rotated to places like Turkey, places like India. And we spent good time with our relationship partners in the country. And I'll show you some data in a moment that describes how this particular market, market #6, UAE, has grown so dramatically for us. Next slide. So specifically for the Middle East, the quarter-over-quarter revenue change was 34% for the year-over-year number was significantly higher, but again, not relevant. This was a big part of what happened in the quarter, not the total part but a big part. Next slide. Indochina was the market's lead that grew the most by percentage 65.7% led by Myanmar. Myanmar was our top country in many, many different categories, not just in revenue, lifted volume not just in patients, but many other key markers. And even though there's still unrest in this market, patients are willing to get on airplanes and come to Bumrungrad. And I can tell you, by the way, there's lots of hospitals in Myanmar, lots of hospitals in Yangon, lots of doctors there. And this is the why Myanmar is the best example of the why these patients come to this institution. Next slide. So we get into the EBITDA throw and the NOPAT throw for the quarter, spectacular growth on EBITDA quarter-over-quarter of almost 46%. Next slide. The margin, even more spectacular is the change when you look from 1Q 2021 to 2Q 2022. It jumped to 34.4%. This is a combination -- now again, for those of you that are not as familiar with our company, as some others of you are who are listening, this is a combination of both volume, complexity of care and revenue intensity. And the other thing that happened in the quarter, which I haven't remarked about, but I will now is our cost control. For the second quarter in a row, the cost control has been excellent. I have to complement our team at Bumrungrad Hospital, our team at VitalLife. They've done a very good job of managing the costs as we transition from a pandemic situation to a very, very live, huge volume change, they were able to take that volume change on, maintain the customer satisfaction, the value proposition I talked about and deliver these kinds of performances. So this is the trend line of the EBITDA margin more than doubled from 1Q 2021. Next slide on margin for NOPAT. Because of the combination of things I just mentioned to you, the net operating profit after tax Q-over-Q, you would expect if you're managing costs effectively, that this percentage growth would be much higher than your EBITDA growth. And in fact, it was. It was up almost by 15 points against the prior number. Next slide. So this trend line I'm presenting to you so you can see something very nominal in 1Q 2021 at 3.4% during the height of the pandemic to 23.5%. We are reaching -- we're close to and are reaching our record margins, both for EBITDA and NOPAT. I expect to achieve that in 2H, all things under control. Next slide. Now as I referenced, Dr. Narinthorn is going to talk in detail about what's driving VitalLife performance. It's really been a really big business, what I would reference as a quite storm, 22-year-old business that has just been spectacular for us, both on volume and on margin. And you can see the revenue growth for Q1 versus Q2. You can see the year-over-year growth of [ 125.5% ]. It's running now somewhere around 30 -- Thai 30-plus million per month on EBITDA. It wasn't that long ago that it was half that number. We have, of course -- and he will speak about our second satellite VitalLife Scientific Wellness Center at RAKxa. And we will be talking about expanding the scalability of this asset going forward in 2H. We'll be reporting some positive news about that in the upcoming quarters. Please go back to the takeaway slide. I promised you that I'll give you some growth information. Let me do that. Go back to the slide with the listing of the international markets, please. Myanmar, et cetera. So these are the percentages that I talked -- that I showed you earlier, and we didn't show you this slide. But for the quarter, not only did the business grow 76.5% on a percentage basis, the Myanmar revenue grew THB 196 million quarter-over-quarter. Qatar grew 49 -- THB 82 million, Cambodia grew THB 135 million quarter-over-quarter. This is the delta I'm giving you. I haven't given you the base, but this is the delta. The United Arab Emirates grew THB 89.3 million quarter-over-quarter. We're particularly proud of this market because it was moving along okay, but it dramatically showed up in Q1 and especially Q2. The U.S. market, which mostly expats here, grew almost by THB 20 million. China grew THB 39 million. Now on the question of China, we haven't been really soliciting any of this business because it hasn't been available to solicit. The country has been closed. But just this past week, if you follow this like we do closely, Beijing has increased by 200%, the number of outbound flights outside of China. And what we're learning is that initially, there are more business executives leaving China to continue their business outbound. But we're expecting the fourth quarter as we talk to our agents, et cetera, we expect in the end of the third quarter, the beginning of the fourth quarter or so, more Chinese residential tourists coming to Thailand. Before the pandemic, it was almost 10 million Chinese who came to Thailand, because they love coming here. And our revenue growth was very nice before the pandemic. We expect to enjoy a similar return of the Chinese patients to Bumrungrad Hospital in Q4. Please go back to the takeaway slide. In the quarter, Our Board of Directors approved an interim dividend to our shareholders of THB 1.15, which represented 48% of EPS for 1H. If I take you back a year ago, the absolute same amount of Thai baht that was distributed THB 1.15 as well as the absolute amount of Thai baht itself, equated to almost 300% of EPS, which shows you the change in the earnings growth year-over-year. The Board looking at historical trends continue to reward their shareholders. And in addition to which, we the management of the institution also rewarded our employees in 1H with a number of financial incentives and loyalty awards as well as increases in base salary in 1H sharing the benefits of the 1H performance with all BHPCL employees. Nonetheless, our cash and cash equivalent balances is almost THB 7 billion. This is before the payment of the dividend payout, the interim payment dividend payout, and we began at the end of August, our forecasting for 2023. We have a number of brand-new markets that we're going to be targeting for 2023 for which we'll do a lot of work at the end of 2022 about. We'll spend more time -- I'll spend more time talking to you about those new markets. These are brand-new markets that we now have ability to penetrate with a different level of management that I put together, but I'll talk more about that at the -- in our November Analyst Presentation. And insofar as guidance is concerned for Q3, can I project the same kind of 20% revenue growth, no one can. And I wouldn't want to try to do that. But what we do see is sustained demand for this value proposition called Bumrungrad, and we're going to keep delivering the experience that we know how so well to do for as long as these patients continue to come here, and we expect that to continue for some time. We, at the end of this week, will be putting on a live stream Q&A. I believe that's going to be Thursday or Friday. Is that Friday? Friday, correct? Friday at 10:00, please join us. Ask any questions you may have. You can submit the questions in advance or during the live stream. Thank you for joining us. [Foreign Language]

[Foreign Language] Good morning, everyone. I'm Jittima Nuntavichithaporn, Deputy CFO. I'm pleased to report the financial highlights and the financial performance of the second quarter and the first half of 2022. For the financial highlights of the second quarter 2022, performance was improved from the second quarter of last year and the first quarter of this year. This was primarily due to a significant growth in international business. For the second quarter 2022, revenue increased by 64% year-on-year. This was mostly due to an increase in revenue from non-Thai patients by 120.8% and Thai patient by 15.8%. EBITDA increased by 196.1% with EBITDA margin of 34.4%, increased from 19.1% in the second quarter of the previous year. Net profit and diluted earnings per share increased significantly by 438.6% with a net profit margin of 23.5% compared to 72% in the second quarter of 2021. Comparing with the previous quarter, the second quarter 2022 revenue increased by 19.3%, mostly due to an increase in revenue from non-Thai patients. EBITDA increased by 45.8% and net profit grew by 60.8%. Comparing with the second quarter of 2019, in order to see the performance of the current quarter to the pre-COVID levels, the revenue increased by 15% from the second quarter of 2019. EBITDA increased by 46.2% and the net profit grew by 60.8%. For the first half of 2020, revenue increased by 59.9% from the previous year. This was primarily due to an increase in revenue from non-Thai patients. EBITDA increased by 191.5% with EBITDA margin of 31.6% compared to 17.3% in the first half of last year. Net profit increased by 514.8% with a net profit margin at 20.8% in the first half of 2022 compared to 5.4% in the first half of '21. Compared with the first half of 2019 pre-COVID level, first half '22 total revenue increased by 1.1% and net profit increased by 4.7%. Net profit margin grows to 20.8% compared to 20.1% in the first half of 2019. Move on to the financial performance. The company reported total revenue in the second quarter of 2022 of THB 4,954 million. This amount represents a 64% increase from the second quarter of last year and 15% increase from the second quarter of 2019. For the first half of 2022, total revenue was THB 9,106 million, 59.9% increase compared to the first half of last year and 1.1% increase compared to the first half of 2019. Revenue contribution by nationality. The percentage of revenue from international patients increased to 62% for the second quarter of 2022 compared to 46% in the second quarter of 2021 and 66% in the second quarter of 2019. For the first half of 2022, percentage of revenue from international patients increased to 64 -- 68% compared to 46% in the first half of 2021 and 59% in the first half of 2019. Revenue contribution by services. For the second quarter of 2020 (sic) [ 2022 ], the proportion of revenue from inpatient services and outpatient services was at 46% and 54% or more the same as pre-COVID level second quarter of 2019 at 45% and 55% while the second quarter of 2021 was at 54%, 46%. For the first half of 2022, the proportion of revenue from inpatient services and outpatient service was at 47% and 53%, or more the same as pre-COVID level first half '19 at 46% and 54%, while the first half of 2021 was at 53% and 47%. Revenue contribution by payor type. Self-pay was increased from 64% to 71% in the first half of this year, mostly due to an increase in international self-pay. Insurance contribution decreased from 22% to 17% in the first half of 2022, mostly due to a decrease in expat insurance business. The government third-party payor contribution was slightly reduced from 12% last year to 11% for the first half of this year. EBITDA was at THB 1,706 million in the second quarter of 2022, increased by 196.1% from THB 576 million in the second quarter of last year and increased by 46.2% in the second quarter of 2019. We are also proud to say that this quarter EBITDA amount is our new high record. The increase in EBITDA was mostly due to an increase in revenue and also our continued cost management programs. The EBITDA for the first half of 2022 was at 2,876, a 191% increase from the previous year and 3.2% increase from THB 2,788 million in the first half of 2019. EBITDA margin was 34.4% in the second quarter of 2022, increase from 19.1% in the second quarter of last year and increased from 27.1% in second quarter of 2019. EBITDA margin was 31.6% in the first half of this year, increased from 17.3% from the first half of last year and 30.9% in the first half of 2019. Net profit for the second quarter 2022 was at THB 1,166 million, increased by 438.6% from THB 216 million in the second quarter of the previous year, and increase by 60.8% from THB 725 million in the second quarter of 2019. Net profit for the first half of 2022 was at THB 1,891 million, increased by 514.8% in the first half of 2021 and increased by 4.7% from THB 1,806 million in the second -- in the first half of 2019. Net profit margin was at 23.5% compared to 7.2% in the second half of last year. And compared to 16.8% in the second half of 2019. For the first half of 2020, net profit margin was at 20.8% compared to 5.4% in the first half of last year and 20.1% in the first half of 2019. Net debt-to-EBITDA was at minus 0.3x for the first half 2022 compared to minus 0.6x in 2021. This is mostly due to the higher EBITDA. Net debt-to-equity was at minus 0.1x as of June 2022, the same as December 2021. Thank you.

Good morning, everyone. Today, I would like to present the hospital operations in second quarter this year. So as everyone knows that Bumrungrad always focuses on patient safety and quality, we are very proudly to present our achievement in JCI CCPC or clinical care program certification in Heart Failure Program. This program is very important and to be the gateway for heart transplantation, which right now, we have successfully done for 3 cases. And now Case #4 and #5 waiting in our queue. Moreover, we just passed the second reaccreditation program from the College of American Pathologists to certify our best practice in laboratory services. And next, we continue seeking for the new advanced technology to support our doctors and health care professionals in order to deliver the best clinical outcomes to our patients. And we just launched a press conference in the new artificial intelligence for radiology in which we use this AI to read and interpret the film chest x-ray and mammograms. It works as a decision support tool to improve the accuracy and also reduce the turnaround time to only 5 minutes per patient. I think everyone knows about this technique, we call water vapor therapy. In fourth quarter last year, approximately around 9 months ago, we have introduced the new innovative minimally invasive therapy, which is designed to treat enlarged prostate. We got overwhelm of the interested patients and positive feedback from our patients. Clearly, we are the first center in Thailand and also in Asia to be certified by Boston Scientific. The criteria based on the reviews of our clinical outcomes around 85% to 90% success rate from over 100 patients in the past 9 months. And this is the performance of our Bumrungrad health network. We expand our MOU partnerships from 73 hospitals in the first quarter to be 77 hospitals in second quarter. The 4 hospitals are already in the presentation. If you see the graph on the right-hand side, the referral revenue is slightly dropped around 7%. I think because of right now our MOU hospitals are overwhelmed by the COVID patients so they have less deferral patients to us. And next, everyone is waiting for our health fair campaign. This year, we arranged in-house health fair event for both offline and online channels to serve our customers. From the slide, you can see that over 2,000 packages, so with approximately THB 51 million in this each channel, we can acquire new patients as soon as the previous year and can get the downstream revenue from our check-up center. And this is the performance from the Digital MarTech. The revenue from online store increased around 160%, approximately nearly [ THB 240 million ]. We sold around 15,000 packages. We are all line mainly from the COVID vaccine Moderna, and gift vouchers. In average per customer, they bought our package 1.95 package per person. And numbers of the customer purchasing via online right now is higher than 200% compared to previous year. And for Bumrungrad application right now, active users that use our application is around 2,500 users per day. This is the new look of the Ward 6 after the renovation of this ward. And this is our maternity ward. We have to decide the new operational workflow and also make the environment look very warm and homey and seem relaxing for mom and baby. It's very beautiful. And right now, we're starting with Ward 7. And this is the new location of the Bumrungrad international airport representative office at Suvarnabhumi Airport. We relocated from the door 10 to door #9, in which we would like to have our office more in visibility to the customers. This office serves flight inpatients since the beginning of May for the very convenience after a long flight. We service our customers by providing the staff to help facilitating hotel reservation, doctor appointment and also the transportation from the airport to Bumrungrad Hospital. This is to ensure that all the journey of patients after they arrive the airport in Bangkok, and they can better comfortable and convenient to come to use our service at Bumrungrad Hospital. So today this is for me, thank you.

[Foreign Language] So today, I would like to update about the VitalLife performance for the first half of this year. So this year, our performance both in VitalLife and RAKxa increased significantly. Now we see the visit year-to-date in June has increased 50% year-on-year, and we can see a comeback of the international market. It's increased about 421%, and we still keep our Thai market and expat market the same. The reason that we have in place of international market a lot because even during COVID-19, during these 2 years, we still keep connect, and we still keep in touch with our patients. We still continue to send our supplement to the patients in Middle East in [ CRMV ]. So when the country opened, they come back. And not only our existing patients, we have a lot of new patients, especially for the international market. And the RAKxa see the good trend in the first and second quarter this year. Now we see the increase of number of membership in RAKxa from 118 last year to 140 this year. And we see a lot of Thai patient -- Thai guests who come to visit at RAKxa. And we start to see the good trend that international markets start to come to RAKxa. And another key success this year for our RAKxa is we start to have the case that have the payer by embassies of Arab. So this is a good trend that in the future, we can have more and more case from Middle East, both self-pay and both [indiscernible] payer. To see the top visit growth by nationality, #1 is still Thai. During COVID-19, in these 2 years, we increased the Thai visit from 7,000 visit per year in 2019 to 14,000 visits last year. So it's double in 2 years. And so the growth in this is because of awareness in health-conscious from COVID-19, our branding, our marketing communications. And we also recruit a new doctor to join VitalLife and bring new technology, bringing new treatment and supplements. #2 is United States. Bangladesh, this is really good trend too, 764%. Myanmar, we still keep in touch with Myanmar, and we visit Myanmar, Yangon clinic of Bumrungrad and we try to collaborate and have program together. Our UAE, Qatar, Kuwait, this is our key market that we want to focus, Cambodia and China we have plan to go out more in second half of this year to visit this key market. We increased our intensity to not only increase visit. Our intensity, we increased it by bringing the concept of Wellness Tree. So you can see some wellness center, they forecast only to give the supplement and vitamin. But with the holistic approach by VitalLife, we focus from genetic. Genetic is one of the key of the Bumrungrad Hospital. And so we try to bring genetic to integrate with wellness and create the wellness plan for our patients. Now we combine lifestyle factors, and we try to combine detoxification program for our patients. And we still focus on hormone, on immunity, but we try to add more functions that we try to help to improve quality of life by improve their gut health, energy into cellular level, brain health, sexual health, detoxification program, sleep health and mobility, so we try to bring new expertise and combined with Bumrungrad Hospital with our specialists to deliver program for these functions. And next year -- second half of this year and next year, we will focus more to treat the diseases like diabetes, hypertension, heart disease, cancer, we will bring program to combine integrated with the Bumrungrad Hospital. Another key success that made the patients come back and repeat visit at VitalLife, we use the Wellness Tree to have a holistic approach, and we develop wellness plan to let the patients understand that, what is the plan for them this year? What is the objective for their health? How to -- how we can fix their health concern, and you know that our patient is highly educated. They are executive. They are rich people. When they see this plan for themselves like this, they appreciate a lot. And this is one of the key differentiators of VitalLife compared to other centers. For our marketing and communication, we focus both direct to customer, we also have a B2B and corporate partnership to take care of their executive in many industry, in the property industry, in financial industry, and we have the program that take care of their executive and their -- that part of their customers to -- Thailand [indiscernible] is another program that we work with the rich people that come to visit Thailand and have a clear program. This according to the health concern. So we focus a lot in the pain point and all concern from the patient not only give the product that we have, but we try to bring the outside in to develop program for our patient. Our online and digital program is one of the co-channel that we can see growth a lot during these 2 years. Now we use the telemedicine with international market. We promote and educate our patients by Facebook Live, by YouTube channel, and we used live communication to convert the sale from the one who is interested from the other platforms. So this help a lot to increase our new guests. And we also have a key strategy in the second half of this year with a new service. Now we will bring new innovation and technology about the hair clinic care center. Now sexual health, this is the main concern of Middle East market and brain wellness clinic. So this not only bring technology, but we have doctors and specialists from both we recruit new doctors and from Bumrungrad Hospital that focus indicate the treatment for wellness. And for the customer journey, we will try to offer the best service experience, not only clinical experience. And as I informed earlier, this year, we will go out more. I will fly almost every month to Myanmar, to Middle East, to Cambodia and our focus country. VitalLife expansion, this is the new era of VitalLife that we can expand more to other locations, but we can update about this expansion in the next quarter. Thank you.

Thank you, Dr. Narinthorn. And this concludes the second quarter 2022 analyst presentation. See you in the live Q&A session for those of you who are invited. And for those who are keeping track of Bumrungrad, the third quarter results will be released on the 10th of November with an analyst presentation followed 1 week after. Thank you. [Foreign Language]