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

[Foreign Language] Welcome to the Fourth Quarter and Full Year 2022 Analyst Presentation for Bumrungrad Hospital Public Company Limited. Before we begin and dive into yet another great quarter for us, I'd like to announce some housekeeping items. I'd like to introduce to you certain changes in the IR team that will take place effective 23rd of February of this year. I'd like to also then introduce you to our new IR Senior Manager, who will be taking over my role in IR going forward. Now that Bumrungrad is very, very busy, and we're looking at expanding our business across the international markets, but also domestically, there are a number of things that I have to focus further on and I'd like to hand that over to somebody who has been very qualified to take over this role. And we're very excited to announce her and to have her as part of our team. So I'd like to introduce you to [ Khun Acaria ] or [ Khun Am ] who will be our new Senior Manager for Investor Relations and Sustainability. I believe that you'll be in very good hands with her, and I look forward to seeing her represent us in Investor Relations function going forward. So without further ado, I'd like to hand over this presentation over to Neil Sorrentino, our Corporate Chief Strategy Officer, who will go through the key takeaways of the year and what were the key drivers for us in this quarter and also for the full year.

[Foreign Language] and good morning, and welcome to BHPCL's Q4 and 2022 analyst presentation. We thank you for joining us. Before I begin the discussion of the year, and then my discussion is going to involve for the most part, 1H and 2H because this is also a yearly presentation of the performance of the company. But before I do that, earlier you heard from Daniel, the Head of Investor Relations for the company. Daniel has taken on additional responsibilities since the last time we spoke to you back in November. He -- since that time has taken on both insurance contracting operations as well as domestic business development which includes Thai and expat business, a substantial amount of increased responsibility. When I hired Daniel, I know he had a high ceiling and he has the discipline to do it all. We will miss him at IR, but at the same time, we look forward to him helping us further in the growth and development of our business place. Daniel, thank you very much for all that you've done. We welcome [ Khun Am ] as well, as the new manager of Investor Relations. You'll be seeing much more of her, as well as seeing her next week at the live call Q&A. So let me begin discussing our -- well, the only way to describe, it has been a spectacular 2022 performance for the company. I will take you first to this slide before I get through the takeaways. And on this slide, you will see a 10-year performance summary of both our EPS, our dividend payments and more particularly, our net profit, our annual profit for the year. And over 10 years -- and for 2022, it was the highest net profit performance in the 10-year history of a 42-year history of our company. And we're extremely proud of that. What drove that? What was it that created this kind of significant performance? And I will tell you that 1H versus 2H, 2H was much, much greater in terms of volume supported by international patients, in particular, and high-revenue intensity patients more particular, but we'll get to that in a moment. So for the year and for the fourth quarter, which was very strong, these results are about Q4. The revenue drivers for the quarter and for the year were the Middle East, Indochina and the international business, in particular. International business was key principal driver. And when I say international, I speak both on the Middle East as well as our Indochina operations. The growth of 1H over 2H was 27% for that revenue changeover. The EBITDA and the NOPAT for the year, quarter-over-quarter and 1H over 2H more particularly was 48% and 61% respectively for EBITDA and NOPAT. When you look at the earnings contributions in particular, by the market, the Middle East, Myanmar, Bangladesh, Qatar and Kuwait, those 4 markets. And if we look at the Middle East as a consolidated market, those 4 markets were the most principal revenue and earnings drivers for the company. We will discuss Thai and expat business in just a moment. They contributed but not nearly as strongly as our international business. When you look more deeply into where the support came from, it came both from existing markets as well as new markets. And as an example, if you look at KSA, KSA stands for the Kingdom of Saudi Arabia, from 1H to 2H, the revenue almost tripled in 2H from the Kingdom of Saudi Arabia over what we experienced in 1H. And further support from Myanmar as the patients started coming back even though there has been significant unrest in that country. Patients continue to come to Bumrungrad especially in 2H. Indochina and China, interestingly, some of which were expat Chinese living in Thailand but others were those as the country started opening up, coming back into Thailand, coming to Bumrungrad. Well, I'll just -- I am going to talk a little bit about that revenue in just a minute. Dropping back down further on the takeaways, you will look at what our Board is going to be recommending to our shareholders at the April Annual General Meeting. The EPS for the year was THB 6.21 per share. It was the largest EPS we had in over 10 years at the company. And as a result of that, our Board is today evening is going to be recommending a THB 3.5 per share -- dividend payment per share, equaling over 50% of the earnings of the company. Now we had monetized 60-some odd percent, because for the last 3 years, our EPS per share or DPS has been THB 3.20. Notwithstanding whatever the earnings were in those years, specifically the COVID years, we maintained a minimum of THB 3.20 per share. This year, because of the extraordinary performance, we'll be distributing -- assuming the shareholders approve THB 3.5 per share or 56.4% of total net operating profit after tax. And that's the largest it's been in 10 years or longer. As we look forward toward the guidance for 2023, dropping down further on the takeaways. My expectation is that given the way the Q1 has begun, January and part of February, my expectation is that we will have double-digit growth in Q1 2023. The quarter has begun as strong, if not stronger than where Q4 2022 ended. Many of you asked, what is our rate increases for the year. Our rate increase -- effective rate increase will be 4.6%, and our budgeted volume will be 8%. As we look at it today, I believe that that's -- I wouldn't call it overly optimistic, and I wouldn't call it conservative but I would call it something that is highly achievable, if not, better than highly achievable. And because we have very, very strong cash collection performance mainly from our Middle Eastern sponsors and guarantors, our cash position as of January-end of 2023 was at a record high THB 8.6 billion. Now I'd like to take you through the individual pieces of the P&L for really the year. It's best that you take a look at it on 1H, 2H basis and then on a yearly comparative basis. This particular slide talks about EBITDA over a 5-year period and going back to that earlier slide where we had NOPAT for a 10-year period, this shows you the trend line for EBITDA over the last 5 years, but most significantly in 2021 and 2022, the growth was significant and highly dramatic when you look at the THB 2.7 billion versus THB 7.1 billion EBITDA from 2021 to 2022. If you look at the margin for that 5-year period, you see the trend line going down during the COVID period, 2020, 2021 and then strongly upward in its trend performance upwards of 34-plus percent EBITDA margin. In the same way, the net profit trending to the same thing over the 5-year period, going back to 2019, which was -- the profitability was THB 3.748 billion. And in 2022 it ballooned out to almost THB 5 billion -- excuse me, almost THB 5 billion in net profit, a record, a 10-year plus record. If you look at the net profit margin related to this 5-year swing, you see the high watermark was in -- it was in 2018. It dropped down to 20.2% and of course, COVID took it down further in '20 and in the short end of 2021, although almost equal to 2020 and then it jumped out this past year in 2022 up to 23.6%, also a record net profit margin. Now going into a little bit more detail by market segment, would have produced for you here is on the left-hand side, the year -- the 1H over 2H for 2021 and on then the right-hand side you'll see the performance for this year. And this reflects both the Thai, Expat and International. International is the brown-colored one. The expat is the green-colored one and the Thai is blue. So if I focus you here, you will see that in 2H 2022, the jump went from 45% for international business to 56%, an 11% revenue of jump increase, 2H over 1H. And this number here, this 11% increase, it was a major, major contributor to our operating performance in addition to a fairly good cost control. We kept adding manpower here throughout Q4 to accommodate the increase in business. We did have some pressure or compression on the organization because of some short staffing, availability of beds. It was a difficult time for us in the sense of accommodating this new business or existing business that returned. But we're now in a position where we're staffed now up to 450 beds. We have 450 beds open, available and staffed. And by the end of April, we will have that pushed up to 480 beds. The changes here are above average for the expat business for 1H versus 2H in 2022. There was a drop here for the Thai business from 41% to 33%. And you may ask, why did that occur? We were taking care of many, many ill and acutely ill patients coming from a very, very long distance, and we had to allocate beds for these patients to be common treated. And so this is a bit intentional where we just couldn't accommodate all of the demand that we had on the organization and it was, in many ways, a first come, first serve basis, but we also had to care for the sickest and most ill patients. That's why you see this difference between 41% and 33%. If you look at the revenue by segment, and we'll stay here for a moment on the left-hand side of this slide, overall, between the 1H and the 2H, the overall revenue growth, 1H to 2H, it was up 20 -- almost 30% in the year. International, which is what I've been talking about, and you see it here now very, very clearly, International for the year, 1H over 2H, the 2H growth was 62% versus 1H. The Thai business is also up in 2H, up 5.3%. The expat business was down. When you look at that, it's partly the reason that I said, having to do with first come, first serve related demand. But it's a little bit benign because this number here is showing a decline. But the revenue intensity for those expat patients was fairly high in Q3 and Q4. I won't comment too much on '21 over '22 because the numbers are very, very positive in comparison. But frankly, they're not really a comparative number, considering that at the end of 2021, maybe the last 6 weeks of that year, we were still recovering -- well on the way, but still recovering with respect to COVID. So going to the sort of the workhorse of the quarter in terms of volume, you see here the Middle East business on a 1H to 2H basis with regard to revenue, was up 110% plus for the 2H period versus 1H period and Indochina business was very strong for us as well. Cambodia, Bangladesh, Myanmar, drove this number dramatically. For the year-over-year, very, very high for the same reasons I mentioned. So let's take a look now at the international revenue by the top 10 nationalities. As is expected when we're in a normal trend line of growth absent COVID, these are the countries that drive our revenue and drive our revenue intensity. And we are operating at about 66% to 67% revenue up as a percent -- international revenue as a percentage of total revenue and the Thai business is about 30%, 31%, 32%, 33%, depending upon the quarter. But for the fourth quarter, it was 66%, I believe, International. But if you look here, these are the percentage growths 2H over 1H. And if you look more closely, you can see the Middle Eastern countries, Qatar, Kuwait, the United Arab Emirates and even Bangladesh was up almost 19%. For the year, of course, these numbers are all positive position, again for the reasons I mentioned. Looking at the consolidated profit, EBITDA and profit. Here on this side of the slide, the left-hand side of the slide, you will see that for 1H, the EBITDA was THB 2.8 billion. And then for 2H, THB 4.2 billion, a 47% increase on the EBITDA line 2H over 1H and not only that, but it kept adding expenses, we continue to purify and improve the margin on EBITDA from 31.6% to 36%. I won't review the '21 over '22 because it's the same story throughout these slides. On the net profit line, both on net profit and net profit margin, it's very, very much the same story, but even more dramatic on the net profit line. For 1H, the company produced THB 1.891 billion but in the 2H period, it was THB 3.047 billion, it was up 61%. And in addition, the margin increased by 5%. This is on the net profit basis, which is very, very dramatic. It tells you a couple of things as we talked about on EBITDA. It tells you that -- and we didn't raise rates here beyond what we normally do for wage inflation. So it tells you that the revenue intensity was very, very strong, and the cost control was quite good. So we move now to the other -- we have 18 subsidiaries in the company, but the other piece of our business is VitalLife. And in the same way, if you look at VitalLife for 1H versus 2H, the total revenues grew 31% 2H over 1H and the EBITDA grew 37.6%. This business, even through COVID was very strong. But after COVID has passed, it's dramatically stronger piece of business for us. We have several expansion opportunities coming forward that we'll talk to you about in the upcoming -- the upcoming quarters. So I'll take you back now to the takeaways for 2023. I mentioned earlier that I did expect double-digit growth on the top line. But the kind of compression -- positive compression we're seeing from our international markets, not only from our existing markets, but from new markets, that we are targeting around the world, we have a very, very positive point of view about what we're going to do in 2023. And we'll talk more about that in April. We expect that, as an example, Saudi Arabia will continue to grow for us. We've opened up 2 referral offices there, and we signed contracts with other third parties. We have -- we're in the process today of working through a Memorandum of Understanding with the Government of Iraq. This is a new market for us that we've never accessed before. Moving to Western Europe. There are several things that are -- the Head of our International Business Development is working on, which I will introduce to you when we get together again in April. That concludes my presentation for 2022, Q4 as well as 1H, 2H of 2022. We will very much look forward to fielding your questions and answering them at our live stream presentation on next Tuesday. Thank you very much.[Foreign Language]

[Foreign Language] Good morning, everyone. I'm Oraphan Buamuang, Chief Financial Officer. I'm pleased to report you on the financial highlight and financial performance for year 2022. For the financial highlight, the higher contribution of international medical tourism, particularly from Middle East and Indochina region, as Khun Neil already mentioned, had a significant positive impact to patient volume and revenue intensity. In year 2022, total revenue EBITDA and net profit were improved when compared to the same period last year and also above year 2019 pre-COVID situation already, as shown in the first table. In terms of the profit margin, in year 2022 EBITDA margin and net profit margin were 34.1% and 23.6% respectively, which had the highest record of the company account. I want you to more detail in the next slide. For financial performance, in the year 2022, total revenue was THB 20,908 million increase from same period last year by 66% and also above year 2019 by 12.7% mostly due to the increase in revenue from non-Thai by 128% and Thai patient by 13.3% when compared to year 2021. For revenue contribution by nationality, when compared to contribution by nationality between year 2022 and year 2021, the revenue contribution from International increased from 46% in year 2021 to 63% in year 2022 mostly due to increase in revenue from non-Thai patient by 128%, while revenue from Thai patient increased by 13.3%. You can see that the percent contribution was coming back to year 2019 pre-COVID situation already. In terms of revenue contribution by service, in year 2022, revenue contribution from outpatients' service increased to 52% from 49% in the same period last year due to OPD revenue increase by 69% while IPD revenue increased by 48%. When compared to the year 2019 revenue contribution, the proportion between OPD and IPD in year 2022 were coming back to pre-COVID situation as well. In terms of the revenue contribution by payer type. Self-pay contribution increased from 66% to 68% in the year 2022 mostly due to revenue from self-pay patients increased by 72.4%. The increase came from the increase in self-pay international segment. Insurance contribution in the year 2022 declined to 16% from 21% in last year due to insurance revenue in year 2022 increase year-over-year by 26.4%, which is lower than self-pay revenue increase by 22.4%. The government 3rd-party contribution in the year 2022 increased to 15% from 11% in year 2021, mainly due to Middle East patient revenue increase by 124%. For EBITDA, as the result of increase in revenue and contribution of the cost management program, EBITDA in year 2022 was THB 7,124 million, improved from same period last year by 159% and improved from year 2019 by 24%. EBITDA margin in year 2022 was 34.1%, which is above the year 2021 and year 2019 at 21.9% and 30.9%, respectively. For net profit. In year 2022, net profit was THB 4,938 million, which improved by 306% and 32% from year 2021 and year 2019, respectively. For net profit margin. In year 2022, net profit margin improved to 23.6% from 9.6% in year 2021 and also above year 2019 at 20.2%. In terms of leverage ratio, net debt-to-EBITDA of year 2022 was negative at 0.3x due to less net debt after repayment long-term debenture THB 2.5 billion in December last year. In terms of the net debt-to-equity in year 2022 was negative at 0.1x due to less net debt as well. This is our financial highlight and financial performance for year 2022. Thank you for your attention.

Thank you, Khun Oraphan. And now on to business updates. Here at Bumrungrad, we never stop innovating, and we never stop introducing new services with which to care for our patients. And as we increasingly become further and further into the more complex and the more critically acute, we need to provide additional services and additional equipment to support excellence centers for the caring of our patients around the world. I'd like to introduce you to 3 key centers that we have been launching -- that we've launched during the quarter for which we're very proud of. The first is our cornea transplant center, yet another step in us being a quaternary care center, in providing corneal transplantation services to patients in need of that. It is also an interesting service for us because not only would it allow us to provide services in the domestic market but also the international market as well, where we could harvest the cornea and provide transplantation to international patients. This is in contrast to, for example, heart transplantation, whereby there are restrictions on organs to be received by international patients. The neurocritical care unit is in support of our neurology specialty, which has grown significantly during the year and has shown great strength. In fact, the neurology department is one of our key focus areas in 2023, and we do fully expect to support more and more cases that are critically ill and complex in this area. A lot of our patients from overseas having previously not received care here at Bumrungrad for the last 2 years during the COVID, where it was very difficult for people to fly in, are seeing more and more need for these -- for this specific specialty in general. And so therefore, we are seeing the need to expand that service in order to support future demand as well. And finally, our motility center, which focuses on motility issues prevalent among the elderly population, which is in line with trends demographically in Thailand, where we see higher and higher numbers of elderly people. In fact, this year, Thailand was officially recognized as a aged society. That is that -- a significant part of the Thai population now is age 60 and above. And these issues related to motility, musculoskeletal issues, neurology become increasingly prevalent in among the aged population in Thailand. And the motility center will not only support that but also the international market as well. On the digital MarTech side, we haven't stood still. So our digital MarTech team has continued to innovate and continued to introduce new services via digital means. I give you some numbers here on what we're doing right now. Currently, our online store, continuing to grow at a solid rate, THB 406 million generated over the year. That's a 10% increase year-on-year in a time where actually the previous year, I think we had a significant discounting provided to the Thai market in general. So when you see that there was a 10% growth on top of that, I think it's quite a strong indicator that the digital market, that online store market has gained good traction for us, and we continue to innovate and introduce new services and products in that area. On to e-payment, THB 497 million of transactions were conducted through our e-payment platform developed in-house and in cooperation with our partners. E-payment provides a convenient means for us -- for patients to settle payments via our e-payment channels. And in return, they receive certain benefits as well. Moreover, the hospital does benefit from this by saving on transaction costs. And that is something we're going to be encouraging further usage on. The adoption rate has been quite encouraging, and we hope to continue to see that growing. On debt collection, an area where every other company would face, collecting outstanding receivables from patients. We're trying to automate that process. It's typically very manual-intensive, very labor-intensive. And by using digital means, by automating it, we're able to save on labor costs as well as to increase the revenue cycle management of our hospital, which in turn will provide efficiency bonuses to us, too. And on the appointment side, you can see there, we highlighted the BH application and chat. So these are 2 channels that we introduced over the last couple of years, whereby you can make appointments directly with the hospital, through the BH application, a self-service way to make appointments with your doctors and also through chat. And that uptake has grown significantly because of its convenience and speediness. And if you compare that with traditional channels, going forward, you can expect to see that continue to climb as younger segments of our patient population continue to use that service in order to make appointments and receive treatment here at Bumrungrad. We won a number of awards for which we're very proud of, in Q4. These 2 awards relate to digital marketing and marketing in general where we were recognized for our excellence in marketing and also the technologies and platforms we're introducing at the hospital. This is a key investment for us. And we're very proud that we've been recognized by a number of awards to -- of our efforts and our endeavors in this area, and we hope to continue to innovate and improve patient satisfaction, patient experience throughout the hospital and of course, to develop further brand awareness of our hospital going forward, too. On the Bumrungrad Health Network side, a quick update on that. So it's grown at a relatively stable level, THB 898 million in 2022 overall. It's around 2% growth. It might not sound like much, but in fact, it is an encouraging sign. The reason being is that we're starting to see a return of normal caseloads whereby the number of COVID cases have come down among the hospitals within our networks. And there is a greater focus on non-COVID-related treatments. And we do expect to see increases in referrals of these cases to Bumrungrad for which we are focusing on. And with the new services and the new procedures that we're introducing almost every quarter, we can expect to see that channel continue to grow. On partnership Centers of Excellence, we generated around THB 56 million for the year. Mind you, if you go back to previous quarters, you will see that, that has been somewhat slow because of, again, the focus on COVID cases. But now with the return of non-COVID cases, these Centers of Excellence, are seeing increased traffic, increased volumes and therefore, also increases in revenue. So we saw around 37% growth in that area. And we continue to add additional partners to the health network, where now we stand at 82 hospitals in total under the MOU umbrella of the Bumrungrad Health network, up from 77. You can see there the new hospitals that we added to our network, too. We hope to continue to develop our relationship further with these hospitals in order to develop our low CapEx branches or spokes that we refer these patients to the mother ship or Bumrungrad Hospital. And that concludes the fourth quarter and full year 2022 analyst presentation and business update section. See you on the 21st of February for a live Q&A session. Thank you. [Foreign Language].