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

[Foreign Language] Welcome to Bumrungrad Hospital Public Company Limited and its presentations for the first quarter of 2023. My name is Achariya Sanrattana, Senior Manager, Investor Relations and Sustainability. I recently joined the team here in February. It's a great pleasure to be here, and I look forward to getting in touch with you all. Without further ado, I would like to start off the presentation with a really good news in the first quarter. We are proud to announce that Bumrungrad International Hospital has been ranked by Newsweek for our third consecutive year as the best hospital in Thailand as well as among the top 200 hospitals in the world. This is an affirmation that we continue to sustain our high standard quality of care, patient safety as well as excellent patient experience. We will talk about this further later into the presentation. Now I would like to hand over the presentation to Khun Neil Sorrentino, our Corporate Chief Strategy Officer, to talk about the key takes away in the first quarter.

Up, and welcome to Bumrungrad Hospital Public Company Limited Q1 2023 Analyst Presentation. Thank you, Khun [indiscernible], for the introduction. Before I launch into the performance outcomes for the quarter, there are a couple of very, very important announcements that I want to make. And in those announcements, introduce a senior health care executive that will be presenting here after me, a gentleman by the name of David Boucher. David has been a senior health care executive in the United States and has worked at Bumrungrad Hospital before COVID, went back to the United States, and he now has been with us as Chief Partnerships Officer. He will be presenting something very, very exciting that our Board last evening approved in the way of a brand-new greenfield hospital campus development project in Phuket that we have been studying for the last year or 1.5 years. It's our first entry into greenfield development, but we think it's a tremendous opportunity for the company to grow and expand its capacity in the field of not only hospital operations, but David will talk more about what the campus development will contain. And David will be the campus CEO in charge of that project, but more to come about that shortly. Moving now to the quarter. mentioned to you, as you look at these takeaways, Khun [indiscernible] mentioned to you about the hospital being voted for a record consecutive third time by Newsweek magazine as the best hospital in Thailand. And I get asked this question quite a bit. Is this a bought award? Is this something that just happens. How do these awards come to play with Bumrungrad gaining so much of this kind of attention. I will tell you that this kind of an award that Newsweek has bestowed upon us is based upon a scientific analysis of what we do throughout the year, how we do it, what our customer satisfaction results are, new services, new centers of excellence, and then they're weighted and scaled and then they make these recommendations to a group of people that come up with whether or not we or whomever is the best hospital in Thailand, and we're so very, very proud of this award for the third consecutive year and one of the top 250 hospitals in the world was also part of this award for our hospital and our company. It deserves merit, Khun [indiscernible] our hospital CEO and our entire staff of people are very, very well deserving with that, and they deserve this recognition. So I mentioned it to you as part of our takeaway, my takeaway regarding Q1 2023 performance. So let's move into the quarter itself. If you look at the results from year-over-year, you will see that the revenue was almost 50% greater in Q1 2023 than it was Q1 2022. And while it's true that the pandemic was just ending, and there was a lot of pent-up demand still the growth of the revenue from quarter-to-quarter is incredibly dramatic because we jumped over pretty good revenue growth in year 2022, Q1. And still, we grew it by almost 40 -- almost 50%, it was 47.5%. The volume drivers for the quarter, as you might expect, both international business and Thai business. Thai business more about revenue intensity, international business as much about volume, if not more about volume than it was about revenue intensity, although our revenue intensity for international business was very, very strong for the quarter. The admissions by international business and Middle Eastern business, in particular, was over 100% quarter-over-quarter, meaning year-over-year. So the -- even we had expectations, positive expectations, as I guided for you in Q4, but the performance for the quarter was really quite something. We will talk about here in just a moment, how it impacted costs and how it impacted EBITDA and how it impacted NPAT. Those are the volume drivers for principally the quarters inside the quarter of 2023. In the quarter, with the exception of us having this kind of performance, we still had 10 days or 25% of Ramadan days in Q1. There are 40 days in Ramadan. We had 10 of those 40 days in Q1. If we hadn't had that impact in Q1, the performance would have been even greater. So please keep that in mind as we go through the remaining portion of this presentation. The other contributing factor, when I look at quarter-over-quarter, meaning year-over-year for Q1, our costs were significantly improved by the overall operations. Cost of revenue percentage was 52% versus 58% in 2022, and sales and administrative was 16.8% versus 21.1% in 2022, and it impacted the EBITDA and the NPAT margin performance, which I will show you in just a moment. I'll come back to the Q2 2023 guidance in a bit. Next slide, please. So when you look at the revenue proportionality for the quarter, you will see that we touched almost 67% of international versus Thai. And the way I get to that is the 55% plus the 12% and then the 33% is Thai business. And that's a -- the highest number we've had in about 7 quarters at 67%. And if you look at it in comparison to 1Q 2022, you see the major growth, 15% in international business year-over-year. Next slide. Revenue by market segment. Overall, we grew the revenue year-over-year by almost 50%, as I mentioned earlier. But for international, it was over 100%, principally driven by Middle Eastern business, although our Indochina business was very, very strong, too. And I'll give you some details in just a moment. Expat business grew, Thai business grew. And the Expat and the Thai business sectors, if you look more deeply and we can talk about this in our last stream Q&A, we can talk a little bit more about the percentage of revenue intensity, meaning resource consumption for all 3 factors that drove the earnings for the quarter. Next slide. As I mentioned, Middle East and Indo-China has 2 payor segments. Middle East grew 147% year-over-year. Indochina grew 60%. Next slide. So let's look at the percentage growth. I'm going to talk a little bit here in just a moment of what the revenue changes were by some of these markets. But I'd point you toward #9. Our China business in the quarter grew substantially for us. This is something we have been expecting and waiting on for the China -- Mainland China to open up, and we saw more Chinese nationals here as tourists in Thailand for Q1. That was very significant growth. The United Arab has very significant growth, not just in percentages, but you'll see the actual revenue number comparisons in just a moment, I'll go through them with you. But China was a nice surprise for us. Not a surprise, it was unexpected. It was just a question of timing, not a question when. Next slide. So moving to the EBITDA and the NPAT, what happened year-over-year. I direct you to the margin change 28% to 36% revenue intensity, volume and excellent cost control. And I direct you to the differences between the earnings, the EBITDA THB 1.1 billion versus THB 2.2 billion, almost double. The earnings were almost double at the EBITDA line quite year-over-year. At the NPAT line, it was even more productive when you look at it in comparison, 17% to 26% margin on the NPAT line and more than double on the NPAT line THB 725 million versus THB 1.583 billion by quite a strong quarter for us year-over-year. I referenced earlier that I was going to give you some additional information that helped drive these numbers by market and by country. And I want to share the revenue changes year-over-year, which really made major contributions by country. We typically don't go through a lot of detail by country. Normally, we show percentage changes, but some of this is so dramatic year-over-year that I wanted to share it with you. As an example, the difference year-over-year for Oman, THB 87 million versus THB 68 million. For the United Arab Emirates, THB 257 million in Q1 2023 versus THB 111 million, more than double. One of the markets, although a new market, one of the markets we're really proud of a year ago, it was THB 11 million, Saudi Arabia. For Q1 2023 was THB 52 million. So we're on track there. We have our own internal targets and budgets. We're on track there to, if not meet, certainly likely exceed what our budgeted revenue is for that market. Qatar, year-over-year was THB 665 million versus THB 166 million 2022 over 2023. If I take you to a market like Myanmar, it was THB 413 million in 2023 versus THB 257 million in 2022. And finally, I referenced earlier about the China market. We have been waiting for this market to open up, and we've been working our referral networks and our agent networks. And in the quarter, we generated THB 96 million of net revenue from the China market. A year ago, it was only THB 34 million. Myanmar, THB 413 million versus THB 257 million, as I mentioned. And for Bangladesh, THB 196 million, which was up almost 10%. So all of these array of markets around the world is what produced the kinds of EBITDA and kind of NPAT that we came out with in Q1 2023. We see that -- we see these positive trends continuing throughout the remainder of the year, absent the issues related to Songkran and the finish off of Ramadan, which by the way, is now over. We expect a significant return of our Middle Eastern business beginning Q3, if not a little bit sooner than that. Next slide. For VitalLife, we talk a little bit about this, and I again, put it in here because it too had a very, very strong quarter. The revenues grew 62%. EBITDA grew 98%, but more interestingly, if I look at the 62% total revenues, the EBITDA margin for the quarter was almost 42%. It was the highest EBITDA margin we had for VitalLife in its 22-year history. And at the same time, if you look at the NPAT margin, it was 32%, also a record high. This is a piece of business. As I've mentioned in the past, it's not -- it continues to grow very, very dramatically. 62% year-over-year is pretty significant. Is it as big as the medical center? Of course, not. But this is a major contributor to our volume on outpatient. And we're very, very pleased with the marginal performance, the operating performance and the EBITDA and NPAT contribution. Next slide. Please go back to the guidance. I'll talk a little bit about the guidance right now. Because we are in Q2 now, Q2, we and the entire country Kingdom of Thailand find ourselves having experienced Songkran, and every business is negatively affected because of Songkran and we're no different. Q2 is always our slowest quarter of any quarter for the year. And in addition to that, I take you back to my earlier comments where I mentioned that 25% of the Ramadan days, 10 days left us with 75% of the Ramadan days, another 30 days, which occurs in Q2. So while I'm guiding double-digit revenue growth for the quarter, and I feel very strongly about us being able to achieve that, will it be the same kind of double-digit revenue growth we experienced in Q1, which was almost 48% and not likely because of those 2 events, which are uncontrollable. But nonetheless, we believe we can drive double-digit revenue growth for Q2. I expect Q2 relative to previous Q2 quarters of the company's history to be quite strong. I will stop there. We'll be happy to answer any of the questions you have during our live stream Q&A next week, I believe it's next Friday at 10 a.m. And with that, I'll introduce to you Mr. David Boucher. Thank you very much.

[Foreign Language] Good morning, everyone. I'm Oraphan Buamuang, Chief Financial Officer. I'm pleased to report you out the financial highlights and financial performance for first quarter 2023. For financial highlight -- in terms of financial highlight in first quarter 2023 financial performance, 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 profit margin in first quarter 2023. EBITDA margin and net profit margin were 36.1% and 26%, respectively, which above the first quarter 2022 and first quarter 2019 as well. I will walk you through in more detail in the next section. In terms of the financial performance, in first quarter 2, total revenue was THB 6.091 billion increase from same period last year by 47% and also above first quarter 2019 by 30%, mostly due to the increase in revenue from non-Thai patient by 78% and Thai patients by 9.5% when compared to first quarter 2022. When compared revenue contribution by naturality between first quarter 2023 and first quarter 2022, the revenue contribution from international in case to 67% from 55% in first quarter 2022, mostly due to an increase in revenue from non-Thai patients by 78% while revenue from Thai patients increased by 9.5%. The percent contribution was coming back to year 2019 pre-COVID situation. In terms of the revenue contribution by service. In first quarter, this year revenue contribution from inpatients services increased to 51% from 49% in the same period last year due to IPD revenue increased by 49%, while OPD revenue increased by 38%, mostly due to higher intensity cases with longer length of stay. In terms of revenue contribution by Payor type, the government third-party contribution in first quarter this year increased to 19% from 12% in first quarter last year due to Middle East patient revenue increased by [ 130% ]. Insurance contribution in first quarter 2023 declined by to 17% from 19% in same period last year due to insurance revenue in first quarter this year increased year-over-year by 40% with lower than Mid-East revenue increase at 130%. Self-pay contribution in first quarter this year decreased from 68% to 63% in first quarter '22, mostly due to renew from self-pay patient increased by 36%, which is lower than Mid-Eastern increase as well. EBITDA in first quarter this year was THB 2,200 billion, improved from same-period last year by 88% and improved from year 2019 by 35.7%. EBITDA margin in first quarter 2023 was 36.1%, which is above the first quarter last year and first quarter 2019 at 28.2% and 34.5%, respectively. Net profit in first quarter 2023 was THB 1,583 million, which improved by 118% and 46% from first quarter 2022 and first quarter 2019, respectively. For net profit margin in first quarter this year improved to 26% from 17.5% in first quarter last year and was above first quarter 2019 at 23%. In terms of leverage ratio, net debt to EBITDA in first quarter 2023 was negative 0.2x due to less net debt and also net debt-to-equity in first quarter this year was negative at 0.1x due to less net debt as well. This is our financial highlights and financial performance in first quarter 2023. Thank you for your attention [Foreign Language].

[Foreign Language] Today, I would like to present about business update of Bumrungrad Hospital during first quarter 2023, we would like to start with the very proud to present award in the beginning of this year, Bumrungrad Hospital received the award from Newsweek Magazine as one of the best hospital in the world for 3 consecutive years. And we are the only hospital in Thailand being in the top 250. In addition, Bumrungrad Hospital was ranked #1 in Thailand with score of the 93% on the 3 main criteria. The first one is recommendations from the experts in the health care industry, including doctors, medical personnel in various fields as well as the management in the health care industry. The second one is the patient experience and his or her perception towards functional well-being and quality of life after treatment. This information was collected directly from patients after receiving the medical service. Last but not least, and very important, the major key indicators such as quality indicators, clinical outcome as well as service quality indicators and safety of patient care. And at the end of January, after COVID we know that everyone start to aware of health because they know that preventive is very important to take care of the health. So Bumrungrad Hospital has announced innovation, we aim to be the most trusted health care and wellness destination, not only providing the best medical care but also extending to the preventive and longevity medicine under the terms most trusted wellness destination. And in order to reach the goal our hospital still adheres to the principles of 4C 1W, which are critical care, complicated care, cutting-edge technology, collaboration of expertise and partners and lastly it's wellness that I already mentioned about longevity medicine. Moreover, we address 4 pillars of excellence, which are the first one, people excellence because our hospital value our staff, our doctors, they are our valuable -- the most valuable assets. The second one is the clinical excellence. We will continue and focus on developing center of excellence with advanced medical technology, as you know, about our strength in various fields, such as heart institute, horizon cancer center, neuroscience center, digestive disease or GI center and eye center. Number three, quality and safety excellence. And this is our core value and the proven record is the accredited and certified by domestic and international certified bodies. The last one is patient experience excellence. We drive our patient experience through our Bumrungrad way. So in order to create positive experience and satisfaction to our patients and family. And this is our event from the marketing. I just pick up some of the events to present to all of you. On the left-hand side, you will see the pictures of the event of Bumrungrad Genomic Institute.. We used the tactic of influencers and key opinion leaders to create understanding on preventive and personalized magazine. And this event is very successful, and we found that many people were interested in many like genetic for the heart and genetic for cancer screening and also the pharmacogenomics that's very important about how to know about the drug allergies and how to know about the dose that are proper when you have to take some type of the medication. And last year, we just bought next-generation sequencing technology to support Horizon Cancer Center. The benefit of this technology are lower cost because we can produce in-house laboratory and shorten turnaround time from 4 days to only 24 hours. This can help our oncologists to provide effective treatment plan shortly. On the right-hand side for the fertility center or IVF clinic, we deliver holistic reproductive care. Egg freezing service and high-risk pregnancy programs. The highlight of this open house is to ensure that our success rate of IVF is more than 80%. This is to show our Bumrungrad Heart Institute. This institute is one of our center of excellence, and we are very proud to have our professor, Dr. Koonlawee Nademanee, the Director of Bumrungrad Heart Institute. He is really leading the medical team and professional team to provide full subspecialties of various hard conditions, including Coronary Artery disease, Arrhythmia, advanced heart failure and heart transplantation and so on. And this picture recently, and I think everyone knows, Associate Professor, Dr. Chanchai Sittipunt, he is the dean of the faculty of Medicine in Chulalongkorn University. He came to sign MoU for academic cooperation with Bumrungrad Hospital. And these collaborations covers medical education and research, innovative medical services between public and private sectors in order to enhance health care services in Thailand. We -- since 15th of March until 15th of May, we launched a Health Fair, Better Health, Sharper You. Because we're aware that during Ramadan, we will have decreased numbers of the Arabic patients. So we launched this promotion Health Fair campaign and asked the patient who buys the packages have to come to use the package within 31st of May. So the objective is to substitute the decreased volume, as I said, and we achieved approximately THB 70 million as of now. So very successful campaign. So that's all for me for Q1. Thank you.

As Khun Neil mentioned, my name is David Boucher and I serve as Chief Partnership Officer, here at Bumrungrad International Hospital. We are thrilled to share with you some high-level information about the first greenfield project ever in our 43-year history. We intend to acquire several [indiscernible] in Phuket and construct a 150-bed boutique hospital, an Advanced Diagnostic Center and a car park of sufficient size to comfortably accommodate all of our patients, their families, our physicians and our dedicated employees, of course. We find the Phuket market a compelling one for a number of reasons. First, there is a population of over 425,000 permanent residents on the island. This is important because like with Bumrungrad here in Bangkok, our first and most immediate focus is with the local Thai and expat patients. Second, there are about 80,000 residents living in Phuket city. From a tourism perspective, Phuket received approximately 5.4 million visitors in pre-COVID 2019 from the top 4 countries of China, Russia, Germany and Australia. Since we know there were over 700,000 Middle Eastern visitors to Thailand in pre-COVID 2019, we fully intend to leverage existing referral relationships from that part of the world as we expand our outpatient and inpatient capacity in Phuket. In addition, we're 100% confident that the 38 airlines currently servicing Phuket will facilitate our international medical tourist growth at this new boutique hospital. Once in Phuket, these patients will have access to the 24 international consulates that operate on the island. Finally, it is favorable to note that as of today, almost half of the world's population can reach Phuket within 6 hours. What services will we offer in our new facilities in Phuket? Think of the usual suspects of VitalLife wellness and anti-aging, family and internal medicine, cardiology, orthopedic and spine surgery, cosmetic surgery and gender reassignment, urology and many others. We have analyzed our data and are keenly aware of the many patients who travel from Phuket to Bangkok today to receive services with us about half are Thai and the other half are ex-patriots. We will not cannibalize patients and top line revenue currently flying to Bangkok, but we'll simply try to make their journey faster and a little more convenient. Let me close today by sharing that we are very excited and confident about this THB 4.3 billion project in Phuket. We anticipate closing on the land within a month and we'll begin construction just as soon as we have all the necessary permits in hand. Thank you very much for your time and attention. We look forward to updating you on this very exciting project over the months ahead. [Foreign Language].

Now we come to the end of the presentation. Please stay tuned for our live Q&A session on Friday, 5th of May at 10 a.m. Where our management will be happy to answer the questions that you may have. Thank you very much for listening in today, and see you soon [Foreign Language].