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

Hello, everyone, and welcome to the live analyst presentations and the live Q&A session for today for the first quarter of 2024 from Bumrungrad Hospital Public Company Limited. So I would like to first thank you very much everyone for your time joining here in person. We are happy to see you all in person today at the hospital. And we also today have the foreign analyst joining online as well. So we have uploaded the presentation slide on the website already on IR page this morning. So you may check the slide online first. And the agenda for today, we will start with the analyst presentations by our management, and then we may start the Q&A session. So today, I would like to welcome our management that are here with us today. We have kun-Neil Sorrentino, Corporate Chief Strategy Officer; and we have kun-Artirat Charukitpipat, Chief Executive Officer; and we have kun-Oraphan Buamuang, Chief Financial Officer; and we have many management joining to answer to your questions as well. We have kun-David Boucher, Chief Executive Officer, Bumrungrad International Hospital Phuket [indiscernible]; and we have kun-Rajeev Rajan, Business Development Officer; and we have Dr. Nipat Kulabkaw, Chief Operating Officer; and we have kun-Daniel Kastner, Chief Transformation Officer; and we have kun-Wisut Ua-anant, Chief Digital Market Officer. So without further ado, I would like to pass on the presentation to kun-Neil Sorrentino talk about the key takes away in the first quarter.

Thank you [indiscernible]. Good morning all. We have a lot of management overhead here. Don't we, Rajeev? A lot of overhead. But all these people are here to answer your questions, both online and in person. It's great to be able to do this again now that COVID is in the rearview mirror, although there has been a little bit of spikes about COVID here recently in Thailand, but now it's nothing more than a bad flu at worst. At best, it's just sniffles. So that's good to know. We're not seeing very, very many COVID patients at all admitted in the hospital anymore. We never did have so many, but now we have very, very few as a result. Well, let's get on with the details of the quarter, the obligatory disclaimer, my own personal disclaimer. I own no shares of Bumrungrad stock for your information. And for the first quarter, it's difficult to be able to imagine the kind of quarter that we had given the fact that Ramadan for us in Q1 was more than a simple majority of the total Ramadan Eid days for this year. We had 21 Ramadan days in the quarter. And typically, when that happens, it reflects a down slide of volume. And while we had less volume than prior year, we also had higher revenue than prior year from the Middle East, up 4.9%. So when you look at the diversity of our business, what drove the earnings for the quarter and the purity of the earnings for the quarter. What drove that was very, very good revenue intensity. Volume from a number of other diverse markets beyond the Middle East, although the Middle East was quite supportive even though we had Ramadan. And the revenue purification, I like to talk about that because it means a lot to us. When we talk about revenue purification, we are talking about the diversity of that revenue from different markets and the intensity of that revenue. Intensity, meaning for those that may not recall, intensity for us means resource consumption per patient. And the combination of those things created what turned out to be a superb quarter. Please go to the slide on revenue, if you would, to show you what I'm talking about. This slide. Now you may recall that I guided single-digit top line revenue growth for the quarter, and I was asked in the live stream Q&A. Well, really, what does that mean? I said, well, it means somewhere between 1.1% and 9.9%, some of you may recall that. Well, it turns out it was 8% total revenue growth. This is on a consolidated basis. If you look at the net patient revenue, which is BH specific -- BIH specific, the medical center, it grew 7.7% of that 8% but this is the part that's really very interesting for me is the diversity of the growth of that 8%, 6.1% international, 9% Thai and double-digit 11.2% expat. Price increases were 6% going into 2024. So it's not only about price. I always get that question. Are you driving this by price alone? The answer is no. Price is a piece but it's not the total piece. Go back to the takeaways slide, please. So the trending upward in the quarter beyond the fact that we were in the middle of Ramadan and Eid. There was positive trending both for revenues, EBITDA, EPS and margins. Each one of those indicators were all up from Q1 2023. And for EBITDA, we hit an all-time high in 40 -- what was it, 40.7%? 40.7%, memory is still working okay. VitalLife recorded almost 12% EBITDA growth for the quarter. And interestingly, with VitalLife, if you look at the revenue distribution of VitalLife, this thing continues to grow every quarter-on-quarter, 62% or 63% of that revenue was international. David and his team are going to be responsible in Phuket to open up a VitalLife Center of Excellence there and sometime in late June, early July. And as you know, in Phuket, there's a large measure of international visitors there, both semi-retired, retired or just playing out visitors. We're hoping that we can get a fair market share of that business. But David can talk about Phuket, I've asked him to give you an overall update about Phuket as well. At the end of this past year, 2023, our second of 2 dividend payouts were approved by our Board and our Annual General Meeting, shareholders approved a total of THB 4.50 per share. It was the highest dividend payout recorded in the history of the company, based upon the performance of 2023, this just happened April 24. What drove the business, each one of our verticals. Every single one of our verticals, if it wasn't if it wasn't the improvement in revenue, despite the fact the Middle East year-over-year volume was down, it was expat. It was Thai. Our China business, and we'll talk about that. Our China business was up dramatically, our U.S.A. business was up dramatically for the quarter. China, I think, was TBH 188 million, both Thai and international revenue just for the quarter. a double-digit percentage growth on the China revenue. That vertical now is working for us, much better, thanks to a lot of people's efforts. I've asked kun-Wisut, this gentleman here in the green shirt at the end, he's going to display for you and discuss for you what we've done during COVID to the present. We hired this good man from AIS. And out of nothing, he will show you what he and his team of expensive developers have created over the last 3 years. It's very, very impressive. We will also talk to you about Kuwait and Saudi Arabia. Kun-Rajeev, and I will talk about that in Myanmar. These are the negatives, not Saudi, but Kuwait certainly, Myanmar certainly were the negatives for the quarter. We'd like to talk about the positive. We also like to tell you about where we are on issues that have some downside impact despite the fact that it was a great quarter. David will talk about market update and Q2 guidance, I'll get into at the end of the session. Let's go through the pieces quickly so you understand the pieces of the quarter, the revenue was slightly down for international, and that's because of Ramadan and because of Kuwait in particular. So they were down 1% on international. Thai, 34% versus 33%. It was up. Expat and Thai business was up for the quarter. Next slide. I talked about this already, very, very diversified positive vertical driver of revenue in the quarter. Next slide. Middle East, as I said to you earlier, was up 4.9% on revenue, down on volume. Indochina was down 1.1%, principally because of Myanmar. Myanmar continues to be a domestic disaster there. You read about it all the time in the papers now. Difficult for people to leave Myanmar, difficult for people to get back into Myanmar. It's a problem. Even though I don't know what was the revenue from Myanmar for the quarter [indiscernible]?

Yes, Myanmar revenue for the quarter dropped around 12%. So Indochina, if excluding Myanmar, will grow actually at 7%.

So for that vertical, Myanmar is in the Indochina vertical for us, it was up that amount if I take out the Myanmar negative year-over-year. And then the all others are listed down there. They were up 17%. All of those other countries collectively were up 17%. Next slide. And there, you have the distribution of the 10 nationalities. Our biggest Middle Eastern country now is Qatar. Myanmar is down, as I've mentioned, Bangladesh is up, the UAE at 9.5% is just slightly down, although the percentage is almost double digit. The U.S. was way up. Kuwait -- Kuwait was down. This is an interesting one. To talk about the diversity and the support up underneath each one of these market verticals. Kuwait was down TBH 200 million -- a little over THB 200 million for the quarter, year-over-year, and we'll explain what's happening there as we get into these countries more deeply. But despite that, which is why the Middle Eastern revenue -- Middle Eastern volume was down to include, of course, the impact of Ramadan despite over TBH 200 million revenue down quarter-over-quarter, which is at 58.4% number. Despite that, we had the kind of quarter that we did. It really does -- especially in this example, it really does speak to how well and how many of our diversified markets are driving the overall business in the company. China was up 23%, Oman, 30% -- that 11% to Kuwait, most of it is expat, some international U.S. travelers, but the majority of that number is expat the U.S. nationals here in country that have been coming to Bumrungrad. Really for the last 4 or 5 quarters, it's been this way and this quarter, even was higher for that support. Next slide. 40.7%, I was right. 40.7%, a record high for the company -- in the history of the company's performance on EBITDA. And you can see the difference in the actual EBITDA change, 22 (sic) TBH 2,200 million to TBH 2,676 million. On NOPAT and NOPAT margin, again, an increase of almost 4%, 3.8%. But more importantly than that, margins are important, but can you continue to grow margins in perpetuity? Of course, not. You can't do that. But there'll be a tipping point for every company in reaching the highest margin number. That's important. Margin is important because it tells you about the efficiency of how the company is operated and it tells you about the purity of the revenue being driven into the organization. But what's more important is the growth of the earnings. That's the key. That's what drives share price. That's what drives confidence in the brand. And speaking of confidence in the brand for the fourth consecutive year I do believe we announced this in November for the fourth consecutive year, we were voted by Newsweek as the best hospital in Thailand, 4 years in a row. And this is not a bought award. This is an award that you earn through a rating system, 4 years in a row the best hospital in Thailand. And the only hospital in Thailand among the top 180 in the world as ranked by Newsweek. Stunning 4 years in a row. Next slide. This speaks for itself. It's pretty uniform and very low ratios between debt and assets, which signifies very, very strong, very, very strong balance sheet performance. Next slide. Cash, you can see the conversion and the variances on cash and cash collected, how we're investing our cash. It grew by 3 -- it went from [ 3.19 ] to [ 3.5 ], when [indiscernible] and her team and the treasury department have been looking very, very hard how to increase yield on available cash. Cash from operations was much stronger. Our AR days -- or what is it? 54. What is the AR days? AR days are 54. The principal piece of what drives AR days for us. Some companies run 35. Some companies run 28, but that's not possible when you take Middle Eastern revenue. They take 4 to 6 months to pay you. It's just the way it is. And that's what drives that. But I don't look so much at that because we've never been stuck on Middle Eastern bad debt. I look more at the difference between operating cash, how well despite the fact that it may take 4 to 6 months to get our cash, how well is Rajeev collecting the money, he's only -- he's not only responsible to build the business, but to collect the money. And this tells me we're doing a good job at that. Financing is very, very small. Investing properly so has grown and operating cash has grown very, very nicely. The difference between the numbers when you look at it, net-net-net is about TBH 600 million -- TBH 604 million, something like that. Next slide. VitalLife I've been showing for the last couple of quarters, last 2, 3 quarters because it's worth showing. It's now becoming less a nominal piece of business as more is becoming a contributory piece of business. And the indicators there are EBITDA 43.4%, net profit up 11%, EBITDA up almost 12%, very strong. Are you looking at this, David? When you go to Phuket? Next slide. This is a new slide that I wanted to show you, so when you look at these company names, it doesn't matter if they're 1 bed or 5,000 beds ROA and ROE are the universal indicators of how efficient a company is running. Now we are best-in-class on EBITDA per bed, we're best-in-class on EBITDA margin. We're best-in-class on NOPAT margin that you know already, but you don't know these numbers necessarily unless you follow all of these companies, some are here locally, some are as far as India, Apollo, [ IHHI ]. You know that Praram 9, BCH.These are different tier of organization, but it doesn't matter. What matters is the efficiency of how they deploy their equity or their debt and how well the assets yield, that's what ROA and ROE is all about. And you can see the level of performance. These are not our numbers. These are their numbers. I wanted to show you the numbers that are sourced through public company disclosure, not something we calculated.

[indiscernible] Thank you. I would like to present in terms of the financial highlights and financial performance of first quarter 2024. In this slide, you can see that the total revenue increased about 8% but EBITDA and net profit amount will improve by 2 digits when compared to the same period last year, as shown in the first table. The improvement mainly came from both Thai and on Thai vision increase as [indiscernible] already mentioned, plus [indiscernible] are implemented continuously in this quarter. This drive EBITDA net profit growth by 21.7% and 25.4%, respectively. The EBITDA margin and net profit margin in first quarter this year was 40.7% and 30.2%, respectively. These are the new high of the company on the quarterly basis cap. I will [indiscernible] to more detail in the following slide. In terms of the financial performance, total revenue in first quarter was TBH 6,576 million [indiscernible] first quarter last year by 8%. Total revenue improvement mainly came from the increase in revenue from hospital operation. Thai patient and non-Thai patient revenue increased by 9% and 7.1%, respectively. In terms of revenue contribution by nationality. In first quarter 2024, the contribution of time was 34% and international is 66%. The percent contribution between Thai and international was slightly change from first quarter last year. This was mainly due to the increase in revenue from Thai at 9%, slightly above that increase in [indiscernible] from non-Thai and about 7.1%. In terms of revenue contribution by service, in first quarter this year and first quarter last year, the revenue contribution from inpatient and outpatient service were 51% and 49% respectively. In patient revenue grow by 7.7% and outpatient revenue grow buy 7.2%. In terms of revenue contribution by payor type, the governmental party contribution in first quarter this year increased to 20% from 19% in first quarter last year. Mostly due to revenue from government sponsor increased by 13%, which associated Middle East pension revenue increase. The insurance contribution in first quarter this year increased to 18% from 17% in the same period last year due to the revenue of insurance for this quarter in this year only by 12%. For self-pay contribution in this year declined to 61% from 63% in previous year, mostly due to revenue from self-pay patient increase at 5.2%, which lowered the revenue [indiscernible] of government third-party payor and insurance payor. In terms of the EBITDA and EBITDA margin, as a result of increasing revenue and continued cost [indiscernible]. EBITDA in first quarter this year was THB 2,676 million, improved from [indiscernible] last year by 21.7%, and EBITDA margin at 40.7%. In terms of net profit and net profit margin. Net profit of first quarter this year was THB 1,985 million, which improved by 25.4% from first quarter last year. Net profit margin in this quarter improved to 30.2% from 26% in first quarter last year. And in terms of the leverage ratio, net debt to EBITDA of first quarter this year was negative at 0.2x due to late net debt and net debt to equity was also negative at 0.1x due to late net debt as we have. These are our financial highlights and financial performance offers for this year. Thank you.

[indiscernible]. So today, I would like to update about Bumrungrad hospital operations. So the first slide in. As kun-Neil mentioned in the beginning of the session, so this year, we received the award from Newsweek and Statista with best hospital 2024, and this is our fourth consecutive year. And we're still the only Thai hospital to secure a spot in global rankings. So this year, we stand out at 130 out of 250, which is very significantly improved from last year, we got the rank of 182. So next slide, I would like to show the commitment of our mission to be the safest hospital. So we attain international standard accreditation for our care of international patients seeking medical treatment in Thailand. This mark at the third consecutive time we have received the commission from global health care accreditation. If you recall, we are the first hospital in the world receive GHA standard for COVID. And this time, we got a very perfect score of 100% full compliance. Another one in the first quarter, we also reacted the renewal from advanced health care accreditation, the third consecutive time as well to confirm our commitment to maintain a strong quality system at Bumrungrad Hospital. Next slide. I would like to show our performance of center of excellence. We add 2 more center of excellence, which are urology and breast center. So in total, in Q1, we have the revenue growth around nearly 2% from center of excellence. This due to the earlier start of Ramadan period this year. However, for non-COEV achieved very good quarter around 10.6% year-on-year. Next is the -- I think everyone may be familiar with this promotion via our website and our Bumrungrad application. We try to secure our volume during Ramadan period. So we made a decision to launch Health Fair in the first of March and until the end of April. We set up the target as 1 million per day. One month, we achieved more than 100% with around 145%. And later kun-Wisut will update you because you already closed this promotion on the 30th of April. Next one is the press conference [indiscernible], our center of excellence, we host a press conference to present for the breast center under the team, excellence in breast can, providing fast and seamless diagnosis and treatment to all breast issues. So every time we launch the press conference and we have the promotion -- in May, we see the significant increase of the cancer center around 52% in revenue compared in -- by quarter, we increased around 35% of revenue growth. And clearly, we still have the very positive feedback and going in terms of the volume in our breast center. Next, we maintain the momentum of the breast center because currently breast cancer also one of the top that we found the cancer in the women. So we promote our Horizon Center or oncology center under the team united in the fight against cancer with a strong commitment to fight cancer to detection and treatment, which are individualized targeted and effective. We placed the very important in early detection and risk assessment to advanced genomic testing. And we would like to enable our patients to manage or even reduce their cancer risk. We also offer a comprehensive palliative care. So many people misunderstood that palliative care is to serve only end-stage patients. But at Bumrungrad we try to introduce palliative care since the patients detect their cancer. So the string of our Horizon Center because we have the oncologists and multi-disciplinary professional team. And they utilize the latest medical advanced technology to ensure that the patient and their family have the highest quality of life possible. Last but not least, I think you already see this news in our [indiscernible]. We MOU with BGI Shenzhen and Bangkok Genomic Innovation company to strengthen its provision of genomic medicine. And through this collaboration, we can concrete the way for a more personalized and precise approach to health care, and we would like to improve patient outcomes and advancing the field of genomics, this is really upcoming trend right now. That's all for me. Thank you.

[indiscernible]. Moving on to the business development. Can I have the slide? So as mentioned earlier, overall, we have seen approximately a 7.7% growth. For the international segment, we have seen approximately a 6.1% growth. The international segment, and again, I'll go on the next slide where I'll talk about the Middle East, the Indochina and the other segment. Thai, we have seen approximately a 9% growth. Expat, close to 11.2% growth quarter-over-quarter. . The major contributors or the countries, which contributed from the expat segment stand to be United States, which contributed approximately 25% growth quarter-over-quarter. China, the expat segment, which contributed approximately close to around 38% quarter-over-quarter in terms of growth. Germany, India, Australia, Netherlands and France. What we did differently, again, we continued our regular engagement with most of the leading corporates. We did outreach, health talks, regular activities, health fair with the respective chambers of commerce, diplomatic missions and international schools. This first quarter of this year, we had specialty specific focused events for these targeted communities, where we also had invited a lot of these chambers of commerce and medical attaches offices of the diplomatic missions for in-house sessions, for closed door discussions between our key specialists and have some product trainings and involvement as well. So moving on to the international segment. Middle East, we have seen approximately 4.9% growth quarter-over-quarter. But again, to remind you all, we had 50% more Ramadan days during this first quarter. So when compared to the last quarter, where we had approximately around close to 10 to 11 days, this quarter, we had closed to around 21 days of Ramadan period. Even during the Ramadan period, the major contributing factor, Qatar, showed a continuously upward trend. We had close to a 50% plus growth from Qatar. UAE also had in terms of -- yes, of course, we had some slowdown towards March, where we saw because of the Ramadan period, the OPD footfalls gradually declining. But again, UAE stands to do well in Q1. Kuwait. Now as you all know, which was shown in the beginning of the presentation, we had a negative impact. We had a negative growth compared to the last quarter. In terms of the development with Kuwait, it was mentioned in the last presentation, that it is somewhat for the Kuwait government to recalibrate again to select and shortlist their selected service providers. So an update on what is happening with Kuwait is the recalibrating is still on. As of now, for those of you who might not know the cabinet has been newly appointed, the health minister is officially also newly appointed. So is the medical attaches in the respective countries, too. So as of now in Thailand, it has not been reinstated. So hopefully, we expect it to happen sometime very soon. We expect the medical attache team, the Ministry of Defense team from the Kuwait also to come back and resume operations in Thailand. As of now, the new offices or the new office has not yet been appointed. But hopefully, in the near future, we expect it to start some time really soon. Yes. Again, moving on to Oman. Even during the Ramadan period, we have seen close to a 30% growth in the Oman business. This is again mostly because of our involvement with most of the private health care service providers there. So we had also collaborated with one of the leading private health care service providers in Oman. So we see a continued progress with them. We see a continued ongoing relationships with them where we are getting high-end tertiary care super specialty referrals from that region. For Saudi Arabia, we had a business trip with Ministry of Foreign Affairs and the Ministry of Health of Thailand between 6th to 11th of January where we had a delegation representatives from the Ministry of Foreign Affairs and the Ministry of Health Thailand. And also we had the presentation from Bumrungrad where we had discussions with the Ministry of Health and the Ministry of Foreign Affairs of Saudi Arabia to have Thailand as one of the approved destinations for their citizens seeking treatment abroad. So that discussion is also ongoing. So we see positive results. We are expecting a delegation from the Saudi side expected towards Q2. So hopefully, we are expecting a delegation of close to 15 to 16 people. Representatives from the Ministry of Public Health of Saudi, Ministry of Foreign Affairs and also some from the leading public institutions in terms of mutually discovering areas of collaboration. And post this visit, there will also be a team delegation going back to Saudi again on the discussed areas -- discover areas and signing up a memorandum of understanding. So the Indochina part, as kun-Neil had also highlighted, we have seen a negative 1.1%. But again, majorly the negative impact is because of the situation in Myanmar. So Myanmar approximately close to 14%. Year-on-year, we see a negative growth, negative impact. But again, even though it is not stable, but we still continue our engagement with this community. We have periodic events. We have our doctors going out there. We are doing consultations in our clinic in Yangon and we are facilitating high-end admissions in terms of -- we might have seen a drop in OPD numbers in terms of volumes, but we are steadily maintaining the IPD numbers in terms of admissions for high-end specialty care from this part of the region. What is interesting for the Indochina part, which comprises of Myanmar, Cambodia, Bangladesh, Vietnam, Indonesia, Laos and Singapore. The highlight would be Bangladesh. For this specific market, we have grown over, close to around 25% quarter-over-quarter. We have -- towards Q4, we had strategized and planned for specific initiatives for this part of the region. And some of those -- one of those events is -- or recently, we have launched a premium exclusive card for selected 100 members from this community, which provides not discounts, but some exclusive benefits, which they can avail, which already we provide for many international patients, but these are more like reserve facilities [indiscernible] services, and we have named it as a reserve card. And we launched it sometime -- just might be a few days back, 100 -- 200 members, but we have seen just immediately after the launch close to 10% of the -- approximately 10 people come and use that card already. Indonesia is a market where we have seen close to 28% growth. Indonesia is something also we started working aggressively towards Q4 of last year, where we had mentioned that TAT had recently started up their office in Indonesia, which was not there before. So in collaboration with TAT, we had also hosted approximately close to around 26 tourism operators who came to Thailand, who visited our facility, and we packaged, as kun-Neil also mentioned about some of the packages that we are trying to promote internationally now. So through these vendors, we are also planning to promote -- offer these services because, again, Indonesia is one of the biggest markets as we all know. Most of them, they travel to Singapore and to [indiscernible]. Thailand is for medical treatment is still not -- they're not much aware of it. So we are trying to promote these kind of services to the tour operators. So that is the initial way of penetrating into this market. And we have seen specifically from Q4, it is working well. We have seen close to around 28.8% growth from this part of the region. So for others, again, internationally, we see China approximately grow close to around 25% plus on the international revenue. We see Ethiopia again, as you all know, to remind all of you, that Ethiopia, we had done the all-time highest revenue as a company last year, but compared to that, quarter-over-quarter this year, we have done approximately 17% growth for Ethiopia, both in terms of volume and in terms of numbers. And for Hong Kong, we have grown approximately 25% compared to the last quarter. A few of the highlights of what we did for international, we had the Bumrungrad RO Conference, which was held on 22nd of February. We had 88 participants, out of which we had approximately close to around 39 international ROs who came into Bangkok and we had a 2-day event in [ Pattaya ]. And to close off, I will just give one quick update on the social media that we did for Chinese social media. When we started sensitizing the social media for China. In Q1 of 2023, we had approximately 1,200 WeChat followers. And then towards Q2, Q3 of 2023, we started social media engagement and dedicated focused approach for this market. And we have -- from that, we have seen a phenomenal response of engagement with this community. As of now, as of 31st of March, for WeChat, we have over 14,000 followers. And we continue making this engagement an upward trend and also engaging with multiple other platforms like Zhihu, Red Book. And also we are also coming up with customized content on Chinese media with Chinese publications related to articles, health articles, and we are promoting on these social media platforms. That's the update from my end.

Let me ask Daniel to say a few words about insurance operations because this piece of the business has grown pretty significantly. He discussed a little bit about this at our last analyst presentation, but the business is now almost touching TBH 5 billion annually, not quite but close. And the way that he has managed it, many of you know him from his past position as Investor Relations, but he's grown well beyond that. So Daniel, maybe you could give us a little bit about the insurance operations and the tactics and the successes and your successes that we've had, please.

Absolutely. Thank you. Good morning, everyone. Nice to see you all here. For the insurance side of the business, I'm sure you've heard from the previous quarter what we plan to do. There are big things that we're planning to do on the insurance side. In Q1, revenue for insurance grew around 12% in the [indiscernible], which is higher than the average growth rate that we're seeing on the insurance sector right now. Currently, premiums are growing at approximately 4.5% per annum. So we are growing at above market rates. We are taking some market share. Now obviously, premiums does not equate with claims. The claims rate is typically higher if you factor in the inflation of health care as well. But even if you do, which is approximately 5%, we are still growing at above insurance rates. And on top of that, Q1 typically is a lower season for insurance. It typically peaks at Q3 -- Q2, Q3 when there are certain seasonalities that come with it, infectious diseases, especially. So we do expect to see the same development on that as well. On the insurance side, domestically, we are growing at well above 12%, which is, I would say, a solid performance, considering that there are certain domestic issues that we have in terms of GDP growth. And we are managing to steer these cases through collaboration, outreach and also education among our key referral channels such as agents and how they bring in these patients and manage the claims process. In a way, these agents work similar to an RO but it's more face-to-face, it's more one-on-one rather than a B2B business. We also have been engaging strongly with brokers. We see that especially in the upcountry region where we've established quite a solid presence in Chon Buri area and also in [indiscernible]. Health care typically either is a bit too expensive given the captured market or the health care there is not quite up to par with what we can provide here in Bangkok and in Bumrungrad, especially. And so we see a lot of high spend cases such as cancer, liver transplants, things of that nature that we are seeing currently now. In addition to that, on the medical assistance side and the international business side, we're seeing a significant growth as well. We've signed up a number of new medical assistance companies, which previously, we did not have a good relationship with for legacy issues, but now we're starting to see a return of that business. So we're quite encouraged by what we're seeing now. We do expect to see that performance contribute towards the second half of this year. Furthermore, of course, the growth in international tourists has also driven that organically as well. And in the region, we're starting to see a return of investment within Thailand, but also within the region, Cambodia and also Laos, but also in Indonesia, we're also targeting insurance cases and even in Hong Kong, where typically, they would either go to Singapore or in the case of Hong Kong, get treatment in Hong Kong, but the costs have increased significantly during COVID. And a lot of insurers are looking at how they can save costs by steering these cases to lower cost alternatives, which would include Thailand. And the key part for that is how do we develop a program that is attractive both for the policyholder and also for the insurer. So packages, as was mentioned is in previous presentations is one part of that. Other parts will also include things such as the whole journey and how we manage that journey similarly in a way to international medical tourism, it's just using insurance, which typically has certain steps that we need to make as well. And finally, I would also say that operational excellence is key. As I mentioned in the previous quarter, it is very important that the patient receives pre-authorization in a timely fashion because sometimes these patients shop elsewhere. Whoever is able to deliver the pre-authorization and the GOP first typically has an advantage. And that's why we have reduced turnaround significantly. Previously, we were targeting 3 to 5 days. We are now looking at internal turnarounds of 4 to 8 hours. So that's a significant decrease. And our compliance there is approximately 88%, which is quite significant considering that we have not added too much in terms of headcount. So on the efficiency side, that has also improved. Communication among insurers is very important, how we engage with their medical teams, how we engage with their network team is very important. So we've increased the channels of communication and also streamlined the Singapore [indiscernible] contact to be one department only. So therefore, the insurers don't need to go shopping around discussing with various departments. They go to one location. They discuss it with one department and they are the ones to manage that. And that cannot be understated because the relationships you build at that level generates organic growth as well. And that's something that we would like to continue to focus on. So as Neil mentioned, it's right that our business is approaching TBH 5 billion. We are hopeful that, that will exceed the case. And currently, trends are looking quite favorable for us, and we're very encouraged by it. Thank you.

Good. Thank you, Neil. Good morning, everybody. [indiscernible]. I'm going to spend a few minutes today providing you all with an update on where we are in Phuket. I'm thrilled to be here. As you might imagine, we've told you over the last 2 quarters, we've got a lot going on in Phuket. What you're looking at here is an artist rendition of the north side and the west side of Bumrungrad International Hospital Phuket. You see certainly planes, as we may recall, there are 53 now different airlines flying into Phuket. Planes flying in from the East, we'll see the sky light up at night, Bumrungrad International. The rest of the roof, you'll see is covered by solar panels. So 100% of the light coming from that, the energy is actually we're taking from the sun. So we're focusing on CSR activities before we even get started. We've had a lot going on. As you see on the right here, that's Road 402, where just about 2 kilometers from the parking lot at the Phuket International Airport. And so we're really thrilled. So there's a lot of activity going on in the Phuket region. I'll go through some of that in the next 4 or 5 minutes. At a very, very high level, again, this is where we are today. We're looking at a 5-level facility, starting with the basement -- 2 basement levels underground, we'll be parking. And as you see, lab, pharmacy, support services and storage, kitchen, laundry and linen, et cetera. The ground level will be the first floor of our advanced diagnostic center emergency services, of course, registration, outpatient clinics, pharmacy and again, food and beverage. Similar to what we see on the mezzanine floor, here at Bumrungrad. On Level 2, the second floor of the advanced diagnostic center, many outpatient clinics at that point. Level 3, our surgical suites, ICU, CCU, maternity, nursery, outpatient clinics and I think 10 or 12 IPD inpatient beds as well. And then the top 2 floors 4 and 5 will be inpatient services. So we're really excited about that in total. We're looking right at 212 inpatient beds total, right at 50,000 square meters. So it's a big facility. I mentioned in previous presentations, we procured 16.3 [indiscernible] in June of last year and moving forward with this. We've got a number of activities on parallel tracks. So we actually apply for our EIA, environmental impact assessment on February 22. So we're really 2 months into that processes now. We've experienced no significant road bumps and Again, if things go according to plan, we'll be breaking ground in the September, October time frame of this year and completing and opening the hospital at some point, Q2, Q3 of 2026. And again, we'll do as many things as we can on parallel tracks. And there's probably nobody less patient in the room than me. We want to start on concrete next week, but cannot. So a day out of time here. One other thing I'll add, we're seeking additional property for staff housing. As many of you are aware, there is very little if any public transportation in Phuket. So as we do here in Bangkok, we need to take care of our staff and offer economically priced staffing for our nurses and clinical staff as well. So we're looking at 2 or 3 options that are relatively close to this site right here. So there's a very short golf cart ride or van ride as well. So that's moving forward. We're excited about that. Overall, from the market perspective, I'll share -- we -- as you may recall, we opened up a referral office as both kun-Rajeev and kun-Neil have shared this morning, we've got up to over 125 referral offices around the world. We opened up a referral office in Phuket town back in 2022, a short walk from Bumrungrad International -- Bangkok Hospital, Phuket, so right downtown. We continue by putting -- making ourselves available. We did not open a clinic. It's actually a referral office. But we continue to see an increase in number of patients through the RO from Phuket and from other regions as well. It's [indiscernible], [indiscernible], [indiscernible] of course, and then [indiscernible] to the South. So we've done a number of events in these areas. So you heard kun-Rajeev talk about some of the physician speaking events as well. We've done several over the last year in Phuket. We just had one last week in [indiscernible] had a very good crowd. We had a cardiologist in [indiscernible]. 3 or 4 months ago, we had an orthopedic surgeon, very well attended. We provide a number of surgical or clinical consults at these events as well. So very well attended. I mentioned, again, we've initiated a number of CSR activities actually last year. We continue to ramp those up. Not only in the [indiscernible] district, where we're building the hospital, but throughout the region as well. And so that will continue to take on increased interest over the months year ahead. But we will do a lot in this space between now and 2026 when we open the hospital. In the recent past, we began providing home nursing visits to post surgical and medical patients from Bumrungrad here in Bangkok, a really key provision that the providers here, the physicians here can suggest to patients. Again, we're not doing extensive nursing care, but we certainly -- we can do wound changes. We can do IV injections. And so a number of those facilities like that. So it's really good. It alleviates the need for some patients to go to the Phuket Airport, get on a plane, fly to Bangkok and come back necessarily. So we're excited about that. And first and most important thing we're thrilled about, as Neil, [ Ling ] and, Rajeev had mentioned, we're in the process, we expect by the third week in June, maybe the first of July in that time frame. We're opening up a VitalLife longevity center in the [indiscernible] laguna area of Phuket. We're excited about this. This was a 2-floor facility. It's 475 square meters. In traditional VitalLife services that we'll provide, but also cardiac screening on the ground floor as well. So we're really, really excited about this. We're in the process of building the space out. We should be done in the next 2 to 3 weeks. For that and start to move in equipment and facilities and things like that. We're working on staffing and again, market development as well. So I'll just close it by saying really, physically, again, we opened an office in 2022. We have 6 full-time employees, including myself, that are working out of the referral office in downtown Phuket. And we -- it's a 7-day affair at this point, there's activities going on just about every single weekend, whether it's a hotel association -- this week at the JW Marriott in Phuket, there's a Saturday-Sunday 2-day International Health care and Wellness Conference going on and a lot of attendees in use from all over the region. And so we're really excited. And we've got staff attending all of the events and a lot of it is continuing to just spread the brand that Bumrungrad has. And as we know over the years that a lot of -- most consumers equate the word Bumrungrad, our name with the word trust. And so a lot of what we do is to simply maintain and improve that trust. We want to have a seamless transition for any patients and family members from the whole Phuket region coming here to Bangkok. So our staff works very closely with Rajeev, Dr. Nipat staff. And it's paying off so far. So we see positive growth month-over-month over prior years. So I'll leave it there. Thank you very much for your time and attention, and I pass it back to Neil. Thank you, David.

Not only an experienced health care executive but understands the value of community development. Right now building a new hospital, what's critically important is the outreach, the community development, and he is a master at it, he's been going at it literally nonstop except for this weekend, it was in the hospital. But because of privacy rules, I won't say why you were there in the hospital. But he's still okay. You can share. You can tell them, so you're ready to go for this challenge for Phuket.

I'll take the challenge. This -- back several years ago in 2012, I had an auto accident in the U.S. driving my car, and I had a case of unexplained syncope. My heart decided to slow down to the point where I passed out at the wheel of a car. Absolutely guarantee you, no drugs in alcohol involved. I had that [indiscernible]. But I had a pacemaker put in my chest and I had it replaced. The battery was only supposed to the last 7 years, mine lasted 12. I can't explain that because I use a lot of energy, but I had that replaced this past Saturday here at Bumrungrad and had a magical experience of -- none of you -- not that we want people in the room to be sick and to be inpatients. But it really is -- it's a different experience here compared to American hospitals. And I would be remiss in not taking this opportunity, Neil. Thanks just -- to thank the nursing staff that not only on the floor, but in the surgical suite, it was like an orchestra. Literally just watching before the anesthesia took place, watching the surgical techs and the nurses and the physicians and everything, it was really incredibly efficient. So I think it's important for us not just to talk the talk, but the walk to walk. And I had no trepidation. It's the third time I've been a patient here but the first time as an inpatient, and I had a great experience and looking forward to getting a patient satisfaction survey. So anyways, thank you.

So we have on kun-Wisut Ua-anant , Digital Market Officer to update about the market transformation platform for the year 2024.

Please remember what he's about to show you, we started from zero -- he started from zero during COVID, and he and his team have built what he's about to show you, which is a whole new revenue vertical for us, which we never had before. Thank you.

Okay. Hi, everyone, and honored to be here. Today, I would like to talk about the MarTech Transformation platform. Before I talk about this thing, let me explain more a little bit about MarTech. All the organizations want to do the [indiscernible] and want to do the digital transformation. 4 years ago, when I come here, I think about, oh, what is the next step beyond the digital time transformation? We think about the way to do MarTech transformation and that 4 year is a new word for MarTech. But right now, it's become the new term. When you talk about the digital transformation, you have to think about the people, process and technology, the 3 anchor you have to concern in every organization. For us, we want to do the one step beyond, we call Digital MarTech Transformation. We want to do people, process and platform. We not only use the technology [indiscernible], but we built the platform that can be used and make the new growth for the health care as well. Let's see what is it. And when you have the data without intelligence, data without [indiscernible] is history, just only what you did in the past. But if you have the data with intelligent, it means you did the insight that due to the marketing part as well. Okay. From the 2019 4 year ago, we built a new concept after new teamwork, it's called [indiscernible] team work. Actually, MarTech is confirm them [indiscernible] and I cut the well to be the MarTech Team. We integrate the SKU of the people for SKU. [indiscernible] you can see we have created IT, marketing statistic together. Every person who comes to here, they need to train for and go when they think about anything when we development. You think about like this if you want to make it done, you need IT. But if you want to make it better, you need marketing. What about if I make it done and make it better in the CMT. That's why we do the MarTech team. Okay. Normally, engineer being inside out, but marketing outside in. That's why when we combine together and build a service, we can make the new thing happen. We use the [indiscernible] development team work. Okay. What we will be achieve for full year? Right now, we actually about 40 awards for 4 years. Actually we got the new award last week about agile -- agility in marketing. We used the proceed of that as well. Okay. And I try to let you see the full year that we developed. We have 5 people for the first year. Right now, we have 40 people. And you can see I try to have the metric that can measurement the success of digital. We have the percentage of the digital transformation. What we have, we have revenue, we have digital in every year, we have the direct revenue via platform in every year as well. And we try to divide by the revenue over hospital. What is the digital part percentage for that? For 4 year, you can see 3.5%. Right now, we grow to 42% right now for the digital [indiscernible], okay? And we also develop the application and a platform, I will show you what is it. The first year in 2020, we developed a health care ecosystem actually because [indiscernible] ecosystem. You can see we have e-commerce part, mobile commerce part [indiscernible] commerice part. And valuable commerce part and we developed a the chat commerce and also the social commerce. This is the -- our goal for the first year that development and we also build the [indiscernible] in the team. We have the customer data platform as well. Currently, for full year, we have more than 8 million people data that have to retargeting to utilize for the data to target them, okay. You can see this before hospitals have the EMR, the electronic medical record is the digital part of the hospital. Right now, we expand more digital in application, online store e-payment, virtual health, IoT, IoMT, RPA and also [indiscernible]. It is a new platform, that market developed in full year. Actually, it led to many service and [indiscernible] to many start touch points. I will show you some next line. Okay. The first one about the application first, this is the easiest one that people can pursue value for digital. It is a touch point of the direct to customer. And customers can do patient profile, customer can do personalized notification, clinical data, [indiscernible] data [indiscernible] and many things, right? It's similar to other people to develop for the application. But for us, we think about the [indiscernible] journey experience we do the design, digital experience transformation in [indiscernible] and go. You can see we focus on the journey of when people before come to hospital. They have to use book appointment and hire a doctor [indiscernible] and inquiry to ask people. After that, when they come to hospital, we need to remind them to come, right? We need to tell them where to go. We need to tell them how long they have to wait, something like that. And after that, we're using app and to bypass the catcher, how to make voucher and they scan and they don't need to go cashier anymore or go back home. That's why we developed the online store. And you can see we have seen doctor in person in hospital, and we also have the telematic digital the COVID part. That's why it will require to see it in the [indiscernible]. And visiting patient, we have the gift card that actually we've got a lot of award for the gift card as well. And the clinical patient profile, seamless payment and it is the [indiscernible]. I show you some feature on that development last year and this year. We have the [indiscernible] appointment doctor for 245 doctor right now. If you select -- but actually, we have the total 1,200 doctor, but we can support the real-time doctor for 245. And we also support the preparation node and remind and confirmation when there are people before they come to a hospital. And we have the way to search the doctor by the [indiscernible] name [indiscernible]. And we also have the [indiscernible], if you don't know the doctor, but you know about your problem, you just select your problem and we recommend doctor for you. And we also got this another award from the Thailand Digital Transformation award. We got the keyword search. That we make the search that cancer in [indiscernible] in real time and use the AI to predict each collector that they type. You can try -- if you type in [indiscernible], the AI will learn that most of the people who type [indiscernible] can predicted before. Every typing that you type is going to predicted and go further and [indiscernible] and go. Okay. And this is the look and say after users, you can take a result from the doctor package, treatment center and [indiscernible], okay? It is the online store platform. The one that kun-Neil just talking about, actually, this is the model that we developed in the, 4 year ago. And we do the 24/7 to sell package more than 400 right now to sell everywhere in the world. And also, right now is a lot of people more than 7 million people data that we track to go to our store already. And this is a new concept of the prepaid model, they have for hospital that they prepaid include the doctor fee when they come to here, they just show the voucher and go back home. No need to go cashier anymore. This is the way to cut the cashier time as well. We got the actually the success one on the Tuesday. We've done with the health [indiscernible]. In 2 months, we can [indiscernible] on the 2 months. And overlaid per day is about THB 1.9 million. On that [indiscernible] on the last day, we got the new high for the full year. We got in 1 day, TBH 13.3 million. Actually, we can go more than this. But we problem with BPL, the daily limit that is called touch the daily limit of them. They never see the new highlights before for the cred card. They worry about the fraud, [indiscernible] they protect the card. But right now, we can ramp up the overall it's about THB 118 million right now. Okay. And the next one is about the [indiscernible]. The new 2 as well that we developed for the O2O concept. Offline to online and also used for B2B that people can use for corporate and special price, the package is special for that company we can do as well. And this is a new thing we have for this year that have been on last week as well is Bumrungrad wallet. We [indiscernible] the way of payment and combine all the [indiscernible] to pay in the wallet. And you can see we have come by 4 parts e-payment part that I will show you, we have some new unique features that are in a way, first in Thailand. We will show you about the split payment and auto provision. The second one about the EHM card, no need the physical anymore, you use electronic. And e-vouncher, for the online store part and e-receipt for the bill. Let's see [indiscernible]. This is a look and feel when you go to application, you click on that, you have payment my card voucer and receipt. Everything is in here that you need is in one-for-all for this project. Okay. I show you the unique one. When you add the credit card in the application, when you switch the credit card, its automatic detect promotion like this picture, when you add a BPL is automotive indd BPL go up. And you can see, oh, what the BPL have promotion for the Bumrungrad, automatically. And if you add more and more credit card, automatically, detect the auto promotion for you as well. It is a new concept. And you can see we have another promotion in there, and we also have the category cashback installment and the [indiscernible] auditing that for you to be [indiscernible], okay? And this is a new innovation one for Thailand -- first in Thailand, split payment hub. We know the pain point of the patient when they come to here and want to surgery, right? Imagine, if they had to pay about THB 2 million, how they can use 1 credit card to pay. If the credit limit is not enough, right? That's why we developed self-split pay. It's mean that you come, whatever you have, you can split and you can see the percentage to split up the payment, and we have [indiscernible] you to select. It's mean if you have payment maybe example TBH 1 million, you sped TBH 500,000, TBH 500,000. You can think about this one for 1 credit card, this one for a second credit card. You can do that. Or you can do 1 credit card and QR code on mobile banking or installment you can do as well. It's another way to help people to pay easier and make them -- can get the earn point and auditing as well, okay? This one, we already launched. And the next one is about the virtual health care. It is the telemed part, but we call virtual health because we do beyond the telemed. Right now, we integrate with the data IoT, and we also integrate with many the digital part in there. You can see we have medical interpreter. Right now, we support more than 120 in the digital and support more than 5 language have in real time. We can have 6 people at the same time when you talk with doctor. You can invite nurse, you can invite doctor, you can invite [indiscernible] and you're [indiscernible] to talk together, for hours at a time. We in-house development, and we got the public health certified [indiscernible] from the government and you can see we have the chat support, we have all the function that people have, okay? The next one is about the PGHD. Actually, it's personal generated health data. This one means you can bring your own device or your valuable IoT, IoMT that you have and send the data, we had a platform, we had an application to the doctor. Right now, our doctor can see all the data that you have. And it is a new project that actually we developed for 2 years ago. Bumrungrad digital health is the one that we combine our variable IoT and IOMT and in the site and use the AI to learn and recommend and also health analytics help host that have to do. In the future in 7 years, Thailand will become the hyper-aging society hub. This is the feature that you can use IoT, IoMT variable for the [indiscernible] one, right? And you can send all the data to us, we have the AI to monitor. It means that we not do only [indiscernible] and [indiscernible], but we can do pro-care. In the future as well for this. It is the future revenue, subscription model and the new high growth [indiscernible] Thailand as well. Okay? And the last one, last but not least, calling queue assistant is the newest platform that we developed in here as well because most complaints in here is a waiting time. We try to develop that maybe we cannot reduce the waiting time, but we can tell you how long you're going to wait. And also, if you have the lab and you have to wait from 2 hour or 1 hour, what about you can go anywhere. And we do the call IVR with the full language support for you before you're going to come back to us. This one, we already developed this year and start to use and really good positive feedback from the patient. Okay. My last line, it's about a MarTech platform. I hope you guys can see that what we develop is [indiscernible] it is the whole ecosystem to develop. And we are great in the clinical, right? But we want to be the best in the digital as well. Thank you.