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

Hi, everyone, and good morning. Welcome to the live analyst presentations and the Q&A sessions for the second quarter and the first half of 2024, Bumrungrad Hospital Public Company Limited. Thank you very much, everyone, for your time, attending the meeting today. And we have the Thai analysts joining in person in the hospital, and we also have some foreign analysts joining in online as well. For the presentation slide, you may see our website IR page for the PDF file as we have already uploaded the presentations already on our website this morning. So we will start with the analyst presentations by our management first, and then we will start with the Q&A sessions after. As we have a time limit up to 2 hours, during the Q&A session we will give the priority to the questions from the floor first. And then we will go through the questions received from online participants. The agenda of the presentation today will start as usual with the second quarter of this year, takeaway by kun-Neil Sorrentino, Corporate Chief Strategy Officer; and then followed by the financial highlights and the financial performance by kun-Oraphan Buamuang, Chief Financial Officer; and then followed by business update by kun-Artirat Charukitpipat, Chief Executive Officer. And today, we have other executives joining the meeting as well to help answer to your questions that you may have during the Q&A sessions. We have kun-David Boucher, Chief Executive Officer, Bumrungrad International Hospital Phuket and Market. We have kun-Rajeev Rajan, Chief Business Development Officer; and we have Dr. Nipat Kulabkaw, Co-Chief Executive Officer; and we have kun-Daniel Kastner, Chief Transformation Officer. And we have kun-Wisut Ua-anant, Chief Digital MarTech Officer. So without further ado, please welcome kun-Neil Sorrentino to talk about the takes away in the second quarter of this year.

Thank you. We welcome you all to our second quarter and 1H performance for 2024. A few announcements before I go through the highlights for the quarter for you. Firstly, as I have done in the past, just a simple disclaimer. I don't own or trade either directly or indirectly any Bumrungrad Hospital Public Company Limited shares. Secondly, an announcement by Dr. Nipat. Dr. Nipat was promoted during the quarter as the co-CEO of Bumrungrad International Hospital, a very, very well-deserved promotion. Thank you, Dr. Nipat. Okay. Let's go through the highlights for the quarter, and then I'll ask some of the other leadership executives to spend some time with you talking about their individual verticals. So you get a deeper understanding of what we're doing. Of course, kun-Artirat here is going to talk about the hospital operations for the quarter in 1H and kun-Oraphan will go through the financial numbers. The takeaways for the quarter or the highlights for the quarter, however, you'd like to call them, it was a very good quarter for us, especially since we were in Q2. We had of course, Songkran. We had almost half of the Ramadan days in the quarter, not quite, almost half though, Eid and Ramadan combined. In the quarter, when you look at Middle East, which is an important market for us, it -- we were able to cover the Kuwait downfall. The Kuwait downfall for the quarter in Q2 2024 was almost THB 265 million, THB 270 million less in Q2 2024 than it was the prior period, Q2 2023, we're able to cover that and more by growing international by 3.5%. So we were pleased to see that diversification. Most of that coverage came from Qatar. Qatar has been a very, very strong asset performer for us and a country that we have a good, strong relationship with. Thanks to many, many people, including Rajeev here. He has spent a lot of time dealing with the officials from Qatar and the administration and the hospital operations has spent a lot of time trying to take good care of these patients. So for the quarter, the revenue was up 4.2%. For 1H, it was up 6%. And let me just make this comment. When you see some adjusted numbers here for the quarter in 1H, we sold a company asset in Q2 2023 for THB 60 million. And because of how it was treated from an accounting standpoint, it was treated as other revenue. So we are adjusting the growth numbers for you, so you can see the actual adjusted growth numbers as well as the natural growth numbers, meaning inclusive of the THB 60 million as you compare versus excluding that THB 60 million, which shows a higher growth number. That's what you'll see here when you get to adjusted numbers. And that's why I point out here going to the bullet point number four, the EPS for the quarter was 10.5%, adjusted 14.5%. And then for 1H versus prior year, the EPS was 17.6% on the natural, which included the THB 60 million from 2023. And if you exclude that, just raw numbers, it grew by 19.7%. Our EPS continues to grow. And if you may remember, in 2023, we closed at 42% EPS growth versus 2022. So we're driving high efficiencies of ROE and ROA as I pointed in our last analyst presentation, that benefit continues to show that we're running efficiently on CapEx, and we're running efficiently on cost and OpEx. The effect of what happened in 2024 Q2, the margin was up 40.7% the actual margin. And that margin you'll see later is both for the quarter and for 1H. It stood at 40.7%. That remains to be the highest EBITDA margin of the company's history. And I believe, you'll have to correct me here, kun-Oraphan, if I'm wrong. The same holds true for NOPAT margin, is at our highest in the company's history, 30.5% for the quarter and 30.4% for 1H. The operating cash was up by THB 1.2 billion, which shows strong liquidation of our accounts receivable. Our accounts receivable is running somewhere in the 50, 54, 55 days number. We've been as low as 47, but because of our large Middle Eastern business, principally from Middle Eastern markets that you're quite familiar with by now, that grows, but we've been liquidating the AR very well. The difference between the prior year and 1H is THB 1.2 billion positive. So because of all of that, our Board met last Wednesday night, we're sitting on, I guess, 12 -- I think [ kun-Lin ] told me THB 12.2 billion in cash -- [ in their cash ], which is available for distribution. Our Board on Wednesday evening, made the decision to distribute THB 2 per share on THB 795 million shares outstanding. That is the highest baht per share the company has ever distributed or translated, in another way, almost 41% of EPS. The last time we did a distribution for legacy guidance, which I gave the Board -- the last time we did distribution on DPS, it was 32% of EPS. This time, they pushed it to 40% -- almost 41% of EPS or THB 2 per share. And we have noticed that on the Investor Relations website as well. If you go there and you see it, there's a notice of this distribution by our Managing Director, kun-Linda Lisahapanya. I'm going to ask David to talk about this next slide because he brought it to my attention, then you move to the next slide, please. David, I'll let you explain this.

[Foreign Language]. Yes. Thank you, Neil. We learned a couple of weeks ago that Bumrungrad was ranked #6 in the world of the top 10 most technologically advanced hospitals by Digital Health Magazine. And it's the first time that we've been named in the top 10. And just specifically, there are 8 or 9 major areas that hospitals were assessed on. And I'll just mention a couple of them. The first is cutting-edge systems to enhance patient care. Obviously, most of you know that we excel there, technologies such as robotics for surgery and for medication dispensing. Perhaps you recall, I think Bumrungrad had, if not the first, one of the first totally robotic inpatient pharmacies in all of Asia. Third area was leveraging AI for diagnostic support and for treatment planning. And the fourth major one I'll mention is telemedicine capability. So you may recall Bumrungrad took the lead back in 2019 and offering telemedicine. And specifically, digital health mentioned about both pre and post treatment and everything. So if you look at the list, I'll just close with this. I mean we're in pretty highest team. Again, you look at the first 3 Mayo Clinic, Cleveland Clinic and Johns Hopkins, are all U.S.-based. The hospital in Berlin and then King's College. Bumrungrad is #6. We were the first in the list in all of Asia in front of hospitals, both in Singapore and in South Korea. So something we're really proud of. And certainly, folks throughout the entire organization over the last years and years and years have been involved with this. And -- so anyway, it's -- we wanted to share that with you. So, thank you.

Thanks, David. No, we're happy to talk about our numbers since post COVID period. Go back to that slide, please. We're happy to talk about our numbers post COVID period. But this is some very serious company we find ourselves in. I assume most of these names you as -- you and the investor community are quite familiar with. But I don't know if you're familiar with Sheba Medical Center. This is also a very, very fine one of the top -- if not the top medical center in the -- in either the public or the private sector. King's College Hospital in the U.K. is a very, very big operation, and so is the one in Germany. So we're very pleased to be in this number. And I always say when we get these awards, we didn't buy this award where you pay for awards and you go to an award ceremony and they give you a plaque, and then it costs you $3,000 to get the plaque. We didn't do that here. This came to us because they thought of us being this serious an organization in terms of our technological leadership skills. Next slide. So we'll go down now a little deeper for you, for your benefit, and then please ask questions either along the way or at the end, up to you. This is the total revenues. We're going to show you today, this morning, total revenues as well as net revenues. And the reason why we're making that distinction is because of the THB 60 million asset that we sold in Q2 2023. But that's the adjusted numbers that I mentioned to you that I was going to show you where we reflect the adjusted differences between the inclusion and the exclusion of the asset we sold in Q2 2023, you can see the growth numbers, 4.0%, 3.0% for the quarter and on the 1H versus 2023, 6.0% versus 5.4%. Next slide. Next slide, please. The proportionality of the revenue really hasn't changed that much in many, many years. It's still 65%, 66% international, and then the balance being tied. And if you look across the quarters and look across the 1H, it generally reflects that very, very same trend. That has not changed at all over -- probably over 10 years. Next slide. Overall -- now this is net revenue. Net revenue does not include that one-off THB 60 million number that I mentioned. So this is raw numbers, if you will, in terms of comparison of the growth overall 4.2% in the quarter, 6.0% net revenue growth. So when I guide on top line revenue growth for your benefit and for the benefit of the investor community, this is what I guide against is net revenue, not gross revenue because gross revenue doesn't really mean that much because we have to account for the discounting piece against that gross revenue, which is somewhere between 10% to 11% for the quarter. It was 11%. Is that right, kun-Oraphan? So you can see the numbers for yourself. I'm not going to read them for you. For the quarter, and year-over-year, the areas that were strongest, especially in admissions was Expat and Thai. They were pretty strong during the -- especially during the second quarter because we had lesser business from the Middle East because of Ramadan, but still up 3.5% Ramadan -- Middle Eastern business was. Next slide. This is the international, Middle East and Indochina sleeve of business. In the middle section, you see Indochina, the effect there is the impact of -- continuing impact of the Myanmar business. We continue to see that being less than what it was in prior years because of the disruption and unrest in that country. The other 2 were quite strong, especially when you consider all others, and that's all others there at the bottom of the list. These slides are available for you online as well. So you'll have these for yourself. Next slide. These are the top 10 countries. The remarkable ones, of course, was Qatar, China. China was almost THB 180 million for the quarter, 2/3 of it was international. The third was if you will, expat, Oman was strong for us. So Qatar was the strongest of the strongest of the top 10. It continues to grow for us. Myanmar was off Bangladesh was strong for the quarter. UAE was slightly off. You have to see the revenue differences as opposed to the percentage. Percentages are a little bit misleading. The revenue was that far off at the UAE, but the base was smaller. And of course, Kuwait, I mentioned earlier, it was about THB 270 million difference quarter-over-quarter. And for the year, if I remember the number correctly, it was about THB 580 million difference year-over-year, 1H 2023 versus 1H 2024. Pretty significant takedown on the Kuwaiti business. The status on that is that they continue to develop their reinfrastructure. They continue to develop their preferred provider network. We're now seeing slightly better revenue out of Kuwait, but it's single-digit number of patients, before we had 50 to 60 patients a day. Now we're seeing 5 to 7 patients a day. We're in the network, but they have made a decision -- I mentioned this the last time, but now I believe it's the case. They have made the decision not to concentrate too many Kuwaiti citizens in 1 country for medical tourism purposes because they don't want to get into the same problem that they got into last time. In addition to which, they're setting up a different organization and utilization oversight and infrastructure to pay more attention to who the citizens are, where they're going, what their initial diagnosis is? Are they going -- are they being directed to the right kind of an institution. If they're very, very sick, they shouldn't be going to a primary care hospital. They should be coming to a tertiary and quaternary care hospital. That wasn't happening in the past. And they -- as I mentioned, they had 70 deaths in Thailand in 1-year period. And they had -- they're very concerned about that, especially the costs associated with that, not at Bumrungrad, but in other institutions. So that business, I think, will start trickling back and growing over time. It's going to take some time. They find us trustworthy. I think this past week, we had 7 or 8 patients in the hospital from Kuwait some of which were guarantee of payment patients, which is very important. We still have that guarantee of payment contract with Kuwait many, many of the hospitals that used to no longer have that guarantee of payment contract. So it's good news for the future. It's bad news today, but fortunately, we're covering it and more by having grown their revenue by 3.5%. China was very positive for the quarter, we may with the China business giving where we are, we may get up to THB 1 billion this year, which will be an all-time record for us. The way it's running right now. Rajeev and his team, his China vertical team are doing a very good job there, especially year-over-year. U.S. is quite strong. When you see U.S., you think citizens are coming -- U.S. citizens are coming from the United States, not really the case. We see some, but most of this is expats that is driving this revenue. Next slide. So we get to the EBITDA and the NOPAT. And as I mentioned earlier, you can see the trend line upward on the margin from 38.9% to 38.3%, slightly off to 40.7% on EBITDA. And you can see the EBITDA growth itself was up 10.4% on an adjusted basis. And the same for 1H, identical 40.7%, continued good growth on the NOPAT -- on the EBITDA line, 15.9% adjusted, 14.4% on the natural. Next slide. Net profit reflects the same thing. We're showing on the 1H version, 17.6% up on the right-hand side here. That's on the natural, if you look. If you consider the THB 60 million in the base in 2023 without it, it's up 19.7% for 1H. And for the quarter, 10.5% versus 14.5%. But the margin for the quarter is -- was satisfying to me because it grew almost 3% for the quarter and for 1H, similarly, almost 3%. And of course, all of you seeing here or you're thinking it in your mind, on this EBITDA margin and NOPAT margin, how much further can you go? Question A. And question B is, is it sustainable, right? Who's not thinking that? I asked myself the same question. I don't know the answer to that. I honestly don't. But we don't really, from a business standpoint, pay too much attention to the answers to those questions because there will be some quarters that it may be less. There may be some quarters it may be more. It's all based upon volume, revenue intensity, cost control, the kinds of patients we bring into the hospital. When you think about the Kuwaiti patients who were in the institution a year ago, they were very sick patients. So they were driving pretty significant revenue intensity. I don't have that anymore really to speak of from Kuwait. At least today, I don't have that. So when I look at admissions and patient days and overall volume coverage, it's difficult to compare those numbers at a gross level and say, oh, well, the admissions are the same. The length of stay is not. And our length of stay is down because we don't have that -- we don't have those very, very sick patients from Kuwait. Not too far down, but it is down, and that's a significant factor when you start looking at whether or not you can drive revenue intensity and drive profitability. So it's many, many different factors that make up how it is that we generate margin. Price is also a consideration. This year, we raised our prices 6%. So we're not -- in part, not doing it with price, but price was disproportionately impactful in the quarter because of the revenue intensity decline because of Ramadan and because of Songkran which both occurred in the quarter. So those 2 events always affect our Q2. Every -- Q2 quarter of every year, we've been in existence, except this quarter, we were able to continue to cover that difference. For many hospitals, you probably look at that number. And if they had the right kind of mix that we have, without the diversified coverage from other countries, from other markets, you would have declines in these numbers on the margins for NOPAT and EBITDA, but we didn't experience that because of our broad, diverse coverage in markets around the world, especially Qatar and Bangladesh and China and the United States and on and on. Next slide. Kun-Lin?

So debt-to-asset ratio has been improved a little bit from last quarter because of -- mostly due to the higher cash and investment and this shows very strong balance sheet performance. Next slide, please. On the cash flow, as kun-Neil highlighted earlier that we have cash balance -- cash/investment balance at THB 12.2 billion as of 30th June this year, and this is because of the THB 1.2 billion increase in operating cash due to the higher operating profit in the first half this year, an increase in accounts receivable collection, especially Middle East government that we can collect more. On investment, investing cash increased due to we have more long-term investment as they generate higher returns where we have more. And on the financing cash is increased because of the increase in year-end dividend that we paid this year compared to last year. So move back to kun-Neil on the VitalLife performance.

For those that didn't meet kun-Lin the last time or were not here, she's our Business Analytics Executive, been with the company a long time, sort of my other brain when it comes to the numbers, very smart lady. VitalLife is continuing to have a record year. I keep saying this about this vertical. But I mean, you look at the numbers, the growth of the numbers, very strong for the quarter and it's moving toward -- if you look at the EBITDA for the year, THB 238 million, call it, THB 240 million, this could easily push THB 500 million on EBITDA for the year. And this was a really small business for us in the past. It's grown quite significantly. We have moved the business integration to lifestyle and longevity beyond just anti-aging and wellness. There's a whole aspect of business lines inside our lifetime and longevity center as part of VitalLife now that's driving part of this new business and the new profitability into it. We will be opening our VitalLife Center of Excellence in Phuket on September 27. And the VitalLife people here who are the management here, led by Dr. Suthee and his team, kun-Lin and David being in Phuket will be overseeing that center. It's located in a good part of town, as I may have mentioned the last time, and we look to have this -- to be a lead product line for us before we open up the hospital. And they will give an update on the Phuket project here in just a moment. 43% EBITDA margin for the quarter and for 1H. Very strong. Next slide. Okay. I will stop here, and I will turn it over to kun-Oraphan.

Thank you, kun-Neil. Good morning, everyone. So I would like to present in terms of the financial highlights and financial performance. Maybe add a little bit detail more than kun-Neil. So in terms of second quarter this year, total revenue increased by 3%. EBITDA and net profit amount were improved by 7.6% and 10.5%, respectively. When compared to the same period last year, as shown in the first table, the improvement mainly came from both Thai and non-Thai patient in case plus cost managment Bumrungrad implemented continuously. The EBITDA margin and net profit margin in second quarter this year were 40.7% and 30.5%, respectively. The net profit margin is the new high record of the company account on the quarterly basis. Please note that total revenue in second quarter 2023 and first half 2023 include an extraordinary item related to a gain on sale of asset, THB 60 million, as kun-Neil already mentioned. When excluding this extraordinary item in last year, the total revenue year-over-year [indiscernible] for second quarter this year and first half this year were improved to 4% and 6% respectively. The EBITDA and net profit amount grew by 2 digit as presented in the first table. Next slide, please. In terms of financial performance on the total revenue in the second quarter this year was THB 6,331 million increased from second quarter last year by 3%. The total revenue improvement mainly came from the increase in revenue from hospital operations, which increased by 4.2% when compared to second quarter last year. The increase came from non-Thai patient and Thai patient revenue increased by 5.4% and 2% respectively. Next slide, please. In terms of revenue contribution by nationality, in second quarter this year, the contribution of Thai was 34% and international, 66%. The percent contribution between Thai and international was slightly changed from second quarter last year. This was mainly due to an increase in revenue from non-Thai at 5.4%, slightly above than an increase in revenue from Thai patient at 2%. For the first half this year, the revenue contribution from non-Thai and Thai were 66% and 34%, respectively, which is the same as first half last year. Next slide, please. In terms of revenue contribution by service, in second quarter this year, the revenue contribution from outpatient service increased to 50% from 48% in second quarter last year due to OPD revenue grew by 7.5%, while EBITDA grew at 0.4%. For first half of this year, total revenue contribution from inpatient service and outpatient service grew 51% and 49% respectively, which is the same as contribution in last year. In terms of revenue contribution by payor type, insurance contribution in first half this year increased to 19% from 18% in the same period last year due to insurance revenue in first half this year increased year-over-year by 10%. The government third-party contribution in first half this year remained at 18%. Revenue from government sponsor increased by 7%, which is associated with Middle East patient revenue increase. For self-pay contribution in this year slightly declined to 62% from 63% in previous year mostly due to revenue from self-pay patient increased at 4.7%, which is lower than revenue growth rate of insurance payer and government third-party payers. In terms of EBITDA and EBITDA margin, as a result of increasing revenue and continued cost management program, EBITDA in second quarter this year was THB 2,577 million, improved from same period last year by 7.6% with EBITDA margin at 40.7%. In terms of first half this year, EBITDA was THB 5,254 million, improved from same period last year by 14.4% with EBITDA margin at 40.7% as well. When excluding the extraordinary item in year 2023, the EBITDA year-over-year growth rate for second quarter this year and first half this year were improved to 10.4% and 15.9%, respectively. Next slide, please. For net profit and net profit margin. Net profit of second quarter this year was THB 1,932 million, which improved by 10.5% from second quarter last year. Net profit margin of second quarter this year improved to 30.5% from 28.4% in second quarter 2023. The net profit margin of this quarter is the new high record of the company. For first half this year, net profit was THB 3,917 million, improved from same period last year by 17.6% with profit margin at 30.4%. When excluding the extraordinary item in last year, the net profit year-over-year growth rate for second quarter this year and first half this year were improved to 14.5% and 19.7%, respectively. Next slide, please. In terms of leverage ratio, net debt to EBITDA of first half this year was negative at 0.4x due to less net debt. And net debt to equity was also negative at 0.1x due to less net debt as well. These are our financial highlights and financial performance of second quarter this year and first half this year. Thank you for your attention. So move on to see the business update by kun-Artirat.

Good morning, everyone. It's my great pleasure to see all of you again. So I would like to start with the award that we are very proud to present. So you know that this is the fourth consecutive year that we got one of the top -- best hospital in the world. And this is another award that we was ranked to be the Best Specialized Hospital in Asia Pacific by Newsweek. And 5 specialties from [indiscernible] we got the first rank in Thailand, which are cardiology, endocrinology, pediatrics, pulmonology and oncology. Next, so I will present only the key highlights up there. As you know that we established 8 center of excellence this year and the performance of these center of excellence contribute around 1/3 of the total revenue. We got 4.7% revenue increase from the first half this year compared to the previous year. For the non-COE, we also have revenue growing around 5.5%. The red color that you see in the slide, which are cardiology, oncology and urology, we have a declined revenue growth because of the unexpected decrease of the international patients that kun-Neil already mentioned in Myanmar, Cambodia and Kuwait. This is the 2 new center of excellence that we established this year, which are Urology and Breast Center. We focus on the advanced procedures. And if you recall, around 2022, we introduced the water vapor therapy to treat enlarged prostate, and we are the first hospital and then other hospitals also followed us and then it becomes the price war competition. So this year, we launched another new technology we call UROLIFT. We successfully 12 cases with excellent patient feedback. Another one is the Breast Center. Breast Center also have the significant growth, especially in the breast excision cases increased around 16% year-over-year and breast cancer screening also has a remarkable around 29% growth compared to the previous year. And the breast cancer is one of the top cancer in the female. And this is another project that we are honored to be the first and only private hospital selected as a sponsor of The Federation of Neurogastroenterology and Motility Meeting. We partnership with Chulalongkorn University. And, Dr. [indiscernible] also being our Head of this Motility Center together with Chulalongkorn. This conference will bring all the leading global experts to share knowledge and develop groundbreaking treatments for gastrointestinal disease. In this event, we aim to showcase our medical innovations, foster collaborations and reposition Thailand as a leader in this field. Next slide. In late May, we launched the press conference title, Prostate Health Revolution. This event highlighted our commitment to provide personalized and comprehensive care for patients with benign prostatic hyperplasia. We leverage cutting-edge medical technology and a team of the specialized urologists and we aim to have the significantly improve in our patients' quality of life. And we are very proud that the track record of managing over 5,000 BPH cases annually, 80% of the case, very successful treated with our surgical intervention. Last month, our Children's Center hosted the Healthy Kids, Healthy Future event. A key highlight was a talk on the diagnosis and treatment of complex childhood disease include those emerging in the digital age. This event we emphasize on the critical role of our high-quality pediatric care providers with multidisciplinary teams deliver timely and effective care for children facing the complex health challenges. Next slide. So beyond only driving the business growth, we also dedicated to create positive social impact and fulfill our corporate social responsibilities. Thanks, kun-Oraphan, to initiate this project, which are BOI investment promotion measures for community and society development program. On July 26, kun-Oraphan, attended online meeting with the representatives from multiple government hospitals to develop the collaborative projects and investment plan. We aim to reduce inequality and expand our health care access with communities this year. So Bumrungrad submitted the 6 investment projects to the BOI to improve health care facilities across Thailand, 2 projects in Phetchabun Hospital and Rehab Center. We support equipment for the rehab ward. Renovation of the rehab center and the provision of the 8 mobile Holter recorders. One project with Rajavithi Hospital. We provide 10 colonoscopes for Rajavithi Healthcare mobile team to provide cancer screening in -- to reach rural area of Thailand. Another 3 projects in 3 Southern border provinces which are Narathiwat, Yala and Pattani. We provide 3 ambulance equipped with auto mammogram machines to government hospitals in these 3 provinces. The BOI committee already approved this investment in July and our Board already approved in August as well. So we will begin this investment in the fourth quarter this year. That's all for the business update. Thank you.

We now ask our executives to give you an update, given their responsibilities in their particular markets including the insurance market, so you get a deeper understanding and you're welcome to ask questions as well. If I could ask you, Daniel, please. Daniel Kastner who's our Chief Transformation Officer; and also the executive in charge of Insurance Operations, to give an update, please.

Sure. Thank you very muc. I must apologize a bit for my voice. I just had a bit of a cold, but it's not COVID, please don't be alarmed by that. And I'm fully recovered now. It's just a nasal...

No 2 red lines, Daniel?

2 red lines.

Okay. Fine. Keep going.

So if you recall from last quarter's update, we mentioned, there was a question about whether insurance business would be able to grow beyond around 18% that we posted at the end of last year? And in fact, we have seen continued growth in that segment. It now accounts for about 19%. And in certain months, it has already reached the 20% mark. So we are moving in that direction that insurance continues to take on more market share. But we are very mindful about the problems with getting to overreliant on insurance, and that's something that we are managing ourselves as well because as we know, insurance typically is rather a zero-sum game, right? There is a certain amount of money, and the provider and the insurer vie for that amount of premium dollar from the patient, and we want to manage that as well as sustainably as possible from our end as well. So I think what we're doing now is quite well. In Q2, revenue for insurance side grew by 7.3%. So on a year-to-date basis, we're looking at 9.6% growth on insurance business. That doesn't include overages, doesn't include copay deductibles, et cetera. Typically, that's another 12% on top. So you could probably factor that in, but we haven't provided you with a management account breakdown of that, but I will provide that to you at the end of the year with the opportunity to give more insight on that. In terms of volume, we've been growing quite nicely as well. So from an OPD side, we've been growing at 4% on a year-to-date basis. And on the admission side, 6%. So it's been quite healthy. And for current trends now, August-wise, very, very strong growth. We're seeing very, very high consistent census numbers for insurance business. We -- I just upped the target for my team to the chagrin of those that are working with me, but we've already breached over 150 inpatients for insurance per day. We're looking now at about 170 in terms of target. And maybe we'll be able to hit that with some seasonality factors. But we're meeting some headwinds as well. I talked about that last quarter, and I mentioned that insurers are now trying to slow things down in terms of the spend and the claims rate of health insurance in general. So what you see is in the market if you follow that, pediatric insurance is starting to come down. So a lot of insurers, they lost a lot of money last year and they've pared that down. They've started to reduce pediatric insurance policies. There is 1 insurer now that is launching that, which is quite interesting, but most of them are actually pulling back. So we do expect some churn from that as well. But nonetheless, we still see strong pediatric growth cases in the insurance side as well from existing policies. It's just that the growth rate towards the midterm, longer term will start to slow down as there are no more policies that cover that. And people will have to pay out of pocket or they have to have higher co-pay amounts as a result. Other growth areas that we see is a very strong growth in oncology, and we launched a program called PAP, which allows -- which we collaborate with drug manufacturers for oncology drugs to provide either buy one, get one for drugs or high discounts. And that has proven to be very successful. A lot of Thai patients are very concerned about the cost of cancer. We know cancer costs a lot of money. And with this, the drug costs are reduced significantly, and it's a large proportion of the spend. And that has also helped to drive more cases to us as well in collaboration with our referral partners, such as insurance agents, brokers, medical assistance companies, et cetera. So far, we are on track our target for -- a soft target for us is approximately in the low teens. So we're moving towards that direction. And I mentioned to you last quarter that growth rates are expected to increase in Q3 and Q4, that's typically the higher season. So we've just passed Q1, Q2, which is typically the lower season, although there is some fluctuation per month depending on the weather and on turnover of expats. And so we see that encouraging for Q3 and Q4 as well. And of course, I will provide you with more breakdown on the margin and how that develops. But so far, we are quite pleased with what we're seeing right now. Growth rate is quite strong, especially among local insurers, AIA, [ Krungthai-AXA], [ Krungthai ] Life et cetera, et cetera, there are many partners and we're continuing to sign on new partners as well internationally. And also from the medical assistance side, we recently attended an international conference for insurance and medical assistance companies, and we developed a lot of new relationships. We never did that before. So that expansion in the network will hopefully drive more growth towards the latter half of this year, and we expect next year as well. It's also encouraging that in the last quarter, I mentioned about our target for international business in Indonesia and in Hong Kong, and we're starting to see some of that happening as well. We are dealing with medical assistance companies that specifically manage the Indonesia portfolio and we're starting to see some referrals from that, albeit it's quite low right now, but we do expect that to continue, and we -- so far, the results have been quite encouraging. So thank you very much, krap. If you have any questions, please let me know.

And on the question of cancer, Daniel touched on it, many of these insurers, of course, want Bumrungrad in their network because of our reputation and the kind of care that we give. And we have been looking for many, many years to see where there are mutual alliances and relationships that were equal or coequal with who we are in the market. And I'm pleased to inform you that in the quarter, as approved by our Board, we signed a 6-digit, I would call it, a management relationship agreement with Massachusetts General Brigham. For those of you that know that name, a few do not. They are going to work with us to help us design and train our doctors and our staff with respect to cancer services in general and in particular, CAR T-cell therapy procedure. Right now, CAR T-cell therapy is treated principally for the diagnosis of non-Hodgkin's lymphoma. But it's moving now, it was just approved in the U.S.A. for solid tissue, relationship between those patients that have solid tissue tumors and using CAR T-cell therapy to help cure meaning 5-year cure rate. Mass General Brigham is going to be working with us. We're building an oncology institute on [indiscernible]. That's the second -- that's the third of 3 buildings. The second building will be the 59 bed hospital, which will be going under construction in about 2 to 3 months just as soon as we get the building permit. So they will be coming to help us design it, They'll help us train our doctors there and here. They'll help us train our people here. And we will co-brand together the CAR T-cell therapy protocol for our future CAR T-cell patients. Co-branding it between Mass General Brigham and Bumrungrad International Hospital. That's the part A of the engagement with them. Part B of the engagement with them is, we're going to explore the idea. We're not convinced yet that this is something we want to do, although they like us and we certainly like them is doing a partner -- a co-branding collaboration with Mass General Brigham. And while we go through this Phase A, we together will look at Phase B, which is co-branding Bumrungrad with Mass General Brigham. I'm not saying we're going to do that because we haven't agreed to do that yet, but we're very positively engaged about looking into this very seriously. They are coming here in October -- I believe Dr. Nipat. Dr. Nipat is leading this charge for us. I believe they're coming in October. Is that correct? September, bringing a team out here to do Part A. And while they're here, they have a vetting process because they just don't partner with just anybody, and they just don't brand with just anybody. So while they're here, they'll also be vetting us from a global branding standpoint, although they've been here a couple of times already and their Head of International Relations, [ Dr. Lu ] has been here also. And he came here for the ceremonial signing of the agreement. So this is going to be a very positive thing for Bumrungrad in the future. There's just no question about it, especially them and us working on making our new cancer institute complete international state-of-the-art and then going from there, perhaps with a partnership between us. So I'll pause there on the whole question of cancer, and I'll ask David here to give the summary update about the Phuket project, please. And we do have a number of people also online listening in and can ask questions at the end of the session. It's a listen-only, so there's both this audience as well as the people online, David. I don't want to make you nervous or anything. But with all that gray hair, I don't think you're going to get nervous.

Not nervous at all, Neil. Thank you very much. So tough act to follow for sure. So and it's great news, I think being a New Englander myself, we're looking at some kind of a collegial relationship with Brigham Mass General (sic) [ Mass General Brigham ] for sure. So a brief update on what we're doing in Bumrungrad. We talked a little bit about this over the last couple of quarters. What you're looking at right now is an artist rendition from DWP, our architects of what the front of the building will look like from 402. As a reminder, we're about 2 kilometers from the Phuket International Airport. So as you see on the left, VitalLife, and our advanced diagnostics center on the right, Bumrungrad International signage and all. So again, not going through the different floors. We've talked a little bit about this last time, but just an update. The photo here is, again, is the artist rendition of what it will appear like at night when you're landing from the East to the West. You'll see Bumrungrad International. You won't be able to miss it if you're on the left side of the plane, I promise you. Again, we're going to build 212 total inpatient beds, right at about 50,000 square meters total. We'll have a total of 8 operating theaters plus a cath lab, plus 2 C-section suites or theaters and plus separate endoscopy suites at all. And as you might imagine, since last July, we put an enormous amount of work in a number of specific people here. Bumrungrad International have been involved in this effort from day 1, primarily nursing and pharmacy staff as well. So -- and operations staff as well. So it's been really, really important. We've totally finalized our environmental impact assessment, it's finalized and submitted. ONEP has scheduled their site visit later this current month as well. And so we're hoping that will go relatively smoothly. And once we earn our EIA, we'll seek building permits. And so we're still planning certainly Q4 groundbreaking for the project. As far as the market development concern, again, we continue to increase our brand leveraging, looking, of course, to increase the number of patients that not only from Phuket, but from [ Phang Nga ], Surat Thani, [ Songkhla ] and other provinces as well. And so that's working out fairly well. Again, through the referral office that was opened back in 2022 and also from the entire region is all. And as you might imagine, and we're expecting that these numbers will continue to go up once we actually break ground. Once the community sees that we're actually pouring concrete and putting in steel, and we're actually doing this, then I think that helps to shift some of the market as well. Over the last quarter, we significantly increased our CSR activities in the whole Phuket region, primarily in [ Maicao ], the Maicao District, where we're building the hospital, but for other things as well. And at some point, happy to expand on some of those efforts, but we're excited about that. Again, working very closely with [indiscernible] at Bumrungrad and trying to -- continue a lot of the good work that Bumrungrad International has done over the last 44 years. We continue to provide pre and postsurgical nursing home services in the region. And as Neil mentioned on his last bullet, for VitalLife Phuket, we actually do have a grand opening day now of September 27. Again, this is an artist's rendition, but it does look very close to this as we speak. And so VitalLife staff have actually moved and relocated and we're ready to go. So we're excited. As Neil alluded to, we're in a very -- we think strategic location in Phuket in the [indiscernible] Laguna area. Obviously, we're surrounded by a number of expats and expat communities as you might be aware. So we're really excited about that and look forward to really expanding those services. We think we're going to do really well in Phuket. Thank you.

We're having a twin grand opening because our old VitalLife building, which is an 8-story building here on the campus, is now ready to be moved into. So we'll be moving from our BIT, Bumrungrad International Tower building, Building C to the new building, Building D, and that will be a grand opening on September 27 as well. So we're having a dual grand opening for VitalLife in Phuket and here. And now if I could ask, please Rajeev to give us an update for -- Rajeev is responsible, as you may know, for international as well as domestic. So I'll ask him to give a summary, please.

Actually, for the international part, specifically, most of the highlights kun-Neil just mentioned in the presentation. But to start with, on the Middle East segment, again, referring to what kun-Neil mentioned on the GAAP or the deficit from Kuwait specifically, THB 200 million plus approximately for the last quarter Q2 compared to the quarter Q2 of 2023. Overall, put together for Q1 and Q2, close to around THB 500 million in deficit from Middle East perspective from Kuwait alone. To fill in that gap or the deficit was something that we managed it well, and I think we have grown from the Middle East specific business for all countries put together. UAE also had a small deficit. But since the revenue was not very high last year from UAE. But we saw a small deficit in the first half majorly due to the holidays because of Eid, because of Ramadan. And usually, UAE -- historically, Q3 is the strongest quarter for us for UAE business. But the deficit into positive was majorly because of the Qatar contribution of the business, for the Oman contribution of the business. We saw continued growth for over 50% plus from the Qatar business compared to last year. Oman, we saw a double-digit growth and it continues to grow. For Middle East, Kuwait, I know we might have a lot of questions on the Kuwait business on the stability of the Kuwait business or how we can win back specifically the account. We see a small growth coming in now already. Early this year, we did not have many guarantee patients coming in from the Ministry of Health of Kuwait. But starting end of Q2, early Q3 now starting, we see some small referrals happening single digit though. But we are optimistic towards that because we have been constantly in touch with Ministry of Public Health of Kuwait. And they are also optimistic because they want to resume Thailand. But again, with a specific team in place, and they want a focused approach specifically by having a medical attachment here. They want to have a medical team to help patients, which was absent before. The team is not yet here, but still we see some referrals, even though it is single digit. But we are optimistic. We expect in Q3 and Q4, the numbers to be higher than what it was early this year. If we manage this specifically from Kuwait, the incremental growth or -- of course, what we predict, it might not be the same as last year, Q3, because we have not started that flow as kun-Neil mentioned, average we used to have around 50 to 60 patients from Kuwait IPD in Q3 also last year, but we've still not accomplished that. So overnight, it will not start to be 60. But yes, gradually, it will trend towards that. It will take some time. And momentarily, we will grow. For the non-Middle East business, specifically from the CLMV region, Myanmar off and on, we have been seeing some political instability and is still there. The market dynamics has not changed much. But our approach has changed. We have made a different strategic approach towards that specific region. We are continuing to do our outreach clinics. We take our doctors to Myanmar. We are continuing to do our outreach programs in our clinic, which we have in Yangon. And we have good turnarounds in terms of conversions, even though some -- we have seen that the OPD numbers are down, but still our admissions continue to grow specifically towards quaternary and tertiary care referrals from that part of that region. And we will continue the same strategy. We're still having regular OPDs, which is outreach clinics in that region, and our doctors are very frequent there. We do it once every month, twice every month for the selected specialties and -- to get the high-end referrals from that region. China is a market which we were very optimistic beginning of this year. We were expecting a double-digit growth, and we were optimistic in terms of the connect, in terms of building our social media for engagement with the customers, specifically for the expat segment, international segment. And we are on track with our plan. Specifically, we are very -- we have successfully engaged with that specific segment, and we see good results. We are seeing double-digit growth from Chinese markets, specifically for international and also for the expat segment. We have some engaging activities coming up later towards the end of Q3, early Q4 as well. Overall, as kun-Neil also mentioned, that we are optimistic, and we are trying to take it up to a THB 1 billion market. Last year, it was close to -- all these segments, international and expat all put together, it was somewhere around close to THB 440 million to THB 500 million. This year, we are optimistic, and we expect to close to THB 1 billion put together from Chinese market. For the African segment as well, Ethiopia continues to grow. To remind everyone, Ethiopia, we had the highest revenue last year, contribution from the market. Africa, we also are planning to diversify further. Kenya did not have a flight to Bangkok last year. But now it has resumed operations specifically twice a week. So we see that as an opportunity and we are continuing to explore. This year so far, we have not had an outreach in that region yet. But towards the second half of the year, we will have some engagement activities. We will have our clinicians go there. We have some outreach, some medical education programs to connect with the -- connect and screen patients and facilitate them here. So overall, first half, we have seen -- even though we had some shortfalls and shortcomings versus the last year for some of the markets, we managed to fill that gap by developing new markets, new territories, new geographies. And we are optimistic to add new more and diversifying our portfolio even further so that we can stabilize and we can even bring in some incremental revenue from the international segment. So that's the update from my end. If there are any questions, I would be willing to take that at the end of the session.

Thank you, Rajeev. We're happy to take any questions either from the audience or from the people online. As you've been hearing throughout this past hour plus, people keep talking about targets and KPIs. It's something that we live with every day in our organization. I'm not sure if this is something that is part of the Thai culture, part of the Thai business here in Thailand. But for those of us that have been educated and had success in Western-style countries, it's something you live by, which is KPIs and targets. And we all have them and we all adjust to them when we have these different kinds of changes that are, in the short run, uncontrollable like what Rajeev is talking about. He didn't get into a lot of detail about Myanmar, but we're doing something very, very different there that we didn't need to do, didn't have to do before that has shown good fruit. Same thing with China. Same thing with other markets. So it's to these ladies and gentlemen's credit here for the kind of numbers you see up here. Yes, you're right. I was hoping you hadn't brought that up.

That's the most important thing.

It's going to be single-digit top line revenue growth. It's not going to change from Q1 and Q2 because the base is so high. To guide more than that would be a little bit foolish on our part because of the base being so high. You saw the net revenue and gross revenue numbers being driven by the company to guide more than top line revenue growth of single digit would just not be smart or intelligent. So that's what it will be. This is the end of our formal presentation for you and to you.