REVENU REVENUE E GR GROWTH WTH CO CONST NSTAN ANT T RA RATE TES 19% total growth 11% actual growth 12,000 8% rate Total: 10.5bn difference Total: 9.5bn 771 10,000 Total: 8.8bn 572 5,001 611 4,637 8,000 3,913 R millions 6,000 4,695 4,000 4,244 4,244 2,000 - HY2011 HY2011 (HY2012 rate) HY2012 Southern Africa Switzerland UAE Mediclinic International Ltd Interim Results | 30 September 2011 25
EBITD EBITDA A AN ANAL ALYSIS SIS EBITDA HY2012 (Rm) EBITDA HY2011 (Rm) 120 90 6% 5% 989 Southern Africa 910 45% Switzerland 49% 866 UAE 1,070 46% 49% Total: R2.2 billion Total: R1.9 billion Mediclinic International Ltd Interim Results | 30 September 2011 26
EBITD EBITDA A GR GROWTH WTH CO CONST NSTAN ANT T RA RATE TES 17% total growth 3,000 8% actual growth 8% rate difference Total: 2.2bn Total: 2.0bn 120 2,000 Total: 1.9bn 86 1,070 90 R millions 1,027 866 1,000 989 910 910 - HY2011 HY2011 (HY2012 rate) HY2012 Southern Africa Switzerland UAE Mediclinic International Ltd Interim Results | 30 September 2011 27
DEBT DEBT AN AND D FIN FINAN ANCE COST CE COST Finance Cost HY2012 (Rm) Debt at 30 Sep 2011 (Rm) 14 512 3,744 2% 2% 186 14% 23% Southern Africa Switzerland UAE 21,837 610 84% 75% Total: R26.1 billion Total: R0.8 billion Mediclinic International Ltd Interim Results | 30 September 2011 28
HEADLINE HEADLINE EARNINGS EARNINGS CONTRIB CONTRIBUTI UTION ON Headline Earnings HY2011 (Rm) Headline Earnings HY2012 (Rm) 18 31 -10 36 4% 7% -2% 9% 69 14% Southern Africa Switzerland UAE Corporate 394 353 81% 87% Total: R484 million Total: R407 million Mediclinic International Ltd Interim Results | 30 September 2011 29
HEAD HEADLINE LINE EARN EARNIN INGS GS Description HY2012 HY2011 % change Headline earnings (R million) 484 407 19% Weighted ave. no. of shares in issue (m) 627 580 8% Headline earnings per share (cents) 77.2 70.2 10% HEPS Bridge: HY2011 - HY2012 100.0 (1.7) 2.2 5.7 (5.8) 75.0 6.6 77.2 70.2 50.0 25.0 0.0 HY2011 MCSA Hirslanden EHHL Corporate Rights HY2012 contribution contribution contribution offer Mediclinic International Ltd Interim Results | 30 September 2011 30
GROWTH GR WTH SINCE Y SINCE YEAR EAR-END END Southern Emirates Total Africa Hirslanden Healthcare Capacity at 31 March 2011 7,103 1,457 336 8,896 Stellenbosch 10 10 Paarl 2 2 Klinik Beau-Site 14 14 Capacity at 30 September 2011 7,115 1,471 336 8,922 Capacity grew by 26 beds over the past six months Klinik Beau-Site Mediclinic Stellenbosch Mediclinic Paarl Mediclinic International Ltd Interim Results | 30 September 2011 31
CU CURR RRENT ENT DEBT STR DEBT STRUC UCTURE TURE 30 September 2011 Local Currency ZAR Asset (millions) (millions) Maturity Effective Interest MEDICLINIC SOUTHERN AFRICA Dec 2011 (50%) - Dec 2013 (50%) (a) 11.0% - 11.1% (1) Propco Debt 2,770 2,770 Mar 2015 (a) Opco Debt 510 510 9.3% - 11.4% Apr 2014 (b) Capex Facility 146 146 JIBAR + 1.4% Other (3) 245 245 2011 - 2023 - Overdraft 73 73 - - Total Mediclinic SA ZAR 3,744 3,744 HIRSLANDEN Barcap Facility (3) Oct 2014 (c) 5.62% (1) 2,433 21,800 Secured Bank Loans 4 37 2013 - 2016 1.9% - 2.7% Intergroup Loan (4) 21 188 2015 2.5% Total Hirslanden CHF 2,458 22,025 EMIRATES HEALTHCARE 2015 - 2020 (b) Variable (2) Secured Bank Loans 233 512 Total Emirates Healthcare AED 233 512 Elimination of intergroup debt -188 TOTAL DEBT 26,093 Note: Majority of the Mediclinic Southern Africa loans are held by Standard Bank. EHHL loans are held by UNB and Standard Chartered. (a) Bullet loan. (1) Effective interest rate taking swaps into account. (b) Amortizing loan. (2) Linked to EIBOR. (c) c.98% bullet payment in October 2014. (3) Includes Capitalised Financing Expenses. (4) Between Hirslanden and Treasury Mediclinic International Ltd Interim Results | 30 September 2011 32
ST STRONG ONG FIN FINANC ANCIAL IAL POS POSITION ITION AND AN D EF EFFICIENT FICIENT CA CAPIT PITAL S AL STR TRUC UCTURE TURE • An efficient capital structure is important to Mediclinic • Property backed businesses able to sustain higher levels of debt • Swiss and UAE debt is matched to assets in the same currency • Swiss and UAE debt is without recourse to Southern African operations • Strong financial position • R1.4bn rights issue completed in August 2010, to finance Swiss growth opportunities • Unused overdraft facilities of R760m, provides sufficient headroom • South African facility of R1.4bn which was due in December 2011 has been successfully renewed for one year • Long term financing in place with a spread of facility maturities Mediclinic International Ltd Interim Results | 30 September 2011 33
STRONG ST ONG FIN FINANC ANCIAL IAL POS POSITION ITION AN AND D EF EFFICIENT FICIENT CA CAPIT PITAL S AL STR TRUC UCTURE TURE • R21.8bn Swiss facility committed until October 2014, fixed at an attractive interest rate and secured against assets of R30.5bn (CHF3.4bn) • An independent valuation was carried out recently and the valuation for Swiss properties has been confirmed at CHF3.4bn (versus CHF3.3bn in the last valuation) • The Group continuously reviews and assesses its capital structure • Range of options available to refinance facilities • Confident about refinancing the Hirslanden acquisition debt • Plan in place to take steps in a prudent fashion • Confidential ratings were obtained from S&P and Moody’s earlier this year • A number of discussions regarding options are underway • Current volatile market conditions have been taken into consideration for the timing on potential refinancing Mediclinic International Ltd Interim Results | 30 September 2011 34
CA CASH SH CO CONV NVERSION ERSION • The Group converted 88% of EBITDA into cash generated from operations, mainly affected by: • Non cash flow IAS19 pension fund adjustment at Hirslanden (R53m) (CHF6.4m) • Decrease in Swiss payables (R104m) (CHF12m) in respect of major building projects Mediclinic International Ltd Interim Results | 30 September 2011 35
REGION REGIONAL AL OVER VERVIEW VIEW
SOUT SOUTHERN HERN AFR AFRICA ICA MEDICLINIC MEDICLINIC SOUT SOUTHERN A HERN AFRICA FRICA
ES ESTABLISHE ABLISHED D LE LEADER ADER IN IN QU QUALITY CAR ALITY CARE At 30 September 2011 Hospitals 52 Beds 7 115 Admitting specialists 2 200 Employees (FTEs)* 16 200 * includes FTEs filled through staff agencies Mediclinic International Ltd Interim Results | 30 September 2011 38
INTE INTERIM RES RIM RESUL ULTS TS CO COMMENT MMENTAR ARY • 11% revenue growth driven by: • 3.2% increase in bed-days sold • 5.5% increase in average income per bed-day • 2.3% increase in other revenue • Strong cash flow: 96% of EBITDA converted into cash generated from operations Mediclinic International Ltd Interim Results | 30 September 2011 39
NHI UPD NHI UPDATE TE GREE GR EEN P N PAPER APER • Green Paper published 12 August 2011 (comments by 31 December) • Must be read in conjunction with other documents: • National Health Amendment Bill – creation of a quality regulator • Discussion Document on PHC re-engineering (November 2010) • Draft HR strategy document (August 2011) • Mediclinic and HASA submissions Mediclinic International Ltd Interim Results | 30 September 2011 40
NHI NHI UPD UPDATE TE CER CERTAIN AINTIE TIES S AN AND D UN UNCER CERTAIN AINTIE TIES Reasonable Lack of clarity clarity 1. Cost 1. Primary health implications care re-engineering 2. Source of 2. Quality financing regulator 3. Human 3. Insurance resources model 4. Benefit package 4. Purchaser/ provider split 5. Role of medical schemes 6. Governance and accountability 7. Provider payment and price determination 8. Freedom of choice Mediclinic International Ltd Interim Results | 30 September 2011 41
NHI NHI UPD UPDATE TE – GREE GREEN P N PAPE APER POSIT POSITIVES IVES AN AND D CO CONC NCERNS ERNS Positives • Pragmatic • Phased implementation plan • Iterative with pilots • Focus on primary care • Acknowledgement of quality issues in the public sector • Acknowledgement on HR shortage Concerns • Lack of clarity on important key aspects • Lack of alignment between implementation plans and HR Strategy Plan Mediclinic International Ltd Interim Results | 30 September 2011 42
MEDICAL MEDICAL SCHE SCHEME ME MARK MARKET ET CO CONSIST NSISTENT ENT GR GROWTH WTH IN IN BE BENEFICIA NEFICIARIES RIES 10.0% GEMS 8.3% 8.0% 6.0% 4.0% 3.6% 3.1% 2.6% 2.0% 2.0% 0.0% 2006 2007 2008 2009 2010 Average annual growth of 3.8% over the 5 year period Source of data: CMS Annual Reports Mediclinic International Ltd Interim Results | 30 September 2011 43
MEDICAL SCHE MEDICAL SCHEME ME MARK MARKET ET GR GROWTH WTH IN IN BE BENEFICIA NEFICIARIES B RIES BY Y PR PROVIN VINCE CE 30.0% 26.1% % Increase in beneficiaries 2006 - 2009 25.0% 20.7% 20.0% 15.0% 13.0% 12.9% 12.4% 12.4% 12.2% 11.9% 11.2% 10.0% 5.0% 0.0% Free State Western Cape Gauteng Mpumalanga Eastern Cape Northern Cape KwaZulu Natal North West Limpopo 379,930 1,294,986 2,909,955 553,501 690,619 168,711 1,233,940 440,911 379,429 Total = 8.1m Source of data: CMS Mediclinic International Ltd Interim Results | 30 September 2011 44
MEDICAL MEDICAL SCHE SCHEME ME MARK MARKET ET SIGN SIGNIFICA IFICANT NT IN INCR CREASE EASE I IN RES N RESER ERVES VES 35.0 Accumulated Reserves in Billions 30.9 30.0 27.9 27.0 24.1 25.0 21.8 20.9 20.0 18.7 13.8 15.0 39.1% 38.0% 37.9% 37.3% 36.6 9.6 10.0 32.9% Solvency 31.6% 29.3% 7.1 Ratio 5.3 5.0 22.9% 20.4% 20.2% - 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2010 Excess Reserves Using Risk Based Capital Approach: R15.2bn Source of data: CMS Annual Reports Mediclinic International Ltd Interim Results | 30 September 2011 45
MEDICAL MEDICAL SCHE SCHEME ME MARK MARKET ET CO CONSOLID NSOLIDATION TION – A H HIST ISTOR ORIC ICAL L L LON ONG G TERM M TREND ND Source: Prof. McLeod, IMSA Policy Brief 8 Mediclinic International Ltd Interim Results | 30 September 2011 46
MEDICAL MEDICAL SCHE SCHEME ME MARK MARKET ET CO CONSOLID NSOLIDATION TION – A N NECESSARY TREND ND Size of Risk Pools 2008 Sources: Prof. McLeod, IMSA Policy Brief 8; Managed Healthcare Business Models for Hospital Organisations, Millman and Robertson Mediclinic International Ltd Interim Results | 30 September 2011 47
MEDICAL MEDICAL SCHE SCHEME ME MARK MARKET ET CO CONSOLID NSOLIDATION TION – IN INCREASE IN IN C CON ONCENTRA NTRATIO ION 2,500 2,181 2,139 2,000 1,800 1,635 1,500 H H I 1,000 500 - 2003 2004 2005 2006 2007 2008 2009 2010 Private Hospital Concentration Administrator Concentration Concentrated Market Administrator Concentration with GEMS separate Source of data: CMS Annual Reports and HASA Mediclinic International Ltd Interim Results | 30 September 2011 48
CAP CAPACITY CITY GR GROWT WTH 8000 60 Acquisition phase 7000 50 6000 40 5000 Hospitals Development phase 4000 30 Beds 3000 20 2000 10 1000 0 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 H2012 Beds Hospitals Mediclinic International Ltd Interim Results | 30 September 2011 49
OPE OPERA RATION TIONAL AL PE PERFORMAN RFORMANCE CE Mediclinic International Ltd Interim Results | 30 September 2011 50
BED BED OCC OCCUP UPANC ANCY Y AN AND D DEVEL DEVELOPMENT OPMENT CAGR = 0.9% (HY2008 - HY2012) 9,000 80.0% 7,115 7,051 6,859 6,808 6,872 Bed occupancy rate 75.0% Number of beds 6,000 70.3% 69.4% 69.3% 69.2% 70.0% 67.2% 3,000 65.0% - 60.0% HY2011 HY2008 HY2009 HY2010 HY2012 Operational beds Additional capacity Bed occupancy rate • Licensed beds increased from 7103 at 30 March 2011 to 7115 • Bed occupancy level calculated on operational beds • Additional capacity (difference between licensed and operational beds) is for projects and expansions at hospitals • Average additional capacity is 8% of licensed beds Mediclinic International Ltd Interim Results | 30 September 2011 51
BUILDING UILDING PR PROJE OJECTS CTS CO COMPL MPLET ETED ED Mediclinic Stellenbosch • 10 additional beds Mediclinic Paarl Mediclinic Paarl • 2 beds and 1 theatre Mediclinic Cape Town • New consulting block Mediclinic Cape Town Mediclinic International Ltd Interim Results | 30 September 2011 52
BUILDING UILDING PR PROJE OJECTS CTS IN IN PR PROG OGRESS RESS – COMPL OMPLETE IN IN N NEXT 6 6 MON MONTHS HS Additional Hospital beds Mediclinic Kimberley (additional beds) 8 Mediclinic Kloof (additional beds) 32 Mediclinic Welkom (additional beds and upgrade) 36 Mediclinic Legae (additional beds and upgrade) 4 Mediclinic Potchefstroom (additional beds) 13 Mediclinic Highveld (additional beds) 27 Mediclinic Otjiwarongo (additional beds) 2 Total 122 Mediclinic Kloof Mediclinic International Ltd Interim Results | 30 September 2011 53
BUILDING UILDING PR PROJE OJECTS CTS IN IN PR PROG OGRESS RESS – COMPL OMPLETE DUR URIN ING G 20 2013 13 Additional Hospital beds Mediclinic Nelspruit (additional beds) 66 Mediclinic Limpopo (additional beds and upgrade) 60 Mediclinic Cottage (additional beds and upgrade) 14 Mediclinic Hoogland (consulting block and upgrade) - Mediclinic Louis Leipoldt (upgrade) - Total 140 Mediclinic Nelspruit Mediclinic Limpopo Mediclinic International Ltd Interim Results | 30 September 2011 54
BUILDING UILDING PR PROJE OJECTS CTS IN IN PR PROG OGRESS RESS – COMPL OMPLETE DUR URIN ING G 20 2013 13 Mediclinic Limpopo Mediclinic International Ltd Interim Results | 30 September 2011 55
BUILDING UILDING PR PROJE OJECTS CTS IN IN PR PROG OGRESS RESS – COMPL OMPLETE DUR URIN ING G 20 2013 13 Mediclinic Louis Leipoldt Mediclinic International Ltd Interim Results | 30 September 2011 56
BUILDING UILDING PR PROJE OJECTS CTS IN IN PR PROG OGRESS RESS – COMPL OMPLETE DUR URIN ING G 20 2014 14 Additional Hospital beds Mediclinic Pietermaritzburg (cardiology unit, 80 additional beds, consulting rooms and upgrade) Mediclinic Windhoek (additional beds and consulting 26 rooms) Total 106 Mediclinic Pietermaritzburg Mediclinic International Ltd Interim Results | 30 September 2011 57
BUILDING UILDING PR PROJE OJECTS CTS APPR APPROVED VED Additional Hospital beds Centurion Private Hospital (new development) 174 Mediclinic Stellenbosch (upgrade) - Mediclinic Milnerton (additional beds) 10 Total 184 Centurion Private Hospital Mediclinic International Ltd Interim Results | 30 September 2011 58
SWIT SWITZERLAND ZERLAND HIRSLANDEN HIRSLANDEN
HIRSLANDEN HIRSLANDEN TOD ODAY At 30 September 2011 Hospitals 14 Beds 1 471 Admitting specialists 1 350 Employed specialists 210 Employees 5 700 Mediclinic International Ltd Interim Results | 30 September 2011 60
HIRSLANDEN HIRSLANDEN ACH CHIEVEMENTS IEVEMENTS • Continuous growth : Steady development in all dimensions • Increase of inpatients by 6.4% to 37 800 • Increase of midnight census days by 4.6% to 184 000 • Increase of average income per bed day by 2.1% • Strengthened Leadership: New EXCO structure • Growing together: Realising convergence and synergies • Continuous investments: Expanding our capacities and capabilities Mediclinic International Ltd Interim Results | 30 September 2011 61
UND UNDERP ERPERF ERFORMA ORMANCE NCE WESTE WES TERN RN REGI REGION ON • Illness of 3 major doctors - back in second six months • Difficulty in recruiting new doctors due to list uncertainties – now resolved • Pre-opening expenses at Klinik Beau Site due to expansion project • Generally lower than expected frequencies experienced by insurance companies Mediclinic International Ltd Interim Results | 30 September 2011 62
CON CONTINUOUS TINUOUS GR GROWT WTH ST STEAD EADY Y DEVEL DEVELOPMENT OPMENT IN IN AL ALL DIM DIMENSION ENSIONS Half year Key figures Full year Inpatients Patient days (H+) 100,000 CAGR FY: 5.0% (HY 3.9%) CAGR FY: 4.8% (HY 3.3%) 500,000 80,000 400,000 60,000 300,000 40,000 200,000 20,000 100,000 0 0 2005 2006 2007 2008 2009 2010 2011 2012 2005 2006 2007 2008 2009 2010 2011 2012 EBITDA (MCHF) Revenue (MCHF) 1,400 300 CAGR FY: 8.6% (HY 7.3%) CAGR FY: 8.4% (HY 7.3%) 1,200 250 1,000 200 800 150 600 100 400 50 200 0 0 2005 2006 2007 2008 2009 2010 2011 2012 2005 2006 2007 2008 2009 2010 2011 2012 Mediclinic International Ltd Interim Results | 30 September 2011 63
CON CONTINUOUS TINUOUS GR GROWT WTH IN INPATIE TIENT NT SE SEASON ASONALITY ALITY 1 st versus 2 nd half year frequencies FY 2009 FY 2010 FY 2011 FY 2012 8,500 1Q 2Q 8,000 7,500 Inpatients 7,000 6,500 6,000 5,500 5,000 4,500 April May June July August September October November December January February March Mediclinic International Ltd Interim Results | 30 September 2011 64
ST STRENGTHE RENGTHENED NED LE LEADERSHIP ADERSHIP NEW NEW EX EXCO CO S STR TRUC UCTURE TURE BOARD CEO Dr. Ole Wiesinger EXCO COO COO COO CHO CFO Magnus Oetiker Andreas Kappeler WESTERN REGION CENTRAL REGION EASTERN REGION Adrian Dennler Nicolaus Fontana André Steiner Hirslanden Klinik Aarau Hirslanden Klinik Aarau Klinik Hirslanden ICT-Services Group Accounting NEW NEW Klinik Birshof Klinik Belair Human Resources Group Controlling Klinik Birshof NEW Klinik Beau-Site Klinik Stephanshorn Funder Relations Service Centre FIN Salem-Spital Klinik Am Rosenberg Clinical Services Business Unit CONTR NEW Clinique Cecil Klinik Im Park Admin. Functions Klinik Im Park Clinique Bois-Cerf Klinik St. Anna Klinik St. Anna Klinik Permanence AndreasKlinik Cham Zug AndreasKlinik Cham Zug Marketing Investments Real Estate + Movables Supply Chain NEW New Hospital Manager Management Mediclinic International Ltd Interim Results | 30 September 2011 65
GR GROWING WING TOGET OGETHER HER REALISING REALISING CON CONVER VERGENC GENCE E & S & SYN YNER ERGI GIES ES Central CFO CHO Organisation Central HR Shared Business Operations, Staff & Group Group Marketing & Service Unit Staffing & leadership Accounting Controlling Recruiting Centre Controlling Salary development Hospitals / Head Office Business Business Business Business Business Business Klinik Klinik Head Partner Partner Partner Partner Partner Partner Hirslanden Im Park Office Mediclinic International Ltd Interim Results | 30 September 2011 66
CON CONTINUOUS TINUOUS INVEST INVESTMENT MENTS EXP EXPAN ANDIN DING G OU OUR R CA CAPACITIES CITIES AN AND D CA CAPAB ABILITIE ILITIES CAPEX projects completed last half-year • Aarau : Renovation ward • Berne : New doctors building • Lucerne : Renovation of two departments • Movables: • Zurich : SPECT-CT, 3T MRI, MRI Symphony (upgrade) • Lucerne : MRI (outpatient centre main station) Mediclinic International Ltd Interim Results | 30 September 2011 67
LOOK OOKING ING FORWARD FORWARD CH CHALLE ALLENG NGES ES AND AND OPPOR OPPORTUNI TUNITIE TIES • Macroeconomic environment: Challenges for a small economy • Internal growth: On going investment in our future • External growth: Seizing the opportunities of beginning market consolidation • Regulatory environment: Being ready for new regulatory conditions 2012 Mediclinic International Ltd Interim Results | 30 September 2011 68
ECONOMIC ECONOMIC ENVIR ENVIRONMENT ONMENT CH CHALLE ALLENG NGES ES F FOR OR A A SMALL SMALL ECO ECONO NOMY MY • Economic outlook for Switzerland has deteriorated over past months • Main factors are unfavourable foreign trade conditions : • Slowing down of world economy • High valuation of the Swiss Franc – even after introduction of exchange rate floor to the Euro • Negative impact on exports and company investments • Effect on real economy is “painful but bearable ” (Credit Suisse) • Forecasts predict a temporarily drop in GDP growth over next quarters • For 2012 as whole the GDP forecasts have all been lowered but are still positive • Acute care market : • Empirically fewer elective treatments observable • Altogether low effect on acute care market expected Mediclinic International Ltd Interim Results | 30 September 2011 69
INTE INTERN RNAL AL GR GROWT WTH ON ONGO GOIN ING G IN INVEST VESTMENT MENT IN IN OUR OUR FUTURE FUTURE Major CAPEX Projects Mediclinic International Ltd Interim Results | 30 September 2011 70
BUILDING UILDING PR PROJE OJECTS CTS IN IN PR PROG OGRESS RESS Complete in next 6 months Additional Hospital beds Klinik Beau-Site (additional beds and upgrade) 9 Klinik Bois-Cerf (radiology department) - Total 9 Klinik Beau-Site Complete during 2013 Additional Hospital beds Klinik Bois-Cerf (radiotherapy department) - Total - Complete during 2014 Additional Hospital beds Klinik Bois-Cerf Klinik Hirslanden (additional beds and consulting 71 rooms) Total 71 Klinik Hirslanden Mediclinic International Ltd Interim Results | 30 September 2011 71
EXT EXTERN ERNAL AL GR GROWT WTH GR GRASP ASP OPPOR OPPORTUNI TUNITIE TIES S – WELL-CO WEL CONSIDERED NSIDERED The market consolidation has already begun … North-western part Eastern part Midland Central part Southern (Italian speaking) part Western part (mainly French speaking) Mediclinic International Ltd Interim Results | 30 September 2011 72
REGULA REGULATOR ORY Y ENVIR ENVIRONMENT ONMENT NEW NEW HO HOSP SPIT ITAL AL REGU REGULA LATION TION IN IN AB ABOU OUT T 50 50 D DAYS Regulatory Key topics Challenges changes Opportunities KVG Revision Cantonal service mandates (hospital listing status) Conflict of interests for cantons (multiple role) fair Hospital planning Equal footing of all treatment of private sector listed (!) hospitals Advantage for superior management expertise “Dual - fix“ financing system Economically viable tariffs (base rate, invest quota) including invest portion Hospital financing Private-sector financing Fee for service DRG readiness: (introduction of SwissDRG) documentation, coding, IT Market consolidation (expansion private sector) Defining requirements Minimum case numbers Highly specialised medicine Meeting requirements Structural requirements Mediclinic International Ltd Interim Results | 30 September 2011 73
REGULA REGULATOR ORY Y ENVIR ENVIRONMENT ONMENT ST STILL ILL VAR ARIO IOUS US UN UNCER CERTAIN AINTIE TIES AG AR BE BL LU SG SH VD ZG ZH List status (service mandates) Regulations for listed hospitals Base rate (tariffs) Highly Severe burns, organ transplantation, cochlea implants, proton specialised therapy, transplant of stem cells medicine Neurology, neurosurgery, neuro-radiology, stroke, and severe injuries Visceral surgery (esophageal resection, rectum resection, pancreas resection, major liver surgery and complex bariatric surgery) Status (progress) No results yet Finished Unfavourable Suboptimal Favourable Mediclinic International Ltd Interim Results | 30 September 2011 74
REGULA REGULATOR ORY Y ENVIR ENVIRONMENT ONMENT MEASURES MEASURES TAK AKEN EN BOARD EXCO Expert panel External LEGAL Corp. Legal / Hospital man. Public Affairs DRG task force Tariff Expert Hospital man. Corporate Task force Funder Relations Hospital man. Communications hospital financing • Internal monitoring and reporting • Formal consultations / complaints • Expert panel • Publications (position papers, etc.) • Central support (Head Office) • Activities in industry associations • Meeting with cantonal authorities • Lobbying • Internal / external communication • Scenario modelling Mediclinic International Ltd Interim Results | 30 September 2011 75
ST STRA RATE TEGIC GIC OUTL OUTLOOK OOK QU QUALITY ALITY LE LEAD ADERSHIP ERSHIP – TOM OMOR ORROW AS W AS WE AR E ARE E TOD ODAY • Active management of political environment • Preparation for new regulatory conditions • Expansion / renovation projects • Screening the market for targets • Supplementary business models • Striving for business excellence • Structural / organisational changes • Convergence & synergies Mediclinic International Ltd Interim Results | 30 September 2011 76
UNIT UNITED ED ARA ARAB B EMIRA EMIRATES TES EMIRA EMIRATES TES HEAL HEALTHCARE THCARE
LE LEADI ADING NG IN DUB IN DUBAI AI At 30 September 2011 Hospitals 2 Clinics 8 Beds: Hospitals 336 Beds: Clinics 10 Doctors (employed) 235 Doctors (self employed 161 with admission rights) Employees* 1 510 * Excluding doctors Mediclinic International Ltd Interim Results | 30 September 2011 78
GROU GR OUP P PE PERFOR RFORMAN MANCE CE • Strong growth in revenue & EBITDA across the group • The City Hospital continues to grow, they now occupy a further 30 beds and only have one floor vacant • Welcare Hospital - at capacity, efficiency drove performance • The three new clinics have been integrated and the second half of the year is expected to be stronger • Increased focus on Dubai Mall Medical Center, with 35 doctors, MRI, CT, Mammography, day ward, laboratory and Lasix Machine • Ibn Battuta continues to exceed all expectations • Other clinics are performing well Mediclinic International Ltd Interim Results | 30 September 2011 79
ECON ECONOM OMIC IC ENVIR ENVIRON ONMENT MENT • Unrest in other parts of the Middle East continues to have a positive effect on Dubai • Property sector still struggling, but stabilised • New competition, yet to open but on the horizon • Renewed focus on Dubai Healthcare City • Dubai Metro fully operational Mediclinic International Ltd Interim Results | 30 September 2011 80
ST STRA RATE TEGY GY GOIN GOING FORWAR G FORWARD • Bring The City Hospital to capacity – last 30 beds • Unified brand! • Centres of competence (Breast Centre, Gamma knife, Nuclear medicine etc) • Dubai Mall Medical Centre focus • Bring Ibn Battuta, Meadows & Arabian Ranches to capacity • EHHL office relocation • Preparation for tariff reformation • Proactive Growth Investigations • Abu Dhabi Mediclinic International Ltd Interim Results | 30 September 2011 81
TOTAL P AL PATIE TIENTS NTS SE SEEN EN ALL ALL UN UNITS ITS 600 CAGR: 19.1% 500 175 144 Total patients (000s) 400 CAGR: 17.9% 157 333 300 303 126 96 229 200 68 69 204 73 176 56 154 145 100 104 100 0 HY2008 FY2008 HY2009 FY2009 HY2010 FY2010 HY2011 FY2011 HY2012 Hospitals HY Clinics HY Hospitals FY Clinics FY Mediclinic International Ltd Interim Results | 30 September 2011 82
TOTAL A AL ADM DMISS ISSIO IONS NS HO HOSP SPIT ITALS ALS 25 CAGR: 24.1% 20 11 Admissions (000s) 15 9 CAGR: 25.3% 6 10 6 6 5 9 4 7 5 3 5 5 2 4 4 3 2 2 0 HY2011 FY2011 HY2008 FY2008 HY2009 FY2009 HY2010 FY2010 HY2012 Surgical HY Non-surgical HY Surgical FY Non-surgical FY Mediclinic International Ltd Interim Results | 30 September 2011 83
BED-DAYS BED HO HOSP SPIT ITALS ALS • Dubai (clinics & hospital southern side). 60.0 CAGR: 23.6% 49.2 50.0 Bed-days sold (000s) 40.0 40.0 CAGR: 23.6% 28.5 30.0 27.2 26.0 21.9 18.4 20.0 13.0 11.7 10.0 0.0 2008 2009 2010 2011 2012 Half year Full year Mediclinic International Ltd Interim Results | 30 September 2011 84
TOTAL B AL BIR IRTHS THS HO HOSP SPIT ITALS ALS • Dubai (clinics & hospital southern side). 3.5 CAGR: 37.4% 3.1 3.0 2.5 2.2 Births (000s) CAGR: 32.5% 2.0 1.7 1.5 1.5 1.3 1.2 1.0 1.0 0.7 0.6 0.5 0.0 2008 2009 2010 2011 2012 Half year Full year Mediclinic International Ltd Interim Results | 30 September 2011 85
GR GROUP OUP PR PROSP OSPECTS ECTS
PR PROSPE OSPECTS CTS • Uniquely positioned across three diverse global platforms • Stable and experienced management team • The Group is focusing on: • Establishment of a global hospital group • Consolidating its collective intellectual capital • Distinguishing itself through verifiable cost effective quality care • Significant resources continue to be invested across the platforms • Constant monitoring of regulatory environment • Optimistic about future prospects depending on the global economic outlook Mediclinic International Ltd Interim Results | 30 September 2011 87
GR GROWTH WTH ST STRA RATE TEGY GY CO COUN UNTR TRY Y AN AND D REGI REGION ONAL L AL LEVEL EVEL • Significant growth prospects in all operating platforms • Short term opportunities presented under the operational reviews • Constantly evaluate growth opportunities to expand global footprint Mediclinic International Ltd Interim Results | 30 September 2011 88
REBRANDING WHY DID WE CHANGE? • Previous brand was dated • Created more than 25 years ago • Not flexible enough to be exported cross culturally • Inherited fragmented brands through global acquisitions • Lack of differentiation • Similar visual language • Similar tone of voice • Development of the optimum brand architecture for current and future global positioning Mediclinic International Ltd Interim Results | 30 September 2011 89
IN INTO THE O THE ST STRENG RENGTH TH OF O OF OUR UR FUTURE FUTURE Mediclinic International Ltd Interim Results | 30 September 2011 90
IN INTO THE O THE ST STRENG RENGTH TH OF O OF OUR UR FUTURE FUTURE Mediclinic International Ltd Interim Results | 30 September 2011 91
THE WA THE WAY Y FORWA FORWARD RD Southern Africa • Internal and external launch • Look and feel of hospitals • Patient Journey Switzerland • Working towards launching in 2013/14 Dubai • Subject to the approval of all shareholders Mediclinic International Ltd Interim Results | 30 September 2011 92
QUES QUESTION TIONS
APPENDICES APPENDICES
MEDIC MEDICLINIC LINIC SOUTHERN SOUTHERN A AFRICA FRICA FIN FINAN ANCIA CIAL L RESUL RESULTS TS ZAR million HY2012 HY2011 % change Revenue 4,695 4,244 11% EBITDA 989 910 9% Depreciation 123 112 10% Operating profit 861 797 8% Net finance charges 166 174 -5% Tax 230 195 18% Non-controlling interests 76 73 4% Attributable income 394 356 11% EBITDA margin 21.1% 21.4% EBITDA interest cover 5.3x 4.7x ZAR million 30 Sep 11 31 Mar 11 % change Total interest-bearing debt 3,744 3,757 0% Total assets 6,338 6,200 2% Mediclinic International Ltd Interim Results | 30 September 2011 95
HI HIRSLAND RSLANDEN EN FIN FINAN ANCIA CIAL L RESUL RESULTS TS (CH (CHF) F) CHF million HY2012 HY2011 % change Revenue 606 562 8% EBITDA 129 124 4% Depreciation 33 29 14% Operating profit 97 95 2% Net finance charges 73 74 -1% Tax 15 16 -6% Attributable income 8 5 60% EBITDA margin 21.4% 22.1% EBITDA interest cover 1.6x 1.7x CHF million 30 Sep 11 31 Mar 11 % change Total interest-bearing debt 2,437 2,437 0% Total assets 4,558 4,602 -1% Mediclinic International Ltd Interim Results | 30 September 2011 96
HI HIRSLAND RSLANDEN EN FIN FINAN ANCIA CIAL L RESUL RESULTS TS (ZAR (ZAR) ZAR million HY2012 HY2011 % change Revenue 5,001 3,913 28% EBITDA 1,070 866 24% Depreciation 268 217 24% Operating profit 802 663 21% Net finance charges 605 558 8% Tax 128 92 39% Attributable income 69 36 91% Average exchange rate 8.25 6.96 Spot exchange rate 8.96 7.18 ZAR million 30 Sep 11 31 Mar 11 % change Total interest-bearing debt 21,837 18,083 21% Total assets 40,836 34,150 20% Mediclinic International Ltd Interim Results | 30 September 2011 97
EMIRA EMIRATE TES HEAL S HEALTHCA THCARE RE FIN FINAN ANCIA CIAL L RESUL RESULTS TS (AED (AED) AED million HY2012 HY2011 % change Revenue 406 301 35% EBITDA 63 45 40% Depreciation 24 18 33% Operating profit 40 27 47% Net finance charges 8 9 -11% Non-controlling interests 15 9 67% Attributable income 16 9 78% EBITDA margin 15.6% 14.7% EBITDA interest cover 7.6x 4.8x AED million 30 Sep 11 31 Mar 11 % change Total interest-bearing debt 233 221 5% Total assets 931 994 -6% Mediclinic International Ltd Interim Results | 30 September 2011 98
EMIRA EMIRATE TES HEAL S HEALTHCA THCARE RE FIN FINAN ANCIA CIAL L RESUL RESULTS TS (ZAR (ZAR) ZAR million HY2012 HY2011 % change Revenue 771 611 26% EBITDA 120 90 33% Depreciation 45 36 25% Operating profit 75 54 39% Net finance charges 14 18 -22% Non-controlling interests 30 18 67% Attributable income 31 18 72% Average exchange rate 1.90 2.03 Spot exchange rate 2.20 1.90 ZAR million 30 Sep 11 31 Mar 11 % change Total interest-bearing debt 512 408 25% Total assets 2,048 1,838 11% Mediclinic International Ltd Interim Results | 30 September 2011 99
MEDIC MEDICLINIC LINIC GR GROU OUP CO CONSOLID NSOLIDATE TED FIN FINAN ANCIA CIAL L RESUL RESULTS TS ZAR million HY2012 HY2011 % change Revenue 10,467 8,768 19% EBITDA 2,179 1,866 17% Operating profit 1,743 1,515 15% Net finance charges 766 709 8% Tax 357 305 17% Headline earnings 484 407 19% Headline earnings per share (cents) 77.2 70.2 10% Weighted ave. no. of shares in issue (m) 627 580 8% EBITDA margin 20.8% 21.3% Normalised debt / EBITDA 1 4.7x 5.6x Normalised EV / EBITDA 1 10.4x 10.6x EBITDA interest cover 2.6x 2.5x 1. Calculated using LTM EBITDA converted at the closing exchange rate. Also refer to notes on financial flexibility slide Mediclinic International Ltd Interim Results | 30 September 2011 100
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