IHH (4Q2019) - 02mar2020
IHH (4Q2019) - 02mar2020
IHH (4Q2019) - 02mar2020
IHH Healthcare
WHAT’S NEW
FY19 results impacted by impairment loss and reversal of 4Q19 revenue and EBITDA increased +21% y-o-y and 25% y-
deferred tax assets. o-y respectively; constant currency (ex-MFRS 16) revenue and
EBITDA rose +22% y-o-y and 13% y-o-y respectively.
IHH FY19 recorded headline net profit of RM552m (vs
RM628m in FY18). This was below our estimates, mainly due 4Q19 EBITDA margins (ex-PLife REIT) improved by 1.3p.p q-o-
to impairment loss of RM200m on Global Hospital, India q to 22.9% (vs 21.6% in 3Q19). EBITDA margins (ex-MFRS
recognised in 4Q19 and RM67.2m reversal of deferred tax 16) fell by 1.6p.p q-o-q to 20% from 21.5% in FY19. EBITDA
assets. The higher net profit was largely due to; i) lower margins (ex-new hospitals; ex- PLife REIT) improved q-o-q to
foreign exchange (forex) translation losses partly from TRY 29% (vs 26% in 3Q19 and 26% in 4Q18). The improved
that stabilised in 9M19 from a sharp depreciation in 3Q18, ii) EBITDA margins were mainly led by Singapore and Turkey.
partly from forex translation gains following the successful
restructuring of non-TRY debt to only c.US$250m, iii) offset by IHH declared higher FY19 final dividend of 4Scts (vs 3Scts in
higher interest expenses (estimated to have more than FY18).
doubled) from higher borrowings to acquire Fortis Healthcare.
Key operational highlights
Excluding exceptional items, core profits fell -10% y-o-y to
RM921m mainly due to; i) higher net interest expenses, ii) • Gleneagles HK occupancy dipped to 50% (vs 58% in
higher depreciation (+18% y-o-y ex-Malaysian Financial 3Q19) with impact from HK demonstrations.
Reporting Standard 16 (MFRS16), iii) Fortis’ tax expense • 3 key markets continue to deliver growth.
increased by RM67.2m mainly due to reversal of deferred tax • Gleneagles Chengdu obtained Yibao approvals;
assets in YTD19, iv) forex losses and fair value exchange losses Gleneagles Shanghai opening likely to be delayed due to
on forward exchange contracts compared to gains recognised COVID-19.
in FY18. These were partially mitigated by one-off items • New 3-prong strategy from new CEO – i) cluster strategy
including reversal of RM21.8m accrued interest on prior years’ in metro areas, ii) review of portfolio of assets including
tax payable and RM28.5m of trustee management fee income divestments and a focus to improve capital returns, iii)
from disposal of RHT asset. cost savings.
FY19 revenue rose +29% y-o-y to RM15b with growth mainly Gleneagles HK EBITDA losses widened on additional staff
from Fortis. Excluding Fortis, revenue increased +6% y-o-y ramp-up; occupancy fell to 50%; COVID-19 and HK
from all key markets; Singapore (+10% y-o-y), Malaysia demonstration led to delays in non-essential procedures.
(+15% y-o-y), North Asia (+21% y-o-y largely from Gleneagles Gleneagles HK EBITDA losses increased q-o-q to RM49.4m (vs
HK), and Turkey (+2% y-o-y). On constant currency basis, RM39.4m in 3Q19) and RM34.5m in 2Q19 (RM39.4m in
FY19 revenue jumped +34% y-o-y. 4Q18) mainly due to additional staff to ramp up its clinical
services. Occupancy fell to 50% on 150 operational beds vs
FY19 EBITDA rose +34% y-o-y to RM3.3bn, in line with our 58% in 3Q19 and above 60% previously (62% in 2Q19 and
and consensus estimates, mainly on good underlying 68% in 1Q19). HK demonstrations and the COVID-19
operational performance, contributions from Fortis and impact outbreak have partly impacted non-urgent and non-essential
of MFRS 16 adjustments. EBITDA growth was largely from procedures and services.
Singapore (+29% y-o-y), Malaysia (+17% y-o-y), Turkey
(+38% y-o-y) and reduced losses from Gleneagles HK (-12% Singapore – continues to deliver good growth. In 4Q19 and
y-o-y), partially offset by start-up losses from Gleneagles FY19, revenue from IHH’s Singapore operations grew 8% and
Chengdu, estimated at c.RM42.5m. On constant currency 10% y-o-y respectively. Both APRIA and inpatient volumes
basis and ex-MFRS16 impact, EBITDA rose +23% y-o-y. continued to grow moderately at 4.3% y-o-y and 1.6% y-o-y
in 4Q19. On a constant currency basis, revenue and EBITDA
IHH’s 4Q19 headline net profit fell to RM41m (vs RM509m in grew 8% y-o-y and 32% y-o-y respectively while EBITDA
4Q18) mainly from forex translation gains recorded in 4Q18 margins improved by 5.4p.p. q-o-q partly from the impact of
on TRY rebound and impairment loss of Global Hospital. Core MFRS-16. Foreign patients, comprising 25% of 4Q19
profits fell 15% y-o-y on higher financing costs (+12% y-o-y), Singapore revenue, was stable q-o-q (vs 26% in 2Q19 and
Fortis’ reversal of deferred tax assets and forex and fair value 23% in FY18).
forex losses (vs forex gains in 4Q19).
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Company Guide
IHH Healthcare
Malaysia – continues to see growth in Indonesian patients. Impact of COVID-19. Following the outbreak of COVID-19,
4Q19 and FY19 revenue from IHH’s Malaysia operations grew IHH’s management expects more delays in non-essential
12% and 15% y-o-y led by higher inpatient volumes (+3.2% procedures and slower foreign patient volume, especially from
y-o-y) and average revenue per inpatient admission (ARPIA) China. IHH is expecting COVID-19 to have a bigger impact on
(+7.7% y-o-y). Foreign patients from Indonesia continued to hospitals in Asia compared to Turkey. In addition, the
rise. EBITDA margins fell to 27.6% (vs 29.3% in 3Q19, 29.8% construction of Gleneagles Shanghai has been halted
in 3Q18). following COVID-19. The opening of Gleneagles Shanghai is
expected to be delayed until the situation in Shanghai
Acibadem – strong performance led by price adjustments and stabilises.
foreign patients; non-TRY debt stood at EUR226m as at
December 2019. On a constant currency basis, Acibadem’s New CEO, new strategy. IHH’s new chief executive officer
4Q19 and FY19 revenue grew 11% y-o-y and 17% y-o-y (CEO) shared his new 3-prong strategy; i) pursue
respectively while, EBITDA (ex-MFRS 16) grew 23% y-o-y and geographical clusters in metro areas to achieve greater
30% respectively. The strong growth was partially led by economies of scale; ii) review portfolio which includes
strong growth in ARPIA of 5.4% y-o-y in 4Q19 while inpatient divestments of under-performing assets outside of its focus
volume was flattish (+0.5%) (mainly due to lower local clusters to priorities returns, iii) leverage international scale to
patients at non-Istanbul hospitals). achieve global synergies and drive cost savings.
Post restructuring / refinancing, IHH’s management has Maintain BUY, TP of RM6.40. We maintain our BUY rating
successfully reduced its non-TRY debt to US$226m as at and TP of RM6.40. We trim our FY20F/21F estimates by 6% to
December 2019. This will substantially reduce its exposure to 10% to factor some COVID-19 impact and higher gestation
forex translation volatility. losses from Gleneagles HK.
India – Fortis’ EBITDA -28% q-o-q; existing India hospitals IHH currently trades at 17x FY20F enterprise value
EBITDA almost halved q-o-q. 4Q19 and FY19 revenue were (EV)/EBITDA, close to 1SD below its historical average. We
RM816m and RM3.3b (vs RM357m and RM851m in 4Q18 remain positive on IHH’s long-term growth plans, with a
and FY18 respectively) on maiden contribution from Fortis. pipeline of new hospitals in China and a potential escalation
Fortis’ EBITDA fell 28% q-o-q. India (ex-Fortis) has turned of expansion into India. We believe the ramp-up in Gleneagles
EBITDA positive since 3Q19 after 3 quarters of consecutive HK and better economic prospects in home countries such as
losses as it converts to a more multi-disciplinary focused Malaysia and Singapore could offset some of the start-up
hospital to reduce concentration risks on a single doctor. losses in China and lead IHH into its next phase of growth.
However, on a q-o-q basis, India (ex-Fortis) almost halved, IHH’s medium-term outlook is bright while it rides out its near-
albeit marginal. term headwinds and gestation period for the new hospitals. In
Latest update on the suo moto notice served by The Supreme addition, with a potential strong platform in India and another
Court to Fortis Healthcare - the next court hearing is on 16 in China, IHH now has exposure to the two largest economies
March. in Asia with the highest growth potential in the healthcare
sector. We believe this further elevates IHH’s long-term
China – Gleneagles Chengdu obtained approval for Yibao in potential.
December 2019. Gleneagles Chengdu which opened in
October 2019 is now operating with 30 beds and 25 doctors. The key catalysts are: i) Gleneagles HK to turn EBITDA
The hospital obtained approval for Yibao in December 2019 positive and shorter-than-expected gestation period from
and will continue to drive the ramp-up from various channels, other new hospitals, ii) better-than-expected organic
ie, corporates, insurance, yibao and private. performance, iii) turnaround in Turkey, iii) positive
developments in new markets such as India.
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Company Guide
IHH Healthcare
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Company Guide
IHH Healthcare
Critical Factors
Providing premium quality healthcare. IHH is a leading
international provider of premium healthcare services with a
global network of over 12,000 licensed beds in 73 hospitals
and medical centres. Its key markets include Singapore,
Malaysia, Turkey and India, which contribute 29%, 16%,
25% & 22% to group revenue respectively. In Singapore, it
operates four hospitals with a total of 942 licensed beds.
Singapore’s inpatient admissions have been steadily rising SGP avg patient rev (S$)
from 55k in FY12 to 79k in FY19.
Tapping into new markets such as China and India. Besides its
home markets, IHH is also building up presence for its next
stage of growth, especially in India and China. The group
finally opened Gleneagles HK in March 2017 and Gleneagles
Chengdu in October 2019. In India, it made three major
acquisitions in 2015: (i) 51%-stake in Continental Hospitals in
Hyderabad, India, (ii) Global Hospital, a 5- hospital chain with
1,100 beds for INR12,838m (RM819m); iii) Fortis Healthcare. Turkey admission
These developments have helped the group gain strategic
footholds in new markets that can provide strong growth
avenues in the future.
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Company Guide
IHH Healthcare
Appendix 1: A look at Company's listed history – what drives its share price
210.0
p eak 14% Share price re-rating
12% driven by EBITDA
F ed Taper
170.0 o f MYR = +37%
T antrum = -11%
8%
f ro m peak
150.0 Minimal drop in share
6%
130.0 G ro wth driv en by Mt E
No v ena Hospital = +38% 4% price on bad news (<
110.0 2% 11%)
90.0 0%
Mar-13
Mar-14
Mar-17
Mar-18
Mar-15
Mar-16
Jul-12
Jul-13
Jul-14
Jul-15
Jul-16
Jul-17
Jul-18
Nov-12
Nov-13
Nov-14
Nov-17
Nov-18
Nov-15
Nov-16
Index
EBITDA growth (%)
EBITDA growth (ex Novena) %
EBITDA growth (ex Novena & depreciation of MYR) %
230.0 A c quisition
A cquisition of o f Tokuda & So ld 6.07% of We see little or no
Sh an ghai
G lo bal Cit y Clinic A p ollo;
h o spital
210.0
f irst
Ho spital G leneagles HK correlation between
an n ounced J V with an d Acibadem share price performance
190.0 Sh an ghai Altunizade opened
Dr L im J V with and news on major
ret ired as Ho n gxin
Wo n land T aikang
Price Index
90.0
Apr-13
Apr-14
Apr-15
Apr-17
Apr-18
Apr-16
Jan-13
Jan-14
Jan-16
Jan-17
Jan-18
Jan-15
Jul-12
Oct-12
Jul-13
Oct-13
Jul-14
Jul-15
Oct-15
Jul-16
Oct-16
Oct-14
Jul-17
Jul-18
Oct-18
Oct-17
150.0
170.0 105.0 105.0
M arket Index
M arket Index
indexes.
150.0 100.0 130.0 100.0
Apr-14
Apr-15
Apr-17
Apr-13
Apr-14
Apr-15
Apr-17
Apr-16
Apr-16
Jul-12
Jul-13
Jul-14
Jul-13
Jul-14
Jan-13
Jan-14
Jan-15
Jul-15
Jul-16
Jan-17
Jul-12
Jan-13
Jan-14
Jan-15
Jul-15
Jul-16
Jan-17
Jan-16
Jan-16
Oct-12
Oct-13
Oct-14
Oct-15
Oct-16
Oct-12
Oct-13
Oct-14
Oct-15
Oct-16
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Company Guide
IHH Healthcare
Key Risks:
Economic slowdown. While healthcare is deemed as a
defensive sector, private healthcare will be impacted by a
slowdown in the economy. Elective procedures can be
deferred and patients may choose public hospitals as a lower-
cost alternative.
ROE (%)
Staff costs. Staff costs account for close to one-third of group
revenue. Supply shortages in doctors and/or skilled allied
healthcare workers could result in higher wages needed to
retain or attract talent.
Exchange rate risk. As the group reports its results in Forward PE band (x)
Malaysian Ringgit (RM), any depreciation of the Singapore
Dollar (S$) and TRY against the RM will negatively affect its
results.
Company Background
IHH Healthcare Berhad is a leading international provider of
premium healthcare services in Asia and Central & Eastern
Europe, the Middle East and North Africa. As at end-2019, it
operates over 12,000 licensed hospital beds in 73 hospitals,
and there are plans to add over 830 beds from 2 greenfield
hospitals currently under construction and expansion of 2 PB band (x)
hospitals.
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Company Guide
IHH Healthcare
Key Assumptions
FY Dec 2017A 2018A 2019A 2020F 2021F
SGP inpatients adm 74,878 74,878 74,878 74,878 74,878
SGP avg patient rev (S$) 3,382 3,585 3,800 4,028 4,269
Msia inpatient adm 208,932 221,170 233,407 245,645 257,883
Msia avg patient rev 2,200 2,354 2,519 2,695 2,884
Turkey adm
(RM$) 202,643 210,628 313,934 313,934 313,934
Segmental Breakdown
FY Dec 2017A 2018A 2019A 2020F 2021F
Revenues (RMm)
PPL-Total 6,903 7,450 10,745 10,785 11,429
Acibadem 3,854 3,676 3,765 4,249 4,623
IMU Health 250 258 259 323 348
Plife REIT 134 133 139 139 141
Others 2.13 3.64 4.07 4.07 4.07
Total 11,143 11,521 14,912 15,500 16,546
EBITDA (RMm)
Includes the acquisition
PPL-Total 1,349 1,518 2,267 2,191 2,389
Acibadem 618 617 854 871 948 of Fortis Healthcare
IMU Health 80.7 84.9 87.2 104 112
Plife REIT 283 322 188 305 311
Others (50.8) (64.4) (78.7) (81.8) (87.3)
Total 2,279 2,478 3,318 3,389 3,672
EBITDA Margins (%) Includes the acquisition
PPL-Total 19.5 20.4 21.1 20.3 20.9 of Fortis Healthcare
Acibadem 16.0 16.8 22.7 20.5 20.5
IMU Health 32.2 33.0 33.7 32.2 32.2
Plife REIT 210.9 241.6 135.0 220.0 220.0
Others (2,389.0) (1,769.6) (1,935.2) (2,011.3) (2,147.1)
Total 20.5 21.5 22.2 21.9 22.2
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Company Guide
IHH Healthcare
Growth
Revenue Gth (%) 11.4 15.1 0.1 3.9 1.3
EBITDA Gth (%) 6.0 10.5 1.8 5.6 (8.3)
Opg Profit Gth (%) 0.4 8.2 (3.7) 9.6 (35.2)
Net Profit Gth (Pre-ex) (%) (589.5) (82.4) 106.7 27.8 (82.8)
Margins
Gross Margins (%) 100.0 100.0 100.0 100.0 100.0
Opg Profit Margins (%) 13.7 12.9 12.4 13.1 8.4
Net Profit Margins (%) 16.1 2.5 5.1 6.2 1.1
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Company Guide
IHH Healthcare
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Company Guide
IHH Healthcare
DBS Bank recommendations are based on an Absolute Total Return* Rating system, defined as follows:
STRONG BUY (>20% total return over the next 3 months, with identifiable share price catalysts within this time frame)
BUY (>15% total return over the next 12 months for small caps, >10% for large caps)
HOLD (-10% to +15% total return over the next 12 months for small caps, -10% to +10% for large caps)
FULLY VALUED (negative total return, i.e., > -10% over the next 12 months)
SELL (negative total return of > -20% over the next 3 months, with identifiable share price catalysts within this time frame)
*Share price appreciation + dividends
Sources for all charts and tables are DBS Bank unless otherwise specified.
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Company Guide
IHH Healthcare
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Company Guide
IHH Healthcare
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Company Guide
IHH Healthcare
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United States This report was prepared by DBS Bank Ltd. DBSVUSA did not participate in its preparation. The research analyst(s)
named on this report are not registered as research analysts with FINRA and are not associated persons of DBSVUSA.
The research analyst(s) are not subject to FINRA Rule 2241 restrictions on analyst compensation, communications with a
subject company, public appearances and trading securities held by a research analyst. This report is being distributed in
the United States by DBSVUSA, which accepts responsibility for its contents. This report may only be distributed to Major
U.S. Institutional Investors (as defined in SEC Rule 15a-6) and to such other institutional investors and qualified persons
as DBSVUSA may authorize. Any U.S. person receiving this report who wishes to effect transactions in any securities
referred to herein should contact DBSVUSA directly and not its affiliate.
Other In any other jurisdictions, except if otherwise restricted by laws or regulations, this report is intended only for qualified,
jurisdictions professional, institutional or sophisticated investors as defined in the laws and regulations of such jurisdictions.
Page 14
Company Guide
IHH Healthcare
THAILAND INDONESIA
DBS Vickers Securities (Thailand) Co Ltd PT DBS Vickers Sekuritas (Indonesia)
Contact: Chanpen Sirithanarattanakul Contact: Maynard Priajaya Arif
989 Siam Piwat Tower Building, DBS Bank Tower
9th, 14th-15th Floor Ciputra World 1, 32/F
Rama 1 Road, Pathumwan, Jl. Prof. Dr. Satrio Kav. 3-5
Bangkok Thailand 10330 Jakarta 12940, Indonesia
Tel. 66 2 857 7831 Tel: 62 21 3003 4900
Fax: 66 2 658 1269 Fax: 6221 3003 4943
e-mail: [email protected] e-mail: [email protected]
Company Regn. No 0105539127012
Securities and Exchange Commission, Thailand
Page 15