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Curtis J. Schroeder

Group Chief Executive Officer

Bumrungrad International

The Global PatientHealth Reform Conference

Kuwait

15 March, 2009

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Summary

Opened 1980

Largest private hospital facility in SE Asia

Over 1.2 million patients treated each year

100 Clinics and Hospitals in 7 Countries

Bangkok: Asia’s first JCI accredited hospital, in 2002

Over 1000 doctors and 800 nurses in Bangkok

International management

More international patients than any other hospital in the world: 430,000 from 190 countries in 2006

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Regional Presence Regional Presence

10 Locations

South Korea

2 Locations

Japan

34 Locations

Taiwan

10 Locations

Philippines

1

Bangkok, Thailand

14 Locations

Thailand

2

United Arab Emirates

4

3

Philippines

19 Locations

Singapore

5

6

7

7 Locations

Malaysia

8

Presence in 8 countries, with 99 clinic and hospital locations

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It’s Time for…

Medical Tourism

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Myth #1

My country is a magnet for tourists, therefore we are ripe for medical

tourism.

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Myth #2

Medical Travelers select their destination based on the quality of

beaches, hill resorts or safari options.

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Myth #3

Medical Travelers are mostly affluent and happy to occupy your private rooms

and fancy suites at full price.

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Myth #4

Medical Travelers are happy to be leaving their home country for

healthcare and are forever appreciative for your hospitality.

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Myth #5

Once the medical traveler has beaten a path to your door, they are yours

forever.

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are Pre 1997

1997-2001

2001-2006

Medical Travel

Transition

Medical tourism

• USA and Europe are centers of the healthcare universe

• Singapore the medical hub in Asia

• People travel for high end medical services

• Asian Economic Crisis• Price is now a factor• Emergence of alternatives to the

established players in Asia

• 911 & The Middle East Boom• Cosmetic surgery boom• Emergence of Thailand and India

as legitimate medical destinations

Evolution of Medical Tourism

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The Face of Medical Tourism

50+

Needs elective surgical service or specialty medicine

Unable to pay for or access healthcare in her home country

Looking for cheaper healthcare options

Willing to travel for significant savings

Selects doctors and hospitals that most resemble what she knows and trusts

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The Global Patient Provider

– One stop, multi-specialty

medical centers

– Internationally Accredited

– Immediate access to doctors

and medical services

– No technology or quality gap

– Competitive prices

– Service focus

– Capacity

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Hotspots of Medical Tourism

Source: Internal Deloitte Analysis

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Where are they coming from?Number of patients; percentage

Asia

Middle East

17

North America

Europe

Latin America

AfricaOceania

Note:The originating geography cut is based on 49,980 patientsSource:McKinsey & Company Provider interviews and data analysis

l

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Where are they Going?Percentage of patients

Source:McKinsey & Company Provider interviews and data analysis

EuropeEurope

OceaniaOceania

Middle Middle EastEast

Africa

North North AmericaAmerica

Latin Latin AmericaAmerica

87

1

26

27

4533

10

5

39

13

95

<1

>99

2

8

4

1

AsiaAsia

61

32

12

93

58

2

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The Middle East and Latin America represent 73% of patients seeking the most advanced technology

Specialty SoughtOriginating Geography

Number of patients; percentage

Latin

America38

Middle East

35

Europe

North

AmericaAsia 58

15

27

Other

Oncology

Cardiology

Specialty mix has significant spread, e.g.,

cardiology ranged ~0-50%;oncology ranged

~0-30%

Source :

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Drivers for Medical Tourism

Geo-Political Events

Lack of “Perceived Quality” & Service

Lack of Access

Cost

Family Microeconomics

– Non-insured Services (e.g. Cosmetics)

– Out-of-Pocket Healthcare Expenses Rising

– Burden shifting to the “Individual”

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Enablers

Media

Web Accreditation

Tourism

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2007-• 1st world managed care model

is prohibitively expensive

• Medical outsourcing seen as a

cost containment solution

Global Patient

Evolution of Medical Tourism

Pre 1997

1997-2001

2001-2006

Medical Travel

Transition

Medical tourism

• USA and Europe are centers of the healthcare universe

• Singapore the medical hub in Asia

• People travel for high end - high cost medical treatment

• Price is now a factor• Emergence of alternatives to the established players• Shift from sellers market to buyers market

• Emergence of Thailand and India as legitimate medical destinations

• Arab exodus• Cosmetic surgery boom

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The New Drivers

Geo-Political Events

Lack Quality/Service

Lack of Access

Family Microeconomics– Individual Burden

Global Competitiveness – Corporate World

3rd Party Payor survival

Government Budgets & Capacity

Self – Outsourcing– The Individual

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Will They Really Go?

“39% will go overseas to save 50% or more”

Source: Deloitte

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The Globalization of Health Care: Can MedicalTourism Reduce Health Care Cost?

Will Governments Outsource?

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New Enablers - the Global Patient

More complex and structural

– Standardization of quality and credentialing

– Portable medical records

– Medical information exchange platforms

– Doctor referral networks

– Legal and liability protection

– New insurance products

– Packages

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What’s At Stake?

6 million Americans by 2010?

15 million by 2015?

Source: Deloitte

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What’s At Stake?

US $10 billion by 2010?

US $35 billion by 2015?

Source: Deloitte

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SWOT Analysis

Making a Business Case for Medical Travel to MENA

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Strengths

Strong tourism infrastructure

Strong Government Support

Friendly Tax environment

Access to Capital

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Weaknesses

Cost & Price

Access to qualified personnel

Capacity– Medical– Hospitality industry

Regional Image

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Opportunities

Reversing outmigration

Re-direction of government contracting/outsourcing

Positive shift of reimbursement systems

Africa/ME

Russia

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Policy decisions to invest in healthcare infrastructure can reduce medical traveler flows

Healthcare investment can reduce flows

Oman

Abu Dhabi

Investment Result

Oncology center established in 2004 with specific goal of filling domestic radiotherapy goal

Cardiac surgery team with significant international experience set up shop in the emirate

Government funded oncology medical travel decreased 92% from 2004 to 2005

Government funded cardiac medical travel decreased 55% from 2004 to 2006

Significant healthcare investments are taking place globally in many countries

Source :

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Threats

Intra-MENA competition

Value-based competitors – Asia– Eastern Europe

Regional Stability

Inflation– Medical– Hospitality/Support industries

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Final thoughts…

Healthcare is moving from a locally to a globally delivered service

Medical tourism and outsourcing are consumer driven initiatives

Core Drivers: Quality, Access and Affordability

Widespread adoption depends on developing networks and connectivity between the 4P’s – patients, payors, providers and physicians

The Middle East can emerge as a regional player if the “value equation” can be addressed

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A World of Care