A World of Care Curtis J. Schroeder Group Chief Executive Officer Bumrungrad International The Global Patient Health Reform Conference Kuwait 15 March, 2009

A World of Care 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

A World of Care 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 Locations Malaysia 8 Presence in 8 countries, with 99 clinic and hospital locations

A World of Care It’s Time for… Medical Tourism

A World of Care Myth #1 My country is a magnet for tourists, therefore we are ripe for medical tourism.

A World of Care Myth #2 Medical Travelers select their destination based on the quality of beaches, hill resorts or safari options.

A World of Care Myth #3 Medical Travelers are mostly affluent and happy to occupy your private rooms and fancy suites at full price.

A World of Care Myth #4 Medical Travelers are happy to be leaving their home country for healthcare and are forever appreciative for your hospitality.

A World of Care Myth #5 Once the medical traveler has beaten a path to your door, they are yours forever.

A World of Care Pre 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

A World of Care 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

A World of Care 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

A World of Care Hotspots of Medical Tourism Source: Internal Deloitte Analysis

A World of Care Where are they coming from? Number of patients; percentage Asia Middle East 17 North America Europe Latin America Africa Oceania Note:The originating geography cut is based on 49,980 patients Source:McKinsey & Company Provider interviews and data analysis l

A World of Care Where are they Going? Percentage of patients Source:McKinsey & Company Provider interviews and data analysis Europe Oceania Middle East Africa North America Latin America <1 > Asia

A World of Care The Middle East and Latin America represent 73% of patients seeking the most advanced technology Specialty SoughtOriginating Geography Number of patients; percentage Latin AmericaLatin AmericaLatin AmericaLatin America 38 Middle East 35 Europe North AmericaNorth AmericaNorth AmericaNorth America Asia Other Oncology Cardiology Specialty mix has significant spread, e.g., cardiology ranged ~0-50%; oncology ranged ~0-30% Source :

A World of Care 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 ”

A World of Care Enablers Media WebAccreditation Tourism

A World of Care

st world managed care model is prohibitively expensive Medical outsourcing seen as a cost containment solution Global Patient Evolution of Medical Tourism Pre 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

A World of Care The New Drivers  Geo-Political Events  Lack Quality/Service  Lack of Access  Family Microeconomics –Individual Burden  Global Competitiveness –Corporate World  3 rd Party Payor survival  Government Budgets & Capacity  Self – Outsourcing –The Individual

A World of Care Will They Really Go? “39% will go overseas to save 50% or more” Source: Deloitte

A World of Care The Globalization of Health Care: Can Medical Tourism Reduce Health Care Cost? Will Governments Outsource?

A World of Care 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

A World of Care What’s At Stake? 6 million Americans by 2010? 15 million by 2015? Source: Deloitte

A World of Care What’s At Stake? US $10 billion by 2010? US $35 billion by 2015? Source: Deloitte

A World of Care SWOT Analysis Making a Business Case for Medical Travel to MENA

A World of Care Strengths  Strong tourism infrastructure  Strong Government Support  Friendly Tax environment  Access to Capital

A World of Care Weaknesses  Cost & Price  Access to qualified personnel  Capacity –Medical –Hospitality industry  Regional Image

A World of Care Opportunities  Reversing outmigration  Re-direction of government contracting/outsourcing  Positive shift of reimbursement systems  Africa/ME  Russia

A World of Care Policy decisions to invest in healthcare infrastructure can reduce medical traveler flows Healthcare investment can reduce flows OmanAbu 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 :

A World of Care Threats  Intra-MENA competition  Value-based competitors –Asia –Eastern Europe  Regional Stability  Inflation –Medical –Hospitality/Support industries

A World of Care 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

A World of Care