Everybody has had time to review the analyst presentation that was posted a couple of days ago, and I'm aware that there are several who are dialing in from overseas as well, including from the United States. Thank you very much for taking out some time, especially late in the night to listen in. We'll jump straight in as usual with the questions. We've tried to structure them by topic, but there are additional questions coming in as well, so we will address them at the end of those topical questions. The first topic is on COVID-related questions. How many COVID PCR tests are done each day in the first quarter of 2022?
We have done about 267 tests in this quarter.
What was the occupancy rate of beds for COVID-related cases in 2022 Q1?
We saw in first quarter this year, the occupancy rate is slightly low. It's about 36% of the open beds.
What is the average COVID revenue per case during the quarter?
It's about THB 280,000 .
What is the revenue contribution of COVID-related services in the quarter to total revenue?
In terms of the overall of the COVID treatment, screening, and vaccine is about 5.6%.
What is management's view about non-COVID Thai and foreign patients revenue in the short term and the long term?
Before we address that question, let me make a comment in general for those of you that have a curiosity about our COVID business in general. If you look back over the last 24 months, COVID has never been a major part of our revenue or our inpatient admissions, principally because many COVID patients had sought other access hospitals and/or were in different step-down services. As time went on over the last, say 12 months, it's become even less and less of a piece of our business. What has more been a part of our COVID business has been vaccinations, as well as testing. You'll see the testing, I think even today, our PCR testing is about THB 1 million, something like that, per day, which is not a lot.
Nonetheless, the point to make is that it's never been a really big part of our business. As the investor community, speaking to you as the investor community, this is not a piece of our business that's a major focus point, from your perspective in terms of our utilization, really going back to day one of COVID, apart from the early days when there was a lot of intensive care patients in our hospital. When I say a lot, it might have been five or 10 patients at the very most. It's not, it's never been material, and it's even less so now. I'm sorry, Daniel, what was the question?
The question is, what is our view going forward for non-COVID Thai and foreign patient business in the short term and the long term?
Well, being who we are, which is an international medical tourism service provider in Asia, if you look at our performance from Q3 and Q4 of 2021, as well as our performance in Q1, you probably have noted by now that our revenue growth for the international business has continued to grow by an order of magnitude of 5%-10% per quarter. We'll talk about what those percentages are a little later in the Q&A. In general, we see rather strong demand as the country opens up and there's a relaxation of the entry requirements, Thailand Pass, quarantine, PCR testing. If we can read the tea leaves with the rest of you as we read the press, governmental press releases, COVID is becoming a thing of the past in Thailand.
The infection rate is down to less than 10,000 per day. The kind of variant that's out there today is much less severe. Death rate is way down across the world as well as it is in Thailand. Given that, and Thailand being such an appealing place for people to come and stay and visit, we are seeing in terms of pent-up demand, unprecedented demand to want to come to Thailand and want to come to Bumrungrad. We expect, from a positive standpoint, continued thresholding positive revenue growth throughout 2022.
I would only qualify that by saying that if there were some unknown COVID variant that no one knows anything about, that somehow is much more lethal than is out there today, we expect our business to continue to return to good positive growth. To give you an idea, in Q4, as I mentioned in my analyst presentation, we grew our revenue 33%. If you may recall, well, we climbed over that number in Q1 and also added an additional 5.7% in top line revenue growth. But more importantly, on that top line revenue growth, the international business turned out to be a much higher number than it was in Q4, and in particular, the Middle Eastern business, which was a much higher number than Q4, and it was pretty good in and of itself.
We are cautiously positive and cautiously optimistic about future quarters going forward in 2022.
What about the Thai business, Neil? What are your thoughts on that?
Go ahead, Daniel, you can pick this one up.
On the Thai business, as we talked about in the previous quarters, since the revenue intensity per case of international business is so much higher, just seeing an increase in international business, you will see then that the overall contribution of Thai business will start to decline just based on that main observation. That doesn't say that it doesn't mean to say that we aren't also interested in Thai business. We accept all business. Because the Thai business will grow probably at a slower rate than international business, given the lower revenue intensity, lower base of international business, you're gonna see that pick up mainly from that side.
There is an observation that perhaps with our discounting programs being tapered or being discontinued, that there may be an effect on Thai business, and we don't doubt that there could be an effect to that, a sort of purification of revenue that we target really. Because if you remember when we had COVID, we actually implemented programs to help drive volume to the hospital, not just targeting our own patients, but helping to drive traffic to support the company during a time where we didn't have much international business. As this goes forward, we will expect to see more targeted growth in our core segments and also in our target markets. On that, we fully expect to grow our market share, therefore maintain our market share as was compared with before COVID period.
Two other comments on the Thai business that would add to Daniel's comments. One is that please recall that we are a premium target market institution, such that when Thai people are sick and have complicated diseases, for any patient in the world, not just Thai people in Thailand, there's a certain level of pricing elasticity that people look at when they're sick. They wanna go to the best place with the best doctors for the best care. We are arguably the best in all of Southeast Asia, if not. As I've said this before to you, I've run healthcare businesses throughout the world. This is one of the best places you could come for healthcare.
As Thai people become ill, and unfortunately we all do somewhere in our lifespan, they will choose the best hospital, and they will come here just notwithstanding what the pricing sensitivity may or may not be or the discounting policy may or may not be. Having said that, if you look at Q1, our Thai business was down 6.7% against Q4. As I explained in the analyst presentation, for those of you that weren't able to listen to it as of yet, I recommend that you do because there's a lot of interesting information there for the benefit of the investor community. During Q4, it was the back end of a 12-month period of high promotions which expired on 12/31.
There was a lot of catch up, buy-in, and redeeming of these vouchers and coupons and such. When you compare Q4 to Q1, you're not gonna be able to match off 12 months of pent-up discounted vouchers versus one quarter of standard business. Plus Q1 had three fewer days. Think about February being three fewer days in the month affecting the quarter. The combination of those two things, when you normalize that out, the Thai business was pushed from quarter to quarter.
I would like to add more about Thai business. I think that's a very good reason that Kunling mentioned, if we compare between Q4 last year and Q1 this year. However, our strategy is we would like to attack into the premium market and also high intensity. When we look at our department revenue, we found that our Thai market having a very good growth, especially in the oncology and cardiology. That means it reflects our key strategy to focus into the high-intensity products.
Because of Kunling's point here, let me underscore something else. If you look at my first slide in the analyst presentation, I had four wavy lines that described and moved, for us, quite fortunately, from the southwest to the northeast in terms of their positive growth for the EBITDA and OPAT margin lines. We are almost at the margins pre-COVID in 2019, and we're not doing that only with international business. The Thai business is contributing to that margin catch-up pre-COVID. You wouldn't be able to do that solely on international business. Yes, the international business is a major contributor to that revenue intensity growth because patients who come internationally are really quite sick, have multiple illnesses and diseases.
Kunling's point is a very good one, and it goes back to my point of Thai patients who are coming here, and they're ill. They will come here and seek a premium target market institution for their care. The combination of these two things are what's taking us closer, ever closer to pre-COVID margins on EBITDA and OPAT.
Last but not least is the third-party payer segment. In the Thai business, we have a very good increase in revenue, especially in the insurance and also our key corporate company. That's our key message for Thai business.
People recognize now throughout Asia, if not throughout the world, that reputation is key, and brand equity and brand vitality is incredibly important to the consumer when they start making healthcare decisions. This is everywhere in the world, not just Thailand. Thanks to Kunling and her staff, and everyone here, the 4,000 people and our board, it isn't by error or happenstance that we've been voted for the second year in a row, the number one hospital in Thailand by Newsweek magazine, the smart hospital of the year, and one of the top 146 hospitals in the world. That goes a long way with people in their mind and their perception of where to go to seek healthcare. I haven't any doubt that when people see that, and we have promoted it 'cause we're proud of it.
I haven't any doubt that when people see that, they make decisions about seeking and choosing healthcare, among other reasons, for that reason alone. This talks about our institution, it talks about our patient experience, it talks about our doctors, and it talks about our 42 years, working hard to deliver high-quality healthcare here. That's a big part of it too. I'm absolutely convinced of it.
Moreover, we haven't talked about how we're also expanding our Bumrungrad Health Network. You know, we've added many more hospitals to the health network. We've expanded our partnership Center of Excellence, and we will continue to do that. We've also expanded our presence up country around Thailand, which we expect to refer then high revenue intensity core target patients to the hospital. All these things we continue to do, and we expect that to bear fruit in the future too. Onto AHQ, ASQ, and Hospitel. What is the total revenue from AHQ, ASQ Test and Go in the first quarter of 2022 compared to total revenue? I'll quickly answer that. It's approximately 14%.
Mind you, one would probably not take too much notice going forward about the revenue contribution of these programs, as the government has clearly stated that they intend to fully normalize international travel in the near term. Test and Go will potentially be abandoned, and that's a position that the government continues to maintain. Therefore, this is good news for us because free travel is a benefit of not only our hospitality peers but also the medical tourism sector too. Onto partnership Centers of Excellence, which we just talked about. Could you please update about the Center of Excellence's operations in 2021 and in the first quarter of 2022? And what is the target growth in 2022 for the year?
In first quarter this year, the net profit from the Center of Excellence about THB 0.4 million. THB 2.2 million baht actually increased from net loss from THB 1.8 million in first quarter last year. For the whole year, 2021 net loss from Center of Excellence was THB 1.6 million, or THB 4.9 million increase from net loss from THB 6.5 million in 2020. For the target net profit in year 2022 is about THB 15 million.
What is the revenue contribution from these partnership Centers of Excellence to total revenue in 2021 and also first quarter 2022?
Regarding the joint operation model, BIHP record the management fee and medical equipment lease from Center of Excellence. Revenue from Center of Excellence was about 0.03% of total net revenue, and in first quarter this year, compared to 0.04% in first quarter 2021 and for the whole year, 2021. The percent contribution is very low because the revenue of the hospital in this quarter is very high, came from other revenue. It's not for the Center of Excellence. That's why the percent contribution of Center of Excellence is very low. If take a look at the total, revenue sharing from this center is about THB 1.3 million. It's the same as level in fourth quarter last year.
How many partnership Centers of Excellence do you currently have, and how many do you plan to establish by the end of this year?
Currently, we have in total five centers in the three hospitals. Five centers in Nakornthon, Ekachai, and Princ, and Joint Center at Princ Hospital Suvarnabhumi, and also Cancer Center that we already announced in Pitsanuvej Hospital. This year we plan to open another four centers of excellence and VitalLife in our plan this year also.
The plan to open was delayed, of course, from COVID. We had expected to open additional Centers of Excellence earlier on, particularly last year, but that has been pushed back and now we believe we're going on track with the opening of the country and opening more partnership Centers of Excellence. Onto the financials in general, can you please elaborate when you say we've had cost savings of THB 58 million in the first quarter of 2022? What are these savings based on, and on which numbers are you using for that?
We have continued implementing many cost management programs. In this quarter, we can save mostly from the resolved inventory and supply management, plus the contract management that we have negotiated on the product price and service fee, and also did the new deals with multiple vendors.
In first quarter 2022, the gross margin remained flat on a quarter-over-quarter basis at 41.9%, despite substantial quarter-over-quarter revenue growth. Hence, is there an implied increase in cost of medical treatment, or was there other major factors behind the cost increase? For example, rising transportation costs, medical supply costs, et cetera.
When you compare QoQ cost margin in first quarter 2022 was 45.5%, remain the same as fourth quarter last year. The overall cost of hospital operation, which mostly of them are variable costs, increased in the same rate as revenue increased at 5.7%. Inside of the hospital operation cost, there are the combination of cost reduction, cost containment program that we have implemented, and also have a few medicine and medical team that its cost increased due to a few vendor could not hold their cost, seeing the cost inflation rise from the oil price increase.
Why did EBITDA margin in first quarter 2022 fall from fourth quarter 2021, despite the lower discount rate and much higher contribution from high revenue intensity foreign patients?
In terms of EBITDA margin in the first quarter this year, it is about 28.2%, slightly lower than the fourth quarter last year at 28.4%, so very small ka. In the first quarter 2022, we have less in terms of the number of days and slightly low in terms of the checkup revenue ka. But in terms of the overall cost, it's pretty close to what I already said in the previous question Ka. The margin is slightly less a little bit ka.
There was also another factor that we had a higher contribution of revenue from vaccinations. We've done a number of Moderna vaccinations during the quarter. These generally are lower margin than some of our higher revenue intensity services. This was not only simply because we wanted to support Thailand's recovery towards COVID with helping to administer Moderna vaccines for which we sell to the public in general and administer here on campus. Its revenue contribution was higher than in the previous quarter, and that generally had lower margins. There was some dilutive impact. If we took that out, the margins on EBITDA would have been higher than in the fourth quarter of 2021. On to the next question. How does the impact from Ramadan on revenues in April 2022?
How is the impact on Ramadan for last month any different from past Ramadan effects during the COVID and post-COVID period? Was there a percentage decline on Middle Eastern revenue in the previous quarter before Ramadan occurred?
As is our practice and policy, we don't comment on going forward performance where we're in the midst of a quarter. Ramadan obviously is part of the second quarter, and that quarter has not ended. We don't really comment on that. What I can say is that, this year, for Ramadan, what we've seen is a lesser impact of the normal effect of less Middle Eastern patients traveling to Thailand as the country has opened up. That's been a positive sign for us, and we understand from our sponsors and guarantors that, like everyone in the world, people are tired of being locked up and, in their country unable to travel, and Arabic people are no different.
We saw a bit of that pent-up demand even during Ramadan, which just ended. The end of April. Now we're in the celebratory ten-day period called Eid. Typically, Eid is a time of celebration post Ramadan, which lasts for 10 days. Then thereafter, Middle Eastern people will start to fully travel wherever they may choose. Early indications, as I said before, are there's a lot of pent-up demand to come to Thailand and to come to Bumrungrad. We're optimistic about that going forward in Q3, going forward.
Has the impact of the lower discount rate been fully factored in for the first quarter of 2022 results, or will there be some further impact in the subsequent quarter?
I would say that the effect of our discounting program was a 12-month-long program, if not longer, maybe 14 months, going back to 2020, end of 2020. That period of compression is being rolled out over the 12-month period being 2022. If you look at a trend line on Q1, you would see that from Q4 to Q1, the discount rate went down by about 4 points, as I recall, from 17 to 13. I think I'm pretty accurate on that number. My sense is that just trending, taking, if you will, the time value of money in reverse, I would expect that our discounting percentage will decline further. Our lowest number pre-COVID was 9.8%. But you have to factor in charges, et cetera, into that number, price increases, cost increases, et cetera.
In summary, I would expect that 13% in Q1 to decline as the quarters ensue throughout 2022.
The discount rate was lower by 3.9% versus the price hike of 3.2%. Can we say that the difference of 0.7% was due to higher revenue intensity?
Actually, in Q2, discount lower by 3.9%, pretty close to 4%, as you already mentioned. In terms of the price increase, about 0.9%, and intensity increased by 2.4%, while volume is slightly down by 2.4% due to the less number of days in first quarter 2022. Daniel, our net patient revenue after discount increased by 5.7% cap.
I agree with Khun. I think the short answer to that question is yes. Especially when you look at the increase in the international business quarter-over-quarter, and then you look deeper into the Middle Eastern business which grew in the quarter. Historically, since 1997, since we've been servicing this population, is a very highly intensive type of business. I agree with you, Khun . The answer clearly is yes, and will continue going forward.
Do you see lower Thai patient volume from lower discounts?
I wouldn't think so. It goes back to my earlier answer that both Kunling and I touched on earlier to the question. I wouldn't think so because of the reasons we mentioned. I won't repeat them again. It's a segmentation. It's a patient segmentation selection issue about coming to Bumrungrad as opposed to going to lower tier hospitals who you know we obviously consider our competitors, but clearly they're lower tier from a variety of different standpoints. I would say the answer to that is no.
How many percent of Chinese patient revenues were of total fly-in patient revenue? International, we categorize that as international business. Is there any plan to focus more on this market? Maybe I can answer that one. Chinese international revenue comprised approximately 2.1% of total revenue. It's slightly higher than the previous quarter. If you compare that year-on-year, it's down for obvious reasons. China is currently in a deep lockdown. Travel from China to other countries is severely restricted and also quite prohibitive, both on a quarantine factor but also on a cost factor. That meant that the Chinese patient revenue business side of things was not as high as in the previous year.
However, if China moves away from the COVID zero policy or strict lockdown, we do expect Chinese business to come back as Thailand is one of the key destinations for Chinese tourism. It's something that will be a catalyst in the future. We know that after two years, you know, things will change. All these things will start to normalize, and we do expect a return to business, even from China itself. What is the revenue contribution of Middle Eastern patients to total revenue in 2021 and first quarter 2022 versus first quarter 2021? It's approximately, for 2021, it was 12.5%. In the first quarter of 2022, it was 15.1%. That highlighted what Neil mentioned earlier about the growth of international business during the quarter. On a quarter-on-quarter basis, it was very strong indeed.
If you compare that with year-on-year, it was around 11.8% in the previous year's quarter.
If you're trying to correlate the 3 percentage point differences quarter-over-quarter, it's not a linear relationship. It's important to talk about this over and over again with respect to Bumrungrad. The reason is that the resource consumption, which is what we define as revenue intensity. Resource consumption for these patients is quite high on a per-patient day basis, which means revenues are higher on a per-patient day basis and/or on an encounter basis. The correlation in many of these patients relative to volume growth is geometric relative to revenue growth. That's a very important aspect to who we have been as an institution and how it affects our bottom line. We see that continuing to improve as it has improved over the last three quarters on a margin basis.
What is the contribution of Indochina patients to total revenue in 2021 and first quarter 2022 versus first quarter in 2021? Well, actually it was a similar picture and indeed Q-on-Q, it was significant growth. For the full year of 2021, it amounted to about 7.8% of total revenue. In first quarter of 2022, it was 14.8%, so a significant quarter-on-quarter increase when you compare that with fourth quarter 2021 numbers of 11.4%. Compare that with the first quarter of 2021, Indochina revenue was only around 6.1%. There was significant growth in the Indochina market, particularly from Myanmar, from Cambodia, and Bangladesh. What is the revenue contribution of the top ten international patients' nationalities as a percentage of total revenues in first quarter 2022?
The top ten first is Myanmar, amounting to about 6.3% of total revenues for Q1 2022, followed by Kuwait at 5.7%, Bangladesh at 4.5%, Qatar at 4%, Cambodia at 3.2%. Mongolia is mainly from our hospital business in Mongolia itself, so UB Songdo Hospital had a very good quarter as well and amounted to and contributed approximately 2.8% to total consolidated revenue. UAE was at 2.7%, Oman 1.7%. Oman has actually seen a recovery. If you've looked at us in the past, approximately three years ago, you would have seen that the Oman business decreased significantly due to changes to where the Omani patients went to visit. They mainly went to India for treatment.
Now that the oil business has started to come back, the gas prices are starting to get higher, there's a bit more revenue floating around, and there's some of that spending being reflected at Bumrungrad as well. United States and China follow then behind after Oman at 1.6% and 0.8% respectively.
If you look at, apart from percentages, which is part of the story, you may ask the next question, which is, what is the revenue magnitude of these top ten countries? I reviewed them with you in the analyst presentation, and if you're curious to know exactly the numbers, I refer you to the analyst presentation on our investor relations site. The big drivers of revenue in the quarter were Myanmar, Bangladesh, Cambodia, and Kuwait. They were the substantial revenue drivers for the quarter among the others that Daniel has mentioned.
What was the revenue contribution of fly-in patients, international patients, excluding expats in the first quarter of 2022? It was around 39.5% of the total revenue. If you compare that with the full year of last year, it was about 27.3%, so there's significant jump there. What are the estimated costs for heart, kidney, and corneal transplants in Bumrungrad?
I would like to say heart transplant because we just performed three cases. It depends on the patient condition severity and the complexity. We have around THB 5 million-THB 50 million in these three cases. For kidney transplant, costs are THB 1.2 million per case, which is quite competitive in the market. For corneal transplant, it's about THB half a million per one eye.
Moving on to RAKxa or our wellness sanatorium at Bang Krachao Island. Would you please update about RAKxa's operation in first quarter 2022, and how do you plan to grow the business in 2022?
In terms of the RAKxa, visits increased about 42% in this quarter compared to first quarter last year, and revenue grew by more than 100%. For the overall in first quarter 2022, revenue of RAKxa about THB 12.4 million, with the EBITDA about THB 0.8 million and EBITDA margin about 6.7%. The plan to grow the business for RAKxa, we will expand for the programs of integrative medicine that I mentioned about cancer survivorship programs or cancer wellness programs. More and more we will focus on, if in Thai market, we will focus on the membership. Actually, the strategy for RAKxa, our target market is international.
We will launch our package together with the accommodation, I mean, VitalLife package, which have a variety of package such as weight management, executive health checkup, stress relief, and post-operation treatment. We believe that we can attract more international market after the country open.
We have touted ever since we went into this new product business, December 2020. I believe that's when we first opened it. Am I right, Khun, December 2020 when we opened RAKxa?
Around November.
November. I don't get into typically individual numbers by entities. To give you an idea of the growth orientation of this business for us, in speaking to the percentages that Kunling just raised and Khun just raised. From Q1 2021, the volume for the quarter was 635 visits, and Q2 was 901. Total revenues doubled from THB 6 million - THB 12 million. EBITDA for the first time ever in this new business was positive for the quarter at THB 835 ,00 Versus THB 2.9 million loss in Q1 2021. Net profit was half of the loss that it was in Q1 2021. This, we've always felt once the country started opening back up, would be a superb business for us, and we're gonna open this medical.
The next expansion point is the medical village cancer, rehab, medical village extension and expansion to the RAKxa portfolio we have there. We expect that to grow as well. 'Cause everybody's talking about wellness, precision, prevention. It's a business for the future, and we are looking into ways we can expand this business beyond the Bang Krachao site into other sites in Thailand and beyond.
What is the nationality breakdown of the RAKxa members if we sell membership programs to patients and clients of ours? Can you please update us on this?
In terms of the nationality that we have right now is mostly Thai. The Thai is about 96% and non-Thai is about 4%. As we know that the country closed, RAKxa opened during the COVID situation. We target the market international, but we cannot let them fly in. But during this period, we still can get the Thai patient come to the RAKxa program. This is another opportunity that once the country open, we can draw a lot of international coming in, while we have the Thai support the profit as well.
I think non-Thai, most of the member are the expat patients, expat customers. I think right now, COVID made our Thai people change their lifestyle of travel. Right now they want to go to some place that can relax and also can take care of their health. That's why RAKxa is the new target of the, you know, the traveling place.
If you think about it, we had positive EBITDA with 95%-96% Thai patients only. When we did the budget for this startup, it was 50/50, is what we budgeted, Thai people and expats and international coming in. Because of COVID, we modified our entire business plan approach, targeting Thai people locally, high-end Thai people locally. Now as the country's opening up, we'll be targeting as well those international travelers. We do expect it to break even at the NOPAT line in some time in 2022, hopefully by the end of Q2. Although it made a profit at the EBITDA line in Q1 with only 4% international patients out of a total of 100. The indicators are very positive here for future growth, double-digit future growth going forward.
Also don't forget that mainly the Thai patients who are at RAKxa, the Thai guests, they usually have less longer stays, right, than the international guests that we're expecting because they have to travel from overseas into Thailand. They will spend a little longer, as is typically the case for international tourism versus domestic tourism. That should even add additional uplift on the RAKxa business as well when the international business returns.
As it relates to wellness, while we're talking about RAKxa being a new wellness entity for us, we haven't talked about VitalLife, our scientific wellness business in a while. I am going to highlight that in our Q2 analyst presentation and talk much more about VitalLife. But I will tell you that it has had a very strong performance even during COVID in 2021, and a very strong performance in Q1 2022. That business is, because of the attention by people being given to wellness, that business has done extremely well, and we'll talk a lot more about that in Q2. Very positive performance by VitalLife.
It has scalability and potential to grow beyond the two sites that we now have, and we're looking at the scalability potential in other sites in Thailand for that business orientation as well. Next question.
Can you please explain about the revenue or the profit share model for RAKxa? How does that work?
This one, we already mentioned about that the revenue that we record is about THB 12.2 million in this quarter. This is we record based on what we sold and what the patient come to use that. Once the patient use that, we record them as the revenue cap.
Maybe add a little bit explanation to that. We currently rent space for the VitalLife clinic at the RAKxa Bang Krachao Sanatorium. That is operated by M.K. Real Estate, our partner. The revenue generated by the clinic and some percentage of the room rates that are gathered from the packages that we sold contribute to the revenue contribution of RAKxa for us. We also do share some percentage of our revenue to our real estate partner, M.K. Real Estate, as well. There is a bit of cross-sharing between the two entities, just to give you that bit of color there.
Well-
Sorry.
In addition, it is very CapEx light investment for us. The only CapEx we spent there is the major movable equipment inside of VitalLife. The box, the building, was built by M.K. Real Estate Development Company, and as Daniel pointed out, we lease back that space, and we do a modest revenue share at the bottom.
The last question on RAKxa is when do you think it will break even? We just answered that, so we'll move on to the CapEx side of the questions. Can you please talk about the expected CapEx spend level this year and what will it be used for?
In terms of the overall total CapEx, including the Campus Master Plan, we plan to spend about THB 2.6 billion in 2022. This is combination of the normal CapEx that we spend for the whole year. As normal is about almost 500 million baht. The rest is the Campus Master Plan that we will plan to use it.
Let me give you a little bit more color than that, since you're asking about it. Of that number that Khun has talked about, approximately THB 1.6 billion thereabouts is going to be spent on a complete IPD and patient renovation of all of our patient floors. We've done one floor already that was completed here about a month ago and opened. We will be doing the entirety of the hospital, and when it's done, it'll essentially be a brand-new 580-bed hospital. That's a large piece of the number. We have two construction projects underway. We have a parking garage underway, which will be completed in Q4. We also have what's called a Bumrungrad Academy building, which is also under construction. That's not a great deal of money.
We're also going to be in 2022 starting the renovation of our BH small building. This is the building that housed VitalLife, which we moved to another building on campus, so we could completely renovate that building. Finally, the other piece of the number that Khun talked about was routine CapEx inside the hospital, which at any given year we spend somewhere around THB 500 million-THB 600 million on routine CapEx. The replacement of older equipment or the addition of new technology. It may be a little bit more than that in 2022 because we're looking at some rather advanced robotic technologies that we want to add into the institution.
The sum total of all of that that I just summarized for you is, as Khun said, THB 2.6 billion in total for the year, assuming we have no delays. If you want further detailed information about that, we're happy to provide it. The big number in our multi-year CapEx Campus Master Plan, of course, was our projected development of a new hospital on Phetchaburi. That's a familiar name to you for those who follow the company. We shelved that project because we didn't need the beds for a lot of different reasons, technological advancements, lower length of stay. It really wasn't necessary. We own the land free and clear.
It's a very, very valuable piece of land. We have projected a timeline at, I believe, 2023 for the start of that project as a slotted budgeted item. We'll make that decision as to whether or not we want to start that project in 2023 or not. When you add up all of those pieces, you will have the totality of our CapEx, both long term and short term. Moving on to general questions. Does management have any concern about competition from new rivals in the market? Of course, we do. We're always vigilant in paying attention to what's going on in the market, who's doing what, how they're doing it, how they're approaching it.
We four up here, as I said to you before, get paid to worry, especially we two, but that lady down there as well and him as well. We're constantly looking at what the competition is planning and doing. But we try not to be reactive to a situation. That's not good to do, to be reactive or overly reactive. We have a very, very rigorous detailed plan of how we want to grow the business based upon who we are, and we follow that plan very carefully. We take no competitor lightly. But we continue to prosecute who we are as an institution, which is a premium market target provider, targeting both Thais, expats, but as well, principally, our international business, and in particular, our Middle Eastern business, which pre-COVID was 25% of our total revenue.
I have every trust that we will get back to that number given what we're hearing and seeing and feeling from our sponsors and guarantors from the Middle East.
It would be good for you probably to be aware that it's not only about new rivals in the healthcare business, but also technology providers as well. We are competing on the digital space, not only for developing new technologies or platforms or software in order to better cater to our patients, but also to compete on resources. IT talent, for example, cloud talent, cloud engineering talent, all these things, IT security. These are things that are in high demand globally, especially in Thailand because of the lack of supply for high-quality talent in those areas.
Therefore, the competition is also there that we have to also manage in how we develop our hospital going forward and becoming a digital hospital offering personalized at the genomic level healthcare to our patients.
I think healthcare is still a business that have to drive through people. The talent people, talent doctors are our good assets. I think the challenge right now is how to engage the good doctor, the good staff to work into your hospital. That's why Bumrungrad try to, you know, like, promote and continue our branding in the global market. We are very proud and very honored. Many times we got the feedback and the comments and also the encouragement from many people that right now Bumrungrad is the representative of Thailand. It's not about private hospital. We try to keep focused on what we do and what we would like to achieve.
As Neil mentioned, the culture of the 42 years hospital is not easy to build the very strong foundation, the healthcare and the medical services that have very high quality and focus on the patient safety.
Will the rising inflation rate provide any negative impact to growth margins? And does the company have the ability to increase prices? Yes. Yes, inflation will have an impact globally. We see that in food prices, energy prices. We see that in medication costs to a certain extent. We've been very fortunate to have managed medical supply costs very and pharmaceutical costs very, very well. There is growing pressure from the bottom up from energy prices, from oil prices driving these costs. Can we increase prices to manage the inflationary impact of that? We believe we can because the cost of delivering what we are offering here is going up.
If we want to continue to offer the level of service and quality that we offer now, we would need to increase costs in order to maintain the level that people expect when they come here. Yes, we do expect that we can continue to increase prices to maintain to minimize the inflationary impact to margins. Having said that, there is other costs that would impact the performance of the hospital, which people may not be aware of, and that is globally the impact of inflation on international patients. Oil prices, as is probably very clear to you all, is a highly beneficial driver for the Middle Eastern business, oil and gas. That will be a boon to us on the demand side.
Food prices, however, would have possibly a negative impact, particularly in the Middle East, because the Middle East is a major importer of food from Ukraine, for example, but also globally. Nonetheless, these governments in the Middle East have the money to be able to afford the social welfare that they need to spend in order to maintain political stability in their countries. That could be a benefit to us as well, because healthcare is one of the major cost drivers for these Middle Eastern governments. To provide good quality health care is something that their citizens would expect. The continued caring for their citizens in a way that they have grown accustomed to is something that these governments cannot take their foot off the pedal that likely.
We have to be very, very careful not to fall into the trap of cutting corners in the way we deliver healthcare to our premium target market of clientele. They expect a level of service that is six-star, which is what Bumrungrad is. There's a level of price and sensitivity by this target market clientele that is willing to pay for six-star service. They don't want entities and organizations cutting corners just for the benefit of worrying about inflationary pressures. We won't fall into the trap of cutting the quality of what we do, cutting the quality of our outcomes. We will not do that. We'd rather recalibrate who we are, but stay true to our vision and our mission and work through this inflationary period.
It is projected to be not good in 2022, but it's also projected to be less so in 2023. That is in contrast to the pent-up demand that we see for the type of target market clientele that wants to come to Bumrungrad in 2022. I expect from our standpoint that while on the one hand, we will not sacrifice quality, technological quality, nursing care quality, physician quality, physician recruitment, we will not sacrifice that. We will continue to do how we've run our business in the past and appeal to the kind of clientele who want to come here, and frankly, can afford to come to Bumrungrad. Not everyone can, but there's a sufficient population of people that want to come here, and that's our target market. Next question.
The other questions are in a similar fashion to talking about the inflationary impact. There is a question in regard to how Russia and Ukraine war directly impacts, whether positive or negative, to our business. I can answer that. The direct impact is quite minimal. Ukrainian and Russian patients comprise a very, very small portion of our business. They're mainly expats living in Thailand, not really fly-in patients. Obviously, during the COVID period, a number of those expats have rotated out and moved back to their countries of origin. That forms a rather low base for us and doesn't impact us directly much.
It's more, as we mentioned previously, about the impact on inflation, on food prices, on stability in the Middle East, whether those governments can manage that in a proper way that we don't have a second Arab Spring or something like that would negatively impact Middle Eastern business going forward. Fortunately, on the Indochina business, Indochina countries such as Cambodia, Myanmar, typically quite self-sufficient, not only on food, but also in the case of Myanmar, they're a major gas producer as well. They have a buffer to the situation that they have currently around the world, and that is fortunate for them. We don't expect too much of an impact on that as well.
Other additional questions that have been rolling in, how many doses of Moderna vaccine has Bumrungrad ordered versus sold in total in 2021?
We order about 186,000 dose, and we already sold in the year 2021, almost half of that, ka.
What is the total value of the Moderna vaccine that BH ordered and sold in 2021?
In terms of the value, we order about THB 214 million, ka, in terms of the value of that we order, ka. We sold about THB 146 million, ka.
When will the unsold vaccines in 2022 expire?
In terms of the vaccine, we have many lots coming into Bumrungrad, ka. The big lot that we have, the last lot is expire in November 2022.
Are there any additional plans to generate synergies with Princ Hospital?
I think, the strategy for the network hospital, we still look at how to strengthen our referral business and also Center of Excellence. The Princ Hospital will be the same as other network hospital. As you can see that we opened Phitsanulok Horizon Center in Phitsanulok, and coming soon, we will have another cancer center in the Northeast, and it's one of the branch of network hospital in Princ.
What is your cost control plan and target in 2022?
In 2022, we actually continue implement the cost management for since 2020, 2021 and now in 2022. In this year, we still have some room focused on the inventory in term of the supply medicine and also the service card that we plan to do more new bidding to find a new vendor to support us. In term of the target of the cost saving is about THB 173 million in 2022.
How come the Moderna vaccine is impacting the hospital with lower margins? The price is THB 1,650, but the cost is about THB 1,100. So the margin is high at around 45%-46%. Also, there should not be much associated expenses relating to these services. Lastly, the COVID revenues, which includes vaccine, are only 5% of total revenue, so it should not move a needle. I can answer that part. Actually, the margins are lower, significantly lower than that. It's not just about the gross cost of the Moderna vaccine, but the ancillary costs associated with that. It includes the staffing, the space. It includes the overtime. It includes the marketing that we do as well. All these costs need to be factored in.
Overall, the margin is lower, and that has impacted the EBITDA margin for the quarter. If you compare it QoQ because of the higher number of vaccinations in the first quarter compared to the fourth quarter, you compare that with the overall medicine margin. It's also significantly lower than what we usually receive from medications.
On the Moderna vaccine program or any vaccine program, any institution doing this around the world is not doing it for profits, profit purposes. We were quite willing, as a matter of public service to Thai people and expat people, to lose money on the Moderna vaccination program. It was a public service thing that we did as an organization then and now. We're quite willing to provide a service to the Thai people, and that hasn't changed. Trust me, we weren't looking for the Moderna vaccine program to provide any bottom-line contribution, not then, not now, and not going forward. For us, it's a de minimis. Actually, it's less than a de minimis issue, really more about public service to Thai people.
Compared with the benefit of if we factor in the benefit of lower discounts, much higher revenue contribution from international business, which has high revenue intensity, and cost savings of THB 58 million during first quarter, shouldn't the margin vastly improve from the fourth quarter of 2021? We just explained that it was an impact due partly from the Moderna vaccine as well as some of the cost increases from medications that Khun mentioned earlier in the Q&A session.
I think you'll see the reduction in the percentages, as I mentioned earlier. You'll see the trend line going downward on the percentages from 17% to 13%. My projections are somewhere very low double digits before the end of the third quarter. I'd like to get high single digits, which is where we were, as I said earlier, in pre-COVID. It is my intent to get to that point because that's our normalized rate. As we move downward on the discount percentage, it'll have a corresponding effect on the bottom line, assuming all other things are equal. If inflation rears its ugly head in many different aspects of our cost side of our business, we'll have to manage that.
There are some things that we don't control, energy prices. When Oraphan and I were just talking about that since Q4, I think our electricity's gone up twice since Q4. You don't control that, and we can't turn off lights and generators and such just because electricity prices went up. There are some things that are in the short term and really in the long term are not controllable, but that's not everything. Food prices will go up. Energy prices will go up. We see room for rate increases within reason that are affordable. People expect some level of rate increases. You recall that we froze our rates for six months, and then beyond that, we had a very modest rate increase.
We'll look to balance that business going forward given inflationary pressures. That's the only wild card in 2022 that every business faces in Thailand, not just Bumrungrad, not just the healthcare sector. The only advantage the healthcare sector has is that it is a counter-cyclical defensive business. What do I mean by that? People get sick no matter what the inflation is, and people seek the best in healthcare when they're ill, and our hope is that they will choose Bumrungrad when they are ill. Next question.
There's also some offset, right? Because the Thai baht is quite a bit weaker now than the US dollar. There is some support there for the international patients flying in if we were to increase prices, just to keep that in mind.
We don't put ourselves in a position of Forex risk. Patients in large measure pay us in Thai baht. There's a few very few exceptions to that, from our Middle East sponsors going long back in time, but for the vast majority of patients, they pay us in Thai baht because we are here in Thailand, trading in Thai baht. We don't take a Forex risk which is important in this kind of a fiscal environment.
The next question is again in regards to the lower discount level, the lower COVID contribution, and we expect Thai revenue to continue to be lower sequentially. We've answered that earlier. We don't expect it. We do expect Thai business to continue to grow for a number of reasons we've stated earlier. How do we guide for 2022 for Thai revenue versus 2021? You know, maybe you would like to add something to it.
We don't guide. For those of you that don't know, we make projections for the coming quarter only on top line revenue growth. I have addressed the issue of guidance for each one of the previous quarters as I did for Q2. How do you guide for 33% revenue growth in Q4 against Q1, which jumped by 0.7%? Not driven by rate increases, I might add. I can only say that Q2, we're cautiously optimistic that it will continue to trend line growth upward. Q3 should be better yet because it's post-Ramadan, post-Eid celebration holiday. We are optimistic about 2022.
What that percentage is in revenue growth quarter-over-quarter, no one has a guess about that except my expectation is it'll be positive, and it'll be above wage inflation, which is running about 3%-4%, depending upon which industry you look at. Even wage inflation is rising, principally because of inflation in general rising. Because we're a defensive anti-cyclical industry, and because the country has opened up, and because we've got a lot of positive signs that international medical tourists want to come to Thailand now that the country is opening up and we're past COVID. I keep stressing that to my staff here. We need to look past COVID. We're past COVID.
It is not the intense problem that it was a year and a half ago. We're focusing our business and looking at how we service our business pre-COVID going forward. Next question.
Last question. How will you guide for international business versus pre-COVID? I'll add a little bit to that. We don't provide guidance. However, if you take a look at what's developing now, Test and Go going to be removed and then much more free international travel is going to come back. That's gonna be a big positive catalyst. Question is how do the airlines respond? What are the frequency of flights? What are the costs of air travel due to high fuel prices? That's something that we are not in control of, but given what we've seen in Europe and United States with people traveling, because people want to travel, there's a lot of pent-up demand of people wanting to travel.
We believe that there is good positive signs to expect a big return of international travel to Thailand and also some of that to Bumrungrad as well.
I'll answer that by saying look at the trend line differences between Q4 and Q1.
Yeah.
There's your answer.
With that concludes the live Q&A session for the first quarter of 2022, Bumrungrad Hospital Public Company Limited. I thank all the management who are present here to take time out of their valuable day to help answer questions. We will see you in August. We will be releasing our second quarter of 2022 financial statements on the 11th of August, so stay tuned then. If you have any further questions, please let IR or investor relations know. Thank you very much.