Welcome to the Fourth Quarter 2021 and Full Year 2021 Analyst Presentation. I'd like to begin first by announcing our latest proudest achievement in being recognized by Bangkok Post as the top-rated, most trusted healthcare providing brand in Thailand. It is yet again another series of achievements that recognizes our Dedication to High-quality Healthcare, Patient Safety, and Excellent Clinical Outcomes at Bumrungrad, for which we are synonymous around the globe with. Our latest agenda, we will begin first with, We recently signed an MoU with Carnegie Mellon University, King Mongkut Institute of Technology Ladkrabang , or CMKL. This is a Collaboration between the world-renowned Carnegie Mellon University based in the United States and the King Mongkut Institute of Technology Ladkrabang , for which it is well-known in Thailand in providing High-quality Education in the Technology or Technical Areas and Sciences.
The reason for this MoU is to support our growing need for talent in the areas of AI and data science to support many of the projects that we have described in the past. If you recall in the previous year, we talked in the first quarter about the hospital's goal of moving towards becoming a smart digitally rendering healthcare hub. In it, the provision of the digital twin to support healthcare on a virtual, on a precision or genomic level, and also to become more proactive in managing people's health and their risks to health, to diseases and other ailments. This MoU will allow us to access talent to support these key strategic initiatives for the long term. Moving on to the 2021 snippets, I'd like to highlight once again some of the key revenue drivers for the quarter, and there were many.
The first was The1 Card loyalty program for which we have now been in partnership for a while, and The1 Card has continued to expand our access to new patients, and drive new patient volumes to come to the hospital for healthcare. And it amounted approximately to nearly THB 1.3 billion in terms of direct accretive value to the organization. A growth of approximately 194% year-on-year. COVID-related revenue as a whole in 2021 was around THB 706 million, an increase of around 477% year-on-year. On Telemedicine & Home Care Revenue, something that we've talked about quite often, and many people ask, "How will that play out in the long term?" We saw an increase of 28% year-on-year growth amounting to nearly THB 450 million .
Telemedicine is clearly here to stay, and it will be part of one of our pillars in delivering Care to our Patients. It's significant to note, though, that while Telemedicine provides easy access to People and to Doctors, especially during COVID period, there has been somewhat of a decrease in demand as the country opened up, and that was something we daylighted to you when the country would open up and, people would prefer to come in person for healthcare to see their doctors physically to come to the hospital for treatment. Nonetheless, the trend is quite sustained, and we are continuing to invest and grow this side of the business, and we expect to see additional growth in the future.
On referrals from other hospitals, another key segment for us and another highlight for us in why we as an institution are one of the key healthcare providers for the country for High-quality Healthcare Services in the private sector. That segment grew 11% year-over-year and amounted to over THB 400 million. On online and Digital Products, this is something we have talked about in the past, and the volume of growth is quite significant. 88% year-over-year amounting to almost THB 370 million for the year directly. Indirectly, the effect of digital marketing, and MarTech departments have been significantly higher in helping to gain access to patients through the digital sphere and to also drive interest, drive content for our patients.
We talked in the past about discounting, about promotions, and why we as an institution had to incentivize our patients during the COVID period to come to the hospital. We provided a number of programs that aim to entice them to come to the hospital, and this was not something that was in isolation. Many other hospitals have done that too. In Bumrungrad, I would like to illustrate that the effect of that discount has been significant, both in terms of discounting the gross revenue generated by the hospital to the net revenue that we display on our financial statements. If you look at the fourth quarter, that amount was around 17.6%, which if you compare with the overall average for the two years prior to COVID affecting the country and the world, the average discount rate was around 9.5%.
We do expect that these discounts to room, costs to medicine, to Diagnostic Tests will decrease as these have expired at the end of the year, and we do expect this to start to normalize to more average levels. This uplift in net revenue, when one calculates, will be a significant contributor in the future for the hospital, and we are keen to see a more normalized rate of discounting, especially as we've seen a pickup in demand over the last several months. Now I'd like to hand over this presentation to Neil Sorrentino, our Chief Global Strategist, who can give you more color on the developments of the quarter. Thank you.
[Foreign language] Welcome to Bumrungrad Hospital Public Company Limited Q4 Analyst Presentation. Thank you for joining us this morning. While the quarter was marked by extensive and highly diversified revenue from many different sectors, the performance in the quarter beat even our internal expectations of what we thought it would be like even after the country opened up, which it did in Q4. It closed down a little bit at the end of the quarter, but nonetheless, it was a very strong quarter for Bumrungrad International. Let's talk about the pieces of it, and I'll go through it in the way of looking at essentially takeaways for the quarter and then getting into some detail for you to give you some color about what composed the performance for the quarter.p
The NOPAT for Q4, to give you an idea how strong the quarter was, the NOPAT for the quarter equaled 50% of the total NOPAT for the entire year of our company performance, which tells you really how robust our our challenge and our performance was in Q4. And a lot of it was driven by multiple business drivers, Middle East, Indochina, and I'll talk a little bit about which countries drove that growth. We also had quarter- over- quarter- over- quarter performance both from our Thai business and our Expat business, and I'll go into that in a bit of detail. In terms of the other takeaways for the quarter, we paid off the remaining amount of THB 2.5 billion of our long-term debt, approximately at 5% interest expense percentage, 4.97%.
The significance of that is that it will represent about THB 124 million in expense savings uplift on interest costs for 2022, and it's significant and it's material. But at the same time, as you see here on the takeaways slide, we still, after that buy-down and finishing off of the long-term debt payoff, we wound up at the end of January with THB 6.04 billion in free cash flow. Part of that was due to excellent trade receivables collections for the quarter. In large measure, in the Middle East, we asked our Middle Eastern sponsors and guarantors to please get caught up by year-end.
They like to do that because if you're not asking them to make these payments, especially the end of the fourth quarter, they run on a zero-based budget basis, and they typically would say, "Well, that was money that was in the prior year. Now you're asking us to pay receivables that were accounted for in the prior year in the next year." It's a little bit more difficult to collect those trade receivables. We knew that, and we were respectfully aggressive in collecting trade receivables, and we brought our AR days down by 20 days. It was material which drove the THB 6 billion of free cash flow after the long-term debt was paid off.
I'll talk about the guidance, later on in my presentation, and then I will talk about, the dividend payout that our board will be recommending to our shareholders of record on April 27th. Next slide, please. Here I put together for you a trend line of the revenue, EBITDA, and, NOPAT for the year, by quarter. You see the wavy lines going in a very positive direction to the northeastern direction, which is always good when you're looking at trend lines. You see quarter by quarter by quarter just what the revenue did, what the EBITDA did, and the net profit did. I'm not gonna read you the numbers because you have the presentation with you and in front of you. But what does it say?
It says in summary that each one of the following quarters after Q1 showed stronger and stronger growth. As I mentioned earlier, the diversification of the business drivers that are producing this revenue, EBITDA, and net profit were really very widely distributed throughout the quarter. I'll get into that in just a moment. I will mention before I swing past this slide that in the quarter Q4, we took a write-off on an investment we made in a Telemedicine company we bought an interest in of 30%, back in 2018, I believe it was, in the form of iDoctor, the name of the company. We did sell our interest in iDoctor.
It's at a level of about $170,000, the balance of which against the cost of the acquisition, which was about THB 80 million, the balance of which was THB 56 million. We took that write down in the quarter. If you look at the net profit line, the bottom line there on this slide, the brown line, you will see where I reflect for you out of operations what the net profit was, before we took that write down, and that number was THB 668 million of NOPAT. After the write down, it was THB 612 million. I'll talk a little bit about that in a moment as it reflected and affected the margins. Okay, next slide, please. Let's look at the business segments of the market.
Again, outstanding quarter-over-quarter growth, 33.8%. Well above your expectations, I'm sure, and honestly, above our expectations. It was just an outstanding quarter for us, and year-over-year change, almost similar percentage growth at 33.1%. Next slide. So on all international, and the biggest drivers here of all international were Middle East and Indochina. Our Indochina sleeve of countries, meaning Myanmar, Bangladesh, Cambodia, and some effect associated with the Expat business in this country, in China, in the United States. There's a number of USA Expats who work here. I'll address that in a little bit, how it affected the differences in Expat revenue from quarter to quarter, Q3 to Q4. Next slide. So let's look at the changes in the quarter as a percentage.
You see here Kuwait, Qatar, Myanmar, Cambodia, UAE. The percentages are very, very large quarter-over-quarter, but they really don't tell the entire story. Bangladesh was a very strong quarter for us. The U.S., I mentioned earlier, these are not necessarily U.S. citizens coming to Thailand. There were some, but a lot of this has to do with Expats here in Thailand or ex-Expats who are corporate executives that were delayed in coming to Thailand because the country was closed in Q3, but opened up in Q4, and then they started coming back. They're an important piece of our Expat business to us because they're well insured, they seek out the best care, they can afford the best care.
As Daniel has mentioned already, with the most trusted brand in all of Thailand, and we're humbled by what the Bangkok Post gave us as an award for that. They'll seek that kind of top-quality care, and we got a lot of USA Expats here. Oman was also a big percentage. Let me give you some numbers associated with the revenue growth changes, so you understand better what that dynamic really was. I'm gonna read you some countries now, to talk about the change in the revenue Q3 to Q4. The United Arab Emirates in Q3, our revenue was THB 16.7 million. In Q4, the UAE revenue was THB 73.2 million. Oman in Q3, the revenue was THB 7.7 million. In Q4, it was THB 55.8 million.
In Qatar, the revenue was THB 115 million in Q3. It was THB 134 million in Q4. Saudi Arabia was THB 6.1 million versus THB 10.3 million in Q4. On and on it goes, where the differences in all international was THB 333.5 million in Q3, and the uplift by the country opening up was THB 519.2 million. Now, those numbers are important, but what's even of greater importance is the level of illness and the drive associated with the revenue intensity of these kinds of patients.
This is our calling card. This is what we're noted for. I have been telling you quarter, through quarter, through quarter during this terrible period of COVID pandemic that we have seen a lot of pent up demand from these countries, people wanting to come to Thailand, people wanting to come to Bumrungrad. And we stayed connected to them, w e communicated with them. We told them what our services were, and we've tried as best as we could to bring them here, even under different circumstances, even under quarantine, even under lockdown. Well, Q4, when the country opened up, this is the result of that. I expect this kind of performance in terms of continuing flow of international patients coming to Bumrungrad to continue in 2022, insofar as the country remains open.
As long as Thailand remains open and is moving toward an endemic status, I expect this level of support to continue. We were gratified that patients still wanna come to Bumrungrad, make it their first choice, and couldn't wait to get here. Many of these patients were very ill. What was also true in the quarter, in terms of revenue intensity remained true historically, and that is that our international patients represent the revenue intensity differences of Thai and Expat patients of three to one, which is significant if you do the math associated with how many Thai and Expat patients you need to make up the revenue intensity of one international patient.
It's logical because these patients sometimes come many times without conditional care in their own country because they don't have these services there and come here and fly here, and they're quite sick, and they need pretty significant diversified medical or surgical intervention. Next slide, please. So I mentioned the Middle East. On its own, it changed with 55.7% for the quarter over Q3, and year- over- year was almost 60% differential. And go back. And it includes the countries, the Middle Eastern countries that are listed at the bottom of that slide that we're showing you. Next slide. Indochina was very strong at 187%.
I'm gonna give you the revenue changes just as I did for the Middle Eastern, but you can see the percentage growth 187% for the quarter-over-quarter, Q3 to Q4 to Q3, and 175%. Let me give you those numbers to give you the magnitude of where the contribution was coming from by revenue changes by country. Q3 in Myanmar, the revenue was THB 62.3 million. Q4 was THB 207.6 million in revenue from Myanmar alone. Bangladesh in Q3 was THB 5.8 million. In Q4, it was THB 79 million. Cambodia was THB 65.6 million in Q3. Q4, THB 129.3 million. On it goes down the list of the Indochina countries.
I'm giving you these numbers, so you get a real clear sense of, as I've mentioned through this presentation, the diversified impact on why Q4 drove 50% of the total NOPAT for the year of 2021. Next slide. The Q4 performance by the five top nationalities. There are the five countries by percentages, and I've mentioned them in giving you the actual revenue changes quarter-over-quarter. You can see it for yourself. Next slide. On the Thai business, moving to, if you will, the domestic side of the house, up in the top left-hand corner there, I've provided for you the changes quarter-over-quarter. We're proud of this as well, in providing our Thai customers, clients, and patients the services that they sought.
You can see from quarter- to- quarter to quarter, the growth in changes of that revenue, 37.4% versus Q1, meaning this is four against one. four against two was 22.6%. four against three was 16.6%. Strong support from our Thai patient population in Q4, and of course, year-over-year was almost up 20%. The effect of what Thais are seeking in the way of healthcare are not a lot different than what we see from our international patients, except it's more driven by routine medical care, routine surgical care, checkups, Ophthalmology, Pediatrics, OB GYN. These are the services that Thai people were taking advantage of in the quarter when the country opened up.
Expats is the next slide. Why the growth in Expats QoQ, Q3 versus Q4 was up 18% in our revenue. That was driven by one principal thing, and that's because in Q3, with the country shut down, there was a delay in corporate executives coming to Thailand, 'cause they couldn't get into the country. They work here, but employers were holding off on bringing these corporate executives in, delaying their contracts, employment agreements, or consulting agreements. They came in large measure in Q4, and there's the translation of that additional amount of corporate executives coming into the country with an 18% growth in revenue. Next slide. I presented this format to you before. It may be a bit confusing.
I'm gonna spend a little bit more time talking to you about it so you understand better 'cause a number of you have asked questions about AHQ, ASQ, and in the quarter, we had Test & Go. Let's start on the right-hand side. On the right-hand side, under AHQ, ASQ, and Test & Go, you'll see percentages in purple. Now, these circles represent the number of patients and/or encounters that have come to Bumrungrad, either through hospital quarantine, through ASQ, or through Test & Go. The percentages 69%, 27%, and 14% are the services that the same patients in each one of these categories said that after they went through this AHQ, ASQ process that the government required or the Test & Go process, they sought healthcare at Bumrungrad.
Let me take you to the upper top part of this slide, and you'll see the difference in the quarter, THB 289 million versus THB 513 million. You collect all of those percentages translated into revenue, and it equates to the differences between Q3 and Q4, dramatic, THB 289 million versus THB 513 million. What was it as a percentage of total revenue? That's the bottom portion, bottom left-hand portion of the slide, which shows you over the period, Q1 going back to Q1 2020 forward.
This is also a pleasing result for us 'cause it represented 13% of our consolidated revenue, which tells me one, we're being favorably selected by people coming into the country for care, and two, the conversion of care 'cause they don't have to come to Bumrungrad once they go through an AHQ or ASQ for that matter or Test & Go for that matter, but they do to the extent of the difference between THB 289 million versus THB 513 million. This is good confirmation for us of how we're treating our international patients as they come in, especially the third piece of it now, which is the Test & Go part of it, which Dr. Thassanawut would talked about earlier in his presentation or will talk about earlier in his presentation.
You will also hear some discussions for Q4 about our abilities as a quaternary care provider. For those of you that may not be familiar, there's primary, there's secondary, there's tertiary, and there's quaternary. Quaternary care is the most integrated complex care that a hospital can provide. We have moved in 2021 into a major quaternary care facility. We have always been to some degree. Now with our Heart Transplantation program and our Kidney Transplantation program and our Cornea Transplantation program, which will be discussed by others in this presentation for Q4, you'll get a better understanding of why we're spending so much time, money, and manpower in developing further who we are as an organization in Thailand. Next slide, please. Now we move to the EBITDA and the NOPAT for the quarter.
The numbers speak for themselves. I'm not gonna go through it. You can see that versus Q3, the EBITDA was up 70%, 93%, versus 2 71% Q1. It was just a remarkable quarter. Next slide. I put this together for you to give you a sense of trend lines like I did at the beginning of the presentation. I take you back to Q1 of 2020. For those of you that may recall, Q1 of 2020, there was one month out of the three months in the quarter that was truly affected by COVID. It was the beginning of COVID for Thailand.
Even in that quarter, Q1, two out of the three months were very strong months for us, especially from the Middle East. In that quarter, our EBITDA margin was 29.9%. I take you here through all of the quarters from Q1 2020 to our fourth quarter, and we almost touched the 29.9% number, which was the end of business as everyone knew it in the beginning of COVID, to where 4Q 2021, we were not far from the 29.9%, and we recorded 28.4% EBITDA margin.
When you look at the trend line as low as 12.9% in Q2 2020, it just tells you all you need to know about our performance over the period. Next slide. Net profit, it's really the same story. A triple-digit positive triple-digit change quarter-over-quarter. As I said to you earlier, Q4 was 50% of the total net operating profit after tax for the company for the year. This slide also shows you the difference between the sale of the iDoctor, sale and write-down of the iDoctor investment, both before and after. Next slide. I'm doing the net profit margin trend line for you to see the same pattern.
Only this pattern because of excellent cost control in the quarter, and it was excellent cost control in the quarter, notwithstanding excellent trade receivables reduction. But if you have a look here at the net profit margin for the quarterly trend line, you will see that in Q1 2021, the net profit margin was 3.4%. Now, mind you, these are percentages, net profit margin percentages, based upon a fairly high discounting that we're doing for domestic business. We will be moderating those discounts as time goes on, as will everyone else who is doing similar things because of supply and demand issues. Mind you, even with those 17%+ discounts, you can see here what the margin was in Q4, 15.6% reported after the write-down of THB 56 million for the iDoctor investment.
Before [inaudible] out of operations, it was 17%. Again, touching almost close to 1Q 2020 of 18.5%. We expect this trend line to improve as we go through 2022, to the extent that Thailand moves into an endemic status insofar as COVID-19 is concerned. Next slide. There were two items remaining that I wanted to draw your attention to insofar as my presentation were concerned. One is guidance, which I will address lastly. The other item had to do with dividend payouts. You may recall, I have covered with you the interim dividend payout that was approved by our board of directors, earlier in 2021.
On Wednesday evening past, our board made the decision, unanimous decision to recommend to our shareholders of record at our annual general meeting on April 27th, the recommendation to pay out 209% of 2021 EPS at THB 1.53. If you look at what that means in absolute total baht paid out, it will be identical in absolute total baht paid out to what was paid out in 2020 and 2021. Our board has been consistent, as has our shareholders. They've been consistent in wanting to reward our loyal shareholders, not only to the extent of historically giving 50% of actual EPS out, but in the last two years, 200%-300% of that year's EPS to reward our shareholders.
Fortunately, we've been able to manage our cash very well. We've been conservative about how we've dealt with cash. Our debt, as you know, is very low, now zero long-term debt. We will submit that as management and our board of directors to our shareholders at our 27 April AGM meeting, awaiting for their approval. Insofar as guidance is concerned, let me address that in somewhat of a bit of a different way for you. As you know, we don't give go-forward guidance except top-line revenue growth. The top-line revenue growth in Q4 was 33%.
We are not in a informed, calculated decisions to say we're going to beat 33% top-line revenue growth in Q1 2022 because it was such a huge number. Not only that, but the number was coming off of a weak Q3 because of the COVID lockdown. What I can say to you is that when we went through the 2022 budget exercise at the end of Q4 2021, we did come to certain conclusions as an organization about what the first half of the year would look like and what the second half of the year would look like.
We assumed that there would be gradual changes to the positive on volume, both internationally as well as domestically, trending upwards slowly, gradually, incrementally in the first two quarters of 2022, and then increasing in Q3 and in Q4, similar to what we saw in 2019. Those are the budget assumptions we put together that are driving our business plan, that are driving our CapEx budget, and they still look quite sound right now. We'll amend them and modify them on a rolling four quarters forecasting basis as we get results quarter- by- quarter. We'll continue to update you about where we are with that, but a lot of it is dependent upon what happens with COVID.
As you could see in the quarter, the strong support was there from our international business community to come to Bumrungrad. It's not a function of the question, "Well, will international business come back to Bumrungrad?" I think Q4 for you we were always confident it would be for us, but I think Q4 for you it's fairly clear that the support was incredibly strong. We expect that to continue. Once we get past Songkran, once we get past Ramadan, which this year happens to be April 1. Ramadan is 40 days, and then there's about a 10-day period of Eid, which is a celebration after Ramadan. Once we get past those, we're pushing toward the end of Q2. Not quite, but almost.
We are projecting and hopeful that what I've just told you will be in line with what our performance will track to. That's probably the best I can give you an insight into guidance at the moment. We're not about to say we're going to beat 33% revenue growth Q4 2021 versus revenue growth Q1 2022. That concludes my presentation for the Q4 Analyst Presentation. We will look forward and invite you to submit your questions during our live stream next week. We'll try and answer all of your questions as fully and as completely as possible. Thank you for joining us.
Thank you, Neil. We will move on to the Financial Highlights and dig into the details of our financial performance by Khun Oraphan. Khun Oraphan, please.
[Foreign language] Good morning, everyone. I'm Oraphan Buamuang, Chief Financial Officer. I'm pleased to report you all the financial highlight, and financial performance of first quarter 2021, and for the whole year 2021. Financial highlights. As the result of Thailand reopening in 1st of November 2021 by allowing fully vaccinated visitor from low-risk country to enter to Kingdom of Thailand without quarantine, together with the continued growth of Thai and Expat business. In first quarter 2021, financial performance were improved when compared to first quarter 2020, and third quarter of 2021. Comparing to first quarter 2020, total revenue increased by 33.1%.
EBITDA and net profit margin improved by 121.1% and 253.8% respectively with EBITDA and net profit margin at 28.4% and 15.6% respectively. In this quarter, we have an extraordinary item on loss from sale of investment in iDoctor, THB 56 million. When excluding extraordinary item, the Adjusted net profit was improved by 286.5%. For the whole year result, financial performance of year 2021 were also improved from year 2020. Total revenue slightly increased by 1.3%. EBITDA and net profit increased by 6.3% and 1% respectively, with EBITDA and net profit margin at 21.9% and 9.6% respectively.
For the net profit and diluted EPS, exclude extraordinary items, improved by 5.6%. I will walk you through more detail in the next slide. Financial performance. In first quarter 2021, total revenue increased by 33.1%, mainly came from Thai patients and non-Thai patients. Revenue increased by 19.7% and 50.2% respectively. For the whole year 2021, total revenue increased by 1.3%, mostly due to an increase in Thai patient revenue by 12.3%, offset with a decrease in revenue from non-Thai patients by 10.1%.
In first quarter 2021, due to a 50.2% increase in revenue from non-Thai patient, which higher than Thai patient revenue increase at 19.7%. As a result of revenue contribution from non-Thai patient was 50% increase from 44% in first quarter 2020. For the whole year 2021, due to 12.3% increase in revenue from Thai patient offset with 10.1% decrease in revenue from non-Thai patient. As a result, the revenue contribution from Thai patient was 54%, whereas revenue from non-Thai patient was 46% for the year 2021, compared with 48% and 52% respectively for year 2020. For revenue contribution by service.
In first quarter 2021, revenue contribution from Outpatient Service increased to 53% due to OPD revenue increased by 46.3%, while about IPD revenue increased by 25%. For the whole year 2021, revenue contribution from Outpatient Service increased to 49% from 48% in year 2020 due to OPD revenue increased by 5.7%, while IPD revenue increased by 3.2%. For revenue contribution by payer type, self-pay contribution increased from 61% to 66% in year 2021, mostly due to increase in Thai and Expat self-pay in year 2021. Insurance contribution remained proportion at 21% in both of year 2021 and year 2020.
The government third party contribution in year 2021 decreased from 15% to 11% due to restriction on travel during the year impacting Middle East business which are the major government sponsor. EBITDA in first quarter 2021 was THB 1,116 million, improved from same period last year by 112.21%. EBITDA for the year 2021 was THB 2,756 million, was above last year by 6.3%. The improvement mainly came from volume and revenue increase, plus the continued various cost management program during year 2021, which consists of workforce management, contract management, and inventory management. As a result, we could achieve cost savings THB 247 million in year 2021.
EBITDA margin in first quarter of 2021 was improved to 28.4% compared to 17.1% in first quarter last year. EBITDA margin for the year 2021 was also improved to 21.9%, compared to 20.8% in prior year. Net profit in first quarter 2021 was THB 612 million, improved from first quarter last year by 253.8%. And Adjusted net profit was THB 668 million, improved from same period last year by 286.5%. Net profit for the whole year 2021 was THB 1,216 million, slightly improved from year 2020 by 1%.
The adjusted net profit was THB 1,272 million, improved from same period last year by 5.6%. The net profit margin and adjusted net profit margin in first quarter 2021 were improved to 15.6% and 17% respectively when compared to 5.9% in first quarter 2020. For year 2021, net profit margin and adjusted net profit margin was 9.6% and 10.1% respectively, compared to 9.7% in year 2020. In terms of leverage ratio, net debt to EBITDA for the year 2021 was - 0.6x due to less net debt after repayment long-term debenture THB 2.5 billion in December 2021.
Net debt to equity of year 2021 was - 0.1 x due to less net debt as well. For interest coverage ratio in year 2021 slightly increased to 21.6 x due to EBITDA increase and less interest expense in this year. This is our financial performance of first quarter 2021 and for the whole year 2021. Thank you for your attention.
Thank you, Khun Oraphan. Our next part is the business updates section, starting with Dr. Thassanawut, who will once again go through all the ways in which our international patients are coming into Thailand and seeking treatment in Bumrungrad. Dr. Thassanawut, please.
I'm Dr. Thassanawut Dhearapanya, Division Director of Medical Transport and Business Development International. I'm so glad to see you all here today again. Today, I will be updating the travel regulations and restrictions for people coming into Thailand, may it be Thai nationals or foreign nationals alike. Currently, people who are coming into Thailand have to go through the Thailand Pass process. For patients, in particular, currently they can opt for either the Thai Test & Go program or the ASQ program. As you can see right here, the exemption from quarantine option or so-called Test & Go, most of them are the OPD cases. If OPD patients would like to come and see the doctor in Bumrungrad International, they have to apply and submit their documents through the MOFA website, tp.consular.go.th, in order to get the Thailand Pass. Currently, the RT-PCR had to be done on two occasions.
First one on the first day of arrival, and the second one on the fifth day. Luckily, yesterday, the CCSA or the Centre for COVID-19 Situation Administration of Thailand, who is holding the policy regarding the COVID-19 in Thailand, they announced that the fifth day RT-PCR would be lifted starting from the first of March onwards. That means people can decide easier to come into Thailand because now only one RT-PCR on the arrival date is needed. Hence, the quarantine is virtually none. After the negative RT-PCR on the first day is available, then they can just leave the hotel room. They can go anywhere in Thailand. Also, they can come to the hospital and seek for treatment. For the IPD or patients who need admission upon arrival, still the MOPH approval is needed.
Now we can seek for the approval very, very quickly, unlike the very earlier times of AHQ. Virtually, we can get the approval within the same day. After they got the approval, they can submit these documents into the Thailand Pass website and of course, they can come in and then undergo the quarantine as needed. For the fully vaccinated, seven days, and for the non-vaccinated, 10 days. I can show you right here some of the stats. The last quarter of last year, we welcomed 217 cases into our hospital from abroad. In January alone, we welcomed 119 cases. For domestic patients, we are still looking forward to welcoming more patients in Thailand as well.
In Thailand, in the last quarter of last year, we admitted 193 cases, and in January alone, we admitted 45 of them. As you can see, as the situation has eased up, the restrictions has been lifted. Hopefully, we can welcome more and more patients, both domestically and internationally. Here the revenue will grow. See you again. Thank you.
Thank you, Dr. Thassanawut. Slight deviation from what we have. Something new from what we have previously presented is our Organ and Tissue Transplantation Center, a key component in defining ourselves as a quaternary care center. I would like to hand the presentation then over to Dr. Suwanna, who will talk further on this issue.
[Foreign Language]. I'm Dr. Suwanna Suwannaphong , Strategic Business Unit Head and Director of Organ and Tissue Transplantation Center of Bumrungrad International Hospital. We have done cases for quite some time, and last year we have tackled more and more complex cases. Let's take a quick overview of 2021. We have done 17 cases of Kidney Transplantation, two Heart Transplantation, six cornea, two livers, and six Bone Marrow Transplantation. Well, as we all know that transplantation is quaternary care by itself.
What we are doing here in Bumrungrad International Hospital is that last year in the Kidney Transplantation, there is one incompatible blood group pairs, which means that actually the blood group of the patients and the donor is not compatible, and we need to adjust the medication and surgical technique to keep the patient and the donor in the best clinical possible. We have also done the third transplantation, which means that the first and the second organ that was transplanted has already failed after some time. Now the patient has gone back to his and her normal lives without the need of hemodialysis. In Heart Transplantation, of course, it's a big deal, but one case of Heart Transplantation last year needs Extracorporeal Membrane Oxygenation or what we call ECMO.
Her heart has already stopped working and solely depends on the machine to survive. Without the donor heart, she is not going to live until today, which, fortunately, she is now alive and well. Our sixth case of corneal transplantation, eye surgery seems to be the smallest one in all transplantation. Actually, there are some certain techniques that is suitable from each patient to each patient, and we can do Endothelial Technique, which is suitable for one type of patient instead of doing the regular ones. This can be done only in medical schools and specialized eye center. Two liver cases. The average age of Liver Transplantation cases is around 50 age. But for last year, we have done a case with 70-ish years and has set a new record for advanced age. She is still doing well until today.
The last but not least, six cases of Bone Marrow Transplantation. Bone marrow we do for saving lives of blood cancer or leukemia patients. We cannot do what we have done last year with the complexity of the cases that we need to depend on our Genomics Team and the specialized Pharmacists on Oncology. Now we are going to forward in 2022. Now we are pushing enhancement of the Clinical Program and strengthening our Transplantation Teams. All the teams, especially heart and corneal transplantation for this year. Doing Heart Transplantation needs more than one center of excellence. Actually it is three. The first is our Heart Institute, the second is Transplantation, and the third one is our Critical Care Unit. Also the cornea, as we have mentioned, that is medical schools and specialized Eye Center Standard.
In 2022, we expanding to our Bumrungrad Health Network hospital referrals. We have successful cases last year on kidney cases, and now we are looking forward for more. Also we involve third-party player and also the international patients of course. All the rules and the regulations are now not only allow, but ease the patient to access the care they need for organ transplantation, even though they are non-residents or foreigners. Our doctors and nurses team is really keen on all these regulations and are willing to help the patients and the family all the way. And finally, I'm happy to announce that last year we have done three cases of Corneal Transplantation. We have already had one Heart Transplanted, as a total is three cases already. Five cases of Kidney Transplantation.
We have done 17 last year. We now have five, and three of which are foreigners that international pairs living related Kidney Transplantation. Just this week, we have one case of Bone Marrow Transplantation. He is still doing really well in the hospital right now. Thank you so much.
Thank you, Dr. Suwanna. Now we're gonna dive a little bit more specifically into our Heart Institute, which has grown significantly over the year in terms of both service offering, and in terms of its revenue contribution. I'd like to introduce Dr. Achi to present further on the Heart Institute. Dr. Achi?
Good morning, everyone. Good morning, all dear Investors. May I introduce myself. I'm Dr. Achirawin Jirakamolchaisiri, the Strategic Business Unit Head, and also the Director of Heart Institute, Bumrungrad International. There was the paradigm shift about Cardiovascular Care, and also the reason why Bumrungrad International changed the Heart Center to become new Heart Institute. We are facing the aging societies right now. People are getting older, people live longer, which result in the more prevalence for the NCDs or chronic noncommunicable disease. Almost half of the NCD was cardiovascular disease. It's not cancer, it's not maternal disorder, it's not liver disease, it's cardiovascular disease.
Composed of our cardiovascular disease, most of them, almost half was the Coronary Artery Disease, followed by the Stroke or Cardiovascular Disease and Heart Failures, which we have to prepare and change ourselves first to answer the unmet needs of our patient and customers. Cardiology was not confined into just cardiology themselves or one department. If you suffer from heart disease, you may have many questions about yourself, about your family, that you might want to get the answers, and not just only cardiologist to answer those questions. You can see this is from our real patients. He was asked all these questions after we give him the diagnosis of Brugada Syndrome. We have to change from single disciplinary to multidisciplinary. You can see at every question, there are responsible members, responsible specialties to answer these questions.
Whether or not I should or can I back to marathon, it should be answered by the cardiac rehabilitation and also the Physiotherapist. Is it the best treatment available for Brugada syndrome is the question must be answered by the Electrophysiologist. Will this disease inherit to my family members should be answered by the Cardiogenetics. Can I go back to my normal life and what I have to do after I implant the defibrillator inside myself has to be answered by Nursings and Home Care Teams. How I can quit smoking should be answered by the Pulmonologist and Behavioral Therapist. Do I need surgery for this particular disease? It should be answered by the Heart Team. Many more questions. The reasons and sole purpose for multidisciplinary team at Bumrungrad International, it for patient best interests, and we aim to be your lifetime partners.
Heart disease can happen at any age. You might be familiar with heart disease in elderly, but actually it can happen even if you are younger, you are teenager or middle-aged man. Middle-aged woman can suffer from the heart disease, and those who suffers from the early period of your life should receive much more care. So, t his is why we change from Heart Center to Heart Institute. I want to introduce our new structure for the institute and all subspecialty and service we provide. The director of Heart Institute was Professor Dr. Koonlawee Nademanee , who is a world famous Electrophysiologist. We offer Coronary Interventions , Electrophysiology, Structural Heart, Advanced Heart Failures, Cardiothoracic Surgeries, Congenital Heart Disease, even Cardiogenetics, and our newest service, Heart Transplantations. Looking back to last year, 2021 clinical outcome of the Heart Institute.
For [inaudible] lab, we performed 500 cases of PCI and CAG combined together. Success rates of the PCI or coronary stent was 99%, compared to our benchmark, which is referenced from United States. The benchmark was at 95%. For PCI mortalities and complication, we are at 0.3% compared to we are far better when comparing to the United States benchmark. For EP lab, we perform around 175 cases. We do 100 Electrophysiology Service. AF ablations, we have zero mortalities. We have complications combining together at 3% compared to United States benchmark at 4.5%. The Ventricular Tachycardia or VT ablations, we have zero mortality. We have zero complication case. TAVI, since we opened service last three years ago, we have 29 cases. We have success rate maintaining at 100%.
We have zero in-hospital mortalities. For last year our new products and new programs. Last year we performed two successful cases of Heart Transplantations, which is we as Bumrungrad International, we are the only one private hospital with these capabilities and get the approvals from Thai Red Cross Society and Organ and Transplant Committee of Thailand to become Heart Transplant centers. We already performed our third case in January of 2022. Thank you.
Thank you, Dr. Archie. This concludes the Fourth Quarter and Full Year Analyst Presentation for 2021. A strong quarter indeed. Stay tuned for our live Q&A on the second of March, and see you in the next quarter. Thank you.