Everyone, good morning and welcome to the analyst presentations for the fourth quarter and for the full year 2024 Bumrungrad Hospital Public Company Limited. I would like to thank you very much, everyone, for your time joining the session here today. We have the local analyst joining us in person at the hospital, and we also have the online channel for our foreign analysts to join in online as well. We have uploaded the presentations on our website, on our IR page this morning, so for the presentations, you can download the PDF file from there. For the agenda, we will start with the analyst presentations and then followed by the Q&A sessions by our management. And so before we move on to the presentations, let me introduce the management that are here with us today.
We have Khun Neil Sorrentino, Corporate Chief Strategy Officer, and we have Khun Artirat Charukitpipat, Chief Executive Officer, and we have Khun Oraphan Buamung, Chief Financial Officer, and we have Khun David Boucher, Chief Executive Officer, Bumrungrad Hospital Phuket and Market, and we have Khun Rajeev Rajan, Chief Business Development Officer, and we have Khun Daniel Kastner, Chief Commercial Officer, so, and then we will have Khun Dr. Polakit Teekakirikul, Chief Executive Officer of the VitalLife Scientific Wellness Center and Esperance, and the Chief Science Officer of Bumrungrad Hospital joining us later on as well. So without further ado, please welcome Khun Neil Sorrentino to begin with the presentations and talk about the key takeaways in the fourth quarter.
Good morning and welcome to Q4 and year-ending 2024 performance for the company. I'm going to do a mixture of fourth quarter and year-end so you get a flavor for what happened in the quarter, in summary, and as well what happened in the year. First slide, please. So if you recall, I gave guidance at the end of Q3 for Q4. What I told you was that it would be flat to -3% revenue change, and we exceeded that guidance where we had slight growth in the quarter. Despite the fact that for bullet number three, number two, we were able to grow the EPS for the year by 11% over a 42% growth in 2023. This was despite the fact that we had THB 1.2 billion negative decline in revenue from Kuwait and UAE.
We were able to cover that difference of THB 1.2 billion negative revenue change between those two countries. In addition to covering it, we grew the revenue by 1.1%. So it was a pretty dramatic performance by the other country assets, and Rajeev is going to talk a good bit about that as I will going through this. The importance of 11% EPS growth over 42% from 2023, I thought from a company standpoint was very, very dramatic because we as management obviously were concerned about the Kuwait issue, which is not only a Thailand issue, it's a Kuwait, the Kingdom of Kuwait issue. It's much bigger than Bumrungrad. It affected every single hospital in Thailand and some hospitals in Kuwait that were getting referrals from the Kingdom. But we can talk more about that in a moment. So the winners driving that differential in revenue were Qatar.
Qatar was our biggest supporter for the year. It was very, very big, 25%-26% growth year over year, over THB 4 billion in revenue for Qatar for the year, and you see the other large contributors. There were many others, but those were the principal ones: Bangladesh, USA, China, and I'll remark also that we had very strong support from Thai and expat business. In the quarter, if I recall correctly, Khun Oraphan will correct me, I'm sure, as I remember, the number was about 3.8% growth in that vertical, which was significant. Not only was it 3.8% volume growth, but the revenue intensity was pretty good too. It doesn't match the revenue intensity from international sectors for all the reasons we know. They come here, they're much more sick.
But nonetheless, it was very strong volume growth from expat and Thai, which, as I mentioned there for the quarter on that next bullet. If you look at the critical and key indicators, and somewhere in this presentation, I'm going to show you ROE and ROA performance as best in class against every other healthcare provider. But beyond that, for us, in the quarter and in the year, we grew the EBITDA, we grew the NOPAT, and remarkably, we grew the margins. And I'll go through that detail for you in just a moment.
At our board meeting last week, because of our strong free cash flow, over THB 14 billion of free cash flow, and the fact that in 2023, our board and our shareholders awarded 51% of EPS to our shareholders in the form of a dividend payout, when you look at 2024, growing the EPS by 11%, in order to match that 51% payout, 23 versus 24, when I presented that to that board, the equivalency for that, if you may remember, was THB 4.50 per share in 2023. In order to match that same 51% with 11% EPS growth, we had to, at a minimum, or they had to, at a minimum, award the shareholders THB 5 per share. Our interim dividend was THB 2 per share in 2024.
They are going to the shareholders at our annual general meeting in April to ask for approval for an additional three THB per share, which will take it to five THB per share for the year 2024, which is a historical record high for the company in its 44-year history. And it's up to the shareholders to approve that, but they have never denied what the board has recommended. So that's the expectation by our board to our shareholders at the AGM that that five THB per share be approved. And I expect that it will. I'll talk about the guidance for Q1 2025 at the end of this presentation, either at my end of the presentation, but I'll probably wait till the end so you can get an understanding of the guidance and why. Next slide. I'll just burn through these.
Khun Oraphan is going to talk much more about the detail. But I thought you'd find this interesting. Since we came out of COVID here, 2021, I wanted to show you, because you don't normally get to see this unless you calculate it yourself, from a lot of data. But as we came out of 2021, our EPS was not that big because of COVID. And this is the percentage growth. Those numbers, those percentages are the year-over-year growth in EPS coming out of COVID in the form of THB per share. So you can see here it was THB 1.53 per share in 2021. There was some slight impact in 2022 at the beginning of 2022 as COVID ended. But you can see we jumped the THB per share differential on NOPAT from THB 1.53 because of the pent-up demand to THB 6.21 and then THB 8.1, and then this year, THB 9.78.
I think this is very, very revealing in terms of the performance of the company. Is there any questions about this? Do you all understand this? Okay, next slide, please. And the same trend line for EPS, obviously. You're going to have the same definitive trend line for EPS minus depreciation, which gives you NOPAT. And you can see the same trend line. But what's very interesting here, here I show you the absolute Baht performance on EBITDA. From 2021, THB 2.7 billion. This year, we closed at THB 10.2 billion EBITDA. And the change this year was THB 6.7 over THB 34.7 the prior year. Next slide. And as I mentioned earlier, in the same way, EBITDA margin and NOPAT margin continues to grow.
And as we have discussed in the past, there are multiple factors that affect this change in EBITDA margin: its price, its volume, its cost control, and its revenue intensity. There are other things, but those are the four principal things that drive our margin. And I get the question from the investor community all the time as we go and talk at all these different investor conferences, and there's five or six of them coming up, wanting to know if this is sustainable, meaning can you hold it and can you grow it. And my answer is always the same. It's those four conditions that are intervening variables in how we run the business here. And it starts with volume.
But it starts with the right kind of volume, that high revenue intensity mix of volume and Khun Ling and her team running the day-to-day operations of the medical center correctly and properly. Next slide. So this is the net profit version of what I've been showing you. And here this year, as I mentioned earlier, it grew 11% over 42% the prior year. Next slide. Here's the net profit margin trend line since 2020. And for all of these indicators, I would add we expect this to continue, certainly on the EPS growth line, certainly on the EBITDA line. I don't know about margin. Margin is something that is a strange one because of all the indicators associated with margin. But can we hold this margin trend line up in this range here? It's the nature of our business. It's the kind of business we have here.
You look at our competitors and they're in the low 20s or just slightly above 20. Some are in the high teens. That's who they are, and that's who they're going to remain. This is who we are, and this is where we're going to remain because we focus on premium target market business around the world. They don't come here unless they can pay. Next slide. So here's the consolidated revenue. Here, interestingly, you'll see that last year in the quarter, fourth quarter, the international and national was 57% of the total. This year, 53%. For the year, it dropped 1%, and that's directly attributable to Kuwait and UAE, which is Middle Eastern business, and when we get to the Middle Eastern vertical, I'm going to show you, you'll see the decline year over year because of that THB 1.2 billion that I mentioned earlier. Next slide.
So overall, year over year, we grew 1.3%. I mentioned earlier 1.1%. There's a variation of 0.2%. And maybe Khun Nim, you can explain that differential between the 1.1% and 1.3% so they're not confused by that when they look at detail of the numbers.
Yes. The revenue drop, the revenue growth drop from 1.3% to 1.1% at the total revenue. That's because of two biggest items. The first one is the one-time gain on sale of asset that we recognized last year, around THB 60 million. And another thing is the decrease in exchange rate gains that's caused by unrealized loss from the exchange rate in the subsidiary in Myanmar due to loans. And another one is unrealized exchange rate loss from the foreign fixed deposit, which will be offset by the higher interest earned on the deposit.
So that's the explanation if you're looking at those two numbers and they don't match. Here is the area that I want to focus on in this regard. These two areas here and some of these countries here, which I mentioned earlier specifically, have made up the difference, and more so in the Kuwait and UAE downturn for the year. This is available to you online so you can see this in detail as you like. Next slide. So you see here, this is Kuwait and UAE. You see here that there's a few countries that we, and I'll show you in just a moment what those few downside countries were, but some upside countries, Bangladesh, I showed them to you earlier. We'll go through that. But if you look down here in the small print, these were several of the countries, not all, USA, China, U.K.
USA, we categorize it as international revenue, but those are United States citizens working in Thailand as expats. Last year and this year, meaning 2023 and 2024, very strong utilization of U.S. citizens here in Thailand coming to Bumrungrad. Next slide. So here is the summary of the changes percentage-wise for the quarter and for the year. You can see here, I mentioned earlier, Kuwait was our largest vertical, regardless of the subset, whether international, whether expat, whether regardless. They were the largest contributor to our baseline revenue. And I might add the most profitable. You see here UAE, and you see here Kuwait. These two, UAE, 27.6% down, 67.9% down. When you monetize those percentages, it's over THB 1.230 billion, the big number that we were fortunate enough to cover from some of these other countries. And maintain and grow the margin and grow the EPS year over year.
It was a tough year trying to cover that difference, but because of the diversity of our portfolio of countries around the world and Thai and expat, we were able to do that and more. Next slide. You probably have seen these numbers. They were in the MD&A if you all got the MD&A and read it, but I'll show it to you nonetheless. For the quarter, the margin grew slightly, 0.7%. Excuse me, the EBITDA grew 1.4%. Year over year, the margin grew 2%, and the 9.5 versus 10.3 was up 6.7%. This is on EBITDA and EBITDA margin. Next slide. In the same way, net profit and net profit margin. You see here for the quarter, the margin grew and the net profit grew by 10.6%, and here is the 11% for the year, so the quarter was quite good for us, fourth quarter.
Again, supported in good measure by expat and Thai. Next slide. VitalLife had a great year, both for the quarter and for the year. Dr. Polakit here. He's here at the front. He's many things now in our organization. He's the CEO of VitalLife. He's a practicing cardiologist and genomic expert and very, very involved in our longevity merger between VitalLife and our mainstream, call them that, mainstream doctors. Working very hard to bring that together in a tangible, usable way to introduce longevity to our patients on the illness side, moving to the wellness side. But Dr. Polakit is going to talk in detail about this. I'll pause here and answer any questions for you that you have based upon what I've shown you here, absent the guidance for Q1 2025.
I will present you all in terms of the financial headline and financial performance of fourth quarter 2024 and year 2024. In fourth quarter 2024, total revenue slightly declined by 0.6%. EBITDA and net profit increased by 1.4% and 10.6% respectively. The decline in revenue mainly came from non-Thai patient revenue down by 5.8%, offset with Thai patient revenue increased by 10.2%. The EBITDA margin and net profit margin for this quarter were 36.8% and 29.2% respectively. For the year 2024, total revenue increased by 1.1%. EBITDA and net profit increased by 6.7% and 11% respectively, with EBITDA margin at 39.6% and net profit margin at 30.1%, which are the new high record of the company for the yearly basis. I will walk you through in more detail in financial performance section.
In terms of the total revenue in fourth quarter 2024 was THB 6,526 million, slightly decreased from first quarter last year by 0.6%. The total revenue decline mainly came from the decrease in revenue from hospital operation, which declined by 0.7% when compared to fourth quarter 2023. The variance primarily due to 5.8% decrease in revenue from non-Thai patient, offset by 10.2% increase in revenue from Thai patient. For the year 2024, total revenue was THB 25.86 billion, increased by 1.1%. Mainly came from revenue from hospital revenue increased by 1.3%. The increase primarily due to 4.8% increase in revenue from Thai patient, while revenue from non-Thai patient slightly decreased by 0.4%. Revenue from non-Thai patient down mainly came from international segment down by 1.1%, offset with expat revenue increased by 2.8%. International segment down mainly came from Kuwait, UAE, offset with the increase in Qatar, U.S., and China.
In terms of revenue contribution by nationality, in fourth quarter 2024, the contribution of Thai was 35% and international 65%. The percent contribution between Thai and international were changed from fourth quarter 2023. This was mostly due to the increase in Thai patient revenue at 10.2%, while revenue from non-Thai patient declined by 5.8%. For the year 2024, the contribution of Thai was 34% and international 66%. The percent contribution between Thai and international slightly changed from last year. This was mostly due to increase in Thai patient revenue at 4.8%, while revenue from non-Thai patient slightly declined by 0.4%. In terms of revenue contribution by service, in fourth quarter 2024, the revenue contribution from our patient service increased to 51% from 48% in fourth quarter 2023 due to OPD revenue increased by 5.7%, while IPD revenue decreased by 4.2%, mainly due to lower length of stay.
For the year, the revenue contribution from our patient service increased to 50% from 49% in year 2023. This is due to the outpatient revenue growth by 4.5%, while IPD revenue dropped by 1%. In terms of revenue contribution by payer type, insurance contribution in year 2024 increased to 19% from 18% in the same period last year due to insurance revenue in year 2024 grow year over year by 7.3%. The government third-party contribution in year 2024 was 18%, slightly dropped from 19% in year 2023 due to lower Middle East revenue in year 2024. For self-pay revenue grow by 1.6% in year 2024, and the contribution remained at 62%. In terms of EBITDA and EBITDA margin, in fourth quarter 2024, EBITDA was THB 2,400 million, increased from same period last year by 1.4%.
This represents a favorable change compared to the 0.7% decline in revenue from hospital operation. This is due to continue of cost management program. EBITDA margin in this quarter was 36.8%. For the year 2024, EBITDA was THB 10,243 million, improved from same period last year by 6.7%, with EBITDA margin at 39.6%. This is due to the continue cost management program as well. EBITDA and EBITDA margin for year 2024 are the new high record of the company based on the yearly basis. In terms of net profit and net profit margin, in fourth quarter 2024, net profit was THB 1,903 million, increased from same period last year by 10.6%. This is due to the continue of cost management program resulting of higher EBITDA, plus higher interest income and lower corporate income tax due to gaining tax benefit from BOI CSR investment. Net profit margin was 29.2%.
For the year 2024, net profit was THB 10,775 million, improved from same period last year by 11%, with net profit margin at 30.1%. The net profit amount and net profit margin for the year 2024 achieved all-time high, primarily driven by 6.7% increase in EBITDA and 98% year-over-year increase in interest income, along with THB 147 million tax benefit from BOI CSR project, resulting in effective tax rate reduced to 17% in this year. In terms of the leverage ratio, net debt to EBITDA of the year 2024 was negative at 0.3 times due to less net debt, and net debt to equity was also negative at 0.1 times due to less net debt as well. In terms of liability to asset, at the end of year 2024, the percent liability to asset was 14.9%, still remained in the low level.
This is due to the higher net asset in the year. In terms of cash flow statement, at the end of year 2024, total cash and investment increased to be almost THB 14.1 billion . This came from higher operating income in this year, and the cash collection from accounts receivable, especially Middle East accounts, offset with the dividend payment to the shareholder. In terms of increasing in short-term and long-term investment, we have invested in multiple financial assets to capture the higher interest income yield in this year. These are our financial highlights and financial performance of fourth quarter 2024 and for the year 2024. Thank you for your attention.
The first slides show that we would like to announce that our hospital won the Outstanding Company Performance Award at the SET Awards 2024, and we also achieved the Top Corporate Brand Values 2024 in Healthcare category by Chulalongkorn University and the Stock Exchange of Thailand. This proves that we are the top brand of the hospital in Thailand, and we are positioning ourselves to be one of the best hospitals in the world. Last week, you may know or not know that we also got the rank of 100 from Newsweek and Statista. It's much better than last year that we got 130, and we are the only Thai hospital that is in the 250 best hospitals in the world.
Next, we are also very excited to announce that our gastrointestinal endoscopy unit is the first in Southeast Asia to be certified by the American Society of Gastrointestinal Endoscopy. We achieved 98.3% success rate for colonoscopy procedures, surpassing the U.S. standard, and this year, we also named one of Asia's top private hospitals for 2025 by Newsweek and Statista as well, and you can see that we have been recognized for excellence in five specialties: knee and hip replacement surgery, shoulder surgery, refractive eye, and cataract surgery. This is to confirm that we are not aimed for only doing the business. We also have public-private partnerships. Our academic and research collaboration in 2024 until now, we are partnering with many institutes such as CMKL, Carnegie Mellon University, on the projects like AI for EP and virtual reality for genetic education. For King Mongkut's Institute, we also integrate longevity knowledge.
VitalLife is very successful, and more and more, we will implement our longevity programs. Additionally, we also collaborate with Chulalongkorn University on cancer vaccines and neonatal screening, and also Siriraj Hospital in clinical pharmacogenomics. Next, this is our eighth center of excellence performance. You can see that we have very remarkable growth in the colorectal surgery and spine and also breast center. But we have a little bit decline in the cardiology and neurology impact from the Middle East market that we already mentioned. This is the last slide for me. Khun Oraphan already mentioned about we launched Health Fair in December. The objective is we would like to promote the Health Fair and not only the health check-up. We also launched a lot of screening packages because we aim to have more downstream revenue from that screening package. Until end of February, we achieved THB 361 million.
You might imagine that this THB 361 million, the patients just come to use only half. That means another half will use in this year. The package is that's very successful in gastro and colonoscopy screening and comprehensive program for both male and females over 40. I would like to say that the Thai patient is not. We didn't just use only this OIC policy. We also have loyalty programs for our loyalty patients. Every hospital, I believe that in the beginning of the year, every hospital also adjusts the price. It will be sensitive for a few one or two more months, and then every situation will come back. Thank you.
Another one that I would like to update you all in terms of the BOI CSR project.
In last year, 2024, we have applied and got the BOI CSR certificate, which provides the tax incentive on the investment to help the community and social development. So in year 2024, we do a lot of investment to help the rural area. In terms of the first one, we already invested for the medical equipment and delivered to the Phetchabun Hospital. Total value is about THB 12 million. The second one is the project that we contribute the 10 colonoscopy machines to Rajavithi Hospital. Total value is about THB 80 million. From this investment, Rajavithi Hospital team will provide colorectal cancer screening about 75,000 cases per year to all rural areas in Thailand. In terms of the third one, is the project in three hospitals in three southern provinces in Thailand. We deliver three mobile mammography and breast ultrasound bus to Pattani Hospital, Raman Hospital, and Yarang Hospital.
Total value is about THB 54 million. These three mobile buses, three hospitals can provide the breast cancer screening about 90,000 cases per year. And we expect to detect the breast cancer cases about 2,610 per year. All of these projects can enhance the quality of healthcare in rural areas around Thailand, which expects benefits for the patients more than 160,000 people per year. But Bumrungrad also gains tax benefits from this program about 200% of the investment, or about THB 294 million in this year. And net, the investment of THB 147 million, we got the tax benefit about THB 147 million in year 2024. Thank you.
[Foreign language]. Good morning to all of you. So this slide was explained by Khun Neil. So I might go into these specific verticals in a little more detail.
Starting with the expat segment, where for the year, we saw close to around 2.8% growth and close to 1.3% growth quarter over quarter for Q4. Majorly, the key contributors or drivers for this were the U.S. and the Chinese market. For U.S. and China, for the expat segment, we have seen the record high performance for the company for 2024. For the Thai segment, yes, of course, we focused on corporate tie-ups, corporate interaction and events, a lot of in-house activities, and of course, people mentioned about the campaign specifically related to our check-up programs that we launched targeting specifically in terms of price sensitivity to attract more patients to use the preventive care program, which of course is linked with downstream revenue as well. Going next slide, please.
Overall, as mentioned by Khun Neil in his opening as well, when we look at the Middle East revenue, the overall loss for 2024 compared to 2023 from two markets being Kuwait and UAE is close to around THB 1.2 billion , which we were able to cover up the differential and narrow down the gap by diversification and developing new markets. For Middle East, specifically, Qatar was a market where we have seen the highest ever performance for the company in 2024, which Khun Neil also mentioned. We closed to around THB 4 billion of revenue from Qatar, which is close to double-digit growth year over year, to be precise, close to around 24% growth on that number from the last year, from 2023 into 2024. To summarize, Kuwait is a market where we have seen a big gap year over year.
There's still a lot of uncertainty around it. We have been expecting a comeback of business last year, but it did not go as per our expectations in terms of we were highly optimistic and we were predicting the business to bounce back last year, but unfortunately, it did not happen. We still expect the business to come back sometime soon, but we're not so clear about when it is going to come back, but based on our understanding and what we see, there have been a lot of changes. It's not about only business associated with Bumrungrad. It's about the business. It's about the economy. It's about the infrastructure and the setup within the country, which manages the entire healthcare system and also other different aspects of business as well, not only limited to healthcare.
One of the changes that we have seen in the healthcare policy for Kuwait overall is also limitations and restricting of patients into private healthcare facilities within the country to private healthcare service providers. So that coverage, which predominantly was one of the biggest programs. So Afya used to be a healthcare insurance program for all Kuwait nationals, which they could use, which is a government healthcare insurance, which they could use in any private hospital and also for treatment abroad, which was unanimously called off, and they cannot avail that facility anymore in a private healthcare setting within the country as well. So this was ruled out in September 2024. I think it was 11th of September or 12th of September when it was ruled out. Ever since, they have to be limited to the government hospital.
Again, this might be a stopgap arrangement to put all the processes and channels in place to ensure that the referrals or the treatment going to tertiary quaternary care is happening through the proper channel. This has affected the local healthcare service providers, private healthcare service providers in the country as well. And in terms of resumption of business to Thailand, we are still optimistic about it. Based on what we had mentioned earlier, I would still refer to the same comment where they will definitely have a workflow and a protocol in place, narrowing it down to limited service providers in Thailand, where previously close to around 17-18 hospitals in Thailand, narrowing it down to might be two or three service providers for optimized tertiary and quaternary care referrals only.
And this has not only affected Thailand as treatment abroad for Kuwait as a country, but it's affected treatment abroad to all major destinations which they used to refer out cases, which used to be U.K., which used to be U.S., and also France. They have cut down the referrals completely, so as of what we know, they have only limited referrals going out only for oncology today, and that too only in specific one or two destinations only. How the new protocol will shape up, we will wait and watch. In terms of receivables, is also account that we have been closely discussing with them. We are optimistic as well as per the government. This is a corporate to a government association, so we're dealing directly with the government.
In terms of the payments, we have assurances that it would be made in the near future, sometime soon, when we don't have a specific date yet. But we have been in continuous dialogues in terms of bill submissions, in terms of reconciliation of some of the bills and things like that. So the dialogue and the discussions are quite convincing, and we can expect some good news might be sometime very soon from that account specifically going forward. For Indochina, overall, again, for Bangladesh, Laos, and Indonesia, we had a record high performance for last year where Bangladesh, even though we had in Q3, we had a political turmoil in the country. The country was blacked out for almost close to 45 days. But still, we managed to have double-digit growth from Bangladesh and all-time highest performance for the company for last year.
Same for Laos and for Indonesia. Indonesia, we have seen almost close to 45% growth year over year, even though the base is quite low, but still, we are very optimistic towards the growth of that market. For Cambodia and Myanmar, Myanmar is a market where we have seen high volatility and a lot of other external factors affecting the decision-making to travel towards Thailand, which one of them initially was for passports. New passports were very difficult to get. Then we saw the Forex devaluation happening where it devalued over 30%-40%, high inflation, which affected the buying behavior and the pattern for consumers. But overall, we were still able to reach out to that market consistently last year.
We managed with our outreach programs where we had our physicians reach out to the market, and we were able to facilitate and bring out patients in terms of optimized tertiary and quaternary care through these programs and initiatives, and also, our clinic back in Yangon in Myanmar was a great support and a foundation for this initiative. Cambodia, when you look at overall historic trend for Cambodia, which of course is again a price-sensitive market, when Q1, Q2, Q3, we had seen some decline. Specifically, again, it is directly reciprocated to the buying behavior of these patients because of inflation, because of price sensitivity. In Q4, we saw a slight change. We saw the volumes and the numbers to get a little better.
And also, I had mentioned last year in Q3 about a new association of ours in Cambodia locally, which we made announced, and we had this partnership with a local service provider in Cambodia with a clinic where we have our doctors, seven of our specialists now having local Cambodian license, and they will be visiting Cambodia biweekly for consults across three specialties, and they will be available locally in Cambodia for consults through this clinic. We have actively engaged into this partnership and made it official, and it has been incorporated since February last month. Moving on to the other segment, we have notable U.S., China, Ethiopia, and U.K. to be the four markets where we have significantly made the highest revenue for the company for last year. U.S. stands out specifically in the expat segment and also in the international segment.
International segment is not mostly from patients who are U.S. nationals flying in from U.S. They are mostly expats living in the CLMV region, are considered to be not expats in Thailand, but expats in the CLMV region flying in for specific treatments, which is Cambodia, Myanmar, Laos, and Vietnam. Chinese, we have seen the international overall, again, the highest performance for all segments, which includes international and also for the expat segment, which is close to around 21% growth. Ethiopia was the highest ever performance for us for last year as well, where we broke all records and we brought up, got the highest performance in 2023. We broke that record of the highest performance for 2023 as well in 2024, getting into again an all-time highest performance by adding close to 6% on top of what we achieved in 2023.
U.K. significantly has also, overall, for all of the expat markets, we have seen a considerable amount of growth across all countries, all nationalities. In addition to that, U.K. as well for international from the CLMV region and also for inter patients, we have seen close to around a 32% growth for the U.K. nationalities. So overall, the other segment, which includes U.S., China, Ethiopia, U.K., seems to have a very strong contribution to the growth, which is close to around 15% for the year and 8% for the quarter, and a snapshot of the top 10 countries, which international, as you can see, Qatar, we made significant growth for the quarter as well, which is around close to 5.7% and for 24.6% approximately for the year. So overall, that's a brief update from my end. I'm open to take any questions specifically if you may have.
Please, Daniel.
Thank you, Neil. Good morning and nice to see you all again. So I'm pleased to give you an update on our insurance business. So our insurance business once again posted solid growth. We saw good growth on the local insurance side. Those are the AIA's, the Krungthai-AXA's, the Muang Thai Life's of the insurance business by about 11.1% year on year. And that's on top of the 36% growth we saw in the previous year as well. On the overseas insurance, you saw a slowdown, growth of around 3.6%. But I'm not too alarmed by that, given that we've seen a good pickup in demand in the last two months of the year.
And that's mainly due to the seasonality of the tourism market and also some high-spend cases in the previous year, which did not materialize, especially on the medical insurance side where there were multiple million THB procedures being done by some of our patients. So overall, we're looking at about 7.3% from a direct billing basis. But on the next slide, you will see that if we include copay component, which, as you're familiar with current regulations, copay will become increasingly prevalent in Thailand. The growth rate has improved slightly on the overseas insurance because there is a copay component built into the insurance policy of many of these policyholders. And the growth rate is approximately 8.2%. So all in all, insurance is contributing around almost THB 5.5 billion in revenue for 2024. On the next slide, you will see the contribution of revenue for insurance.
So it's approximately almost 20% now from a direct payer. But if we include copay, it's already almost at 23%. And given current trends that I am seeing in the early part of this year, we expect that to continue to grow and approaching the almost 25% mark absent any significant changes in the Middle Eastern business. From an overseas insurance standpoint and medical assistance standpoint, these are typically the higher revenue intensity cases because they are mostly evacuations where people may have a stroke or have heart disease, etc., or cancer. And so therefore, they are referred from overseas to Thailand. With the increasing amount of investment in Vietnam and also in the Southeast Asian area, we do expect referrals coming in from overseas. And we have seen our partners refer medical evacuation cases to us as well.
Moreover, on the local side, we also are quite optimistic about the growth rate given that we are starting to expand geographically. I mentioned last year our strategy on expanding our catchment area, and I believe that has borne fruit. When I looked at, for example, the contribution of Bangkok Metropolitan Area, which includes Nonthaburi, Samut Prakan, etc., it equated to around 66% of our revenue in 2023. That has dropped to 63%, so that means that has been made up by other provinces as well, like Chonburi, Rayong, Nakhon Ratchasima in Phuket as an example. These are notable provinces that have seen growth from referrals from upcountry in the. If you go to the next slide, this is a breakdown of the specialty growth, so we see oncology posting very strong growth. Cardiology kind of mirrored what we saw for the overall basis.
That's because in the previous year, we saw an increase of 45%. That's a very high base that we're working out of. From OPD and IPD numbers, it's slightly down, but we're targeting this segment, and we expect that to recover going forward as well. Pediatrics is one area that you may have questions about because a lot of the insurance companies focus on pediatric and simple diseases as a way to manage their costs. We expect pediatrics to continue to slow down, perhaps on this aspect, as a lot of insurance policies have increased their copay from 20%-40% and perhaps even higher. They will respond with higher premium increases as well. On orthopedics, solid growth. OB-GYN, most of these specialties have shown significant increase. On the neuroscience side, where we've seen a decrease, that's mainly because neuroscience grew last year by 70%.
And so therefore, we're working off of quite a high base. So on the IPD side, a high base from last year compared to this year, and that's where mainly the weakness came from. On nephrology, similar way as well. There was significant increase in nephrology cases, especially high-intensity cases. This year, less so, but working off a high base from the previous year as well. And on the final slide, just want to highlight to you what we are focusing on. A lot of this is similar to the previous year, but what we've looked at, for example, is much more targeted programs in terms of discounting. And I can talk to you a little bit about that in the Q&A session on what we see and what we think on that.
Our expansion of geographic area continues, and that's where I've detailed to you that there has been an expansion of the geographic catchment area for insurance. We will continue to intensify our marketing activities and focus on the complex, the critical, the high turnaround cases. Something that we will continue to do, and I think is something we can strengthen, is education on clinical outcomes and benchmarking. It's very important for our insurers to understand that Bumrungrad is the top destination for referrals for complex surgeries or procedures. We have clinical outcome data to support that in order to convince the medical teams and also our insurance agents, our assistance companies to refer these to the mother house, as we say. We will also continue to strengthen our case management process and coordination.
It's very important, especially with overseas insurers and medical assistance companies, that we communicate rigorously with them, update them on progress of the patient prognosis, including, of course, the billing and how we manage that. Many medical assistance companies, they derive their value out of reducing costs, doing cost containment, and that's something that we will work together with them for value-added purposes. We also will start to look at longevity as part of the conventional mix of insurance. That's something that from our managing director's vision and strategy is something that we want to incorporate in the insurance mix. It will take a long time to do because insurance typically focuses on conventional medicine, but what insurers struggle now to manage are simple disease costs.
This is why you see the copay starting to come out with the new policies that are being released this month with the OIC, etc., as well, and one way to reduce simple disease admissions is, of course, longevity and how we can help maintain people's health better, longer, reducing simple disease admissions, etc., and on operational excellence side, we're looking at continuously reducing our turnaround times. That's a challenge for us because as insurers become more and more cost-conscious, they review more and more thoroughly applications for pre-authorization and claims, and so therefore, we need to respond in kind for the benefit of our patients, reducing the turnaround time on that aspect, and as we continue to roll out new technology and also new hospital platforms, we will look at process automation and also AI application as part of the insurance journey as well.
So I think that's the end of my presentation. I'm happy to answer any questions.
[Foreign language] . Nice to see you all again. Just a few slides here. I'm going to share with you an update on the Bumrungrad International Hospital Phuket project development and some of the things we're doing in the referral office and all. So as you've seen these pictures, these artist renditions over the last few quarters, again, this is up to date. You'll see Vital Life on the north side of the building and Bumrungrad on the south. Just an update on some of the recent activities here. I'm not going to go through the five or six stories that we've got you seeing this information that's available. But finally, we're at 212 beds as the final bed complement, just shy of 50,000 sq m and just shy of 23 m tall from the top.
We're awarded our Environmental Impact Assessment back in November. We've received all of our construction permits, first land clearing and then construction and all. That process took us about two and a half months from the time we earned our EIA until we got construction permits. We had a very wonderful Buddhist blessing and groundbreaking ceremony on the 5th of February on the site. It was mostly a private ceremony with our board and executives and all. I can assure you, just as soon as their vehicles left the horizon, we started construction. Things were moving ahead pretty quickly. We have commenced that, as I mentioned. If you go to the property again, we're about 2.5 km from the Phuket International Airport.
Right across the road from Blue Canyon, you'll see that we've already driven a number of pilings, really, for the perimeter pilings for the retaining wall that goes around the entire property and everything else. So we're waiting on a couple of other things, working with the local Phuket government. We anticipate driving the main setup. About 1,000 pilings will be putting in before we pour concrete sometime over the next week to 10 days that will start. Our exterior design is complete. Our interior layouts and finishes are near completion as well. I would say probably about 98%. We're moving ahead. Next slide, I'm going to show you a very short video, short meaning about 30 seconds. It will give you an idea.
This has been an incredibly detailed project, as you might imagine, much more than I had imagined, although Neil, full disclosure, warned me but a ton of moving pieces with this project. We've had a number of both external consultants, but more importantly, internal subject matter experts from nursing to pharmacy to lab to operating room on and on that have been involved in this whole process. We focus Khun Jittima. Our Deputy CFO has been very, very involved with patient flows, cashiering points, all of that, so without further ado, this was put together by DWP, our architect but it gives you a pretty good idea of the complexity of what we're doing, and before I hit the click button, also share with you, our managing director's vision was for us to build a six-star boutique hospital and so two years of planning, this is what's evolved.
You can tell it's going to be quite the facility when we're finished. We're pretty optimistic from a timing perspective because I'm pretty sure there's going to be a question about that. We anticipate any place from 22-24 months of actual construction. You can do the math then. So there's a chance that we could complete construction at the end of 2026, more likely Q1 of 2027 at this point. You may recall from our last gathering a quarter ago, we opened up a VitalLife Scientific Wellness Center in the Cherng Talay area of Phuket back in September the 27th. And you can see, and so that's been open, and we're operating and continue to grow volume almost on a monthly basis now. On the right is the current team.
You see them holding up what we may think of as the peace or the victory sign. No longer. In Phuket, that means Vital Life. And so the staff is really, they dream this up. They're running with it. And so a lot of our clients are using that as well. So it's caught on. So what it means to our staff in Phuket is the V is Vital Life, again, driven by science and powered by Bumrungrad. From the Phuket referral office, you may remember some of this again, just to touch on it. We're located at 268 Yaowarat Road, almost right across the street from another unnamed hospital. We opened in mid-2022, staffed up and managed it mid-2023. We have three main functions in the RO. We have a small staff, maybe six or seven total people, but three main functions.
First and foremost, to assist Phuket patients and the Phuket region patients and insurance agents with facilitating care here at Bumrungrad International, and we're networked in a number of different ways. We facilitate, we meet with everything from airport officials, again, insurance agents, travel agents. The hotels, we're very active in the Phuket Hotels Association. Again, not just hotels, but I mean, not just in Phuket, but in the neighboring provinces of Surat Thani, of Phang Nga, of Krabi, most recently Songkhla as well, and the numbers really between 2022, 2023, 2024, we continue to see pretty healthy growth, again, of patients from that region, some directly through the RO, other not, but actually being facilitated and coming here, receiving services at Bumrungrad, and you see some of the statistics that Rajeev and Khun Oraphan and Neil shared that reflect that. The second main function is community networking and brand awareness.
And so we're out there just getting, passing out business cards and trying to really represent the brand of Bumrungrad and Vital Life as well. And the third very important thing is CSR activity. So you may recall a quarter ago, we talked in significant a number of the things that we've done out of the RO throughout 2024. And we'll continue to do that. Again, not just in Phuket, but in the greater region as well. So a number of really important things. So it's 2025. I think we've already completed maybe four CSR activities this year already, a couple more planned in the next couple of weeks. So it's really, really important. Again, these stacks will reflect these are specifically patients from Phuket who have received services here at Bumrungrad in Bangkok, 2022, 2023, and 2024, similar to slides that Neil and Rajeev and Daniel distributed.
So you'll see we know that cardiology is one of the top diagnoses for people from Phuket specifically that end up coming to Bumrungrad. You see with the rest of the breakdowns in it. So one of our functions, and we're out there, is trying to facilitate those patients coming here. And not necessarily select care at a local facility. And what we expect, just the final note I'll make, this is my last slide. The final note I'll make is that we would expect in 2025 and 2026, once the community sees the structure, right now, the land's been cleared, the sign is up, they're seeing pilings come out of the ground, they're seeing trucks being driven around.
Once the community starts to see that, a lot of times what they'll do is they may have thought that we were just dipping our toe in the water, that maybe Bumrungrad wasn't serious, maybe they weren't going to build. But when they start to see the structure, and we'll use this video at Rotary Clubs, we'll use this with the Chamber of Commerce, we'll use this with the Hotel Association, they will be able to see the vision. We're updating our website on about an every six-week period. The community can see, here we were November 1st, a rainforest. Here we were February 1st to clear a lot. Here we were probably April, we'll update it. Here's what it looks like and everything else.
When that happens, increasingly, patients from the local community will start to say, you know what, I'm going to change my commitment, my loyalty, if you will. I haven't had maybe a choice in the last 15 or 20 years. Now Bumrungrad's coming to town, so we'll start to do that. We will use that, obviously. And so yeah, that's it. Again, thank you very much. Happy to answer any questions if you might have them.
[Foreign language]. Good morning, everyone. I know that we are approaching noon, so I promise I will not spend a long time, but I will present the key highlights of Vital Life. My name is Dr. Polakit . I'm a cardiologist and also a geneticist. I'm also the CEO of Vital Life and Esperance and also Chief Science Officer for the whole organization.
So as you can see here, today I will be presenting the key highlight, including financial performance. Let me give you the background. I know that last time when we met together electronically, I did present most of the background, but today I hope to complement more with more comprehensive service and the whole highlight for the past year. But who we are, I think VitalLife, as you know, we are almost 25 years old. We are a subsidiary of Bumrungrad Hospital focusing on scientific wellness. I think for the global healthcare, we understand well that we need to address financial aspects, societal aspects. But I think scientific preparation is one of the key highlights for our organization. And that's why we have a scientific wellness center. More recently, in 2018, we even launched something more special called Esperance Integrative Cancer Care and also Early Cancer Prevention.
I am going to go through this very quickly so you can see all the timelines since 2001. We have transformed. We have achieved the milestones, as we said, and we challenge ourselves all the time. Last year, toward the end of the year, on the 27th of September, we have moved to the new home, Building D, six-story building. Everything is brand new. It's called VitalLife Scientific Wellness Center. In addition to that, we also offer skin and aesthetic services, and we are located on 844 of Building C. Together with Bumrungrad Hospital, I think this year we are going to even launch more service, and I hope that maybe next meeting we have more information for you.
We are going to continue to expand for a few more floors focusing on lifestyle medicine and comprehensive service for longevity-based medicine, which I'm going to talk more about that. You can see that we are very proud to be recognized by most of the prestigious awards. More recently, we have received the most innovative corporate brand in wellness in 2024. Let's talk about VitalLife. Why do we need VitalLife? Because we are already great at taking care of the sick patient at Bumrungrad Hospital, right? The mother hospital, because the whole landscape has changed. We are trying to focus more and more, and we have done very well in terms of advanced preventive medicine. I'll give you some historical background of the medicine because I'm a doctor. I cannot help talking medicine. 100 years ago, people talk about past medicine.
We basically treat the patient based on our induction. It's so sad to say that, but I think that's true. So we look at the clinical science and symptoms, talk to the patient, and we prescribe the medications. But in the past 20, 30 years, we have moved into what we call evidence-based medicine, and that's what Bumrungrad has been great and excelled. We use all the clinical trials knowledge, and this is present on modern medicine, but going forward, it's not going to be like this. It's going to be future. We call Medicine 3.0, where we really focus on precision, accuracy, the so-called precision and personalized medicine, preventing disease, optimized health, and the term that may sound very cliché nowadays, you might have heard this term a lot on media, longevity.
But what we're trying to do here, and in fact, we have done that. We are the leader. It's what we call healthy longevity. This is a new era of medicine. Why are we talking about longevity medicine? Because it's great, but why are we now? It's not just now, but we talk about this 20 years ago, 25 years ago at VitalLife. But the reason why that it became popular in the past year, I would hope so, because of the global aging, decreased fertility rate. By 2050, you could see a marked increase in terms of the aging population. Thailand has entered into aged population, and soon we will be super aged. 80% of global population will be more than 65 years of age by 2050. To address this, we focus on 12 hallmarks of aging at VitalLife.
For each single hallmark, we have all the way to interact, to intervene, and even also prevent it. 25 of them are related with genetics, and the rest of all the agings are related to environmental factors or even lifestyle. That's the concept of VitalLife in the modern era. We try to address what I call health span rather than lifespan, and that's the concept of VitalLife. We work collaboratively internally with people in Bumrungrad Hospital. The whole idea is to close the gap. As Khun Neil mentioned at the very beginning of presentation, we kept talking about health span, but we forgot about how we are going to achieve the better health span. I think one of the key factors is to decrease the age-related disease. So we try to have the optimal longevity.
So on this figure, basically, we try to broaden and increase the blue bar, and hopefully the whole lifespan will increase. So this is one of my favorite slides when I talk to people even outside the analyst meeting. Bumrungrad is great at taking care of sick people. You look on the left-hand side on the scale of 10, if you have very sick patients, disease, or poor health, we serve as quaternary or tertiary care organization. We are very good at preventing people from death, right? And most of the time, we bring patients to the comfort zone, which is 5 over 10. But VitalLife will come into play and work in concert with Bumrungrad Hospital and other subsidiary companies in our organization to maximize the wellness and bring those people from 5 over 10 to 10 over 10.
I think for the long term, you will see the whole catalog of what we service here at our organization, ranging from 0 all the way to 10. Bumrungrad will take care of 0, bring it back to 5. Vital Life will bring them all the way to 10. I think that's the whole concept. We're not talking something about snake oils here. We have been supported, and we work very closely, as Khun Neil mentioned, through our academic collaboration internally within the countries like Chulalongkorn University, Mahidol University. We also reach out and work with people around the world. This is only examples of the Scientific Advisory Board or SAB for our organization. I'm going to skip these. I think this is available publicly. But just to name a few, Evelyne Bischof is the leading longevity medicine doctors who practice in Asia and also in Europe.
And the rest, you can see it on our website. We try to harness our 25 years of expertise, insights on advanced diagnostics together with the AI to address the preventive medicine or proactive medicine. What we propose here together with Bumrungrad Hospital is longevity from day one and basically across the lifespan, starting from the beginning of your life, prenatal testing, newborn testing, all the way to geriatrics population. I think that's the complete portfolio. One of the good examples of how we work together and harness the technology is genomic or genetic medicine. Bumrungrad Genomic Medicine Center has been around for a couple of years, and we actually are the first center that has been approved by the Ministry of Public Health to serve the genetic medicine service to provide one-stop service.
Also, as you know, we are the only lab, a private lab that has been accredited by the College of American Pathologists. What we propose and what we have been using in the past several months, perhaps the last quarter since we opened the new building, is the AI-driven subscription service where we compile all of our expertise together with our AI engine to assist, not to replace, but to assist our physicians to take care of the patients in terms of preventive medicine so we can provide long-term care. Let's go to the highlight, the key financials, as Khun Neil mentioned at the very beginning. If you look at the quarter, the fourth quarter on the left-hand side, you can see that the total revenues increased by 13.1%. For the EBITDA, it is 13.8% net profit.
We saw a net profit of 14.5% increase, and that translated into the EBITDA margin of 39%. Also, net profit margin is 30.7%. Let's look at the whole year for 2024. Total revenues go up by 8.9%. EBITDA is 10.9%. Also, net profit is 10.8%. EBITDA margins for the whole year is 42.7% and net profit margins 30.5%. This reflects our operational excellence and also our commitment to excellence. I think going forward, VitalLife is going to lead the way in scientific wellness using an innovative approach and our commitment to excellence in preventive medicine, especially advanced preventive medicine. Let me show you some other information from the customer perspective. You see that customers trust us. And thanks to all the colleagues in this room. Last year, 2024, we see almost 80,000 outpatient visits.
I think you're going to see it continue to grow up. For our patient or client portfolio by residences, you can see the significant number are from the Middle East and China. Because of the referral office, we have more than 100 referral offices across the three continents. I think given the interest of time, I'm going to stop here in case anyone has any questions. Thank you so much.