[Foreign language] Welcome to the analyst presentations for the first quarter of 2025, Bumrungrad Hospital Public Company Limited. My name is Achariya Sanrattana, Investor Relations and Sustainability. For this time around, we are holding the analyst meeting in an online format. As usual, we will post our pre-recording webcast of the analyst presentations on our website, and then will be followed by the analyst meeting online Q&A sessions with management later on.
For this kind of online format, we will hold this analyst meeting in an online format for every first quarter and every third quarter of the year. We will hold an in-person analyst meeting at the hospital for every half year and for the full year result. For the presentation today, we have Khun Neil Sorrentino, Corporate Chief Strategy Officer, to talk about the key takeaways in the first quarter of 2025.
We have Khun Artirat Charukitpipat, Chief Executive Officer, to talk about the business update. We have Khun Oraphan Buamuang , Chief Financial Officer, to talk about the financial highlights and the financial performance in the first quarter of 2025. Lastly, we have Khun Rajiv Rajan, Chief Business Development Officer, to give us an update on the business development performance.
Before we start with the presentations, in terms of the guidance, usually the management will provide the guidance for the top-line revenue growth year over year on a quarter-by-quarter basis. Please note that this time in this quarter, the management will provide the guidance for the second quarter of 2025 during the analyst meeting Q&A sessions. Now let me hand over the presentations to Khun Neil Sorrentino.
Good morning and welcome to Q1 2025, Bumrungrad Hospital Public Company Limited. Looking at the takeaways for the quarter, the most significant thing about Q1 was the fact that we experienced over 90% of the Ramadan days in Q1, given the fact that the Islamic calendar has advanced year after year. This year, we almost had almost the full impact of the Ramadan length of stay declines and revenue intensity declines.
While we showed significant improvement in Qatar and UAE admissions, and I'll go over that in detail, at the same time, we showed a greater length of stay decline of those Middle Eastern patients that were in our hospital for a long period of time but went back to their home country. These were long-stay patients that generated a lot of resource consumption and drove a lot of revenue intensity.
Let me go through some statistics for you so you'll have a better understanding of the depth of the quarter. Insofar as the Middle East was concerned, we saw approximately 30% decline in revenue, again, as a result of lower length of stay and lower revenue intensity. For Qatar and UAE, we saw positive improvements. Even though it was Ramadan, we saw positive improvements.
For Qatar, our admissions increased by 8.4%, and our outpatient visits increased by 13.4%. This, though, is in correlation with the lower revenue intensity and lower length of stay, which drove down additional revenue changes. Insofar as the UAE was concerned, we showed inpatient admissions of 12% growth for the quarter, although on an outpatient basis, it was less because we had far few travelers coming back into the country during the Ramadan period.
It was a contradiction in terms, in a way, because on the one hand, we had greater outpatient utilization and inpatient utilization for Qatar, greater inpatient utilization for UAE, but the revenue intensity and the length of stay declined relative to other quarters. We will talk in detail next week at our livestream Q&A about Kuwait. We do not really have much to say because the kingdom has been rather quiet and silent about their future plans as to where they are going to be sending patients, if they are going to be sending patients.
Currently, as we understand it, almost all, with few exceptions, almost all of their patients are now being cared for in-country. Not totally, but almost all. Insofar as Indochina was concerned, Bangladesh, because it is an Islamic country, also was impacted. We were also impacted by Ramadan.
We saw significant declines in that utilization, but this was predicted in my guidance on revenue declines. Myanmar was a strong comeback country for us in Q1, not affected, obviously, by Ramadan. We showed almost a 20% growth from Myanmar on revenue. In addition, other winners, as I referred to them as the United States of America, were driven almost down the middle between growth and revenue from expats, U.S. expats working in Thailand, as well as those coming from abroad.
The China growth was mixed. We saw strong 7%-8% China growth on revenue from Chinese expats in-country and around the Thailand area. We saw a decline in international China visits, mainly because the country of Thailand is experiencing a significant decline in Chinese tourists from mainland China as a result of safety concerns.
There was a question, as you may or may not know, about a Chinese national that was kidnapped out of Thailand into Myanmar, and that created a chilling effect on Chinese nationals coming into Thailand as tourists. That continues to this day. Just recently, I was reading where for the entire period of 2025, the Chinese mainland tourist visitors into Thailand are down by almost two-thirds. Those were the beneficial improvements, changes, increases, decreases with respect to revenue, outpatient admissions, and OPD.
As we look at the rest of the quarter, we were proud to report, and Khun Achariya will mention this in her comments later, we were proud to report that for the fifth consecutive year, we have been awarded the best hospital in Thailand, and we improved from a 130 ranking in the world up to 100, to the 100th best hospital in the world, and we're extremely proud of that.
This helps us in many, many ways, especially with international tourists coming into Thailand, looking to just go to the best hospital and not knowing what that best hospital is. We promote this achievement because it's well-earned by our doctors and our staff. In addition, in the first quarter, we were the first hospital in all of Thailand to install and have operational a Siemens photon counting CT.
Now, what that means is higher resolution, faster throughput, being able to detect lung cancer through CT diagnosis, being able to, most importantly, avoid potentially angiograms being done on patients as opposed to just having them go through this machine. It was a very, very significant expenditure, well over THB 100 million plus plus, but it was worth it because our patients are benefiting from it. Finally, in the quarter, I have commented in the past about our relationship with Massachusetts General Brigham Hospital.
We have developed a formal partnership agreement with them on a cancer institute collaboration. That has passed phase one. It's now into phase two, and we're looking to finally and finalize develop what our cancer institute will look like using and getting the benefit of expert advice from Mass General Brigham. As you may know, we are building our Bumrungrad Cancer Institute. It's underway now.
It's coming out of the ground. It should be finished somewhere between 15-18 months from now. That cancer institute will very much have a number of recommendations by Massachusetts General Brigham Hospital as part of that clinical services design. Moving on now to the consolidated revenue by vertical. In general, this is very indicative, what you see here of the revenue proportionality by market segment. In Q1 2024, the international/Middle Eastern revenue was 54% of the total revenue for the company, dropping down to 51%.
I commented earlier about 30% of that revenue decline overall came out of the Middle Eastern Q1 2025 revenue change. The rest of it is pretty pro forma, 13, 13, 33, 36, picking up 36% versus 33%. Q1 2025 is a difference between that 51% and 54% of the prior year quarter. Next slide.
Looking at the overall revenue decline for the quarter, within our guideline that we gave the last time we met, down about 6.1%. As a subpiece of that, the international was down 11.6%. I've commented by country what that amounted to. Thai was up, expat was down, mostly by revenue intensity. Volume was up, but revenue intensity was down for expat.
Next slide. Middle East, as I said earlier, was down 30% on revenue. Indochina up 2.4%. That's the negative of Bangladesh, the high positive of Myanmar, and others were 6.3%. Next slide. These were the ups and the downs for the quarter. If you look at Myanmar and you look at the United States, you look at Cambodia, slightly down. The United States was up significantly.
Inside the numbers of Qatar and UAE, as we've spoken about, while average length of stay and revenue intensity was down, admissions and outpatient visits were up. Next slide. These are the consolidated numbers on EBITDA, NOPAT, Khun Orapan will talk about this in detail. Slightly down on revenue from 40.7 to 37.7 on margin. The difference on EBITDA as a result of Ramadan, 12.6% decline on EBITDA, and on net profit, just about the same percentage decline. Very, very slight decline, though, on net profit for our margin.
We did a very good job of containing costs and controlling costs, especially when you consider that our Middle Eastern revenue was down 30% for the quarter. Did a really good job on cost control. Next slide. Moving now to our other one of several other business lines of principal importance was Vitallife. Vitallife had a very good quarter.
When you look at it quarter to quarter, this is a business that continues to grow, continues to improve, and continues to diversify in the longevity and longevity leisure market space. EBITDA was close to the prior year, THB 114 million versus THB 117 million. Net profit, very close, THB 89 million versus THB 91 million in Q1 2024. The EBITDA margin was slightly off because the revenue was slightly off as a result of Middle Eastern patients not being on our campus and not using this service.
Net profit was 30.6% versus prior year, which was 34.1%. That is the highlight of the quarter. Insofar as guidance Q2 is concerned, we will be addressing that at our livestream Q&A. Please join us. That is at 10:00 A.M. on Wednesday, April 30. We are happy to answer all questions at that time. Thank you.
Good morning. [Foreign language] I'm Oraphan Buamuang, Chief Financial Officer. I would like to report you all the financial highlights and financial performance of first quarter 2025. In first quarter 2025, total revenue declined by 5.6%. EBITDA and net profit declined by 12.6%. The decline in revenue mainly came from non-Thai patient revenue down by 9.7%, offset with Thai patient revenue increased by 1.2%. The EBITDA margin and net profit margin in this quarter was 37.7% and 27.9% respectively.
I will walk you through more detail in the financial performance section. The total revenue in first quarter 2025 was THB 6,208 million, declined from first quarter last year by 5.6%. The total revenue decline mainly came from the decrease in revenue from hospital operation, which declined by 6.1% when compared to first quarter last year.
This was primarily due to a 9.7% decrease in revenue from non-Thai patients, highly correlated to the greater impact of Ramadan days experienced in first quarter 2025 compared to first quarter 2024. This decline was partially offset by a 1.2% increase in revenue from Thai patients. In terms of revenue contribution by nationality, in first quarter this year, the contribution of Thai was 36%, increased from 33% in first quarter last year, while the contribution of international was 64% in first quarter 2025, declined from 67% in first quarter 2024. This was mostly due to an increase in Thai patient revenue at 1.2%, while revenue from non-Thai patients declined by 9.7%.
In terms of revenue contribution by service, in first quarter this year, the revenue contribution of outpatient service increased to 52% from 49% in first quarter 2024 due to OPD revenue decreased by 4.8%, while IPD revenue decreased by 7.3%, mainly due to lower length of stay. In terms of revenue contribution by payer type, insurance contribution in first quarter 2025 increased to 22% from 18% in the same period last year due to insurance revenue for first quarter 2025 grow by 12%.
The government third-party contribution in first quarter this year was 13%, dropped from 20% in first quarter 2024 due to lower Middle East revenue. For sale pay contribution increased to 64% in first quarter 2025 from 61% in first quarter 2024. In terms of EBITDA and EBITDA margin, in first quarter this year, EBITDA was THB 2,338 million, decreased from same period last year by 12.6%.
The decrease mainly due to total revenue decreased by 5.6% and offset with total expense slightly declined by 0.8%. EBITDA margin in this quarter was 37.7%. In terms of net profit and net profit margin, in first quarter this year, net profit was THB 1,734 million, decreased from same period last year by 12.6%. The net profit decrease is in line with EBITDA decline. Net profit margin was 27.9%.
In terms of leverage ratio, net debt to EBITDA of first quarter this year was negative 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 first quarter 2025, the % liability to asset was dropped to 14%. This is due to the higher net asset continuously.
In terms of cash flow statement, at the end of first quarter 2025, total cash and investment increased to THB 16 billion from THB 12.9 billion in first quarter 2024. This came from the accumulated operating cash flow and cash collection from account receivable, especially Middle East account, offset with the dividend payment to the shareholder. In terms of increase 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 first quarter 2025. Thank you for your attention.
[Foreign language] Today I would like to update about the hospital operation part. This is the fifth consecutive year receiving world's best hospitals by Newsweek and Statista, and we rank at 100, which is the best ranking in the past five years, coming up from 130 last year.
This is why we still remain the number one best hospital in Thailand. Bumrungrad Hospital Press Conference titled "Where Life Gets a Second Chance," we reaffirm our leadership in heart, kidney transplant, liver transplant, and corneal transplant services. With strong outcomes and high expertise, Bumrungrad continues to be recognized by the Thai Red Cross Organ Donation Center as a trusted transplant center.
We co-host the 57th International Endoscopic Spine Surgery Training with St. Anna Hospital, Germany. We welcome over 120 surgeons from 10 countries. This event reinforces our global reputation in minimally invasive spine surgery and strengthens our position as a regional training hub. Bumrungrad became the first hospital in Thailand to implement photon counting CT technology. We introduced it at the press conference on March 13 this year. This cutting-edge diagnostic intervention with AI technology improves early detection, precision, and safety, while significantly reducing radiation exposure.
For our Center of Excellence performance in the first quarter 2025, due to Ramadan falling in March this year, while it spanned in March and April last year, this impacted revenue in some Center of Excellence. However, we still continue focusing on strengthening differentiation and driving long-term value through medical innovation and clinical outcomes. Bumrungrad Hospital Foundation and Bumrungrad International Hospital are committed to promote public health and well-being.
To support this initiative, we organized the Bumrungrad Rest to Heal 2025. This is a charity fund run held on February 16 at Chatuchak Park. The event welcomed over 1,000 participants, supported by 37 sponsors, and very successfully raised a total donation around THB 2 million. A testament to the strong engagement from our staff and partners. Thank you.
[Foreign language] My name is Rajiv Rajan. I'm the Chief Business Development Officer. I would be presenting to you the first quarter update of 2025. Net patient revenue by market segment overall, we had a negative 6.1% versus the first quarter of last year. International, we had a deficit of 11.6%. For the Thai segment, we saw growth of approximately 1.1%. For the expat segment, a negative growth of 1.9%.
Further to elaborate on the international segment, further to elaborate on the international revenue into three categories: Middle East, Indochina, and others. Middle East, we saw a significant 30.6% approximately. This was majorly because of the early onset of Ramadan, which affected the healthcare utilization patterns across this region. Also, because of the early Ramadan calendar moving, you know, every year a few days early, this year, most of the key Ramadan period was in Q1 of this year, unlike last year, which was shared between Q1 and Q2.
Further to have more details on the Middle East revenue by major markets, Qatar, we saw during the period of first quarter, our admissions increased 8.4% quarter over quarter. Our outpatient services visits rose by 13.4% approximately quarter over quarter. However, reductions in average length of stay and treatment intensity led to a close to around 24.4% quarter over quarter revenue decline. UAE, our inpatient admissions increased by approximately 12% same period versus last year, while OPD visits declined during this period, resulting in an overall quarter to quarter revenue decline of approximately 39.6%.
Again, this mostly also because of the early onset of Ramadan and mostly over 90% of the Ramadan holidays being in Q1 of this year. For Kuwait, we do not have any specific update or any other data as of now.
You know, we expect similar trends, which is anticipated because of the regional factors that were mentioned earlier as well. For Saudi Arabia, we will be participating in the Thai Festival, which is expected to be organized in the first week of May. It will be held in Riyadh, and we will be joining this event and representing our organization there. It is expected to be held over three days, having over 20,000 visitors who would be visiting this booth, local residents, Saudi nationals.
This is organized by the Thai Ministry of Tourism, Health, and External Affairs. We believe that this will influence future engagement and opportunities from this region. Moving to the Indochina segment, where we saw approximately 2.4% growth quarter over quarter, breaking it down into further in terms of countries.
Bangladesh, we experienced a 16.8% quarter over quarter decline, primarily due to Ramadan and also another factor, which is approximately a 20% decrease in incoming travelers during the month of February and March. This is likely, you know, it is linked with the visa challenges.
You know, Thailand had introduced the new e-payment, you know, e-visa for Bangladeshis, which was brought into effect in January of 2025. For the e-visas, the payments had to be done physically in banks, which was creating a lot of backlogs. In March, they reintroduced an e-payment link, where they can make the payments online. Because of this, we can see some of the backlogs getting cleared.
Because of the visa challenges and the backlogs and accessibility issues in terms of making payments, we could see slowing in the process of visas, which was also a reason for a drop in the number of tourists coming into Thailand. As per the numbers, a 20% decrease in incoming travelers during February and March. However, the e-payment is now in place, and we expect these issues to improve moving forward. For Cambodia, OPD visits grew approximately 22% quarter over quarter.
However, revenue dropped about 7.1% due to lower intensity services. Myanmar, we noted a significant growth of around 19.8%, indicating a robust recovery from this market this quarter. We are closely monitoring the post-earthquake situation. Our clinic in Yangon continues to operate normally today. For other markets, China international patient revenue declined by 11.6% approximately.
This highly correlates with the, you know, 24% approximately decrease in Chinese tourists' arrival into Thailand, as reported by the Ministry of Tourism and Sports. However, revenue from Chinese expats for us grew by 8.5% quarter over quarter. For international Chinese revenue coming in from mainland, the decrease we expected because of the, you know, it correlates with the tourism and the factors being the economic challenges and safety concerns that have contributed to the downturn in Chinese tourists into Thailand.
For the U.S., we overall see an increase by approximately 17% quarter over quarter, reflecting a positive trend in the healthcare engagement from this market, which is a significant contributor to the 6.3% from the others vertical. In the next slide, I have the international revenue by top 10 nationalities.
As mentioned before, Qatar, we overall see a 24% drop in revenue, but we see a significant growth in terms of our admission numbers and also the OPD numbers. Myanmar, a strong growth by 19.8%. The U.S., a strong growth quarter over quarter by 17% approx. Cambodia, close to 7% in terms of the value. In terms of OPD numbers, we see a growth quarter over quarter versus last year. Bangladesh for Ramadan and also for the visa factor, but, you know, 16.8%
. The UAE, a strong growth in terms of numbers for IPD, where we see a significant growth quarter over quarter for inpatient admissions, 39.6% mostly because of Ramadan and also from OPD footfalls coming down because of the Ramadan period. China, Ethiopia, and Oman. Overall for international, 11.6% deficit versus quarter last year. That's the update from Business Development. Thank you. Sawadee ค่ะ
Now we come to the end of the presentations. We will hold another meeting Q&A session on Wednesday, 30 April, at 10:00 A.M. to 12:00 P.M. Management will be happy to answer all your questions that you may have. If you have any questions before the meeting, please feel free to send your questions to email at ir@bumrungrad.com, and then we will address those questions during the meeting. For today, thank you very much, and Sawadee ค่ะ