[Non-English content] . Welcome to the analyst presentations for the first quarter of 2026, Bumrungrad Hospital Public Company Limited. My name is Achariya Sanrattana, Investor Relations and Sustainability. For the first quarter, we will have the analyst meeting in an online format. We will upload this pre-recording of the webcast for the analyst presentations on our website IR page. Later on, we will have the live Q&A sessions live streaming for our analysts and fund managers. For the presenter today, we have Kun Aniello Sorrentino, Corporate Chief Strategy Officer, talk about the 1Q 2026 BHPCL performance summary. Then we have Kun Artirat Charukitpipat, Chief Executive Officer, to talk about the business update. Then we have Kun Oraphan Buamuang, Chief Financial Officer, to give us an update on the financial highlight and the performance.
We have Kun Rajeev Rajan, Chief Business Development Officer, to update us on the business development side.
Good morning, and welcome to Q1 2026 performance summary for Bumrungrad Hospital Public Company Limited. The quarter was an interestingly strange one in that 100% of Ramadan occurred in the quarter. Despite that, our performance from the Middle East was unusually strong. Part of that was due to slow incoming Middle Eastern patients, but the other part of it was that homeward-bound Middle Eastern patients were not able to get back into their country because of the war impact ongoing between Iran and the United States. We benefited from that by Middle Eastern patients remaining at Bumrungrad while sick. They weren't so acutely ill that they couldn't go back home, but because of the war, they remained at Bumrungrad, and it helped us with revenue. It helped us with revenue intensity.
When you look at the first bullet point up there, you see that our EBITDA performance and NOPAT performance was up significantly, especially for Q1 of any given year when Ramadan occurs. Up 5% and 3.2% from EBITDA and NOPAT respectively. More importantly than that, because of our good cost control, our margins at EBITDA almost touched 40%, which is a record for EBITDA margin for the company for any quarter, notwithstanding the first quarter 2026. When you look deeper into the numbers, and Rajeev will get into those numbers, I'm not gonna cover them here, but you can see the bullet points here of the countries that drove the earnings for the quarter, Myanmar, Qatar, Bangladesh and UAE.
I mentioned about the war impact having an inverse effect on our ability positively to drive earnings in the quarter. We'll see what happens in Q2, but early reports about Q2 are showing now with the war sort of settled down and there's a ceasefire, at least temporarily, we are seeing some incoming Middle Eastern patients coming to Thailand. They're few, but they are migrating to Thailand, and we have seen increasing admissions vis-à-vis Q1. We'll see where that all ends up by the end of the quarter. For Cambodia, really nothing has changed there, and it's affected our Indochina statistics. Rajeev will cover what it looks like before Cambodia and after Cambodia. For us and our competitors, none of that has really changed. It's still a very soft piece of business for Thailand.
Let me talk a little bit about some other aspects of future development for the company that came up during our annual general meeting this past Wednesday. We had a lot of questions about the Phuket project. As you know, we've had some community interruptions with respect to EIA and with respect to permit pulling, but we're well past that now. The project is well on its way. All the foundations are poured, steel is poured. The project is coming out of the ground, and we expect to have a soft opening at the end of Q2 2027. Soft openings typically take four weeks or six weeks, depending upon how things flow. As importantly, we are already building the human infrastructure about the project in Phuket. Meaning we have an executive director now on board.
He comes to us from Kaiser Permanente. We have a CFO on board. We have a medical director on board. These people as a group are looking to create lists of physicians who they want to recruit to the hospital. We have a lot of interest from the local physicians in the market that want to work at a Bumrungrad Hospital. As you may know, we have a long history of caring for patients from Phuket here at Bumrungrad Bangkok. That's an important positive new source of income for the company once that opens in Q2 of 2027. As well, we are continuing to build out our Soi One project, which has two buildings now under construction. That's going to be 50-some-odd new beds.
They'll be med-surg beds, but mostly driven surgically as opposed to medical, but there'll be some of both. The third building on that project will be clinical operations. Down the street from it, we're in the process of building something called the Annex Building, but that name will change from Annex Building to Bumrungrad Oncology Institute. We'll be moving all of the outpatient oncology business out of the main hospital into that new building. It's gonna be a very, very nice third tertiary level outpatient oncology center. It'll be interconnected into the main hospital. It'll be seamless for our doctors and our patients to move from one building to another building.
As it relates to M&A, we have seen a continuous request from a number of different entities, and I think part of it is because of the very, very weak Thai economy, geopolitical situations, where we've seen more inquiries about Bumrungrad, looking at different M&A projects, greenfield projects, brownfield projects, none of which at the moment is beyond an exploratory analysis. We are committed to building a greenfield diagnostic center, outpatient diagnostic center in Bangladesh, and that's going to look like somewhere around Q2, Q3 that'll be opening. We're well on our way. We have an in-country partner already signed up. The structure is arranged. The leasing is, I believe, fully done by now. The equipment list is already packaged up. We know what we wanna put in there.
It's gonna be a larger version of a diagnostic center that we now have in Yangon, doing more things in the market with the opportunity to do further diagnostic centers in Bangladesh because it's a very important market for us. As it relates to the question of guidance for Q2, we are next Wednesday at 10:00 A.M. going to have an online live stream Q&A that we, the management, will be answering questions that you may want to pose to us. As you pose them to us, I will be addressing what the guidance will be for me and for the company in Q2 going forward. We encourage you to join that. It'll be important for you to ask your questions, as many did online.
Our AGM was handled electronically, and we had a lot of questions about not only Phuket, but a number of other things. We're seeing that the response to the performance of Q1 was a bit of a surprise, a good surprise for the investor community, and we were happy to be a part of delivering that. This is an important slide on net patient revenue proportionality. If you look over here on the left side of this slide, you will see that on Q1 2026, the Middle East piece of the non-Thai was up 22% versus last year, Q1 2025, which was 18%.
18% is a little less than normal for Q1 during Ramadan, but nonetheless, because of the war impact and some infiltration of Middle Eastern patients coming from other parts of the world, not necessarily Middle East, Bangladesh, et cetera, the Middle East patient rose by 22%, up 4% from last year. Indochina almost the same, and others were exactly the same. You'll see that for Q1, 2026, the non-Thai was up 66% versus 64% the prior year, and that's principally due to greater Middle East revenue participation in Q1, 2026. Next slide. This one depicts, and we show this to you quarterly.
This one depicts the changes in the non-Thai, Thai business, and you'll see that in Q1 2026, the non-Thai is 66% versus the prior year quarter was 64%. Again, driven by Middle Eastern incremental business in Q1. Unusual for the Ramadan quarter. We're very, very pleased that the Middle Eastern population and the country, Kingdom of Qatar in particular, has been very, very supportive of Bumrungrad, and we're supportive of that country. We'll look forward to seeing you next Wednesday. Thank you very much.
[Non-English content]Good morning. I'm Oraphan Buamuang, Chief Financial Officer. I'm pleased to report to you all the financial highlights and financial performance of first quarter 2026. In first quarter 2026, total revenue slightly increased by 0.7%. EBITDA and net profit increased by 5% and 3.2% respectively. The EBITDA margin and net profit margin in first quarter 2026 were 39.3% and 28.6% respectively, which improved from first quarter last year. I will walk you through more detail in financial performance section. The total revenue in first quarter 2026 was THB 6,254 million, slightly improved from first quarter 2025 by 0.7%.
The total revenue improvement came from the increased revenue from hospital operation, which improved by 1.4% when compared to first quarter 2025. This was primarily driven by 4.2% increase in revenue from non-Thai patient, which offset 3.6% decrease in revenue from Thai patient. The increase in non-Thai patient revenue was mainly attributed to a higher contribution from Middle East, increased by 21.3%. Myanmar increased by 15.1%. Bangladesh increased by 25%. In terms of revenue contribution by service, in first quarter 2026, the revenue contribution from in-patient service increased to 51% from 48% in first quarter last year due to IPD revenue increased by 7.4%, while OPD revenue declined by 3.9%.
IPD revenue increased mainly due to higher intensity and longer length of stay. In terms of revenue contribution by payer type, the government third party contribution in first quarter 2026 was 16%, increased from 13% in first quarter last year due to higher Middle East revenue. Insurance contribution in first quarter 2026 is 22%, remain the same as first quarter last year. Self-pay contribution slightly dropped to 61% in first quarter this year from 64% in first quarter last year, but still be the highest contribution by payer type. In terms of EBITDA and EBITDA margin, in first quarter this year, EBITDA was THB 2,455 million, increased from same period last year by 5%. This represent a favorable change compared to the 1.4% increase in revenue from hospital operation.
EBITDA margin in this quarter was 39.3%. In terms of net profit and net profit margin, in first quarter this year, net profit was THB 1,790 million, improved from same period last year by 3.2%, with net profit margin at 28.6%. In terms of leverage ratio, net debt to EBITDA in first quarter 2026 was negative at 0.4 times, and net debt to equity was also negative at 0.1 time due to less net debt. In terms of liability asset, at the end of first quarter this year, the liability to asset ratio stay at a lower level of 14.8%, primarily due to the ongoing growth in net asset. These are all financial highlight and financial performance result of first quarter 2026.
Thank you for your attention, Ka.
[Non-English content] Overall performance in Q1 2026 reflects modest growth with underlying strength across key segments. Total net patient revenue grew 1% year-over-year. Excluding Cambodia, revenue growth was significantly stronger at 4.8%. The non-Thai segment delivered a 4.9% growth, improving to 9.9% excluding Cambodia. The Thai segment declined by 3.6% primarily due to softer domestic demand. The non-Thai revenue performance, the Middle East remained a key growth driver despite late quarter headwinds. Overall, 21% year-over-year growth. Strong contribution from Qatar, which grew by 28% approximately, UAE which grew by 25% approximately, and Oman which grew by 12% approx, and also continued growth from Saudi Arabia. Key trends from the Middle East, inpatient revenues and admission increased during this period, offsetting to softer OPD volumes.
OPD slowdown emerged towards the end of February due to escalating geopolitical tensions. Qatar sustained growth driven by higher patient inflows and improved specialty mix. UAE continued the momentum from the new empanelments established in second half of 2025. For Kuwait, the old receivables were settled up to a defined cutoff date. Ongoing discussions for phase II collaboration and referral partnerships are still undergoing. I was in Kuwait in February, mid-February during the discussions, but the progress has slightly slowed down due to the regional geopolitical dynamics. But however, the long-term outlooks remain positive. For Indochina, performance reflects mixed trends with strong underlying growth excluding Cambodia. We had an 8.5% decline year-over-year, however, 13.6% growth excluding the Cambodia revenue. Bangladesh has seen a 25% growth, strong across both IPD and OPD services.
Our first clinic launch in Bangladesh is underway. We are expected to commission it within this financial year. Myanmar has seen a steady 15% growth. It has continued to grow over the high base last year, sustained through outreach programs and our Yangon clinic network, which we have been utilizing and leveraging upon for continued engagement and performance. Cambodia has seen no specific recovery, you know, observed following the ongoing political tensions. Business trend remains subdued and consistent with post-tension levels. For other markets, China being one of the key other markets, we have seen a decline in both expat and fly-in segment for Chinese nationals due to the travel sentiment sensitivity towards Thailand.
However, we have seen a good number of patient referrals through the networks and collaborations that we started last year during this period. New partnerships and regional collaborations have brought us new patient referrals from the region, from both the expat segment and from mainland. We continue our strategy to diversify our presence across multiple other cities in China. For United States, overall the revenue declined 6.5% year-over-year. The weakness primarily from the expat segment, which was driven by workforce recalibration across corporates, public institutions and nonprofit organizations. Fly-in segment, which are the U.S. nationals flying in from the U.S. and also from the neighboring countries of Cambodia, Myanmar, Laos, Vietnam. We see continued growth in both volumes and revenues during this period.
For the non-Thai revenue, overall for top nationalities, as mentioned, Qatar, Myanmar, Bangladesh, UAE, U.K., Canada and Oman stands out to have a great performance for the quarter. The total for non-Thai patients is a 4.2% growth year-over-year. If we exclude Cambodian revenue, the total non-Thai patients excluding Cambodia stands at close to around 9.9% approximately in this quarter versus the last quarter. That is the update from my side. Thank you so much. [Non-English content] .
[Non-English content] . Today I'm going to present our operational report for the first quarter 2026. Let's start with the first slide. Let me walk you through the key highlights from this first quarter. We launched a new personalized weight management program in January. This program takes a personalized approach, covering lifestyle, nutrition recommendation and medical treatment. On 26 January, VitalLife announced the launch of its longevity ecosystem, a strategic network built across five partners, such as tourism, financial services, lifestyle, academic research and digital technology. The goal is to help people live longer and live better with care that extends beyond the hospital into everyday life. On 29 January, we signed an MOU with Chulalongkorn University to collaborate on medical research and innovation. We aim to develop new technologies that meet Thailand's healthcare needs and support our country's vision as the medical hub of Asia.
As usual, on the 5th of February, Bumrungrad Spine Institute co-host the 58th international training course on endoscopic spine surgery. Now, this is the 18 years that we doing continuously. This course trained Thai and international surgeons in minimally invasive techniques. We are so proud to share that Bumrungrad has climbed to number rank of 96 in Newsweek World's Best Hospitals 2026. This is up from the rank 100 last year, and we still are the number one hospital in Thailand for the sixth consecutive year. This achievement belongs to all our physicians, every team members, and our board of directors whose continued support and make this success possible. We were also recognized as one of the Asia's Top Private Hospitals & Clinics 2026 by Newsweek. We rank number one in Asia in knee, hip, shoulder and refractive eye surgery.
Number three in Asia in cataract surgery, but still remain number one in Thailand. This is the second year that we got this award. Now let me share our Center of Excellence performance for Q1 compared to the Q1 last year. Overall, Center of Excellence grew 9% year-on-year, showing strong demand in our specialty services. Some centers perform especially well, like Neuroscience grow the most at 20.6%, followed by Cancer Center at 15.7%, and Spine Pain Management at 10.6%. The Heart Center also achieved nearly 10% growth. These are complex specialties and the growth shows strong clinical quality and patients' trust. Some areas such as gastroenterology and colorectal surgery declined this quarter, but overall Center of Excellence performance was still strong.
On our medical innovation, da Vinci robotic surgery program completed 100 cases between March last year until March this year. Primarily in urology with successful expansion into cardiovascular, gynecology, ENT and colorectal specialties. Another one is a spine hypoglossal nerve stimulation program has completed seven cases already. In March 2026, we also achieved a national milestone by completing Thailand's first ECMELLA procedures, combining ECMO and Impella support for advanced cardiac care. Last but not least, our health fair campaign, which ran from February through March. The campaign supported preemptive health and attracted strong customer interest. This campaign generated THB 144 million in revenue and sold out 4,300 packages. We also have the promotion give out 250 Huawei smartwatches for package over THB 100,000.
Due to the good results, we have extended the campaign from the first April to 30 of June this year. That's all for me. Thank you, ka.
Okay, now we come to the end of the presentations. Thank you very much for your attention to our presentations. To those of you who receive invitations to join our Q&A sessions, it will be on Wednesday, 29 April, 10:00 A.M. to 12:00 P.M., where our management will be happy to answer to all your questions that you may have. If you have questions before the meeting, please feel free to send your questions by email at ir@bumrungrad.com, and then we will address those questions during the meeting. For today, thank you very much and [Non-English content ].