Hello, everyone. Good morning, and welcome to the live analyst meeting Q&A session for Bumrungrad Hospital Public Company Limited for the first quarter of 2026. Today we have uploaded the webcast for the analyst presentations already on Monday, and we received a few of the questions before the meeting. Today we will start with those question list first, but if you have any more questions during the meeting, please feel free to send your questions to the chat box or also to email at ir@bumrungrad.com, and then we will add those questions into the list to be answered later on. Today, before we begin with the questions, let me introduce our management that are here with us today. From my side, we have Khun Rajeev Rajan, Chief Business Development Officer. We have Khun Neil Sorrentino, Corporate Chief Strategy Officer.
We have Khun Artirat Charukitpipat, Chief Executive Officer. We have Khun Oraphan Buamuang, Chief Financial Officer. Without further ado, let me begin with the first questions that we received from online first. For the first questions, what were the utilization rate and total bed capacity in the first quarter of 2026?
The utilization rate is 20%. The total available bed is 485 bed.
For the next questions, what were the average length of stay in the first quarter of 2026?
Length of stay average is about 4.93 days.
Next questions. What was the revenue contributions from the Middle East in the first quarter of 2026?
It's about 22%.
Next questions. How much is the revenue was generated from Saudi Arabia and Kuwait in the first quarter of 2026? For this question asked about the revenue contributions. Usually, typically, we don't provide the revenue contributions numbers by countries. Next questions. What was the revenue intensity for the Middle East, Thai, and Indochina market?
We provide only the overall number. The first quarter 2026 overall revenue intensity is about 7.1%.
Next questions. In the first quarter of 2026, revenue increased by 1.4%. Would you break down this growth into revenue intensity, patients volume, and pricing? Specifically, how much did each factor contribute to the change? For these questions, we usually don't provide this level of details. For the next questions, are there any updates on the returns of the Kuwaiti patients?
Good morning. For Kuwait, as mentioned, as uploaded on the file as well, I had given a summary on the progress and the update on the future Kuwait business. In February, in mid of February, I was in Kuwait. We had a very fruitful discussion, bilateral discussion with the Ministry of Health of Kuwait. As for our position for now, the old, most of the old outstanding account receivables have been settled and the phase two part of the negotiations and discussions, and by exploring the bilateral areas of collaboration is in process. We have identified few of the areas where there would be some kind of a technical capacity sharing, and we are in discussion in process for discussion for that.
That will further might be have a consolidated and a very, very focused approach for the patient referral program as well. Unfortunately, because of the political sensitivity in the region and also the geopolitical you know, situation which happened towards the end of February and which still continues, we did not have any mature discussions after that date. We are in touch and there are a lot of exchanges happening in terms of communication. Hopefully once the once this situation stabilizes and we will come to a point where this matures to a patient referral program, that is definitely the future plan for the Ministry of Health of Kuwait also. They have expressed the interest over the past that they want to reestablish the referral relationship with Thailand, specifically with Bumrungrad.
There will be selected service providers that they will be shortlisted for the referral program. Bumrungrad is one of those hospitals and we are confident that once this gets established, we can restart the process. To a specific date, we do not have that date as of now. We are quite convinced and we're quite happy with the progress and the quality of negotiations and discussions that we are having as of today with them.
Thank you . Next questions. Would you please provide a breakdown of EBITDA margins for in-patients and out-patient segments and between Thai and non-Thai patients in the first quarter of 2026?
Yeah. We look at this information for two years ago, and we think that its result is follow the same trend. Profit margin across market segment do not different significantly, as Thai patient typically receive the higher discount and non-Thai patient tend to consume higher level of support service.
such as interpreter and medical coordinator.
Next questions. What percentage of total revenue was contributed by the top 10 nationality in the first quarter of 2026? For this questions, we also do not provide the revenue contribution numbers by countries. Next questions. What is the ratio of self-pay and government sponsor of the Middle East revenue in the first quarter of 2026?
The overall is estimate about 75% of the Middle East patient are government payer. The 25 are self-pay.
We can also say that, with respect to non-Thai business, depending upon the quarter, can range from 65%-66%-67% of total revenue. I think for Q1, Khun Oraphan was 66%. Am I correct?
Yes.
Yeah, 66% for Q1 for non-Thai.
Next questions. What are the revenue growth year-over-year of Kuwait, Cambodia, and expat in the first quarter of 2026?
Rajeev?
For Kuwait, even though, you know, it's overall in terms of percentage, it's a deficit of close to 42% year-over-year for the quarter. For Cambodia, it's close to around 78% approx. Again, for Kuwait, I would like to add more color on that. We are talking about a base which is very low when compared to what we used to have in the past. Even though the percentages might be very high, but the value associated with it is quite minimal. For the expat revenue for the Q1 of 2026 versus Q1 of 2025, we had a close to around 4% growth approx.
I think it's also important to make the point that despite the Cambodia revenue being down by such a large amount, not only for us, but for every other provider because the border is closed. In the quarter, which was 100% Ramadan, we were able to deal with Ramadan, we were able to deal with the Cambodian revenue decline and still grow the EBITDA by 5%. It speaks again to the diversity of our business base to be able to drive 5% EBITDA growth and almost 40% EBITDA margin in the quarter. Next question, please.
Thank you. Next questions. What percentage of Middle Eastern patients were new patients in April? For these questions, we also don't provide this level of details. Next questions. In which department do Middle Eastern patients mostly seek treatment for?
Khun Leng?
Mostly our Middle East patient will come to treat, oncology, cardiology, neurology, general surgery, and nephrology, which is very complex cases from this market.
Thank you . Next questions. What were the reasons for choosing to establish a clinic in Bangladesh? What makes it stand out from other countries? What is the investment amount? Will BH doctors be presenting there?
Rajeev?
Bangladesh, in terms of the possible opportunity for treatment abroad or patients traveling out of country, to Singapore, to India, to Thailand, from a strategic perspective, we saw a long-term vision where we feel that there is an opportunity there which is untapped and which can be diversified even further. We, for our two decades plus, we have a very strong relationship with Bangladesh. We have a pretty decent base of business. For the last couple of years back, you know, we started with a strategic vision to further diversify our presence locally, first through adding more referral offices or information centers in Tier 2 and Tier 3 cities. In the last couple of years, that is what we were focusing on, diversification.
We added or diversified our current capacity to Tier 2 and Tier 3 cities. With those efforts, we also added it with more periodic outreach and projects which we initiated in the last couple of years. Our doctors were more present in the region. We built a better connect with that community, which of course translated to a consistent growth, a double-digit growth in the last couple of years. We feel that there is a potential to expand even further. Similar to what we do with our Myanmar market, and we have consistently done, and we have also set up a clinic in Myanmar. Similar to that kind of a setup, we plan to further in order to provide some services locally within Bangladesh for our routine and regular customers.
We plan to set up this center, which would be a primary screening facility and will have the same capacity as what it has in our clinic currently in Myanmar. Through this, we can again ensure that we are providing the seamless care we are providing and reaching out to patients more continuously and more effectively and also providing a solution to their day-to-day needs and ensure there is a continuity of care, and they can connect to our specialists back in Bangkok more frequently and with ease of access. With this objective. We are planning to have that clinic. The clinic will be commissioned this year and it will be same with the capabilities what we have currently in our clinic in Yangon in Myanmar.
We will, you know, in terms of doctors being positioned there, we will not be having full-time doctors or doctors from Bangkok who will be stationed there. The model of operations also will be similar to Myanmar, where based on the current rules and regulations of Bangladesh, you know, having visiting consults in country for foreign doctors are legally not possible because of not having a legal entity registered which provides medical services locally. With our company being registered there locally, providing medical services locally there, it will give that access for our clinicians in Bangkok to have a temporary registration with the Medical and Dental Council in Bangladesh, which will further facilitate visiting consultancy in a much more regularized platform in our center.
This is also similar to what we do in Yangon and which will further be there. We'll have a GP, a full-time practitioner who will be based out of the center in Bangladesh. For the specialist, we will have routine periodic camps and organized OPD schedules for experts with a calendarized schedule for them for one year, for six months, for three months in a very planned and focused way.
We also have a very, very strong in-country partner that will be actively involved. Although he's involved in many different businesses in Bangladesh, he's very interested in healthcare. He's a long-term patient at Bumrungrad, and we're excited to have him be a part of this venture. With respect to the investment, in the context of things, it's de minimis. We may daylight that to you once we finally finish the project, which will be sometime into Q3, if I recall correctly. Is that right, Rajeev? Next question, please.
Thank you . Next questions. What type of treatments do Bangladesh patients mostly seek for? Are they self-paying patients or do they use insurance?
Rajeev?
Mostly, Bangladesh patients usually come in for high intensity care. By specialty is mostly cardiology, neurosurgery, and gastro and also oncology. For the case mix or in terms of the payer mix, over 97% of them or approximately 97% of them is self-pay.
Thank you . Next questions. How is Bumrungrad preparing for potential drug shortage?
Khun Rain?
So far, we don't see any impact from the shortage of medicine and also medical supplies. Actually, since the war, we already prepare for the stock around three months, and we also freezing the cost and negotiate with the pharmaceutical vendors and also medical supply vendors.
Thank you . Next questions. Move on to the financial questions related. By how much did Bumrungrad increase price in 2026?
The overall, we increase about 4% , in the beginning of this year to cover in term of the wage inflation and cost inflation . There is no any plan in term of increase during this year .
Thank you . Next questions. What is the discount rate in the first quarter 2026?
Discount is about 12.2% .
Yeah, we are seeing more conversion to insurance coverage. In which case, when that happens in any market, you're going to have an increase in the discount rate. Typically our fourth quarter has a higher rate because of year-end packages and checkups and such. The impact of insurance conversion also is a factor on this discount rate in the quarter.
Thank you . Next questions. Could you explain what happened to higher accounts receivable days on hand? It is due to Qatar have difficulty in paying on time or not?
In the overall AR day in first quarter this year is about 71.7 days , which increased from last year. This is due to in term of the sum of certain of Middle East account and the balance trade of receivable over more than 90 days increase as well, primarily related to the Qatar accounts . In term of the discount, we discount with the Qatar along the way, and we expect to have the partially pay in June, July this year . With our experience more than 20 years, the third party government has low payer, but they will always pay .
Do you have any other comments, Rajeev, on Qatar? Because you've talked to them at some length.
Yeah, I think, I would might be rephrase the question, because is it due to Qatar having difficulty in paying? I don't see any difficulty here. I think, you know, there is geopolitical tensions for sure. You know, there are a lot of processes involved in the payment. There is also, in light of the account receivables from Qatar, there is also a process change for the receivable management where Qatar has introduced a new third party insurance company for the process, for processing the claims, for claim management, which was introduced towards the end of 2025. This is not related to geopolitics, or this is not related to the war.
This is related to a process where they are migrating to a digital platform for claim submission, which will save a lot of time and which will, in terms of the processing, in terms of the verification of the documents being submitted, will be faster and smoother. When we are migrating and when we are getting used to this system, it usually takes some time. This is a process we started towards October 2025. Since that, you know, there has been multiple training sessions, multiple, you know, periodic understanding their software at both sides, from our side and also from the team back with the insurance, the third party who is facilitating such. This is a teething issue.
You know, I think once both parties are aligned together on the processes and going forward, it will be much more faster and smoother for claim management and processing. So far as of from our end, you know, in terms of the account receivables, all major bills for specific periods have been uploaded and have been settled in terms of financial checking. We believe, as mentioned by Pipooh, that, you know, by June, July, we will might be having the funds partially, and going forward it will be much more smoother and faster.
We have a very, very strong partnership, with the Kingdom of Qatar. I wish I had more like that. We're very happy with our relationship, with that country and the people that represent the Qatari citizens. Next question, please.
Next question. For the 3.6% year-over-year decline in Thai patients revenue in the first quarter 2026, could you please provide a breakdown of year-over-year percentage change in in patients and outpatients revenue?
In term of Thai patient revenue down by 3.6 is compounded by the revenue from IPD declined by 5.8% offset with OPD increased by 1%.
Thank you. Next.
Let me, let me talk a little bit more about that as to why we believe the decline is there. Part of it is in the way that insurance companies are now instructing insured on how to, especially with pediatric patients, how to access healthcare, how to access outpatient healthcare versus inpatient healthcare. In fact, we understand there are some in-insurance underwriters that are not even writing insurance for newborns. For the pediatric Thai business, there is a change in the behavior of how insurance companies are interfacing with enrollees, and how enrollees, as a result, are taking a different approach about how they seek care for their children, whether they be less sick or more sick. I think that has affected utilization at some level.
In addition to which, when you're in this kind of a depressed economic environment, people around the world, and it's not unusual, and it's typical here in Thailand as well, they start looking for insurance programs to participate in because they're trying to handicap the cost of healthcare against a premium cost risk. We're seeing that, we're seeing that change, especially in pediatrics. We're also seeing some change in the way people are making healthcare decisions for elective surgery. Some of that, it being elective, some of that is being delayed for economic reasons, for uncertainty reasons. Until the economy turns back around in Thailand, this is going to be an impact that every healthcare provider in the region will feel, especially with Thai patients. Next question.
Thank you. Next questions. Of the 4.2% year-over-year increase in the non-Thai patients revenue, how much was driven by volume growth? For these questions, we also don't provide this level of details in terms of the separations between volume, price, and intensity. Next questions. Could you also provide a breakdown of year-over-year percentage change in inpatients and outpatients revenue for non-Thai patients in the first quarter 2026?
In terms of non-Thai patient for IPD increased by 15.3%, while OPD declined by 6.8%. We saw a longer length of stay in this quarter for non-Thai patient.
Thank you. Next questions move on to the outlook questions. The revenue growth guidance in the second quarter of 2026.
When you look at Q1, we were somewhere between 1.5% to 2%, depending upon how you calculate it, whether it's inpatient versus total growth. This was during an entire quarter of Ramadan and in fact, some of Eid holidays. I expect in Q2 a slight improvement in the revenue growth, given the fact that now we are seeing more patients coming from the Middle East that began at the end of Q1, and we continue to see some of that positive movement in early Q2. I'm guiding ±2% for Q2. Top line revenue growth.
Thank you . Next questions. What are the outlook for income trend among Thai patients in terms of the volume and intensity of competition?
Well, I've commented earlier to a previous question about the weakness in the demand in Thai business for the reasons I've already discussed with you in an earlier question. Revenue intensity and volume are main factors in driving revenue growth. These two factors will be mitigated to some extent because of the economic conditions in Thailand. We'll see how that changes from quarter- to- quarter in calendar year 2026. Right now, Bank of Thailand is looking at somewhere something close to a little over 1% GDP growth. When you look at that compared to the guidance for Vietnam as an example, which is 7% GDP growth, there's a dramatic difference between Asian countries, Southeast Asian countries. And there are many reasons for that.
Many of you may know what they are. There are many reasons for that change in Thailand's weak growth. The economic fundamentals in country are at least today in the short term problematic. For price increase, I think Khun Pu mentioned earlier that there's 4%, and we only look at that with respect to wage inflation coverage. Next question.
Thank you . Next question. When will the Soi One and the Annex building finish?
We expect two projects. Actually, that would be two buildings in Soi One and and building in the Annex building, which will be the Bumrungrad Outpatient Oncology Institute at the end of 2027.
Thank you . Next questions. In the current situations impacted by the tensions in the Middle East, will this impact the initial break-even period for the BIH Phuket?
Let's see. Let's see here. Well, the person who asked this question is asking two very, very different things. One has to do with break-even point, which is at best a forecast depending upon how we prosecute the opening of the institution and how well we're able to recruit international medical tourists into Phuket and then into our institution. I think in our Annual General Meeting last week, we talked about this question to the shareholders and projected a 12 to 18 month break-even point, depending upon a lot of things, some of which are very controllable, which means how it is that we run the business. Some of these external variables are much less controllable. The economy, geopolitical situation, these are things we don't, we don't have control over.
We're less worried about those elements right now. We're much more concerned about finishing the hospital, building the medical staff. We've already built the management team. We know the direction where we're going. Rajeev will be responsible for the business development for the institution, he and his organization. We do have Khun Leng and Andrew Giles, who I believe we've introduced before. He's the Executive Director of the hospital. He's already on board. He's been with us since January. We'll be moving to Phuket in July, he and his family, working in the market and developing the relationships, carrying forward from what David Boucher had done in the early days of the development of the community development aspects of the market. We're very excited about the Phuket project.
When you think about a new greenfield, you don't think about 12-18 months. You think about the long term, brand-new revenue, brand-new income for the corporation, without having to worry about where does the organic growth come from, which we'll worry about here at this institution. There it'll be brand-new revenue. We see it as a tremendous opportunity because even despite the geopolitical situation and the economy, Phuket, frankly, is doing much better than is the greater Bangkok and Chiang Mai area insofar as inbound tourists are concerned. We're very, very positive about the Phuket project.
Whether it's 12 months, whether it's 18 months, that matters, that matters less than, you know, are the fundamentals of what we're doing there and the market conditions and the competition and how it is we think we can drive revenue share and EBITDA share and NOPAT share. Those are the much more important issues as opposed to is it 12 months, is it 18 months? I really don't care about that. I care about us executing correctly from day one, and running a very, very good hospital inside the four walls of that. If we do that, we'll be very successful there. Next question.
Thank you . We finish with the questions that are sent prior to the meeting. I will start with the questions that we received from the chat box . The question is, since Thai patients revenue is down, can you confirm if the local patients reduce visiting for minor ailment, whereas continue to visit for complex needs such as cardiology and oncology in line with the strategy of 2026?
Khun Leng.
We found that for our Center of Excellence, Thai patients increase more utilizations. You can see the numbers of our heart center, or the neurology and also DDC from the Thai patients increase a lot.
Thank you . Next questions. Could you share details related to the oncology center at BH? When it will be finished, what are the related CapEx expense? How many patients can it support?
You, you should remember that this is an outpatient center. This is not an inpatient facility. It'll be finished at the end of the year, as I mentioned earlier. How many patients can it support? Lots, because it's going to be a six-story building with two stories underground. We expect to move all oncologic business, outpatient business from the main hospital into that building for better efficiency and economies of scale in dealing with all those patients in our, in our center. I don't know what the average patient utilization is per day now in the hospital, but it is significant, especially when you consider chemotherapy patients, first time patients that are visiting, follow-up patients. It's, it's a significant number because oncology is a very big service at Bumrungrad.
Very, very big, tertiary service at Bumrungrad.
Thank you . Next questions. For the procurement policy for medicines and medical supplies during high oil price, what are the procurement policies during this period?
Sure, please.
Okay. Actually, as Khun Oraphan always mention, we have very strong procurement policy and always prepare for the inventory management. Since, by the end of the last year, we will negotiate with all the vendors and try to freeze the cost from the medicine and medical supply. Even, during the high oil price, that's why I said we are not impact from that, topics. The policy of the procurement is still the same because we still monitor the inventory very closely and also we freezing the cost from the vendor, as I already mentioned.
Yeah. To add in terms of regarding to concern on this one as well, the petroleum increased price, so it reflect to the plastic or anything else that related to the supply as well. We have been talk with the vendor and lock the price and also, post some of the future order in terms of the freezing price as well .
Thank you . Next questions. If the U.S.-Iran conflict weaken the GDP in Qatar or other Middle East countries, how could that affect patients referral to Thailand?
Rajeev?
I'm not a geopolitical expert.
None, none of us are.
Neither can I predict the GDP of what the GCC countries would be or how it would be affected. You know, in lines to this question, so what if more infrastructure is affected? What if the overall revenue generation streams, in terms of the inflows of how they make money, because most of the revenue generation in the GCC is from the energy sector. With this interrupted supply, the energy prices are going high, and also with shortages of energy, I think it will lead to a global crisis because it's not only a question of the GDP of Qatar. It's also because Qatar is a leading energy supplier in terms of LNG to the world.
It is the largest producer of LNG and that shortage could create a global crisis and increase overall prices everywhere. But in that scenario, if there is less revenue coming into Qatar, and they have to control the spending, I believe that could be an opportunity overall everywhere because that means they will have to cut down on the healthcare spends, cut down on other spending, and have to focus. We, you know, we are one of the destinations where Qatar is sending its citizens for treatment. In terms of treatment abroad, we are one of the many destinations. The majority of the destinations are either in the EU or towards the West, which is United States of America.
We provide in terms of clinical quality and also far beyond service excellence standards for the citizens who visit our facility, which is absent in the EU or in the U.S. We know that there are capacity constraints in those regions. At our facility here, treatment is more accessible, it's more fast, and we have the hospitality as well, which is a much more added layer to those patients coming here. So far, the volumes from Qatar have increased because of these reasons I mentioned. We feel that, you know, if there is a sensitivity around it, I think the volume should increase or might be redirected towards within Asia and especially towards Thailand.
There's another hypothesis here also to think about. With energy prices being high, if countries in the GCC, including Qatar, are able to outbound their products and services around the world at such high prices, they will be generating a great deal more revenue on a per unit of service basis, which only adds to the wealth of the country. Qatar is an extremely wealthy country in the first place. This conflict will resolve itself. All wars resolve themselves historically either with surrender or a diplomatic solution. That's just the way the world has worked since the beginning of time, and this will get resolved as well.
Until that time comes, I am sure Qatar is working very hard as all GCC countries are in finding alternative routes to ship their goods and services. To the extent that they're able to at these high energy prices, they'll be making a great deal of money in the interim until it rebalances back down to normal numbers. This conflict too will resolve itself. It just has to. Next question.
Next questions. Could you provide more light on comprehensive weight management program such as GLP-1 therapy? What is the interest seen Thai versus non-Thai? Which company have you tied up for the GLP-1 drugs?
We launched a weight management program event to show to the public that we emphasize on the concept of the multidisciplinary, and we have more subspecialty to take care of the patients. Starting by the assessment by the endocrinologist, and we also provide personalized approach to consult to the patient about their behavior and lifestyle modification, nutrition. Also when you mentioned about GLP-1 therapy, of course, it's very popular drug, and we also emphasize about fake drug in the market. With the two market between Thai and non-Thai, of course, non-Thai patient are interested and more consumption in terms of this GLP-1. For the company, we not do any exclusivity with any company. We open for. Currently, we have two companies.
Thank you. Move on to the next questions. Would you please share the bed utilizations in the first quarter 2026? Also giving that bed utilizations in the last few quarter have been lower compared to the three years ago, is management looking to boost bed utilizations or is management very happy with the utilizations level as it is?
In terms of the bed utilization is based on the available bed as well. You can see that in terms of the past we have available bed maybe is about 400 or 410. Now available bed we increase about 516 some about this level because we already finished in terms of the renovation, something like that. The calculation of utilization, we based on the available bed. It depends on the available bed as per your information. In terms of last quarter, we have about 70% cap, pretty close to the in year 2025 cap.
For an institution like ours, utilization is defined as at least two factors, if not more. One is volume, two is length of stay, three is revenue intensity. Each one of those factors affect bed utilization. I don't know that there's any management in the healthcare sector that would tell you that they're happy with their bed utilization and the way that this question is framed and posed. For us, it's not only about volume. You have to understand that it's all three of those factors, if not more. At least all three of those factors affect bed utilization at our institution, especially revenue intensity. It's not only about numbers of inflow and outflow of patients. We're constantly looking at new markets, as Rajeev has talked about in prior analyst presentations.
We even see some uptick, even in the last six months from Saudi Arabia, even though we don't have a guarantee of payment contract, nor do the two countries have they signed an MOU yet. We're hopeful that this year that that'll happen. If it does, then we're able to execute contracts with the government directly on a guarantee of payment basis. To- date, that's not, it's not happened yet. Next question.
Thank you. Next questions. Do you start to see cost pressures, for example, logistics medical supply procurement, utilities, and fuels?
I think we've answered that question. Have we not?
We already discussed about the medical supply procurement. Yes.
Next question, please.
Next questions for the outlook, can you discuss what are you seeing in the Middle East patients trend in the second quarter of 2026 to date?
Well, I think I addressed that earlier, that Ramadan fully was impacted Q1. As Q1 ended, I'll repeat my comment if you weren't listening. As Q1 ended and we moved into Q2, we started seeing additional flow of patients coming out of the Middle East, not in large numbers, but more so than earlier in Q1. That has continued. I'm not at all disappointed with our Middle Eastern volume. In fact, I'm quite happy with it. We were not far from our high, even in the last two weeks. We weren't at our highest point of volume per day, reasonably close. I'm really quite happy with our Middle Eastern patient trending, not only in Q1.
Part of that was because those that would go back normally during Ramadan weren't able to go back because of the war. After Ramadan ended and there was a ceasefire, we saw some continued growth in the volume of admissions and outpatient business from a number of GCC countries. I'm not at all displeased with the Middle East support that we've seen, frankly, for all of 2026, including Q1 during Ramadan. Next question.
Thank you. Next question's about UAE. Will the UAE withdrawal from OPEC impact patients referral for treatment? If government revenue becomes more volatile due to fluctuations in oil price, will this affect the UAE patients referral abroad?
I'm not sure how the person who asked this question is connecting the disengagement of UAE out of OPEC with UAE patient referrals abroad. They're really two very different things. UAE is dissatisfied in the manner by which OPEC is making decisions about limitations on volume, different aspects of the amount of oil to be produced by the OPEC participating countries. I would expect, I don't know. I would expect that the UAE would like to be able to do more in the way of production, but that dispute is between the UAE and the OPEC participating countries' leadership.
As it relates to UAE referrals, when I look at Bumrungrad in Q1, and as I say, going into Q2, the support from the UAE to Bumrungrad has been very strong. Because of some potential reorganization that we understand, Rajeev can talk more about that, there's a good possibility that that business will grow further in the upcoming quarters in 2026. Maybe you want to comment about that, Rajeev?
We had mentioned this in the past as well, I think.
Yeah
towards the mid of 2025
Mm-hmm
where we had seen a lot of decentralization happen to different government institutions and structures. Their policies for patient referral, which is treatment abroad. Prior to 2025, they had centralized this function under a unified body through which all the referrals were going out. Maybe towards the mid of 2025, the decentralization happened, where again, all individual government institutions were allocated the budget for their own patient referral engagement programs from within the country, which was operated directly from UAE. When this decentralization happens, that is where we had to recalibrate, reassign, and recontract with most of these institutions back again. That was a positive for us. Ever since second half of 2025, we have seen that steady comeback of business from these institutions again.
We have recontracted and got into an MOU with all these individual government institutions, which are not new for us. We have been doing this contractual institutional business for the last 26-plus years. We are today, again, back to that pre-stage where we have these individual contracting ready. This is already yielding us high-intensity referrals from UAE, from these individual public institutions. We are quite optimistic because we see the offices in Thailand also for these institutions have restarted. They're going back to the old pre-COVID capacity. That is when UAE used to have the highest referrals from in country to Thailand.
That is a positive sign, and we expect this to have the similar momentum, and we should have that kind of a new incremental business from these institutions back again.
Yeah, I mean, when you look at the geopolitical situation at a higher level, there's a lot of pressure by the GCC countries politicking the U.S. government to get the Strait of Hormuz open. Nonetheless, there are countries that are shipping oil. We'll leave Russia out of the discussion because they're in a separate situation. There are GCC countries, including Saudi Arabia, that is shipping oil through the Red Sea, not necessarily coming through the Strait of Hormuz. The question for the GCC countries is this whole one of uncertainty. Is the strait open? Is the strait closed? Is the strait open? When is this thing going to get settled? To the extent that they're shipping limited volumes, they're shipping at a very high revenue cost per barrel.
It's not about them not making good money at the moment. It's the question of the discontinuity and the uncertainty of how business is going to carry on in the long term. In fact, when it does get settled down, oil prices will come down. They'll be making less money, but they'll be shipping more product out of their oil wells or gas, you know, gas fields. That's the issue. It's not that they're necessarily going to be losing revenue, except if the oil fields get bombed like Qatar's oil fields that they share with Iran got bombed by Iran. The thing needs to get settled is the really bigger question, rather than, you know, is it going to affect their income.
Right now their income for, on a per barrel basis is quite high, but it's the instability, uncertainty that's causing the problem in these countries. Next question.
Thank you . Next questions. Do you see an increase in business from Japanese expat recently similar to other listed hospital?
I think you missed one with AIA. AIA, did you get that one?
No, I think go back to that question next. For the Japanese expat, for year-over-year in first quarter of 2026, the revenue grew by 4%.
Missed that one.
For the expat segment. In total, Japanese revenue represent close to 1% of our total revenue in first quarter of 2026 and also in first quarter of 2025.
Next questions on the AIA. May I confirm if BH is already in AIA Health?
Missed that one.
Network? Please discuss the benefit of the program if Bumrungrad is already in it.
We are a part of the AIA network. In terms of the benefits of the program, the benefits usually depends on the eligibility or the premium, what the customer usually pays for it because AIA have different benefits under different programs and schemes which are highly customer focused, and it is reciprocative to what kind of premium they pay for this insurance. We cover end to end, mostly all the customers of AIA and especially to those segments also. We provide all those services which are in different categories. We also have different partnership agreements with AIA where we work very closely to selective target audience and also on the customer acquisition and information and awareness also.
Thank you . Next questions about the guidance. To follow up on the second quarter guidance, ±2% growth top line revenue appears contradicting to your earlier message that the revenue growth will improve from 1%-1.5% in the first quarter 2026. Could you explain why?
I don't understand your question. There's no contradiction there. If the, if the growth was 1%-1.5% in Q1, depending upon how you looked at it, I've guided 2% ±. What that means is, for those that are unfamiliar with using terms plus or minus, what that means is it could be slightly under 2% or it could be slightly over 2%. It could be 3%. That's what plus or minus means when you talk about a number. There's no contradiction there. Next question.
Thank you . For the questions that we already answer, I will not go through those questions . On to the questions on the cost saving. How much does cost saving do you expect to achieve this year, and how much have you already achieved in the first quarter 2026?
In term of the cost saving, we continue to, including in term of the inventory contract management and also tax as well. In this quarter, we already achieve about 32% of the overall target .
Thank you . For the next questions, for the increase in Middle East patients that are, that you are seeing post-war, are this mostly government or self-pay?
We do not see any changes in the payer mix prior to this period. Our payer mix for the Middle Eastern sponsors, we follow the same trend, and we do not see any changes in this trend.
For the longest time, our division has been 75%, guarantee of payment and 25% self-pay, for as far back as I can, think back. We don't expect any major changes to that ratio.
Thank you . On to the last questions here for now. The question is, I like to get a sense on potential change given that UAE has built medical hub for a long time. Current situations may totally change the business structures like higher operational costs and lower traffic make them less competitive. How do you see the structural change and how you take it as opportunity for Bumrungrad?
You know, I was specifically working in that part of the region in UAE based out of a regional healthcare service provider providing services all across the GCC. Working in those medical centers prior to my assignment here in Bumrungrad, you know, I can share from my experience, these special economic zones and medical health cities in the region, especially in the GCC, are being built because there is a demand, and that demand specifically is among a lot of high-income expat population, which is also an increasing population in those areas because of a lot of corporates being established, a lot of regional exports happening from there. It's developing as a financial hub.
A lot of residential projects which attracts a lot of high income individuals who come and invest in properties. They need the healthcare capacity to serve the audience as well in terms of the per beds that they have to establish and create, you know, hospitals, schools, parks, infra. That is the primary reason which we have seen a very steady increase in all these kinds of infrastructure projects in the GCC. What we target basically as medical tourism is a very niche, a very focused segment of people, especially when we target for healthcare. We target usually the UAE nationals who are currently seeking for care outside of country.
There is a lot of localization which happens by this advanced center setting up, but it is primarily in the diagnostics for the UAE nationals, where they go for routine checkups, continuity of care, and a lot of diagnostics and health checkup program. Thailand has always attracted Middle Eastern tourists across, that is also one of the primary reasons why most of the Middle Easterners, they love to come to Thailand. Medical care is something which Thailand is also very well known for, and Bumrungrad is very well known for its care and its clinical advancements and very high intensity and advanced clinical excellence that we have here. For some institutions and some programs which is absent or if present is quite expensive compared to Thailand.
That different segment of the expat community is not our target. For Middle Easterners who are nationals from that region, we'll continue our same strategy for these markets.
Thank you . I think we have a couple of questions coming in. The next questions . For the medical procurement, is the price typically fixed for one year in advance? How much stock on hand do you typically have for medicine, medical supply? Will you increase this to address the ongoing uncertainty?
Yeah. In term of the price, as Khun Artirat already mentioned, we lock the price for one year . In term of during the war situation, we also additional talk with the vendor in term of the expand of the lock the price and also place some of the future order to ensure that we can gain in term of the freezing price as well. In term of, now we already at the stock level more than like one month some of item, and on the critical item we about three months. We certain that we have the stock enough to serve for the patient coming into our hospital, and we ensure that this situation we will have no any stock shortage to the company . Also we think about in term of the inventory turnover as well.
Now we still have the very good level that inventory turnover still be about 11 days .
Thank you . Next questions about the M&A. You talk a bit about potential M&As. Can you talk about what are the factors that you are looking at in and assessing them?
We really didn't at this session talk about M&A, Mergers and Acquisitions. We talked about greenfield growth related to Bangladesh, not Mergers and Acquisitions. We look at everything with what idea? The idea being how can we grow the earnings in a market that has long-term potential and where there are synergies to this organization. If I look at something that I may want to buy, either a portion of or all of, can I drive synergies from that acquisition, meaning tertiary referrals here into this institution? That's the very first thing I look at. The second thing I look at is cost economies of scale and synergies associated with an acquisition. Is there combinations by which we can combine overhead where we eliminate duplication of overhead that drops to the bottom line?
That's a more of a short-term reason to do an M&A, but certainly not a long-term reason. Just two days ago, I looked at three opportunities brought to us, none of which fit the criteria that I just described. We are a conservative company. We're very careful about how we deploy CapEx, and it has to fit that criteria that I mentioned. There are other criteria that applies, but those are the principal criteria, and that they meet our internal rate of return. Our internal rate of return hurdle is 20%. We do things at less than 20% on smaller CapEx deployment, but not usually. They usually have to hit a 20% IRR before we'll proceed.
We've done some minor investments over the last two years, but they're very small. Mostly in VitalLife associated with brand deployment and brand upgrade of their products using VitalLife to help them grow. We're not an acquisitive company per se. We are built and designed and our vision here is to be the Mayo Clinic of Southeast Asia. However, we do look at everything, rare do we do any mergers and acquisitions. Our greenfield in Phuket is the very first one that the company has done in its 45-year history because we see a tremendous opportunity there for long-term growth for that market. That's how I would answer this question on how we assess M&As in short.
I can give you the long version of it, but for that, you can come visit me. Next question.
Thank you . Next question's about AI and robotic. How do you expect AI and robotic surgeries to impact the headcount of medical staff and doctors in the medium to long term at the main Bumrungrad Hospital?
For the purpose of the medical treatment, we launched and implemented AI in a few areas such as radiology, and also we use robotic surgeries in, now in more than, you know, around six subspecialties. In the past, we just used majority in the urology. Now we expand to more than 30 surgeons that can using robotic such as the gynecology, ENT, heart, general surgery. This is a very good adoption rate since I report from March last year to March this year. We achieved around 100 cases already. In terms of the AI to reduce administrative expense, in the future, I think we can reduce the workload for the admin staff and the nursing and also other clinical staff.
For in general, for the doctors, number of doctors, I don't think it will impact for the quantity or number of the doctors.
I think also one of our biggest challenges for all, for any company, including the healthcare sector, is going to be how do we reskill our staff to be able to adapt better to jobs that get replaced by AI, replacing humans, especially clerical function, cost center functions, things where there are routinization of functions where it's pattern recognition that you keep doing the same thing over and over again. Those jobs are going to be taken over by AI for people that are now doing them. The question for us is how do we reskill our manpower to be able to remain with us but also be effective in what else they may do for us.
If we're not able to do that or they're not able to adapt, there's going to be significant impact on unemployment as AI continues to grow and take over routine functions. 1 other comment on the guidance and the top-line revenue growth. I want to make sure, because I think it's important that we as an organization continue to speak with the investor community, educate our investor community. With respect to Bumrungrad, we are not a linear organization, meaning that revenue is linear to earnings growth. In our situation, because we're a tertiary and quaternary company with high revenue intensity, longer lengths of stay, especially for Middle Eastern patients, the issues that drive earnings is not solely volume, for sure. And revenue.
It's the quality of that revenue, it's the intensity of that revenue, it's the resource consumption associated with that revenue that drives earnings. When you look at Q1 as an example, our top line revenue growth was 1+%, depending upon how you look at it, 1.4%. Our EBITDA growth was 5% year-over-year. In the same way, when you look at Q2, when I say ±2%, our top line revenue growth could be 3%, could be 1.75%. You know, it's going to be, it's going to be what it'll be. That's less important than what kinds of patients are we driving into the hospital and how sick are they and what kind of resource consumption are they driving.
This is very important for you to understand the differences between this kind of an organization versus a primary and secondary hospital. I'll leave it there, but I think it's important to state that fact. Next question.
Thank you . Next questions . Are there any plans potentials for a VitalLife spin-off or listing or do the IPO?
Well, if we were going to do that, I wouldn't tell you. That's not something we would tell the general community that we were planning on doing an IPO or not. We'll see how VitalLife is growing very, very well. We're expanding into other markets. We have other markets that will continue to. There's a tremendous amount of interest on the longevity side for VitalLife, not only from other healthcare providers, but from third-party hospitality services, et cetera. Khun Leng was talking to a lot of people about that. Our CEO, Dr. Polakit, is constantly fielding inquiries from all kinds of hospitality organizations of every type to co-brand with our VitalLife product.
As you know, we have a VitalLife center that's now doing, gaining traction in Phuket, and we'll be also having one on the Phuket campus. We have other sites that we will be scaling up to. An IPO at this point, is not something I'm prepared to discuss with the investor community. Next question.
Next question . Can you provide the expected opening date for the Bangladesh office?
It will be this financial year, probably towards the end of Q3 or early Q4.
Thank you . Move on to the last questions that we received today . Would you share if the government GOP processing has slowed given the recent Middle East tensions, and what the usual time for approval process to travel for treatment before and after the war?
We do not get into that level of details related to the GOP process because we have multiple different sponsors from the GCC who every different sponsor have a different protocol for the GOP management. The broader question in terms of has it slowed down, you know, we have shared the Q1 performance, overall we see a double digit close to 22% growth from the Middle East in the Q1 versus 2025 Q1. Khun Neil also mentioned that, you know, we're seeing the momentum of Middle Eastern patients coming back towards the end of Q1, we see that same kind of a momentum get into Q2, early Q2 as well. No, there is no slowdown that we have seen from the Middle East, GOP or patients coming in.
We expect the situations, of course, and the geopolitical tensions in the Middle East to get better and our business back to usual. In terms of overall, in terms of Middle East GOP, we do not see any structural change.
Thank you . That's all for the questions that we received today . If you have any further questions, please feel free to send your questions via email , and then we will reply to you through email . For today, thank you everyone for attending, and also thank you for our management for taking the time to help answer to the questions. We will see you again on the next quarter, the second quarter 2026 in August .
We-
For today, thank you very much.
Yeah, we will be conducting the next analyst presentation live. That will be in August, and that will be conducted in the afternoon as opposed to 10:00 A.M. in the morning for our shareholders in the EU and the U.K. We have that session. We'll announce it as we get closer to it, but that session will be conducted at 1:00 P.M. in the afternoon live.
Okay . Thank you very much again for everyone joining today . [Non-English content] .
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