Ladies and gentlemen, good morning, and welcome to the first quarter 2024 financial results of IHH Healthcare's analyst briefing, conference call, and live webcast. At this time, all participants are in a listen-only mode. There will be a presentation followed by a question-and-answer session, at which time, if you wish to ask the question, you need to press star one one on your telephone keypad. I must advise you that this conference is being recorded today, thirtieth May, 2024. I would now like to hand the conference over to your first speaker, Ms. Penelope Koh, from Investor Relations at IHH. Please go ahead.
Thank you. Good morning, and thank you for joining us. I'm Penelope Koh from IHH Investor Relations. Welcome to joining us for our first quarter 2024 results briefing, whereby we're doing it live via a video broadcast available on our webcast. And with me today are Dr. Prem Nair, our Group Chief Executive Officer; Mr. Dilip Kadambi, our Group Head of Finance, my apologies, my Group CFO; and Mr. Ashok Pandit, our Group Chief Strategy, actually, Chief Corporate Officer. And I have the pleasure to invite Mr. Evren Gence, which is our Deputy CEO of Acibadem. The results materials are available for download on the IHH website. We'll begin with an opening address by our Group CEO, Dr. Prem, and then our Group CFO, Dilip, will present the financial highlights, offering a clear view of our financial status and core operating performance. And following that, Dr.
Prem will give us an update on operations across our various markets and conclude with a brief outlook. With that, we'll move on into a Q&A to address the specific questions. With that, I'll turn the call to Dr. Prem. Dr. Prem, please.
Thank you, Penny. Very good morning, and thank you for joining this early morning call. So before I go into the results proper, I would like to say a few things about our chairman, who has just retired. Tan Sri Azlan stepped down as the group's independent and non-executive chairman at the recent AGM. At the conclusion, he retired. So on behalf of all of us at IHH, we would really like to thank Tan Sri Azlan for his steadfast leadership, contribution to the group's success. As you all may be aware, we listed in 2012 as, at that time, the world's third-largest IPO in 2012, and since then, we have gone on to become a truly global healthcare player with eight... more than 80 hospitals, 10 countries, 70,000 staff today.
So his passion, his energy, his commitment to the group has been immense, and I think he has left a very strong legacy for us at the group. So we are very grateful to him and wish him all the very best in his retirement. Now into our Q1 numbers. It's been a remarkable quarter as we enter the new financial year. I think it's very clear indication of our performance, of our core businesses, and the continued execution of our strategic priorities, which we have outlined for some time already. But if you look at the slide, I think there are three areas that I would like to focus on. First, the first takeaway, I think, for all of us, is that we carried very strong growth momentum from 2023 into Q1 2024.
Quarterly revenue hit MYR 6 billion mark for the first time, so it was record quarterly revenue. Revenue, EBITDA, and PATMI ex EI all grew by double digits. This outstanding performance cut across all markets, so it was across the board. As we took in more patients, so higher volume of patients, both local and foreign in our markets. Higher equity treatment, so there was higher intensity for our patients as well, all right? So, and this was, you will see it as we go across the countries, you will see it, see it happening in all, all of our countries. Second point that I want to make is on a couple of operational highlights. First is you would have read about the official launch of the Proton Beam Therapy Centre at Mount Elizabeth Novena Hospital in Singapore.
I think this center, together with the rest of the oncology treatment facilities we have at Mount Elizabeth Novena, reinforces IHH's position as Asia's leading center of excellence in oncology. It's a comprehensive cancer care setup, and I think we are the first, in fact, we are the first healthcare provider to provide proton beam therapy services. So patients have access now to advanced and highly specialized cancer treatment, in addition to all the other things that we are doing, all right? Chemotherapy, radiotherapy, CAR T-cell therapy, which is a stem cell therapy that we provide, LINAC, the highest-end LINAC machines, TrueBeam, Gamma Knife, and now the proton therapy machine as well, not forgetting the genetic testing services that we have in the same hospital as well. So it's complete. We also made a strategic investment.
As you know, we've been investing in a lot of innovative companies. The most recent one is in a company called Belun Technology, and this is an AI-powered, medical-grade, FDA-approved, wearable sleep device. So as you know, for patients whom we want to diagnose sleep disorders, in the past, it has been a rather cumbersome procedure, inpatient admission. But today, we can do it with Belun Technology, which is pretty much a ring that detects your sleep patterns, right? So this is the recent investment that we made. And the third point I want to make is that our strong foundations and continued execution of our strategy, all right? We have several growth priorities which we have outlined in recent times. All right? We continue to execute that well, and this is aligned with the ACE Framework that I've outlined in the past as well, right?
So our outlook remains positive, and we expect to continue with our market leadership position across all our core markets, all right? Because all the trends for private healthcare, all the secular trends remain very, very favorable. So with that opening, I'd like to hand over to Dilip, our Group CFO, to take you through our financials. Dilip?
Thank you. Thank you, Dr. Prem, and good morning to all of you on the call. Thank you for joining us today. Here, on this slide, we, you know, we have two sets of numbers. The one on top shows our, you know, numbers, which are reported, which includes the MFRS numbers, the MFRS 129 numbers, which is the hyperinflationary accounting. And the box below, which is highlighted in blue, shows the numbers that are ex-MFRS, which means without the inflationary accounting taken into account here. As you can see, there's been a strong double-digit growth in revenue, EBITDA, as well as PATMI.
We would like you all to focus on the blue box, which are representing our core operating performance and which does not include the MFRS numbers, mainly because some of the MFRS numbers have an adjustment which are non-cash in nature. So hence, going forward, we would highlight the blue box and the non-MFRS numbers. Looking at the PATMI performance, on the last towards your right, right-hand side, the PATMI itself was marginally down compared to Q1 of last year, mainly because of a one-off gain that we had in Q1 of last year due to the sale of IMU. Some of you might recall that we booked a gain of MYR 862 million last year, Q1, and that's the real difference that you see here in, on the slide. Moving on to the next slide.
Again, as Dr. Prem mentioned, you can see very, very strong business performance across all our business units, as well as countries and our core markets here, both revenue as well as EBITDA growth. You can see, even in places like Singapore, Turkey and India, we've had double-digit revenue and EBITDA growth. However, in Malaysia, we've seen a slight dip over Q1 of last year on the EBITDA. This is mainly due to the adjustments that we did for our healthcare workers, which is very important for retention going forward, and a sustained growth in our business in Malaysia. On the next slide, I would probably like to kind of focus first on the bold purple line.
As we'd mentioned in the past, in terms of our EBITDA percentage expectation, you can see that we are fairly rock solid and stable at about 23% EBITDA margin. Next, if you look at our PATMI, which is the bold green line, you can see that we've delivered a PATMI of 9.9%, and it has grown in terms of 100 basis points over similar quarter last year. The next slide here, you know, some of you had questions around our operating cash flow generation, and the CapEx that, you know, we invest in. As you can see, in this slide, we have very strong, you know, operating cash flows that we've generated last quarter, and this is to continue.
As you can again see, our cash balances are very, very healthy, which enables us to roll out our brownfield expansion that we have spoken about in the past. This slide highlights our net debt. This is again, some of the questions that, you know, you all have asked, in the previous quarter earnings call. As you can see, our net debt is stable, despite our CapEx spend having gone up, in the quarter to enable our brownfield expansion plan. And we expect our operating cash flows to take care of a bulk of our, you know, brownfield expansion plan as we go along. These are the capital efficiency ratios, which we have been showing in the past.
What I would like to highlight here is, given the seasonality and the variation quarter-on-quarter, we would like to show this on a yearly basis rather than on a quarter-on-quarter basis. And as you can see, in FY 2023, we've had a pretty strong run rate, touching double-digit ROE, and our focus is really on delivering shareholder value through ROE accretion. With that, I'll probably hand over back to Dr. Prem. Thank you.
Thanks, Dilip. So before I go on, let me just recap our objectives under our ACE framework. You can see this on the five strategic priorities on top, so please take a look at it once more. And second, I think we just want to reemphasize that we are. We would want to create positive change at scale, right? To be a sustainable healthcare leader, and I'll talk a little bit about sustainability as well. You know, our aspiration to care for good, right, which is patients, public, people, public, and planet, right? So this slide shows the five strategic priorities. Quick mention about sustainability. We've been on a very, very interesting sustainability journey, I must say, right? We've produced a sustainability report. You'll see the link there, all right? It's available online. It's very detailed.
We are tracking very well against the clear time-bound targets that we have laid out, right, for the goals that we set in 2022. And as you can see on the chart here as well, there are several rating agencies that look at sustainability, and we have improved our ESG scores, right, across all major rating agencies, and we continue to improve even as we speak. Moving on is... This is what I've been presenting for a few sessions already. I'm not going to elaborate on it. I think you know this very well, but we're very happy to take questions later if we need to, all right? So this is our ACE Framework, right, to propel growth and be a sustainable healthcare leader. Next slide, again, is something that you'll be familiar with, right?
This shows a snapshot of our operational information and our growth that we have stated in the past, 4,000 beds over the next 5 years across all our core markets. All right? Now, this information, we update it from time to time, and one of the changes that I will need to point out to you is that Acibadem's numbers, I think we gave an indication of it previously, that they were revising their numbers, and they have done so. Acibadem's numbers are higher now, as they intend to add more beds in Europe over the next few years, Bulgaria, Serbia, and Netherlands. So this, this is the latest slide that we have on, our, on the operational beds.
Now, I will talk a little bit about our countries, and I'm going to start off with Malaysia, where you will see that revenue grew 10%, mainly due to higher intensity, higher acuity, all right? Taking on more complex cases. Census was also higher, although the first quarter had an extended Ramadan period, right? But Malaysia still did well. And of course, as all of you know, we welcomed Timberland Medical Centre into our fold, all right, into the group. EBITDA margins are at 25%, and occupancy, Malaysia runs at a very high occupancy, usually at 70%. It took a bit of a dip to 67% because there was a 5% increase in the operational beds, all right? But we think it should come back to 70%.
A few things on Malaysia that you will see there, all right? Adding 50% more beds in the next five years. Tactical acquisitions like Timberland, we continue to look for such opportunities, right? The transaction has been completed, as I said, and we look forward now to the 200, the piece of land that comes with our Timberland acquisition that allows us to build a 200-bed facility, and work will start on that sometime later this year, okay. Singapore. Despite no increase in the number of hospitals, revenue increased 18%, mainly on higher revenue intensity. So Singapore continues to deliver on higher and higher intensity cases. You know about the proton therapy that we mentioned, but the other sort of technological innovations, robotic surgeries, cancer treatments and all that, that brings them to a higher equity level.
EBITDA margins in Singapore are at 30%, right? They, they are always in that range, 29%-30%, right? And their occupancy has gone up as well, so they now stand at 63%, Singapore. So, I know I keep talking about clinical leadership and oncology and all that, but that is something that we just keep emphasizing in Singapore, because we really have a very, very comprehensive suite of cancer treatments, and you'll see the pictures there. Opening of the official opening of the Proton Therapy Centre recently by our former chairman. We have also executed another element of Singapore strategy, which is the out-of-hospital strategy, and you will see that fertility center there, which is in the vicinity of Mount Elizabeth Orchard Hospital, in the commercial area, where they have taken space to open fertility center, hematology center.
So that's what you will see in some of the other pictures as well. We also extend our primary care into homes, so we launched an entity called Parkway Home Care, which is going to become increasingly important in countries like Singapore and Hong Kong. Next, we'll go to Turkey and Europe. This is our Acibadem business. Revenue grew 23% on higher revenue intensity, so they had improved performance across existing hospitals and some of the newer hospitals that you remember that, that they have opened. And EBITDA margins increased by 100 basis points. Again, like Malaysia, despite Eid, their inpatient admissions went up. Now, we have been emphasizing quite a bit about Acibadem's European business because it is part of their overall de-risking strategy, right? There are some macroeconomic challenges in Turkey, right? It's improving, but there are still some challenges there.
Turkey is really our core market, right? Okay, and they do very well locally, but they have de-risked by moving over to Europe, and you will see that in the first quarter. The non-lira revenue makes up 40% of its top line in this first quarter, right? So that's, that's a feature of our Acibadem business. And the next slide, I think, gives you a sense of some of the things that they are doing. They are ramping up the new hospital that they opened, Atasehir. They've got Acibadem Kent Hospital, the one that they acquired in 2023, and that's being ramped up as well. In Europe, they're already in Netherlands, Amsterdam. They're moving into Rotterdam, and they're growing their footprint in Eastern Europe as well, right?
So I think the pictures show you some of the areas of medical excellence that Acibadem is involved in. India, which is a very exciting market for us, and so we've got our twin engines, Fortis and Gleneagles. Gleneagles completed its rebranding, so it's Gleneagles in India, right, which is one of our international brands across the Asia. Revenue increased by 20%, and EBITDA increased by 50%, right? Fortis, in particular, had a very, very strong first quarter. They did very well, their hospital business, with improvement in ARPOB, as they call it there, the average revenue per patient bed, volume growth, and they have been very good at cost management as well, right? And I think which is an integral part of our business, right. So revenue intensity increased as well.
India does a lot of high-level surgical treatment as well, so that's reflected in the numbers. Next slide is one that you are also becoming very familiar with. This is the pan-India footprint of our two brands, Fortis and Gleneagles, right? And so just to remind you of where we are in India, and they continue to increase bed capacity. In the earlier slide, we show you where they will be in 2028, but they do it year by year, all right? They've invested in cutting-edge medical equipment to offer a very high level of treatment. One of our flagship hospitals in Delhi, which is Fortis Memorial Research Institute, FMRI, will be re-opening in the next couple of months. They will be opening their MRI LINAC machine, right, which is a combination of MRI and LINAC treatment.
For more accurate radiotherapy treatment, they'll be opening it, as well as their Gamma Knife machine as well. Again, one of the very few in India. And as with our other core markets, they will explore acquisitions within their clusters as well, right? So just some of what's happening in Fortis, you can see there, all right? brownfield expansion of beds, specialties such as oncology, neurosciences, cardiac sciences, which they are very good at. Some highlights of recent opening of Fortis Institute of Blood Disorders. That's another area that they're very good at. Mohali and Jaipur are outside the national capital region, all right, but there are lots of things happening there as well.
Gleneagles Hospitals, I'm pleased to say that with the rebranding, right, where they are upgrading, I think Dilip can give some info later on the amount of investments that we are putting into Gleneagles. Gleneagles Chennai was hit by, as you know, floods, quite bad flooding, and in such a short time, they have cleared up the place. They've put back their heavy-duty machines, PET scans and all that, and they've reopened their high-end cancer center in Chennai as well. So, lots of good things happening with Gleneagles as well. Now, Hong Kong. Hong Kong continues their ramping up, continues their momentum, growth momentum. Revenue grew by 24%. EBITDA margins were at 14.2%, which is about 400 basis points up from a year ago, right? Occupancy is at 64%.
A slight dip because they opened, they opened up more beds within the hospital, 30 new beds. And as we mentioned the last time, they've already broken even on EBIT, and we our target is for them to become EBITDA positive by early next year. All right? So that's good news for Hong Kong as well. And you can see some of the things that they are doing in Hong Kong in the next slide. Again, like Singapore, from a single hospital, now they are moving into clinics and ambulatory centers in the community, which are doing very well. So hospital open more beds, and in the community, they will open more clinics, right? I think the plan is over and beyond what they have now. They'll open another 2-3 ACCs, more beds in Gleneagles Hospital.
Again, high technology treatment as well. You will see that they have opened a new very sophisticated head and neck... Nasopharyngeal cancer is very high in Hong Kong, all right? So they've got a new methodology for treatment. Side effects are quite common for NPC, but I think they are looking at – they have initiated a new treatment, right? That's very good. Laboratories, which is our new growth business, where we have put Singapore and Malaysia together, they continue to do well. Revenue went up 10%, right, from previous year, so they're growing well. But most interestingly, and this is something that we have mentioned about our lab business, it's not just a matter of cobbling all our lab businesses together, but it's also to move higher up the technology ladder, right?
So high-end tests, growth was around 20%, all right? And I think that's what we are aiming for, really, okay? And EBITDA margins was at 21.6%. We are looking at doing reference lab business. These are some of the things that we have spoken about, and you will see in due course that we have got some reference labs coming up in the region as well, right? And I think this is in the next slide as well. You can see, laboratory is very high technology business, use of AI, machine learning, opening of reference labs in our core markets, all right? Offering test menus. And reference labs are very important for higher end treatment, especially oncology, targeted therapies and all that, right? So, that's what our lab is doing. So those are the countries and lab segment, some information on that.
I'd just like to quickly summarize, right? For quarter 1, 2024, essentially, strong growth momentum continues. We recorded highest quarterly revenue ever. Revenue, EBITDA and PATMI ex EI all showed double-digit growth, right? We focus very strongly on clinical leadership and care leadership, right? We are a healthcare company, so that's very important to us, and because of that, we remain very, very confident about our growth trajectory. So the focus will remain on extending our market leadership, driving profitability, sustaining a healthy ROE. At the same time, prudent capital management, allocation of capital to our various markets, but we will have to contend with some macroeconomic changes in some of our countries, so we'll have to mitigate inflationary interest rate pressures. So these are the things that we will be working on.
With that, I will hand over to Penny for the Q&A session. Thank you very much.
Sure. Thank you very much, Dr. Prem. Before we actually start the Q&A, I just want to make a very quick comment. I think among the sell side, there is, they're trying to bridge, you know, the difference between including MFRS, the core net profit, including MFRS and excluding MFRS, which is on your slide 5. Hence, that's where I want to bring the attention of the sell side and, of course, you know, the audience here, that we actually do provide that variance on slide 41 for you to be able to reconcile the MYR 402 million versus the MYR 586 million.
So do take a look at it, and as we, and Dilip has mentioned before, a lot of the items that had the MFRS effects was mainly non-cash, and that's clearly illustrated in that slide on 41. So please do take a look at it. So now, we'll actually start the questions and taking from the participants on the call before we move to the questions on the webcast. And I would like to kindly request for each participant to keep to two questions. I know you have many follow-up questions, but please do rejoin the queue, if possible. So with that, operator, can you please proceed with the Q&A? Thank you.
Thank you. Ladies and gentlemen, as a reminder, to ask the question, please press star one one on your telephone keypad, and then wait to hear your name announced. To withdraw your question, please press star one one again. Please stand by while we compile the Q&A roster. Our first question comes from a line of Rachel Tan with DBS. Your line is open.
Hello, good morning, Dr. Prem, Penelope and team. Congratulations on a very strong result that you have achieved this quarter. A few questions from me. I think firstly, maybe just on Singapore, I noticed that Singapore has been very strong this quarter. Could you give us some color as to where it's coming from, i.e., is it driven by local patients, or is it foreign patients? How much do foreign patients contribute? And lastly, I think margins have hit 30%. So, moving forward, do you think that 30% margin is sustainable?
Yeah. So maybe I will take the question first, and maybe Dilip and Ashok can chime in. So Singapore is a very important market for us, and it continues to do well simply because it is one of our countries with lots of centers of excellence, right? So although we have the four hospitals, no further growth of the hospitals beds, and beds actually are decreasing because the demand for four bedders and two bedders is actually going down, right? We are converting, you know, Mount Elizabeth Orchard is now undergoing a major transformation. The bed numbers will actually go down because we are converting all the beds to practically all to single bed. We are retaining a small number of four-bedder rooms.
But what's happening in Singapore is, as they get more technology into their hospitals, and I always use the example of the proton beam, where if you have got a LINAC to do radiotherapy, the whole cycle costs SGD 20,000-SGD 25,000. Proton beam is SGD 50,000-SGD 60,000. Now, is this inappropriate use of technology? It is not, because what does proton beam do? Conventional radiotherapy causes damage to surrounding tissues before it hits the tumor on its way out. Proton goes directly to the tumor, and it will treat it. So it's very good for certain kinds of cancers where the spaces are very narrow, like head and neck, prostate. It's very good for children, all right? Because so as when they grow up, they will not have long-lasting side effects.
So this is the reason why Singapore continues to have higher and higher equity, right? So that's the first thing. Second thing is, is it driven by changes in the mix of patients? We know that foreign patients typically come with more serious problems, right? Of course, so their bill size is higher. But Singapore's foreign patient percentage has remained fairly steady. It's always in the 20s, low 20s, 20%-25%, right? I believe it's about 20% now.
2% .
20% now, right? So it's fairly stable. So although Singapore is not a cheap destination for medical travel, all right? But the demand for that high-end care means that it continues to have a steady flow of foreign patients coming in, right? So that's the next thing. Thirdly, is this sustainable, the EBITDA that you talk about, right? And I think one of the concerns about Singapore always is that because we only got the four hospitals, where do we expand to? So they have outlined their out-of-hospital strategy, and this is in line with Singapore government policy. Healthier SG, the government says that care must be right-sited. We don't want to do everything in a hospital, so please move out of the hospital and provide care, especially to the elderly population, who would prefer to have it in the community.
So Singapore, as you see, they've got the primary care group. They've now started the ACC, Parkway MediCentre, and they're expanding that area as well. They are going into step-down care, right? That means a patient who has had, say, knee surgery, actually only needs to remain in the hospital, be in the hospital for one day, but they stay in the hospital for physiotherapy and sort out various things, get them to walk. You can move them to a step-down facility. So what does that do? It will free up the bed for more patients to come in. So Singapore is quite confident of maintaining their margins, all right, with this, the strategy that they have outlined.
Maybe just to add, in terms of, you know, foreign patients, we had about 20%, as Dr. Prem mentioned, we had about 20% of our revenue contribution coming from foreign patients. And the interesting thing is, despite the Raya period, which is overlapping this year, 11 days in March, we've actually had a growth in our foreign patient revenue, and actually a very strong growth in our local patients as well. So it's been a very balanced growth, both in terms of foreign patients as well as local patients, I would say.
Sounds good. Thanks. Thanks, Dr. Prem. My next question is really on, are there any price increases in your respective markets? And if you could please give us the percentage of price increase that you have put in for first quarter by the individual market.
Rachel, sorry, I didn't hear the first part of the question.
Sorry, the price increase. So have you imputed any increase in your treatment prices? And if you could, give us by individual market.
Okay. I can tell you in general, in all markets, we will try to do an inflationary increase at least, right? And I think that's not unreasonable. Our payers, mostly insurers, companies and all that, right, would accord us inflationary increase. Over and beyond that, in certain countries like Singapore, where nursing costs are very high, manpower costs are extremely high, in fact, led by the government, public sector in Singapore, and we follow suit. I think again, the payers and patients know that this is because we want to keep our nurses, retain our nurses, train them, hire more nurses, all right? So they would accord us maybe what I would call over and beyond CPI, a medical CPI component as well, right? But we can't keep increasing prices, right?
So, prudent cost management, right, we at the back of our hospitals, and in the countries, right, we do a lot of things to manage costs better. As a large purchaser, we can get good prices if we were to consolidate, buying all our heavy, heavy machines, the CT scans, the MRIs, the PET CTs as a group. So I think these are all the things that... Yeah, but price increases, you know, just for the sake of increasing our top line is never our intention, and it will not stand under, you know, sort of scrutiny as well.
Well, okay, thank you. But would you be able to give us a range in terms of how much you have increased, and specifically on Turkey? Because, Turkey inflation is, way off the chart, so just to give us a sense.
So, Rachel, I think as you would appreciate, different markets are different. You know, the inflationary adjustment, let's say, in Singapore is different from, you know, Malaysia and is very different in, let's say, India versus, let's say, Turkey, where obviously the inflationary adjustments are very, very different. So, you know, very difficult to put it in a small range. It'll have to be a very big range. But suffice to say, as Dr. Prem said, we do look at inflationary adjustments and, you know, pass some inflationary adjustments on that is required.
Okay. Thank you. I'll, I'll come back to the queue then. Thanks for, for answering.
Thank you. As a reminder, ladies and gentlemen, that's star one one to ask the question. Please stand by for our next question. Our next question comes from the line of Pooja Bhatia with Morgan Stanley. Your line is open.
Thank you for taking my question, and good morning, everyone. The first question from my side is that we are two months into the second quarter now. It'd be great if we can get some quarter-to-date trends in terms of volumes and intensity. Intensity has been very good in the first quarter across different markets. Thank you, Dr. Prem, for giving in-depth details of what kind of technology and improvement has been going on in Singapore. Do we expect a similar trend in the second quarter? If we can get some quarter-to-date trends, that will be helpful.
... Well, I think we expect to see continuing growth momentum, right? No, no reason why it should not, right? No specifics, of course, at the moment, right? But I think we are continuing to see the growth trajectory continue in the same way that it has been in the first quarter.
In terms of the proton center, like you said, that, the average cost to the patient is 2x. It'll be about $50,000 versus a LINAC, which is $20,000. What kind of opportunity does this bring? Because this is first in the region. In terms of the number of patients that you expect on a daily basis, or maybe through the life cycle of, you know, a patient taking this, just some sort of dynamics that we can get on the proton therapy center.
Okay, maybe just to give you an idea. Okay, the proton center is actually tracking very well, I think better than pro forma, right?
Yeah.
So it's tracking very well. In fact, the team has just opened up a second shift. So as you know, a lot of the machines, like the MRIs, the CTs and all that, they operate for office hours. Then we keep some machines operating till 9:00 P.M. or 11:00 P.M. to cater to the emergencies or the cases in the ward, right? Proton initially was running on one shift because it's a new treatment, and we wanted to assess the demand for it, but the demand has been really quite overwhelming. And for the reasons I told you, oncologists now feel that if a patient can benefit from it, like a child, why even do traditional radiotherapy? Go straight for proton. Okay?
Now, for local patients, they're very fortunate because all the local insurers, what we call integrated plan insurers in Singapore, the AIA, Great Eastern, Prudential, Income, all of them cover proton therapy, right? And, so if you are insured, and 70% of the Singapore population is, insured with private plans, their proton treatment will be covered, right? So that's good. Foreign patients obviously come in, right, either paying cash, all right, these are patients who can afford to pay, or we have some countries that have, direct agreements with us. A lot of the Middle Eastern countries, for example, they send their patients over to us, paid for by the state. So proton, in terms of payment, it's fully covered for most cases. And so because of that, the demand has gone up.
We have now started the second shift, so we are ramping up operations into, into double shifts, right? So, so that gives you a sort of a flavor of what happens when we introduce some of these sort of technologies. If they are approved treatments, they will be covered. Ministry of Health will tell the insurers, "Please cover this as well, so it's part of your, the plan." Now, but proton is just a single machine, right? If you have a cancer patient, the diagnostic part needs to be taken care of. So Mount Elizabeth Novena has opened a genetic testing center as well, right, to, to make it comprehensive, and that's what makes it a comprehensive cancer care center. That means if a patient comes in, all right, you've got to diagnose it. And today, genetic tests are very important for oncology.
It tells you what targeted treatment can be given to the patient. It's already decided. And then it can go either chemo, targeted chemo, it can go to radio, it can go to, to proton. Traditional radiotherapy continues to be heavily utilized because Ministry of Health will say there are certain indications for proton, right? Not everything can be treated with a, with a proton machine. Some still goes the traditional radiotherapy route as well, right? So I think this gives you a sort of a flavor of what the addition of a particular machine in Singapore, all right? I'm sure this happens in other countries as well, right? We have got Malaysia, Turkey, introducing machines, robots, and all that kind of things, right? So judicious use is very important, right? Cannot be inappropriate. But we would...
Just to give you a sort of an idea of how Singapore continues to maintain that, the high acuity treatments.
Maybe just to kind of add to Prem, if you look at, proton beam therapy center itself, we have more than, you know, 100 cases registered, and 50% of that is really foreign patients. So again, we are seeing a pretty healthy mix of both foreign as well as local patients to, you know, use the proton therapy center.
But I think just to Dr. Prem's comment, one way to think about us and discovers, you know, the question that Rachel asked as well, is last few quarters, we've been talking about healthcare leadership, establishing centers of excellence. So Singapore and Mount Elizabeth Novena is one center of excellence when it comes to oncology. And similarly, in Fortis in India now, Dr. Prem talked about introduction of MRI LINAC. So you will see us doing or focusing on these centers of excellence eventually across our platforms and our four core markets, including Malaysia, Turkey. This is a big priority focus for us, which eventually helps us in our revenue intensity.
Hopefully, to some extent, some of the questions that were raised in terms of how do things go forward, one thing for you to think about is: where are we investing, and what does it mean in terms of, you know, long-term trend for us in terms of our revenue trajectory? And by the way, I've been talking about Singapore, which is, and centered it around our two Mount E hospitals, especially. India, we've spoken about MRI. The same thing is happening in Turkey as well. I don't know, Evren, whether you want to give a flavor of some of the technologies that you are having in Turkey as well.
... Sure, as Dr. Prem and Ashok mentioned, constantly, we're aiming on upgrading our infrastructure in our hospitals and bringing the modern technology, because that's not only important for the local aspect, because we are, we are a regional powerhouse when it comes to medical tourism in Eastern Europe, Middle East, CIS countries. We cater to a lot of cancer patients or organ transplant patients, so that's why we need to keep our infrastructure and, you know, medical equipment, investing the latest technologies, in our hospitals to prove that out.
I think of proton beam, Dr. Prem. There is a question on the webcast from Alex: Will proton therapy be introduced in Malaysia, Hong Kong, Turkey, and India? Any thoughts?
Yeah. Okay. We would look to introduce... So a proton machine is very expensive, right? It's probably the most expensive, machine that we can introduce into any of our hospitals, all right? So there must be a very good reason for it. We are not in the business of generating patient care for, you know, for, for reasons that do not require that treatment, right? Okay, so treatment must be appropriate, it must be right. In certain countries, it's well-regulated. Ministry of Health in Singapore says you can use proton for these ten treatments, but you cannot use it for these other things that, you know, all kinds of cancers and all that, right? So in other words, we do not want to have inappropriate use of the machines, and this must apply to every country, whether MOH states it or not.
So the science of treatment is very important. Malaysia, India, these are all large countries, all right? And I'm sure if the indications are right, they have the similar cancer profiles, we can introduce proton machines as well. So there must be both a clinical case for it, and there must be a business case for it, all right? But I would say, I can see protons coming up, proton machines coming up in countries like Malaysia, Turkey, Europe. In fact, Europe has already got some, right? I presume in Germany, maybe. All right, they have it, all right. India has one already, and we may want to have a proton, possibly in our comprehensive cancer center in Delhi as well. So the answer is yes, but we want to be very prudent about it.
Since we are also on the topic on Singapore, there is another question on the webcast about, from Sue. So follow up that question from Rachel earlier. Is the current EBITDA margins of 30% close to a max? Any further upside? Maybe, Dilip, you want to take that question?
Sure. Thank you. Thank you, Sue. You know, I think, look, we've spoken about the EBITDA margin itself, and we've mentioned that, you know, high 20s, thirty percent is, you know, we're about. You know, we should look at Singapore at, especially given, the growth that we've seen. I think the focus really would be if you look at the EBITDA growth, the dollar value, we have a double-digit, you know, EBITDA growth while maintaining a 30% margin. I think that really should be the focus. And we, you know, our endeavor is really to grow the dollar value growth in EBITDA going forward, rather than just expand margins, for the sake of expanding margins.
Okay. Thank you, Dilip. Sorry, Pooja, since you were on the question about Singapore, and hence I took the opportunity to extend that question. Probably back to you, Pooja, but I would appreciate it if you can keep it short, or if there's no follow-up question, I would like to move on to the next caller. Is that fine with you, Pooja?
Uh, I-
Sure. Thank you.
Thanks, Penny. If you don't mind-
Yeah.
If you don't mind, just one follow-on.
Sure
... on this current topic that we talked about, which is proton. So if both the shifts that we have in proton in Singapore, if that's running at full capacity, and with the 100 cases which have been registered, how long would it take for these 100 cases to be getting fully treated? Like, would it be a couple of days, months?
Okay. So just like radiation therapy, traditional radiation therapy, which has got many sessions, right? It's a course, it's not a one-time treatment or two-time. Proton as well has got a number of treatments. It can go as high as 20, 30 treatments to complete a course. And that's the reason why we cannot just keep increasing the number of patients indefinitely. I mean, we cannot say from 100, we hope to go up to 200. We can't, right? Because the 100 cases will have multiple treatments, all right? So you may have actually, 100 cases will have maybe, I don't know, 500 appointments or something like that, right? So it's, I can give you, give you a very simple example, but it's, it's, it's a fairly complicated process. We have what we call low fractions, and we got high fractions.
I mean, certain cancers only need a small number of treatments. Some cancers require a high number of treatment, right? So we've got to mix a number of things, local patients, foreign patients, low fraction treatments, high fraction treatments, all right? And now there are proton, the proton machine has got some software which will allow you to give higher dose for each fraction, all right? So these are all the, I would say, the various parameters, all right, in a proton machine. So at 100 now, we are already, the first shift has been maxed out, all right? Now, the second shift allows you to bring in another group of patients, all right? And that will max out as well at some time. So this is a constantly moving target.
Okay. Thank you, Dr. Prem.
Thank you everyone. Bye.
Thanks, Pooja. Operator, you can move on to the next caller.
Please stand by for our next question. Our next question comes from the line of Shu yan Tan with Goldman Sachs. Your line is open.
Hi. Morning. My first question is on first quarter EBITDA margins for Malaysia and India. Can you walk us through what caused the margin shift, and whether these are sustainable?
Sure. So, you know, Malaysia, as I mentioned, you know, in my, in my slide, you know, Malaysia has, you know, corrected some of the, you know, healthcare worker salaries, and that's really the reason why it has reduced. But bear in mind, this is comparing to first quarter of last year, where, you know, we actually were under-resourced in terms of nurses and staff, right? Now, you know, I must say that we are fully resourced. We are in a good place with Malaysia, and in order to ensure that we have low attrition, we have to make adjustments to, you know, nursing wages. So I think that's the impact that you're seeing in Malaysia. With regards to India, India, obviously, as Dr. Prem mentioned, there's been a lot of focus on margin expansion.
And as you've seen in the Fortis results as well, Fortis has done well to expand their EBITDA margin, and they continue to do so. And on the other hand, Gleneagles India as well, we are, you know, as I mentioned previously, in early teens EBITDA margin, from single-digit EBITDA margins, which were there last year. So there's been a substantial improvement in operations, you know, Gleneagles India, and we expect to continue on that path.
Got it. Thank you. Second question is on Singapore. I think earlier you were mentioning you're converting the multi-bed to single-bed wards. What is the current operational bed, and how will that look once the conversions are completed? And also, how should we think about revenue impact?
Okay, I don't know if you have the exact number, but let me just give you a flavor. In Singapore, there is no demand for double beds, all right? Two-bedded rooms, absolutely no demand, right? So there will be. We are converting. And it's not just in Mount E, it's in Gleneagles, the other hospitals that we have as well. As you know, our Integrated Shield Plans in Singapore pay for a single room, right? If you buy the private option, it pays for a single room, so everybody wants a single room. We keep a few four-bedded rooms in the other hospitals, like Parkway East and Gleneagles, because we do have some company contracts, all right? Where their mid-level employees, their room rate, their reimbursement is not as high, so we keep a few, all right?
But otherwise, it's all single room. But the single room utilization will be very high, okay? Because everybody wants that. The exact numbers... So Singapore's total bed capacity will come down, all right? If I'm not wrong, somewhere around 800. Maybe we can give the-
Yeah
... the figures subsequently-
Yeah.
so that you have a sense of it.
How should we think about revenue impact?
Single room, typically... Okay, so as I mentioned, right, four-bedded means that these are the, the company contracts and all that, which may be of a lower, sort of intensity. Single-bedded rooms, of course, the charges are higher, right? The room rate itself. Typically, they come in, and it's fully covered by, most of it is covered by insurance, either local or global, right? And the, I think our projections are that we'll still be able to more or less maintain Singapore's, financial numbers.
Okay, great. Thank you so much.
Shuyan, just to add, I think in terms of the Singapore licensed beds, as of full year 2023, we are about 1,017 beds, and in terms of operational beds, we're about 793. So, the information can actually be found in our annual report as well.
All right. Thank you.
Hi. Thanks, Shuyan. I think with that, I see that we have many questions on the webcast, and perhaps let's move to the questions from the webcast participants. Right. I have the first question from Kok Xiang. Actually, it came in four parts. The first is: Singapore's revenue intensity and BOR improved Q on Q. Can you clarify whether this is mainly due to medical tourism, or more patients due to proton technology? Maybe the first question first before I move on to the remaining three.
Sure. So, so yeah, you know, as we mentioned, Singapore medical or other medical travelers' revenue contributed to about close to 20% in Q1, which is about the same in terms of proportionate, in proportion of revenue contribution in compares, in comparison to Q4 as well. So, so overall, the proportion remains the same. However, as I mentioned, we have seen strong growth, volume, volume growth as well as revenue growth, both in local patients as well as foreign patients, despite having the Raya period. And as you know, you know, Singapore does attract, quite a few medical travelers from Indonesia. Despite that, we saw an uptick in revenue, in Q1.
All right. Thanks, Dilip. And second question is, congrats on the sequential improvement in India's operation. So what kind of EBITDA margins are we looking at in 2024 and 2025?
... Is this specific to Singapore?
I think it's India.
India.
Yeah.
India operations.
Yeah, India.
But, you know, as I said, you know, so we have two different platforms in in India. One is Fortis, and again, as you've seen in Fortis, they have surpassed, as per their announcement as well, they've surpassed the 20% EBITDA margin mark and progressing well, in terms of their EBITDA margin expansion story. As I also mentioned, if you look at Gleneagles, India, not too far back, we were low single-digit EBITDA margin. From there, we've progressed to, you know, the early teens EBITDA margin already on a run rate basis, and we expect that to continue over the next, I would say, 18, 24 months going forward.
The third one is about, maybe much more to Evren. News quoting a lot of doctors leaving Turkey. Can you shed some light on how this impact Acibadem? Should we be concerned on gradual losing of these important assets?
The way that I would react to that, probably, if you think about Acibadem in Turkey, the brand has got a very high reputation, and it, this is very valid for all different types of medical professionals. Think about doctors, you know, doctors leaving to Western Europe, other countries, we're not affected at all. In fact, we are a true attraction center within Europe because we cater to a certain segment. I mean, I just wanna emphasize one more time why Acibadem, in its own home market in Turkey, is so different than the others, because like I said, our services are provided to a certain clientele. We employ... And because of that, because of the high expectations of our patients, we ensure that we employ the highly qualified, you know, medical professionals, including the doctors.
Because of that, the unique differentiation of the brand, doctors also prefer Acibadem within the local market. So, I mean, just to respond, in short, no issue at all. Not concerned at all.
Sure. Thanks, Evren. The fourth question is about actually what makes IHH to continue venturing into China instead of divestment, given China's average bed per 1,000 population is six, which is much higher than global average of three, and the market's very competitive. Dr. Prem?
Okay, so China, and I've, you know, been on record as saying this already, right? China is not... In, if, in our view, China is not a market to be ignored in the medium and long term, right? So a lot of foreign healthcare companies that have gone into China, all right, have been experiencing difficulties. But is this going to be the case forever? What if we exit China now, if we divest and exit China, all right, and China goes through another boom cycle as it did, all right, for, during the pre-COVID phase? I don't think we will get our licenses back, all right? In China, to get a hospital license, to get clinic license, the regulatory situation is not that easy. So, we feel that China is not a market to be ignored in the long term.
We are only in Shanghai at the moment, right? The clinics and hospital. We are now rationalizing our business there. We are putting the two brands together to run it as one entity. We are working very strongly with the government. Shanghai government is very interesting because their public hospitals are very full. They've got an entity called Shenk ang, right, which puts all these public hospitals together, and they are quite keen to work with the private sector. We are located in a government medical park, New Hongqiao Medical Park, which is part of the Minhang District, all right? Part of Shanghai. So, and because of that, and the medical park is, they are our partners, all right? So it's in their interest to help us succeed as well, right? We've met all of them.
They're very, very earnest to get, to ensure that we succeed, as would be the other private hospitals in Shanghai as well. So strategy is very simple. We are only in Shanghai. It's a very small part of our overall business at the moment, all right? We rationalize it, we stay there, and when China is as it inevitably will, I'm sure, all right, improves, right, and starts prospering again, we should write the China story as well. So I think that's, that's our strategy.
Sure. Thank you, Dr. Prem. Moving on to the next question, from Kok Xiang, from Hong Leong. Given India's BOR hit 70%, Acibadem hit 75%, and Malaysia hit 67%, should we or how many beds we can expect to be replenished in this year?
So, you know, I think if you look at, you know, that's something we've been telling investors for a while now, that as a group, our utilization is fairly high. If you look at our full year numbers last year, we were at 70% already, which means there are certain countries which are operating much above 70%, and that's one of the key reasons why we took upon ourselves the brownfield expansion plan. So we have a very clearly laid out expansion plan for 4,000 beds, which we intend to do over the next, you know, four years. And, you know, we will stagger it over four years to ensure that, you know, we release beds in a more sensible manner. And you will see bite sizes of that come in, you know, every, every quarter, every year.
As we saw this time already, if you look at Malaysia, we said, you know, we've already increased our bed capacity by 150 beds in this quarter alone. So that is something that continues to happen, and, you know, as we go along, we will kind of communicate more in terms of, as and when we open these brownfield expansion plans.
I think some more details are given on page 15 of the slide deck. I think roughly around 470 beds in 2024.
Yes. Moving on to the next question from Macquarie. Congrats on the strong quarter. Can you give us more details on the Malaysia's salary adjustment? When and how much, and when do we expect Malaysia's margin to come back to the high 20s? Dilip?
Thank you. So, you know, as we mentioned earlier, you know, we do believe, and we mentioned this in the last call as well, I think we do believe that Malaysia margins should stabilize overall at about 25%. As Dr. Prem mentioned, you know, we have to be, you know, conscious about price increases. However, if you look at the intensity increase in Malaysia, the intensity in increase has been double digits. So we have high intensity, we've had very good patient volumes, and we have increase in, you know, medical tourists as well, coming into Malaysia. So with all of that put together, we believe a 25% EBITDA margin should be something that we should be stable at.
Sure. Thank you. Moving on to Melvin from TA. Will Malaysia's EBITDA improve moving forward? And despite higher revenue of 9%, EBITDA was down 4%. So roughly, how much was the cost increase from healthcare workers' reward? I think it's quite similar to the one that you just earlier, Dilip mentioned. So I'll move on to the next question, which is from Rachel. A few follow-up questions. First, the proton beam therapy is very exciting, but based on your projection of a stabilized operation of the proton beam therapy, how much does it contribute to your Singapore revenue? And what is the EBITDA margin for this center, and can it drive Singapore's EBITDA margin higher than 30%? And what do you need to see to think about adding a second machine? Perhaps, Dr. Prem.
Okay, the proton beam therapy is not a profit center. All right? It doesn't stand alone. It is part of Mount Elizabeth Novena Hospital, right? Okay, so it sits in the hospital accounts as part of the overall services of the hospital. Adding a second machine. Now, we put a single bunker, all right, five feet underground. To add a second bunker is not going to be easy, right? Obviously, you try and put it. Some of the other center, private center, also has got one bunker, but our National Cancer Centre, in anticipation of higher workload, they have put in four bunkers. But proton technology is changing as well, right? Why is the bunker so big?
Because patient lies flat now, right, and the rays, the accelerator will come at a certain angle, so you need to have a big space. But I can tell you, proton technology is going to change. A lot of treatments are better than standing up, patients standing up or sitting down, all right? And some of these at least two or three of companies already come up with this technology, and we are exploring this as well for expansion. You can pretty much use a store room, right, a big store room, to install a stand up, standing, proton gantry, right? So these are some of the things that we are looking at, all right? It's not imminent. We want to make sure that the technology is adopted. It's already been in U.S., in France, right? Coming to Asia as well.
So no rush. We want to make sure that... And as I also mentioned to you, the software for proton machine is also improving, so we can use the same machine to improve the efficiency further as more and more software come, software upgrades come. Right, so these are the kind of things that we look at when it comes to proton machines.
Sure. Thanks, Dr. Prem. Second question to Rachel is, any updates on Parkway Shanghai operational performance? I think, Dr. Prem, you have covered in the earlier question, so I shall not go into it again. Third, noticed that Turkey's percentage of medical tourism fell this quarter. Could we have more color, and is this a structural trend moving forward? Evren?
Yeah. Thanks, Rachel. I actually wanted to explain that. Basically, what happened in the first quarter, the local volume increase compared to last year was higher than the change in our foreign patient volume. So, this kind of reflected, we had a higher portion of Turkish patient revenues compared to foreign patient revenues, resulted in a decline in the patient ratio. But what I would say, obviously, what happened during the first quarter, we had some declines in the number of patients coming from certain regions, like Africa, Middle East. And the reason for that was obviously the month of Ramadan falling into the whole March, so these people kind of delayed, you know, their treatments. So we have seen an uptick in the medical tourism volumes in April, and also May is going quite well.
To me, that decline was more specific to first quarter.
Thank you.
I think there's some seasonality in healthcare in different countries.
For sure, for sure.
Yeah.
I mean, even, I mean, if you think of... I think this was also asked, but Turkey has got a lot of seasonality because of the shift of festive holidays-
Mm.
from second quarter to the first quarter, as well as, you know, the local elections.
Yeah.
So that it's all a factor.
... Sure. Thanks, Evren. Moving on to the next question, Raymond Choo. Q1 2024 inpatient admission rose about 1%-3% year-on-year across the board. Any concerns here? And can we have some indication in the months of April and May that patients are flocking back, or are you already seeing increase in inpatient admission?
So, yeah, sure, I can take that. So, you know, I think if you look at inpatient admissions, you know, bear in mind, you know, Q1 had two factors, you know, in some of our geographies. In Southeast Asia, we had the impact of Chinese New Year, as well as unlike last year, we had, you know, 11 days of Raya/Eid in Southeast Asia, right? Which obviously had an impact on Southeast Asia. So despite that, we can see that the patient volumes have actually increased across various countries. In Q2, we believe, again, we're seeing, you know, good robust volumes in most of our countries. But, yeah, again, bear in mind, in June, we have the Eid festival again.
But apart from that, I think Q2, as far as we can see now in April and May, the volumes seem to be indicating pretty robust trends.
Thank you, Dilip. The next question from Sue CLSA. Could we have some updates on any regulatory or government policy updates across the country you operate in that could cause headwinds or tailwinds to your operations? Alluding to India, but are these present in other countries? Thanks.
Okay, so I think right now, we are sort of quite comfortable with developments around regulatory government policies in all the countries we are operating in. I think you got a specific reference to India. I think we are still in discussions with the regulators, and we are patient around the legal process. And if you look through slide 24, you can basically see that we are quite comfortable in the two brands we have in India now, Fortis and Gleneagles. So it doesn't impact, you know, the backdrop doesn't impact us. In fact, both the platform, as Dilip has mentioned earlier, continue to grow forward as well. And then if you look through...
You know, one of the things that I wanted to highlight, if you look through slide six, this is the strength of our group. We are across multiple geographies, so we basically have size, scale, and a diverse portfolio. These are different levers we can you know, we have to make sure that we are delivering, you know, on our financial performance.
Also a follow-up question from Sue, with regards to China update. What has been done so far since December, when you first said you were going to keep China ops? I think, Dr. Prem, had earlier addressed this, so maybe we'll move on to the next question from Sue, which is: What's the cash burn, guided cash burn for the year, and how much are you putting in for the revitalization of China hospitals and clinic? Dilip?
Sure. So, you know, we—this is something, Sue, we spoke about, you know, last quarter as well. We did mention that, you know, we if you look at the overall money that we're going to put into China, is going to be fairly minimal. The hospital is brand new. You know, you must recall that, last year, first quarter, is when we opened the hospital. So the CapEx required in the hospital is very, very little. It's more about recruiting doctors and ramping up the hospital itself, right? The second part of it, which is the clinic, again, we have the clinics. All we're doing is rebranding and revitalizing some of the clinics and refurbishing some of the clinics, which is very minimal CapEx investment in that sense.
So, I would say the money required to revitalize China is fairly marginal in the whole scheme of things.
Sure. Thanks, Dilip. I think I'm just very mindful of time, and perhaps I just have time for one last question. And I know there's a lot of questions on webcast, but I'll be selective as to what makes sense and not repeat the same question. So maybe I'll take the question from Andrea, and particularly because I think no one has asked about M&A, and I thought that'd be interesting for Dr. Prem to talk a little bit about it. So, which geography will be the key priority for IHH organic growth plans? And can you talk a little bit of the opportunities in Vietnam as well? And then before I talk about the last point from her, yeah, Dr. Prem.
Yeah. Thanks, Penny. So, I think we've been on record as saying that other than the geographies that we are already in, right, as a responsible healthcare organization, we will have to look for new opportunities in other markets, right? And the two markets that we are focusing on, and I want to reiterate here, we are looking at it from a business development viewpoint. No decision has been made on whether we will go into these countries, because we have to look at many, many factors when entering a country. So let's take Indonesia, which we have spoken about, all right? It is adjacent to several of our countries, Singapore, Malaysia. It is a source of a lot of our patients.
But the most important thing about Indonesia now is the reforms that are taking place under the current health minister, right? Who is addressing many of the problems that have plagued Indonesia's healthcare sector, primarily the number of specialist doctors. In the past, we were reluctant to go into Indonesia, right? Although it was a country of 300 million people with high affordability among the mid and upper tier of the population. Primarily because of the regulatory environment, not enough doctors. Foreign doctors couldn't register there, right? Now the minister has made it easier for foreign doctors to register in Indonesia, right? And that's positive. But it does not mean that immediately there's going to be a whole lot of doctors available for us when we go into Indonesia, right?
So we are watching the situation. We have spoken to the various people there. We've met some potential partners, all right, people whom we can work with. So very early stage, all right? But it's definitely a country that's on our radar, all right? That's what I will say. Now, Vietnam is. We have mentioned Vietnam because other foreign players have gone into Vietnam, all right? No, they have gone in, all right, to buy private hospitals. Vietnam, economically, of course, is doing very well. Again, it's a big source of foreign patients into our hospitals, in especially Singapore. So affordability is high, right, insurance penetration and all that. But the question is, do we go to two countries, right? Do we stick to one country? So these are all the various things that we will have to look at.
So, yes, Indonesia, Vietnam, some time away, but we will continue looking. We continue to explore until such time we decide that it is worth our while, our time, our management time, okay, resources that we put into Indonesia or Vietnam, all right, whether it's gonna work out.
All right. Thank you, Dr. Prem. And the third, that last question from Andrea is: Previously, there was a plan to IPO the lab business in India. Is the management re-looking at plans at the moment, Ashok?
Yeah, I think so. On the labs in India, that IPO, it is basically a process of sale by some of the private equity investors in Agilus. So the company was just facilitating the IPO. At this stage, you know, there are still some discussions going on on the next stage, as the sellers have decided that on a commercial basis, at this stage, they don't want to pursue an IPO. But just to add to, you know, some of the points that Dr. Prem made, as you know, all of you have given us a lot of feedback over the years, the management is very focused on delivering M&A, which is, A, strategic, and B, accretive. And therefore, to a large extent, our focus remains on our core markets.
Also, you know, we've taken the last few years to actually, you know, make sure that there is proper portfolio rebalancing. Some of the non-core assets have been disposed, like, IMU. We've sold some assets in India, consolidated some assets in India. So I think that prudent discipline will continue, as far as, inorganic growth is concerned.
Thank you, Ashok. So before we actually conclude the results briefing, I would like to have Dr. Prem probably share a few key takeaways, and before we conclude, an outlook for IHH. Dr. Prem?
Sure. Thanks, Penny. So maybe just to reemphasize a few points. One is, as I've said, we are a healthcare company, all right? So other than business leadership, we look to ensure that, clinical leadership is right on top as well. And that's why I place a lot of emphasis on quality, on appropriate care. All right? So these are things that are very important to us from a clinical standpoint and clinical leadership standpoint, right? And that, we feel, would translate into business leadership as well, right? Okay. A point that I've made in the past, if you look after the patients well, the business will look after itself. That's a very simple way of putting it, but, you know, what I'm trying to say is that we have to focus on the important things in healthcare.
And that's why I see some of the questions on doctors and all that. Nurses, Malaysia trying to retain nurses by, you know, making sure that they are paid appropriately. But I think we are very, very confident that with this strategy, the outlook is very positive. Our growth trajectory is secure, I feel, and we will continue to grow. We will execute our plans under the ACE Framework that we have spoken about. There are some headwinds, all right, in certain countries, Turkey, China and all that, but we've managed that very well, I feel, all right? So I think at the end of the day, I think we feel that we are on a good growth trajectory. Clinical leadership, care leadership, and all this comes under really our aspiration, which Care. For Good. describes, right?
Patient, people, public, and planet, right? Yeah. Thank you.
Thank you, Dr. Prem. With that, we will now conclude the IHH Healthcare First Quarter 2024 financial results briefing. Thank you for joining us today, and I know there are a lot of questions, and please do feel free to reach out to the IR team at ir@ihhhealthcare.com. With that, we will conclude. Thank you once again.
Thank you.
Ladies and gentlemen, this concludes today's conference call. Thank you for your participation. You may now disconnect.