Good evening, everyone, and welcome to our analyst briefing for Q2 2025. Thank you for taking time off Friday to join us. My name is Kelvin. I'm from the IR team. Together with me today is Dr. Prem, our Group CEO, and Mr. Dilip Kadambi, our Group CFO. A warm welcome to all. Dr. Prem will kick this off by giving a high-level overview as well as opening remarks for the quarter, followed by Dilip who will take us through the high-level financial highlights for Q2 FY 2025. We will then cover some key operational updates across our key markets, after which we will open up the floor for a Q&A session. Dr. Prem, over to you.
Thank you, Kelvin, for the introduction. Good evening, and thank you all for joining our results briefing. As usual, we will do the operational highlights, and then we will move on to all of you for the Q&A session. In Q2 2025, we achieved resilient financial performance despite a challenging macroeconomic environment, driven by an increase in inpatient admissions and a higher revenue intensity across our core markets. Our performance was even stronger on a constant- currency basis, clearly demonstrating how our diversified portfolio strategy enhances IHH resilience. EBITDA and PATMI margins remain stable and within our guided range. The ACE framework that was put in place since 2023, following the appointment of the new management, has allowed IHH to stay ahead of the curve and respond to structural shifts in our care model.
One of the growth pillars focuses on expanding across the care continuum, and this has allowed IHH to transition seamlessly from inpatient to daycare. We have anticipated this shift and are already seeing this in Malaysia, where net daycare revenue has increased by 20% and day cases volume by 18%. In Singapore, we are leveraging our existing new ACCs, Tong Building, Royal Square, to decant hospitals to focus on higher-intensity equity cases. We are also further driving efficiencies by standardizing and modernizing platforms across our core markets, including procurement, IT, and in time, shared services. We have rolled out Cerebral Plus in Singapore and India first, followed by other countries. We are also pleased to share that Mount Elizabeth Orchard's renovations were completed on schedule in end 2025, with phased reopening done by the third quarter of 2025.
We will see contribution ramp up in the following three quarters, with stabilized contribution from Q2 2026 onwards. We remain cautiously optimistic about the financial performance despite erosion from a strengthening Ringgit for the rest of 2025, supported by a robust financial position. We are also pleased to share that despite payer pressures and operational headwinds, IHH has declared an interim dividend of $0.05, up from $0.045 last year. With that, I'll pass the time over to Dilip to cover the financial highlights. Dilip, please.
Thank you, Dr. Prem, and welcome all of you on the call, and thank you for making time on a Friday evening. As mentioned earlier, our diversified platform across multi-geography ensures that we always have areas that outperform, enabling us to mitigate risk from other geographies, allowing the Group to remain strong and resilient. As always, let us focus on the blue box, which more accurately represents our operating performance without any non-cash items that are in there. Despite several headwinds, such as FX volatility, including this appreciating Ringgit, payer pressure, some of the structural changes Dr. Prem spoke about, and the Mount E Orchard facility operating at half the capacity, the company still showed a 7% growth in revenue and a 2% growth on EBITDA. On a constant currency basis, we had a very robust growth.
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Okay. Apologies for the sound disruption. Again, on this slide, on a constant currency basis, you know we had a robust growth of 18% and 11% on EBITDA, demonstrating a strong operational performance across all our key markets. Despite some of the uncertainties and macroeconomic headwinds, we are cautiously optimistic about our performance for the remainder of 2025. We are also pleased to announce that we have been given the highest rating of AAA from two of the top Malaysian rating agencies, which will further help us manage our financing costs better going forward into 2025. In addition, and with the structural shift in the care model, where we have anticipated we'll focus our CapEx/cost structure more towards daycare, it will also allow us to reduce CapEx and pare down our debt faster. Finally, we completed the phased reopening and ramp-up of Mount Elizabeth Orchard by Q3 of 2025.
We will see a corresponding ramp-up in contribution over the next two quarters, stabilizing by Q2 2026. On a year-to-date basis, we see a continuing trend of strong core growth, offset by currency translation losses due to the strengthening Ringgit. Revenue and EBITDA grew 7% and 1% amidst a challenging operating environment and macroeconomic headwinds. On a constant currency basis, revenue and EBITDA grew by 17% and 10% respectively. Again, we are optimistic about our performance for the remainder of 2025. Similar to the previous quarters, we have in blue box the reported revenue and EBITDA, and next to it, the respective matrices on a constant currency basis, i.e., stripping out the translation impact. Overall, the Group achieved an 18% growth and an 11% growth, respectively, in revenue and EBITDA on a constant currency basis, thereby demonstrating very robust financial performance.
In Malaysia, we saw a structural shift in the care model, which we anticipated, with an increased focus on daycare and a skew towards more surgical cases, moving away from medical cases. Net daycare revenue and daycare cases increased by 20% and 18% respectively. Despite the discounts given to insurers, given the payer pressure, we have seen intensity increase by 3%, which you will see in the following slides. For Singapore, Mount E Orchard renovations were completed on schedule, as mentioned by Dr. Prem , in June of 2025, and is going through a phased reopening and ramp-up as we speak. We also saw some payer pressure in Singapore, as well as our focus on developing care through the care continuum. To respond to this, we are ramping up our ACCs, as we have announced in the past.
We are building out both Tong Building and Royal Square, and that would address some of the payer issues. As a result of these trends, we have anticipated some of these trends, and as you can see, the intensity in Singapore has gone up by 9%. Turkey and Europe demonstrated robust revenue and EBITDA growth, both on a reported and a constant currency basis, despite FX erosion. With double the EBITDA growth on a constant currency basis, India continues to be a key growth market for us, and we are looking for further driving operational synergies between both our platforms, Fortis and Gleneagles India. As a result of which, we have recently signed the MSA, and we are in the process of integrating the back end for both Gleneagles and Fortis. Margin for the countries and IHH Group continue to be within our guided band.
Overall, we have seen resilient operating performance across all our key markets, which we continue to build upon. On the next page, similar to what we just saw, this is on a year-to-date basis. What I'd like to call out really here is double-digit growth in both revenue and EBITDA on a constant currency basis, growing at 17% and 10% respectively. This slide shows our financial performance trends over the quarterly basis. The solid purple line shows our EBITDA margin, ex-MFRS, in Q2. This was at 22%, which is well within our guidance of 22%- 24%. Next, our core PATMI, which excludes EI, noted by the bold green line, it was at 8% in Q2. Without financing cost, this would have been 9%. Looking ahead, we still maintain our EBITDA margins to be within the range of 22%- 24%.
This slide shows our strong business operations and the cash flows thereof from the business operations in Q2. Our strong cash generation and healthy cash balances allow us to fund our CapEx and investing activity. We paid RM485 million of dividends on the 28th of April for the previous year. We are also actively, as I said, paring down debt, and the rating would really help us further drive down interest expense. We are also looking at the budgeted CapEx for some of our countries, and given the new care model, which is more daycare-driven, we are looking at paring down some of the inpatient bed CapEx, which will allow us to pare down debt faster. With that, I would like to hand it over back to Dr. Prem to go through the operational highlights.
Thank you, Dilip. This slide now focuses on Malaysia, where the management is taking the lead to manage medical inflation and has mostly concluded negotiations with the respective payers. The Island Hospital acquisition, which was completed in fourth quarter 2024, now seems to be a very timely and strategic decision, especially enabling us to tap into the medical tourism segment to capture additional revenue. As you can clearly see in Malaysia, the inpatient admissions have increased, driven by this acquisition. EBITDA margins have remained stable, mainly due to measures taken to address medical inflation. We are very mindful of tackling and addressing these inflationary pressures through proactive measures, including discounts to selected payers to allow patients and policyholders to utilize our hospitals and better manage costs. Earlier, we've seen a shift more towards daycare, and this is something quite encouraging.
We have anticipated this, and coupled with the factors above, we expect to see a more robust set of numbers in Q3 and Q4 this year. As always, we are actively managing manpower costs and optimizing variable costs through rationalization of procurement. In Singapore, as we have mentioned earlier, the Mount Elizabeth renovations, which have been completed, revenue intensity actually grew 9% for the quarter, which helped offset the temporary decline in volume. As it progressively ramps up through the third quarter, we expect Mount E to see a corresponding ramp-up in contributions over the next two quarters. Just like Malaysia, we are also facing increasing payer pressures, given the rising medical inflation. We work with our payers' insurers to address this as well. With insurers, we are offering targeted packages for both local and foreign patients.
Actively managing manpower costs and boosting productivity through automation is another of the strategies that we have in Singapore. Turkey and Europe, now this relates to our Acibadem business, which has actually done very well. On both reported and constant currency basis, revenue and EBITDA demonstrated robust growth at 40% and 30% respectively. The compression in the EBITDA margin that you see is mainly due to the pre-op cost of Vitosha in Bulgaria. Kartal Hospital in Turkey broke even on a run-rate basis in July, and without the pre-op costs of Kartal and Vitosha, margins would have been at about 20%. Despite the foreign exchange volatility and translation effects, our Turkish and European operations have done well and continue to contribute significantly to the group.
Foreign patient contribution declined to 13%, but that was mainly due to a faster increase in the local patient revenue, which grew almost 50% from last year, coupled with the smaller depreciation of the lira versus the Malaysian ringgit. We are actually quite confident about Turkey's outlook as its economy continues to grow following the move back to conventional economic policies. Now, a word about India, which continues to be a key growth market for IHH. We can see that the growth trajectory continues with double-digit revenue and EBITDA growth on a constant currency basis. We hope to drive further operational efficiencies between Fortis and Gleneagles India through the recently signed management services agreement. We are optimistic on seeing convergence of margins through operational synergies of these two entities, efficiencies through standardization and centralization of procurement, IT, and operating expenses.
The recent Fortis results, which you have seen, are very healthy. There was also some forex impact on revenue, which grew even more on a constant currency basis. Admissions have gone up 8%, revenue intensity has increased by 6% with a more complex case mix. For Gleneagles Hong Kong, it continues on a steady growth trajectory and increased capacity because we opened 18 more beds in anticipation of a ramp-up in the second half of this year. Revenue intensity rose 7%, and we are focused on driving inpatient admissions through the care continuum by driving more volumes through clinics and specialist consults with the ambulatory centers that we have opened. With the pickup in the volume margins, I think we will converge closer to our initial guidance on the high teens.
Our laboratories business remains stable, increased test volumes, and we will continue to increase the menu of tests offered, especially the high-end ones, to make more accurate and effective tests available, thereby allowing doctors to make more informed decisions and provide better treatments. You will see a few slides on some of the key milestones within the Group. We actually had a very, very interesting forum called the Forum Ilmuwan Malaysia. It's a thought leadership forum with the government of Malaysia. Because AI is such a big thing nowadays, we have an award-winning Nurse Shift AI, which automates the rostering system in Singapore, fully deployed throughout its Singapore operations. As I said earlier, Singapore has fully rolled out its Cerebral Plus EMR system as well. In India, Fortis has launched the Fortis Institute of Genomic Medicine, and I think this will also set a new benchmark for precision medicine.
Fortis is also on the C+ EMR system, and this will be followed by a rollout in other core markets. In Turkey, Acibadem completed the acquisition of yet another group of hospitals, the Bayındır Group. For the labs, we continue to go higher up the testing ladder with the introduction of metabolomic testing for personalized preventive care. I think here you can see a few notes on sustainability, which is still a very big focus for us as part of our care for the planet. Maybe I will end here. There are just a few key takeaways for everyone. We remain cautiously optimistic about the financial performance for the rest of 2025, supported by a robust financial position. We will continue to drive growth through transformation and clinical leadership, anchored by our framework set out back in 2023.
I think we can now move to the Q&A, and I'll pass this back to Kelvin.
Thank you, Dr. Prem and Dilip, for the insightful updates and the sharing session. Operator, we will now begin the Q&A. As always, we will take questions first from participants on the call, followed by those joining via the webcast. We have a large number of attendees today. May I kindly request that each participant limit themselves to two questions, and if you have additional questions, you can always jump back into the queue. Operator, please begin the Q&A session.
Thank you so much. Dear participants, as a reminder, if you wish to ask a question over the phone, please press star one on your telephone keypad and wait for a name to be announced. To withdraw a question, please press star one again. Alternatively, you can submit your questions via the webcast. We are going to take our first question on the audio line. It comes from the line of Neha Manpuria from Bank of America. Your line is open. Please ask your question.
Thanks so much for taking the question. Two quick ones. First, Dr. Prem, you mentioned about payer pressure both in Malaysia and in Singapore, and I think in Malaysia you also alluded to taking measures to address this, which is why margins are flat. Could you give us some color on how we should think about incremental pressure? I mean, is this the fair assumption? Are we settled on all the negotiations and therefore we shouldn't expect any more pressure on margins in both Malaysia and Singapore when we think about operations going forward?
I've said many times in the past that payer-provider issues have always been there in healthcare, and every now and then it will sort of flare up, and that's what happened in Malaysia last year because medical inflation went into the mid-teens, and I think that is what really caused the issues that we saw in Malaysia last year. While different providers have addressed the problem in different ways, what we decided to do was to work directly with the insurers, our partners. We worked with them and gave them discounts that we felt appropriate for our hospitals, and that has been concluded largely. I can say that our negotiations with insurers have already been concluded, and you will see that the temperature in Malaysia with respect to payer pressure has somewhat come down.
I would also say partly the credit goes to the setting up of this joint committee, which you have read about. I think the Malaysian government decided that instead of having payer-provider issues playing out in the newspapers every day, it would be much better to form a committee, and that committee has already been constituted, and now there's another forum for payers, providers, patient advocates, and regulators to come together, and I think that will also help to streamline things in Malaysia. You'll notice that many of the issues that we have spoken about in Malaysia have pretty much gone off. What else have we done? We also want to make sure that this thing doesn't flare up again.
One of the things that we have mentioned several times during this presentation is, one, to really look at whether many of the healthcare procedures that are done as an inpatient can be done as daycare, and that has pretty much moved daycare up considerably in Malaysia. That is one, and we will continue on this path. That's the first thing. Secondly, I think we really looked at our costs, and we have focused on procurement, consolidated procurement, not just countrywide, but as a group, as one of the ways for us to manage our costs as well, because I think it's imperative for us to look at ourselves and ensure that we are also pricing our hospital services, daycare services, laboratory services appropriately.
I think these are things that have been done, and I would say it's pretty much working because you don't hear very much about this in Malaysia anymore.
That's very helpful, sir. My second question is on Singapore. You mentioned stable contributions starting from, I think, second quarter next year. When you say stable contribution, would it be fair to assume that occupancies and margins go back to the pre-disruption level by the middle of next year? Would that be a fair assumption?
Let me take that. I think, you know, overall, what we mentioned is that specific to Mount Elizabeth Orchard, we had earlier guided everybody that, you know, we would be finishing our renovation of Mount E Orchard by Q2 of 2025, which has happened. We will then take a quarter or two to ramp it up back to, you know, currently from 110 beds to about 220 beds. The remaining 100-odd beds would come up in the next, I would say, quarter and a half. It takes a bit of time to ramp that up as well. We expect from a Mount E Orchard perspective for it to go back into, I would say, reasonably full utilization by Q2 of 2026.
Thank you so much.
Thank you. Now we're going to take our next question. The next question comes from the line of Yen Wu from JP Morgan. Your line is open. Please ask your question.
Thank you, Operator. Good evening, Dr. Prem and Dilip. This question, you mentioned the shift to daycare has helped to accelerate the debt paydown. Now, the question is, how quickly and to what magnitude is that going to benefit and translate into a structurally higher ROE rather than just near-term balance sheet relief? On the second question, on the procurement side, could you give some quantum of how much this could be to help defend margins? Thank you.
Sure. On your first question in terms of a shift to daycare and hence the reduced CapEx requirement and the impact on ROE, this is something, as you know, we've been speaking about in Singapore. We've taken action in Singapore. In Malaysia, this is something that we are seeing almost for the first quarter this time. Accordingly, we are actually sitting down with our team here to make plans to see what kind of CapEx scale down we can do because I also mentioned a lot of medical cases that used to get admitted are not getting admitted anymore, which is the right thing to do, right? We do have availability of inpatient beds, and hence we focus on surgical procedures inpatient beds and improve our intensity on inpatient beds without having the need to build more inpatient beds.
At the same time, we have dedicated daycare facilities within our premises and drive volume for run-of-the-mill procedures through daycare. That is something which is what we are focused on. I would say give us a quarter or two, we will be reviewing our CapEx and we will come back to you. I know that in the beginning of the year, some of you had asked me in terms of Malaysia what our CapEx spend, expected spend would be, and I did mention it's close to about MYR 700 million. I think we would scale that down quite substantially given where we are.
Can I quickly follow up on that? How do you balance between the CapEx needed to refurb some of your older hospitals with that savings there?
The refurbishment cost is the refurbishment cost, right? What we need to do, we need to do, and we will continue to refurbish some of our older hospitals. In terms of increasing inpatient capacity, one way to do it in a more capital-efficient way is to look at daycare facility and see whether we can expand a dedicated daycare facility, which, as I said, would be at a much lesser cost per bed, and also from an operational cost point of view, it'll be much lesser as well.
Maybe just to clarify, in our annual budgeting cycle, we factor in all the refurbishment that's required for the older hospitals, right? That's part of what we do every year, change the carpeting or the wallpaper or some of the repainting upgrades to certain areas of the hospital, the lobby. That's part of what I would call the annual budgeting.
The big CapEx items are obviously the heavy-duty machines, putting in new beds, putting in new bed capacity. These are the ones that are more expensive. When you shift more to daycare, the CapEx requirement to set up a daycare center or a day surgery center is actually much lower, right? The turnover is faster as well because daycare means that the patient comes in the morning and goes home in the afternoon or in the evening. That is really the difference that we are now seeing in Malaysia.
With regards to procurement, just to kind of draw a parallel, as you know, over the last few years, we've been very focused on the capital equipment side, and a lot of capital equipment has been, I would say, centralized, and we buy for the group at the group level across various countries. We negotiate. That's already resulted in savings of over $150 million- $170 million over the last two to three years.
That's good. Thank you very much. I'll jump back in the queue.
Thank you so much. Now we're going to take our next question. The next question comes from the line of Nicole Go from UBS. Your line is open. Please ask your question.
Hello. Hi, Dr. Prem and Dilip and Kelvin. Thanks very much for the call. My question is also related to Malaysia. I think you have shown that there is a 15% revenue growth as well as a 14% EBITDA growth. Of course, you know, when it comes to volumes, there's a 4% growth in terms of inpatient admissions. I'm just wondering, because you also did mention, I think, that a lot of this growth came from the fact that you acquired Island Hospital. I'm just wondering how much of that revenue and EBITDA growth actually came from Island as well as Timberland. What does this, I guess, what does this mean for the rest of your hospitals ex this? That's my first question.
In terms of the bulk of the growth, it actually did come from both the acquisitions, I would say. In terms of volume, I would say we were flattish for the rest of the hospitals. To my mind, that actually is a pretty good outcome, given some of the headwinds that we faced over the last two quarters. From a revenue perspective, if you look at revenue growth minus Island and minus Timberland, we'd probably be flattish to slightly low. That, given where we started in the beginning of the year, I think it's a great outcome.
I think I'll just follow up with another question there, because I know you've mentioned several times that you are in final stages of negotiations with all the payers. At the same time, there's this shift, right, towards day cases, as well as you giving discounts to some of the payers. If we think about the outlook for the next two quarters, how should we think about it? If you are swapping, let's say, an inpatient to a day patient, will it mean that there's lower intensity, so lower price per patient, and also because you are giving discounts? Can you help us think about how we should expect revenue growth as well as margins over the next year or so? Thanks.
Sure. Maybe, you know, let's kind of start with, you know, the inpatient itself, right? Even though, as I said, you know, as we see, you know, medical cases reduce in terms of admissions, the surgical cases, you know, do have the opportunity to go up. That's why even this quarter, despite the discounts that, you know, all our facilities gave, we saw an increase in intensity in Malaysia specifically of about 3%. Obviously, what happens is when medical cases go off and when you have surgical cases go up, the case mix changes, and we see the intensity go up, number one.
Number two, I think from a daycare perspective, if you think about daycares, even though probably the bill size will be half of what you would have in an inpatient setting, given the air loss and the efficiency at which you lose the bed, it'll actually more than make up for it if you think about it, right? Overall, we're actually quite bullish about, you know, what is happening in the market, I would say. From an outlook perspective, I feel that Malaysia operating at about 25% margin is something that is definitely doable going forward as well. I don't see that as an issue.
Okay, got it. Thank you.
Thank you. Now we're going to take our next question. Just give us a moment. The question comes from the line of Amanda Foo from Macquarie. Your line is open. Please ask your question.
Hi, good evening, Dr. Prem, Dilip, and Kelvin. Thanks very much for the call. A few questions from me. Firstly, given the development of focusing more on the daycare model, and I believe that you've also mentioned that there will be a part of your inpatient bed CapEx, does this then change your longer-term plans of adding 4,000 new beds by 2028? If so, what is the new target that we will be looking at? My first question.
First, I can comment on the shift towards daycare. I think we have been saying for some time that the healthcare trends of the future are less hospitalization and more out-of-hospital procedures, right? That is a trend that we are seeing in many countries. In fact, in Singapore and Hong Kong, it has taken root some time ago. We are actively opening ambulatory care centers. As you know, in Singapore, we've got the Royal Square, which is next to Mount E Novena coming up, and then in Tong Building, next to Mount E Orchard, plus the expansion of the primary care clinics. Hong Kong as well, where we've only got one hospital, but we can't open any more, is the same thing as well. These trends will also take place in all the countries that we are in, right?
Although I would say we are pretty hospital-heavy in Malaysia, India, and Turkey. The trend is indisputable. That means we have to prepare for a day when we are doing more and more procedures. This is also partly because of the way the care is taking place. Today, many things that in the past were done as an inpatient, be it knee replacement, angiograms, various procedures, gallbladder surgery, can be done either as day surgery or as ambulatory surgery, which means within 24 hours and then off you go. We have been preparing for this, and that's why we kept saying in our presentation that these are not unanticipated. What does this actually mean from a structural perspective, cost perspective? Inpatient ward needs three shifts of nurses, right? Even permanent night shift of nurses to supplement, right?
They are all rooms, hospital rooms with 24x 7 air conditioning, lighting, various things. A day surgery center operates one shift of nurses, office hours plus, right? You don't operate, keep it open at night. The costs of, and the beds are not the regular inpatient beds, but they are trolley beds because you move the patient in and out of the OT. The costs actually are much lower. That translates into better pricing for patients and the insurers, the payers. That actually translates into higher utilization as well, turnover. This is the link between inpatient, daycare, manpower, costs as well, right? I think this is going to be a trend that we will see in Malaysia and possibly in India as well.
We are focused on Malaysia for the time being because this is where last year there was a big flare-up, and we have to address these issues. We will see increasingly our hospitals, which today, in many hospitals, we admit daycare patients into the inpatient rooms, and that's actually not very efficient. We would much rather put a dedicated daycare center in place of adding beds. You asked about the 4,000 beds. That still continues because these were mostly, you will note, in hospitals that were operating at a very, very high occupancy, 80%, 90%, close to 100% in some of our hospitals. At that kind of occupancy, we are actually losing patients to other hospitals, right? These 4,000 beds will still continue, but I think we now have an opportunity to recalibrate further expansion.
Thank you. That's very clear. Secondly, if I could kind of get an update on the plans for your double-digit ROE, is there a timeline that we can start looking out for already, or is that still in the works?
We are, as I've already mentioned, that is something that we are working towards, and we hope to get there as soon as we can. We're definitely targeting to kind of ramp up the ROE going forward.
Okay. If I could just squeeze in one very quick question, can you share with us what's your latest foreign patient revenue contributions from Malaysia, please? That's all for me. Thanks.
Is this for Malaysia or?
Yeah, for Malaysia.
For Malaysia, yeah, sure. If you look at revenue growth for the quarter, we've had a pretty healthy growth in Malaysia. We've had foreign patient growth of over 100%. If you strip out the Island effect, it is still high double-digit growth for the rest of Malaysia. In terms of contribution for Malaysia, we are almost doing 13% revenue contribution for foreign patients for Malaysia.
Thank you very much.
Thank you.
More questions?
Yeah, participants, as a reminder.
We will move to those that are on the webcast.
Please kindly proceed with any written questions.
First one comes from Chun Song. How severe does the payer pressure affect Malaysia margins in Q2 2025? Can you elaborate further? What are the restrictions imposed by private insurers? The second one, do you have the year-on-year comparison for inpatient admissions volume in Q2 2025, considering Island was completed November 2024? If we were to exclude contribution by Island Hospital, what was the growth for Malaysia? I think for the second question and the second part that has been covered, it was flattish without the Island Hospital acquisition. In terms of year-on-year comparison for inpatient admissions volume, if you look at the Malaysia slide, it's up 4%. First part of your question, how severe does it? I think Dilip and Dr. Prem r have already shared that we are in the process, if not already concluded, negotiations with key payers.
We would expect payer pressure to continue, as Dr. Prem said, it's prevalent in an industry. Our margins we've shared remain stable and within guidance. The second question comes from Chi-Kok Siang. For Singapore, any updates on the dispute between Mount E and Great Eastern? Any of these two hospitals repanel at what cost? Second part for Malaysia, does EBITDA margin in first half already reflect all the discounts IHH Malaysia compromised to insurance companies? If not yet, when will it be and how much % point impact can investors expect? For the second part, already shared, margins are within guidance. Our guided band in Malaysia around mid-20s range and it has remained stable. Payer pressure would continue and it would flare up every now and then, but we are working very closely with the payers. On the first part, Dr. Prem.
Yeah, let me clarify. Great Eastern did not depanel the two Mount Elizabeth hospitals. They removed pre-authorization for patients going to the two hospitals. Let me explain. Pre-authorization is an additional step imposed by certain insurance companies when their patients go to a hospital. In Singapore, there are other insurance companies that do not even have pre-authorization at all. All that a patient needs to do is go to our hospital, they get an estimated bill size, and the insurer will agree to cover or not to cover. Pre-authorization is just an additional step. The two hospitals were not depaneled. There are still Great Eastern patients who come into the two Mount Es. You would know that the two Mount Elizabeths are the hospitals in Singapore that have the most complex equipment, the robots, the proton beam therapy, and CAR T-cell therapy and all that.
There are still patients who will need to go to Great Eastern. We are working with Great Eastern. There are still discussions going on. We have created packages for them to adopt, and we are offering this at our other two hospitals. In case they are concerned about cost, they can go to the other two hospitals as well.
Thank you, Dr. Prem. One more question on the webcast. Again, it comes from Chun Song. What was the reason of the year-on-year decline of Malaysia occupancy? This is because Island Hospital was added in Q4 2024. Island Hospital, as we've shared, is structurally very different in terms of occupancy. It caters primarily to tourists, predominantly from Indonesia. Because of how they are operating, it's a Monday to Friday heavy business, pretty quiet on the weekends. Because it's a material contributor to Malaysia, you'll see if you compare on this basis, occupancy has, so-called in parentheses, come off. It's a structurally very different hospital. Operator, maybe we'll take one more question on the line.
The speakers that are on the further questions on audio lines, please proceed.
One more question on the webcast from Amanda Tan. Can you share your foreign patient contributions outside of Malaysia? Could you also comment on insurer dynamics in Turkey, Europe, India, Greater China? Perhaps the second part. I think Dr. Prem deliberately shared payer pressure will be there and will continue to be there. That's why we work very closely with the payers and countries where we structurally see a shift towards daycare. I think that helps with that discussion. Dilip, if you can share the patient contribution outside Malaysia.
Yeah, as I said, Malaysia, on a quarter-to-date basis, we saw about, you know, close to 13% in terms of foreign patients. Singapore, we've always said it remains in that range, so it's about 18% in Singapore. Fortis is roughly about 8% odd, and Turkey is about 14% plus in terms of foreign patient contribution. The foreign patient contribution is pretty strong across most of our geographies.
All right, we don't see any further questions on the webcast, and if there are none on the line, we can conclude the Q&A, and that brings us to the end of this results presentation. Thank you so much all for joining us on short notice, and apologies for the earlier inconvenience. Thank you all once again. Have a great day ahead.
Thank you. Thank you.
This concludes today's conference call. Thank you for participating. You may now all disconnect. Have a nice day.