Healthscope. Healthy vital signs. Healthcare Providers & Services AUSTRALIA June 13, 2014

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1 Healthscope Healthy vital signs IMPORTANT DISCLOSURES, INCLUDING ANY REQUIRED RESEARCH CERTIFICATIONS, ARE PROVIDED AT THE END OF THIS REPORT.

2 Healthcare Providers & Services AUSTRLALIA (EXCLUDING THE SPECIAL ADMINISTRATIVE REGION OF HONG KONG). By accepting this report the recipient hereof represents and warrants that he or she is entitled to receive such report in accordance with the restrictions set out below and agrees to be bound by the limitations contained herein. Any failure to comply with these limitations may constitute a violation of law and may lead to legal or regulatory action. Confidentiality This report may not be (i) copied, photocopied or duplicated in any form by any means in whole or in part or (ii) redistributed or passed on, directly or indirectly, to any other person in whole or in part, for any purpose without the prior written consent of CIMB Securities (Australia) Ltd. Under no circumstances may it or its contents be passed or communicated in whole or in part, directly or indirectly, in any form or by any means to the media. Non-reliance, No Warranties, No Liability This report has been prepared by its authors independently of Healthscope Hospitals Holdings Pty Ltd (ACN ) (the "Company"), Carlyle Group Pty Limited, TPG Capital (Australia) Pty Limited and other existing shareholders (the Existing Shareholders ) and their respective direct and indirect subsidiaries. The author(s) of this report has no authority whatsoever to give any information or make any representation or warranty on behalf of the Company, the Existing Shareholders or Credit Suisse (Australia) Limited, Goldman Sachs Australia Pty Limited, Macquarie Capital (Australia) Limited, Merrill Lynch Equities (Australia) Limited and UBS AG, Australia Branch (collectively, the Joint Lead Managers ), and any advisors to the Company or the Existing Shareholders, or any other person in connection therewith. In particular, the opinions, estimates, and projections expressed in it are entirely those of the author(s) hereof and are not given as an agent of the Company, the Existing Shareholders, the Joint Lead Managers or any advisors to such persons or any other person or in its capacity as a manager or underwriter of any offering. This report has been prepared by its author(s) to provide background information only and may not be reproduced or redistributed, in whole or in part, to any other person (including the press or other media). This report does not, and does not attempt to, contain all material or relevant information about the Company or the business of the Company and/or its related bodies corporate. CIMB Securities (Australia) Ltd and/or one or more of its affiliates is or may be acting as an underwriter or manager in an offering of securities of the Company. 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If an offer of ordinary shares or other securities in the Company is made by the Company that requires disclosure in accordance with Chapter 6D of the Corporations Act 2001 (Cth), a disclosure document relating to that offer will be made available when the securities are offered and anyone wishing to acquire the securities offered will need to complete an application form that will be in or will accompany the disclosure document. A decision whether to subscribe for or purchase Company securities should be made on the basis of the information in the relevant disclosure document or offer document lodged with the Australian Securities Exchange. CIMB Securities (Australia) Ltd or one or more of its associates or affiliates may perform, or may seek to perform, financial or advisory services for the Company, or its associates and may have other interests in or relationships with the Company, or its associates, and receive fees, commissions or other compensation in such capacities. 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3 Healthcare Providers & Services AUSTRLALIA TABLE OF CONTENTS 1. INVESTMENT HIGHLIGHTS COMPANY OVERVIEW A leading healthcare services provider Brief business history Business overview WHAT S NEW ABOUT HEALTHSCOPE? Healthscope and Ramsay Health Care a comparison CORE BUSINESS PROFILES Hospitals Hospitals- focus on quality to improve commercial outcomes Hospitals-Expansion and growth Hospitals- Where we see upside Hospital financials Australian Pathology Australian Pathology - background Australian Pathology - Financials International Pathology International Pathology - background International Pathology - Financials INDUSTRY OVERVIEW A leading healthcare provider across APAC Strong fundamentals - varying across regions Economic-development based industry profiling Australia healthcare funding Hospital funding the largest area of expenditures Public-private hospital mix: funding, number and beds Profitability drivers of private hospitals Australian pathology Australian medical centres International Pathology VALUATION Equity valuation range - A$3.9bn-A$4.6bn DCF-based valuation - A$3.7bn-A$4.8bn Multiple-based valuation - A$3.8bn to A$4.9bn FINANCIAL INFORMATION Historical overview Pro forma income statement Reconciliation with statutory accounts Pro forma balance sheet Pro forma cash flow Liquidity Capex profile Tax Working capital Sensitivity analysis RISKS Regulatory risk Change in relationship with health funds Changes to Australian pathology funding Capex Reliance on specific labour and rising costs Contract renewals Competing hospitals Mobility of medical professionals SENIOR MANAGEMENT BOARD OF DIRECTORS (EXCLUDING THE SPECIAL ADMINISTRATIVE REGION OF HONG KONG). THIS REPORT HAS BEEN FURNISHED TO YOU SOLELY FOR YOUR INFORMATION AND MAY NOT BE REPRODUCED OR REDISTRIBUTED TO ANY OTHER PERSON. 3

4 CIMB Analyst(s) Healthy vital signs Healthscope is a leading hospital and healthcare provider across APAC. Its developing portfolio of assets offers the potential to drive margin expansion and earnings growth, underpinned by attractive industry dynamics, a defensible reputation for quality and service, and a competent management team. Derek Jellinek T (61) E Show Style "View Doc Map" Healthscope is targeting EBITDA growth of 9.1% per annum and margin expansion of 101bp to 15.8% through FY15, supported by solid organic growth and ongoing efficiency improvements, with cash conversion of 98.5%, on effective working capital management. We derive an equity valuation range between A$3.9bn-A$4.6bn using a DCF and adjusted peer-based multiples. Strong healthcare provider Healthscope is the fourth-largest hospital operator (by beds; 4,500) across APAC, manages the second-largest portfolio of private hospitals in Australia (44), driving 81% of FY13 EBITDA, and has complementary businesses across Australia and International pathology, contributing ~6% and 13% to FY13 EBITDA, respectively. Underpinned by defensive macroeconomic drivers (eg, growing and greying population, increased healthcare expenditure per capita) and supportive industry fundamentals (stable private health insurance pricing, a public system under pressure), the company has delivered strong earnings growth and cash flow generation since its 2010 privatisation (FY11-13 EBITDA CAGR 8.1%; 98.5% cash conversion). High-return, low-risk growth Since its 2010 privatisation, Healthscope has completed 21 brownfield projects (costing A$196m; 318 beds, 18 operating theatres), with nine additional projects underway (A$274m; 199 beds, 14 operating theatres) and others under consideration, with three-year ROIC targets of >15% supporting growth mainly beyond FY15. In addition, relocate and grow (ie, volume shifting to higher-capacity facilities) projects and ongoing operational improvements (eg, case mix; labour/procurement) support the earnings outlook, with upside potential from government partnerships and outsourcing. Leading quality reputation Healthscope is setting the industry standard for quality and service with its publicly reported hospital KPIs via its MyHealthscope website and Never Events initiative, helping to drive commercial benefits (eg, improved position with health funds, government, physicians and patients). Pathology-growth focused International and Australia pathology appear to be moving in the right direction, with the former cementing key market positions in New Zealand, Singapore and Malaysia (management pro forma FY13-15 EBITDA CAGR 12.6%) and the latter restructured and returning to growth (FY13-15 EBITDA CAGR 14.7%). Pro forma financial summary (A$m) FY11A FY12A FY13A FY14F FY15F Sales revenue 2, , , , ,448.4 Other Revenue EBITDA EBIT Pre-tax Profit Net Profit After Tax

5 1. INVESTMENT HIGHLIGHTS Healthscope is the fourth-largest private hospital operator across APAC (by bed number). It also provides pathology services in Australia and internationally (ie, New Zealand, Malaysia, Singapore and Vietnam) and owns and manages medical centres in Australia. We detail below key investment highlights: Equity valuation range of A$3.9bn-4.6bn: We value Healthscope using an equally-weighted, three-pronged approach based on a three-growth phase DCF, market cap weighted peer PE multiple, adjusted for business and geographic mix, and market cap weighted peer EV/EBITDA multiple, adjusted based on a SWOT-derived competitive score. Based on FY15 pro forma net debt of A$866m and NPAT of A$166.1m, we derive an equity valuation range of A$3.9bn-A$4.6bn and enterprise valuation range of A$4.7bn-A$5.5bn. Using FY15 pro forma EBITDA of A$387.3m, our valuation implies an EV/EBITDA multiple range of 12.2x-14.2x and PE range of 23.3x-27.8x. As at 6 June 2014, Healthscope s nearest Australian comparable, Ramsay Health Care, is trading on FY15 EV/EBITDA of 12.7x and PE of 24.4x and the weighted average of APAC hospital peers (including RHC) is trading on FY15 EV/EBITDA of 16.6x and a PE of 30.2x (see Figure 78). Strong macroeconomic fundamentals: The APAC region boasts favourable demographics underpinned by a growing and ageing population, increasing level of healthcare expenditures per capita, emerging middle class (varying across regions; see sections ), increasing medical applications and technologies, and growing prevalence of chronic disease. Attractive Australian hospital industry dynamics include: a universal system of healthcare which offers free treatment to all Australians; public hospital capacity (67% of total beds) which has not kept pace with demand; and shrinking federal/state budgets exacerbating waiting times for elective procedures. This dynamic should continue to underpin volume flowing to the private hospital system, with private hospitals accounting for 41% of total patient separations (10-year CAGR of 4.2% vs public hospitals at 3.1%) and accounting for an estimated 67% of elective surgeries in FY13, according to the Australian Institute of Health and Welfare reports. Supportive Government policies around private health insurance: Currently, Private health insurance (PHI) contributes ~80% of Healthscope s hospital revenue, underpinned by health fund member payments received. Growing budgetary pressure and capacity constraints in the public hospital system have led to government policies that attempt to shift patients toward the private hospital system mainly via PHI incentives (eg, higher tax levied on those without PHI; up to 30% means-tested rebate on PHI premiums; increased PHI premiums when insurance is taken after 30 years of age). While there have been concerns that the recent introduction (1 July 2012) of PHI rebate means testing would have a negative impact on memberships and private hospital operators, current industry data from the March 2014 quarter, show a continued strong PHI participation rate of 47% of the population, with a 45.8k gain in new membership since the prior quarter. Defendable market position: While the Australian hospital sector is fragmented and dominated by religious/charitable and not-for-profit groups (which currently control ~56% market share by beds), it has remained stable, with numerous barriers to entry (eg, scarce land in attractive catchments, need for strong relationships with health funds and physicians, and required licenses). As such, Healthscope s number 2 market position, equating to an estimated 16% market share by beds on our estimates and only behind market leader Ramsay Health Care (RHC; holds 28% market share) looks well entrenched and positioned to leverage its broad geographical coverage. 5

6 A portfolio of high-return, low-risk brownfields and relocate and grow projects: Management is focused on setting the growth path for the future by unlocking the potential of the company s hospital pipeline. Targeting sites with capacity constraints and in strong demand catchment areas, Healthscope is targeting A$436m in projects (A$86m under construction, A$188m planned, A$162m under consideration) through FY18, with a three-year ROIC target of >15% supporting growth mainly beyond FY15. In addition, through its Gold Coast Private Hospital relocate and grow project, Healthscope is building the new facility to access greater capacity (284 beds, 13 theatres; opens 1HCY16; co-located with 750-bed public testing hospital), shifting volume from a capacity-constrained hospital (Allamanda; 220 beds, 10 theatres) which will be closed. Healthscope is also looking to construct the Holmesglen Private Hospital (144 bed, 8 theatres), transferring patients from Como Private Hospital (53 beds, 2 theatres), with management flagging construction commencement 1HCY15 and hospital opening mid Increasing opportunity for Government partnerships and outsourcing: As state/territory governments attempt to relieve public hospital capacity constraints, there is opportunity for private sector involvement in public healthcare through partnership and outsourcing. Currently, Healthscope is one of two preferred tenderers for a 423-bed Northern Beaches Hospital in New South Wales, with expected returns in line with brownfields beyond FY15 if the tender were to be successful. Healthscope also looks well placed to benefit from capturing outsourced public services, such as the recent A$450m initiative of the Victoria State government to reduce public waiting lists by having public patients treated in private hospitals. Track record of margin expansion and earnings growth: Since its 2010 privatisation, management has delivered strong operational performance, with FY11-13 annual EBITDA growth of 8.1%, 98.5% cash conversion and operating margins expanding 80bp to 14.7%. Management expects continued momentum through FY15, targeting a pro forma revenue growth CAGR of 5.5%, with EBITDA margins expanding 110bp to 15.8.% over the same time period. We view estimates as obtainable, if not conservative, as favourable macroeconomics trends and industry dynamics remain supportive, cost initiatives across labour/procurement ongoing, case mix improving and quality metric based top ups possible with health funds. However, given the lack of visibility across these areas and with at least some uncertainty around the volume impact of means testing of the PHI rebate, we make no changes to pro forma estimates over the forecast period. Leading reputation for hospital quality and service: Healthscope is setting the industry standard for quality and service with 21 publicly reported hospital KPIs via its MyHealthscope website. In addition, Healthscope recently introduced its Never Events initiative, in which it will forego payment by health funds if specific adverse events considered to be serious occur at its hospital. The program prompted a first-of-its-kind agreement with Bupa last October. There is also scope for quality top-up payments from other health funds. Management is confident the agreement will drive change, is likely to be followed by other health funds and sets a precedent for the consistent provision of quality healthcare. Australian pathology restructured and returning to growth: Management s focus has been on restoring profitability via sale/closures of underperforming business units, cost-out initiatives and site-by-site performance reviews. These efforts appear to be paying off, reversing prior management s strategy of rapidly expanding collection centres post the July 2010 deregulation to increase market share (from 320 centres to >600 by 1H11), which resulted in declining profit as rent and labour costs increased and competitive pressures intensified. Management s pro forma forecasts look reasonable, targeting an EBITDA increase of 14.7% annually to A$26.3m through FY15, and margin expansion of 170bp to 7.2% over the same period. 6

7 International pathology a strong growing asset: Management is focused on cementing its market positions across New Zealand, Singapore and Malaysia, with 10 New Zealand District Health Broad (DHB) contracts, covering 65% of the population in New Zealand and offering estimated double-digit operating margins, locked in until We view management s pro forma estimates as achievable (FY13-15 EBITDA CAGR of 12.6%, margins +70bp to 24%), but somewhat conservative given ongoing benchmarking initiatives, increased laboratory automation, cost savings and the upcoming Wellington tender later this year. That said, as we have little visibility efficiency capture and tender wins, we make no changes to pro forma estimates over the forecast period. Strong management team with proven execution record: Healthscope s 20 senior managers, led by Robert Cooke, a well-regarded industry veteran with more than 30 years of experience, have considerable industry knowledge and are keenly focused on achieving strong operational performance. 7

8 2. COMPANY OVERVIEW 2.1 A leading healthcare services provider Healthscope is Asia-Pacific s fourth-largest private hospital operator (by bed number; second-largest by hospitals) and pathology/medical service provider. Figure 1: APAC competitive landscape by hospitals Figure 2: APAC competitive landscape by hospital beds As at 19 May 2014, the company s portfolio comprised 44 Australia-based hospitals, 69 Australia-based pathology labs and 46 medical centres, including 11 skin clinics and 1 breast diagnostic clinic, and 43 international pathology laboratories. These businesses encompass three separate divisions: Hospitals, the largest business unit; Australian pathology and medical centres; and International pathology, which covers businesses in New Zealand, Singapore, Malaysia and Vietnam. At the end of 2013, the company had over 19,800 employees. Figure 3: Business segments SOURCE: COMPANY REPORTS 8

9 2.2 Brief business history Healthscope was founded in 1985, and listed on the ASX in 1994 with a portfolio of five hospitals. In 2010, the business was delisted through its acquisition by a consortium advised by TPG and The Carlyle Group. Since its original listing, Healthscope has grown significantly, expanding its hospital portfolio from 5 to 44 facilities, as well as entering into the pathology and medical centres market. Figure 4: Asset expansion timeline FY2002 FY2003 FY2005 FY2006 FY2007 Acquired 7 hospitals from various vendors Acquired 6 hospitals from the Mayne Group Entered into ACHA management agreement Acquired Gribbles Pathology Acquired the Nova Health Group (6 hospitals) Acquired Quest Pathology (Singapore) Acquired 14 ex Affinity hospitals Acquired 3 hospitals from various vendors Commissioned Campbelltown Private Hospital (greenfield hospital) Awarded DHB contract to provide community pathology testing services to Auckland district commencing in 2009 (NZ pathology) FY2009 FY2010 FY2012 FY2013 FY2014 Commissioned Campbelltown Private Hospital expansion (Hospitals brownfield project) Commissioned Norwest Private Hospital ( relocate and grow hospital) Commissioned the Melbourne Clinic Stage 2 expansion (Hospitals brownfield project) Commissioned Knox Private Hospital Stages 1 3 expansion (Hospitals brownfield project) Commissioned Norwest Private Hospital Stage 2 expansion (Hospitals brownfield project) Awarded DHB contract to provide pathology testing services to Canterbury region (NZ Pathology) Commissioned Northpark Private expansion (Hospitals brownfield project) Extended ACHA management agreement for a further 10 years DHB contract for Auckland district extended to 2020 (NZ Pathology) SOURCE: COMPANY REPORTS 9

10 2.3 Business overview Hospitals Healthscope is the second-largest private hospital operator in Australia, with its portfolio of 44 hospitals mainly located in the heavily populated Eastern Seaboard. However, the company is the only operator with hospital facilities in every state and territory of Australia. Its facilities include: 31 acute-care hospital facilities (11 hospitals are co-located with large public teaching hospitals) including 3 managed on behalf of the Adelaide Community Healthcare Alliance; 7 psychiatric hospitals; and 6 rehabilitation and extended care facilities Figure 5: Hospital portfolio SOURCE: COMPANY REPORTS 10

11 Australian Pathology Healthscope s pathology division features 578 collection centres, 69 pathology laboratories, 46 medical centres, 11 skin clinics and 1 breast diagnostic clinic. In Australia, Healthscope s pathology business operates through referrals from medical practitioners. Samples can be collected directly by the practitioner or at collection centres, with samples couriered to laboratories for testing. More than 85% of revenue for pathology services is provided through Medicare; however, charges by providers above the schedule fee can be covered through out-of-pocket expenses paid by patients. Healthscope s medical centres as well as a dozen specialist clinics operate by providing a central area for consultation, with ancillary services in exchange for service fees. Although doctors are not employed by Healthscope, they pay a service fee for the use of consulting rooms and other administrative services. Practitioners continue to receive their usual Medicare fee and any out-of-pocket payments on top of the schedule fee. Figure 6: Market share implied by collection centre SOURCE: CIMB, MEDICARE, COMPANY REPORTS as at 19 May

12 International Pathology New Zealand In New Zealand, Healthscope s pathology business runs through contracts that pay agreed rates for services which are won through a competitive tender held by District Health Boards (DHBs). Healthscope currently has contracts to provide pathology services with 10 of the 20 DHBs. Most samples are collected at collection centres and transported by courier to laboratories for testing. South-east Asia In Malaysia and Singapore, Healthscope s pathology services operate primarily through medical practitioners, who collect the samples. These samples are sent to laboratories by courier and the medical practitioner is invoiced for the services. The fees are then passed onto the customer. Furthermore, the company has service contracts with certain corporate clients and also takes walk-in patients in Malaysia where referrals are not required. Figure 7: International services SOURCE: COMPANY REPORTS 12

13 Figure 8: What s new about Healthscope? Experienced personnel Focus on quality and clinical outcomes Leveraging quality focus to get better health fund pricing 3. WHAT S NEW ABOUT HEALTHSCOPE? In the table below, we outline what we view as key developments in the company s focus and strategy since new management took the helm following the company s privatisation in October Hired experienced and well regarded managers led by CEO Robert Cooke with 30+ years of experience, intimate knowledge of the portfolio and proven track record of delivering shareholder value Initiated internal development and corporate training as well as succession planning Instilled continuity and stability, with turnover slowing Strong emphasis and market leading position on quality and clinical outcomes, with commitment to deliver best in class healthcare services MyHealthscope, the first hospital website that publishes 21 hospital indicators and reflects the quality and safety across hospital portfolio Management believes the initiative could save tens of millions due to lower acquired infection rates and lower re admission rates Never Events, the first initiative of its kind in Australia covering 14 preventable errors, with payment forgone if errors occur We believe health fund payments are below industry peers, as prior management was not focused on obtaining the best outcomes and junior managers were utilised in price negotiations Emphasis now is on quality and clinical outcomes, with MyHealthscope and Never Events initiatives A new team has been built to focus on developing stronger relationships with key personnel from health funds and help shift negotiations from a price to a quality focus A quality focus is also important to attract and retain physicians and nurses PHI rates are locked in through September 2015 covering ~96% of hospital revenue that comes from PHI (which is ~80%), with some health funds offering top ups payable to Healthscope provided key targets are met Brownfields Prior management failed to capitalise on the growth potential of the hospital portfolio, with development ~5 years behind Ramsay Healthcare 21 projects have been completed for A$196m delivering 318 new beds and 18 new operating theatres, with ROIC targets >15% 9 developments are currently under construction or planned for A$274m, estimated to deliver 199 new beds and 14 new operating theatres, with most capacity coming on line from FY16 An additional 143 new beds and 8 operating theatres is under consideration for A$162m from FY16 18 Emphasis on growth initiatives Relocate and grow Focused on higher capacity and quality infrastructure with new hospital to replace/support an existing facility Plans to invest A$295m to deliver an increase of 208 beds and 11 operating theatres at the Gold Coast Private Hospital (a co located facility with a large public teaching hospital; 284 beds; opening 1H16), with the Allamanda Hospital closed and patients moved across, and Holmesglen Private Hospital (144 bed facility located close to a large public hospital; opening mid 2016) Public Private Partnerships (PPPs) and government outsourcing Better positioned to capture work from state governments as the demand for public hospitals outstrips supply With an emphasis on quality initiatives, Healthscope is one of two preferred tenders to the New South Wales government to construct and operate the new Northern Beaches Hospital (a co located facility with a minimum of 423 beds). Work is scheduled to commence in 2015, with meaningful earnings contribution anticipated from 2018 if the tender is successful Opportunities in PPPs and government outsourcing is expected to continue as pressure on public hospital funding and waiting lists for elective surgeries continue to grow (eg Victorian State Government tendering A$610m of public patient elective healthcare services over four years to reduce waiting lists) Labour Management has implemented a range of labour management initiatives, including more sophisticated rostering of nursing staff, greater emphasis on implementing a team nursing model and increasing casual nursing pools to drive labour efficiencies Focused on further improvement in registered nurses to enrolled nurse ratio. Strong focus on operational improvements Australian pathology restructured and returning to growth International pathology a strong asset Case mix Management has improved the range of specialist services provided by physicians to improve the mix toward higher acuity patients Procurement Management has put in place a new procurement team to focus on extracting efficiencies across the business through improved coordination of activities, with key initiatives including: new national agreements with suppliers and use of clinical product specialists to support purchasing decisions We believe there are opportunities in direct sourcing of some consumables Management s focus has been on restoring profitability via sale/closures of underperforming business units, cost out initiatives and site bysite performance reviews, reversing prior management s strategy of rapidly expanding collection centres post the July 2010 deregulation to increase market share (320 centres to >600 by 1H11), which resulted in a profit decline as rent and labour costs increased and competitive pressures intensified The focus remains on improving efficiency and throughput across the collection centre portfolio Management is focused on cementing its market positions across New Zealand, Singapore and Malaysia Ten New Zealand District Health Board (DHB) contracts serve 65% of the population and offer double digit operating margins, with the Labtests contract locked in until 2020 Benchmarking, laboratory automation and cost savings are areas of focus SOURCE: CIMB, COMPANY REPORTS 13

14 3.1 Healthscope and Ramsay Health Care a comparison Slower revenue growth, but more stable/faster expanding margins across Australian hospitals than RHC. While Healthscope has ~35% fewer beds than RHC, translating into lower top-line growth, its margins appear more stable and are expanding at a faster pace over the forecast period, international operations are in higher growth regions, its capex profile is mature offering potential upside and its costs out initiatives are gaining traction. Figure 9: Healthscope and RHC- Hospitals Figure 10: Healthscope and RHC- Beds Healthscope generates less revenue and has a lower revenue growth rate in Australia than RHC (two-year CAGR from FY11: 5.5% vs 7.1%), with forecasts through FY15 indicating a similar differential (two-year CAGR from FY13: 5.5% vs 7.9%). In addition, Healthscope s FY11-FY13 EBITDA growth profile was also behind that of RHC (two-year CAGR: 10.9% vs 12.4%). However, management s forecasted pro forma FY13-15 growth profile is similar to our estimates for RHC (two-year CAGR: 8.7% vs 8.7%). Figure 11: Healthscope and RHC- Australia-based revenue Figure 12: Healthscope and RHC- Australia-based EBITDA A$m 4,500 4,000 3,500 3,000 2,500 2,000 CAGR 7.1% CAGR 5.5% CAGR 7.9% CAGR 5.5% A$m CAGR 12.4% CAGR 10.9% CAGR 8.7% CAGR 8.7% 1,500 1, FY11A FY12A FY13A FY14F FY15F 0 FY11A FY12A FY13A FY14F FY15F RHC revenue HSP revenue RHC EBITDA HSP EBITDA SOURCE: CIMB, COMPANY REPORTS 14

15 We also note Healthscope s hospital margins appear more stable and offer more expansion potential than RHC s Australian operations (FY11-13: 160bp vs 150bp; FY13-FY15: 100bp vs 20bp) when comparing management s forecasted pro forma estimates with our RHC estimates. Figure 13: Healthscope and RHC EBITDA margin 20% 16% 12% 8% 4% 0% FY11A FY12A FY13A FY14F FY15F HSP margin RHC margin Exposure to faster growing, developing international markets While we acknowledge the different international business mix between Healthscope and RHC, we note the former s pathology businesses have outpaced the latter s hospital businesses between FY11-13 (2 year CAGR: 12.6% vs 0.5%). While results are confounded by acquisitions, Healthscope s 43 laboratories across New Zealand, Malaysia, Singapore and Vietnam are exposed to regions underpinned by faster organic growth characteristics (see Figure 37), with opportunities for increased spending by potential contract wins, growing referral base and outsourcing by the public sector, compare to those seen with RHC s international exposure in the UK and France. However, we acknowledge RHC s JV with Sime Darby to expand its Southeast Asia presence may hold upside. Figure 14: Healthscope- Offshore earnings contribution Figure 15: RHC- Offshore earnings contribution A$m 13.5% 15.0% 18.2% 7.2% 20% 18% 16% 14% 12% 10% 8% 6% A$m 4.1% 37.1% 16.0% 40% 35% 30% 25% 20% 15% 10% 5% 10 4% 2% % 0% -5% 0 FY11A FY12A FY13A FY14F FY15F 0% 0 FY11A FY12A FY13A FY14F FY15F -10% HSP Intl EBITDA EBITDA growth RHC Intl EBITDA EBITDA growth SOURCE: CIMB, COMPANY REPORTS 15

16 Less mature brownfields than RHC, but poised to fuel future growth A lumpy capex profile likely reflects a less mature brownfield program than RHC s, but increasing capex to fund investments in hospital development programs to meet unmet demand should support the potential acceleration in future top-line and earnings growth, in our view. In FY13, we estimate Healthscope s capex as a percentage of revenue was 100bp below that of RHC. However, while we estimate this percentage to stay fairly flat for RHC, we estimate increasing capacity expansion expenditures by Healthscope through FY15 (capex 23% of revenue). Figure 16: Healthscope - Capex profile Figure 17: RHC - Capex profile A$m 23% % A$m 8% 9% % 10% % 20% 250 7% 7% % % 200 6% % 136 7% 116 9% % % 100 5% 2% FY11A FY12A FY13A FY14F FY15F 0% 0 FY11A FY12A FY13A FY14F FY15F 0% HSP Capex (LHS) Capex/sales (RHS) RHC Capex (LHS) Capex/sales (RHS) SOURCE: CIMB, COMPANY REPORTS Improving cost management While we acknowledge varying product and geographic mix make a direct cost comparison between Healthscope and RHC challenging, we view favourably Healthscope s increasing focus on initiatives to drive efficiencies and incremental gains, improving its opex to sales ratio. Between FY11-13, Healthscope s overall opex declined 80bp to 85.4% of sales, compared to RHC s decline of 90bp to 85% of sales. We estimate Healthscope s opex as a percentage of sales, will decline 110bp to 84.3% between FY13-15, compared with RHC s decline of 60bp to 84.4% over the same period. Figure 18: Healthscope vs RHC Opex as a % of sales 87% 86% 86% 85% 85% 84% 84% 83% FY11A FY12A FY13A FY14F FY15F RHC opex % of sales HSP opex % of sales 16

17 4. CORE BUSINESS PROFILES 4.1 Hospitals Healthscope s hospital portfolio is made up of 31 acute-care hospitals, 7 psychiatric hospitals and 6 rehabilitation and extended care facilities which employ a total of about 13,900 people. Healthscope s hospitals are present in every state and territory of Australia, with 74% of the facilities located in Queensland, New South Wales and Victoria, where 77% of Australia s population resides. This geographic spread looks favourable, considering capital cities of these states are expected to record population growth above the national average, at 1.9% vs 1.7%. Figure 19: Acute beds as a % of total Rehabilitation and extended care 13% Figure 20: Acute hospitals as a % of total Rehabilitation and extended care 14% Acute 76% Psychiatric 11% Acute 70% Psychiatric 16% SOURCE: CIMB, COMPANY REPROTS, AIHW, AIHW These facilities have about 4,400 beds, making Healthscope the second-largest private hospital operator in the country. The division is also the largest within the company, contributing 75% of revenues and 81% of EBITDA for FY13. We provide in the table below a brief overview of key metrics across the division. Figure 21: Hospital overview SOURCE: CIMB, COMPANY REPORTS 17

18 4.2 Hospitals- focus on quality to improve commercial outcomes Healthscope has shown a strong commitment to high-quality service as the first Australian private hospital operator to publish 21 quality indicators into the public domain from its MyHealthscope website. These include emergency department waiting times, infection rates, as well as unplanned readmissions or returns to theatre. In addition, it has recently introduced its Never Events initiative, where it will forego payment by health funds if specific adverse events considered to be serious occur at its hospital. The program prompted a first-of-its-kind agreement with Bupa last October. In addition, there is scope for quality-based top-up from other insurers. We believe these programs are critical in helping Healthscope to differentiate its service offerings and negotiating strategy with private health insurers, where the focus is on quality as opposed to the traditional factor of price. We believe the emphasis on high quality standards also shifts focus to the well-being of patients and could help to improve Healthscope s standing with nursing staff and physicians, as well as to position the company to possibly win contracting opportunities from governments. Management is confident the agreement will drive change, is likely to be followed by other health funds and sets a precedent for the consistent provision of quality healthcare. Figure 22: Key quality performance indicators- Healthscope vs industry SOURCES: CIMB, ORIX AUSTRALIA 4.3 Hospitals-Expansion and growth Brownfields and relocate and grow Healthscope utilises two strategies to expand its hospital facilities to cater to growing patient demand: 1) Brownfields where capacity in existing hospital facilities are expanded 2) Relocate and grow where a new facility is built as a replacement to an existing facility nearby, usually offering superior facilities and capacity. This new facility can then either replace or supplement the existing hospital, which can sometimes operate as a different facility type These projects generally have low demand risk, given the relationship Healthscope has with incumbent medical practitioners who can estimate their likely utilisation of new facilities. Brownfields tend to offer higher returns, with an ROIC target of at least 15% over a three-year horizon, as they leverage off existing infrastructure and expand EBITDA margin. 18

19 Management is focused on setting the growth path for the future by unlocking the potential of its hospital pipeline, targeting sites with capacity constraints and in strong demand catchment areas. Since its 2010 privatisation, Healthscope has completed 21 brownfield projects costing A$196m and delivering 318 new beds and 18 operating theatres. Healthscope is planning to expand of major hospital facilities over the next ten years, targeting A$436m in projects (A$86m under construction; A$188m planned; A$162m under consideration) through at least FY18. To ensure delays in receiving permits are avoided, the company has already submitted development approvals which have a period of 2 to 4 years before expiry, often with an option to extend. Figure 23: New beds by year and type Figure 24: New operating theatres by year SOURCE: CIMB, COMPANY REPORTS In terms of the relocate and grow projects, Healthscope currently is pursing two opportunities, the Gold Coast Private Hospital and Holmesglen Private Hospital. In the former, Healthscope is building a new facility to access greater capacity (284 beds, 13 theatres; opens 1HCY16; co-located with 750-bed public testing hospital), shifting volume from a capacity constrained hospital (Allamanda; 220 beds, 10 theatres) which will be closed. In terms of the latter, Healthscope is also looking to construct the hospital (144 bed, 8 theatres), transferring patients from Como Private Hospital (53 beds, 2 theatres), with construction expected to commence 1HCY15 and the facility expected to open mid Strong focus on operational efficiencies across the business Since privatisation in 2010, a new management team has been undergoing various operational changes to improve the efficiency of the hospitals division. Multiple initiatives detailed below have improved operation performance, with total operating expenses as a percentage of management s pro forma sales forecast to decline 100bp to ~84% by FY15. 19

20 Figure 25: FY13 operating expense breakdown Figure 26: Operating expenses A$m Occupancy expense 6% Service expense 11% 2,100 2,000 1,900 86% 86% 1,888 1,963 2,064 87% 86% Prosthetics expense 14% Personnel costs 55% 1,800 1,700 1,725 1,818 85% 85% 84% 85% A$ medical consumables 16% 1,600 84% 1,500 FY11A FY12A FY13A FY14F FY15F 83% Operating expenses Opex as a % of sales The main areas of focus have been as follows: Case mix optimisation better matching the types of patients in the hospital (ie distinguished by specialty, sub-specialty and treatment required) with medical professionals, hospital facilities and length of stay. Healthscope has introduced initiatives to try to ensure patients receive the optimal care that matches their clinical needs. Labour representing the largest cost, Healthscope has implemented strategies to maximise labour efficiency based on four key areas: Management of labour hours improving forecasts for patient admissions to ensure the level of staff rostered on is optimal. Skill mix improving the skill mix of the labour force to have staff of varying qualifications in each team to help deliver effective and efficient care. Agency reducing the reliance on agency to meet spikes in demand for nursing staff due to changing hospital occupancy. Nursing recruitment and retention training nurses at the student and graduate level, with ties with universities and teaching colleges deepened. Procurement restructured to make more centralized, gaining efficiencies in ordering and reporting as well as strengthening relationships with suppliers, hospital management and medical practitioners; the company has also started to use direct sourcing. 4.4 Hospitals- Where we see upside Focus on public-private partnerships As state/territory governments attempt to relieve public hospital capacity constraints, there is opportunity for private sector involvement in public healthcare through partnership and outsourcing. Currently, Healthscope is one of two preferred tenderers for a 423-bed Northern Beaches Hospital in New South Wales, with expected returns in line with those of brownfields (opening 2018) if the tender were to be successful. We highlight below numerous projects at various stages of planning/development. 20

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