Medical Tourism Category Overview

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Medical Tourism Category Overview Yandex International Business Development ussales@yandex-team.ru +1 857.288.8762 uksales@yandex-team.ru +44 020 3291 3306

Medical Tourism Market and Health Treatment Abroad Market Volume Market Structure

Market Size 1.2 Annual Expenditure on Medical Services Provided to Russians Abroad Billions of Dollars 1 0.8 0.6 0.4 0.86 0.98 1.10 0.2 0 2011 2012 2013 In 2013 Russians spent over 1.1 billion dollars on health care abroad. Source: Insurance Marketing Report

Market Structure by Business Segment VMI (voluntary medical insurance) 0.8% Travellers insurance 20.0% International health insurance 0.4% Direct appeal to the hospital 20.0% Medical tourism 58.8% Medical tourism makes up the majority of all healthcare services provided abroad (58,8% of market). Source: Insurance Marketing Report

Top Spenders in International Tourism: With over $43 billion spent on international tourism in 2012, Russia shows an impressive advance in recent years, moving up to 5th position with over 35% annual growth. Russia along with China, India and Brazil will drive growth in the coming years. Source: World Tourism Organization (UNWTO), Data as collected by UNWTO June 2013

Main Locations & Purposes of Tourism Sanatoriums and rest houses 7.9% Hiking 13.4% Beach tourism 28.3% In the Country 14.2% Medical tourism 16.5% Sightseeing holiday 19.7% Medical tourism made up 16.5% of the tourist market in Russia.

Outbound Patient Flow Dynamics 2010-2013 350,000 300,000 300,000 Patients 250,000 200,000 150,000 100,000 120,000 145,000 215 000 50,000 0 2010 2011 2012 2013 Over 300,000 Russians traveled abroad for medical care in 2013. Source: Patient Management

Projected Growth in 2014 In 2014 the number of search queries on outbound medical tourism grew by 23%. Future growth is expected to be fueled by: Population aging and the rise of chronic diseases Rising interest in disease prevention Decreasing trust to the local health care system Rising interest to alternative therapies

Medical Tourism Market and Health Treatment Abroad Motivation behind outbound medical tourism Market structure

Motivation of Outbound Medical Tourism Determining factors for outbound medical tourism in Russia: Combining both treatment and rest 21.0% Russia Seeking treatment in CIS countries to save money 7.0% Cannot obtain treatment in the home country 72.0% Need urgent help, cannot obtain treatment in the home country 15.0% Rely on a higher service quality 33.0% Other Countries Seeking treatment abroad to save money 10.0% Going abroad for tech medical help 42.0% The lack of domestic high quality treatment in a wide range of cases is the major reason for outbound medical tourism for Russians Source: McKinsey and Company, www.treatment-abroad.ru, Medical & Health Tourism Magazine, 6

Local Opinion on Healthcare in Russia How does the local population estimate national health care system? 1.5% Poor 54% Sufficient 28.5% Good This objective state of things combined with a profound lack of trust in the local health care system contributes to a low opinion of the Russian healthcare system. Source: Medical & Health Tourism Magazine, 6

Determinants for Patient Choice of Healthcare Providers 1.0% The cost of treatment 8.0% 12.0% 12.0% 35.0% Range of services Distance and location convenience Recommendations of friends and acquaintances Doctor recommendations 32.0% Advertising The Russian audience is still extremely price-conscious. Approximately 50% of searches related to treatment abroad are made by users from the outer regions of the country. Despite the fact that 65%+ of patient flow from Russia is directed to Israel and Germany, cheap countries such as Turkey, CIS-countries and Eastern Europe remain popular. Source: Medical & Health Tourism Magazine, 6

Medical Tourism Market and Health Treatment Abroad Segment Volume: User interest dynamics Audience location

Segment Dynamics Apr 2012 Mar 2013 Apr 2013 Mar 2014 180,000 160,000 +23% Queries on treatment abroad 140,000 120,000 100,000 80,000 60,000 40,000 1,216,562 1,500,622 20,000 14 0 2013-08 2013-07 2013-06 2013-05 2013-04 2013-03 2013-02 2013-01 2012-12 2012-11 2012-10 2012-09 2012-08 2012-07 2012-06 2012-05 2012-04 2013-09 1 2 2013-11 2013-10 2014-03 2014-02 2014-01 2013-12 wordstat.yandex.ru. Apr 2012 Mar 2014

200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 User Interest Dynamics: +17% in 2014 Queries Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Apr 2012-Mar 2014 statistics Forecast (Apr 2014-Sep 2015) User interest is expected to grow by 17% by 2014. 15

Audience Location: Top Cities Moscow 28.05% Saint-Petersburg 5.30% Ekaterinburg 2.48% Kiev 2.43% 16 Search Volume for health care abroad Nizhny Novgorod Rostov-on-don Novosibirsk Krasnoyarsk Ufa Irkutsk Krasnodar Perm Chelyabinsk Samara Minsk Saratov Kazan Voronezh Tyumen Vladivostok 2.10% 1.94% 1.59% 1.59% 1.56% 1.23% 1.19% 1.00% 0.99% 0.98% 0.92% 0.89% 0.83% 0.82% 0.78% 0.72% The majority of searches are made by users from the largest Russian and Ukrainian cities: Moscow, Saint- Petersburg and Kiev (36%). In Russia, searches from Moscow and Saint- Petersburg make up 40%+ of the total volume.

Audience Location: Regional Popularity 17 Regional popularity is heavily dependent on two factors: Purchasing power (high affinity in Moscow: 152% compared to average 107%); State of healthcare system in region (the highest affinity: 350-450% in the north regions of far East).

Medical Tourism Market and Health Treatment Abroad User Interest in Destinations: By regions / countries Search patterns

Health Treatment Abroad: Destinations 6.8% European countries 12.9% 22.2% 39.8% Asian countries (China, India etc) Middle East CIS-countries 18.3% Other countries Queries on medical tourism and health treatment in TOP-10 countries make up to 65% of all queries. Most users are seeking treatment in European countries (40%), Asian (China, India) 18,3% and Middle East 22,2%.

Health Treatment Abroad: Top Countries Israel Germany 44,118 46,817 Average number of queries per month China USA Ukraine Korea Bulgaria Czech Republic Kazakhstan India Turkey Hungary 17,100 13,486 10,462 7,670 7,510 5,797 5,665 5,338 5,056 28,206 Belarus 4,576 Japan 4,448 Abkhazia 4,360

User Interest Dynamics:Top-10 Destinations 60,000 Israel Queries 50,000 40,000 30,000 20,000 10,000 0 2012 May Jun Jul Aug Sep Oct Nov Dec 2013 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2014 Feb Mar Germany China Bulgaria Czech Republic Hungary Slovenia India Turkey USA

1.6 1.1 0.6 0.1-0.4 User Interest Dynamics:Top-10 Destinations 350,000 300,000 Apr 2012 - Mar 2013 Apr 2013 - Mar 2014 250,000 Queries 200,000 150,000 +69% +60% 100,000 50,000 +4% -3% +38% +14% +35% +33% +31% +27% 0 Israel Germany China Bulgaria Czech Republic Hungary Slovenia India Turkey USA

Search Patterns: Generic & Specific Queries 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 65% 71% 58% 59% 46% 51% 82% 75% 47% 44% 50% 79% 58% 47% 89% Israel Germany China USA Ukraine Korea Generic queries Bulgaria Czech Republic Kazakhstan India Turkey Hungary Queries on specific deseases Belarus Japan Abkhazia For Israel, Germany, Bulgaria, Czech Republic, Hungary, Abkhazia, user interest has a universal form for more generic queries including clinics, hospitals, treatment etc. For Ukraine, Korea, Kazakhstan, India, Turkey, Japan, user interest is more specific. For the majority of queries, users specify the type of operation or disease.

Treatment in Israel: Top-15 Related Diseases Oncology 5,164 Average number of queries per month IVF (In Vitro Fertilization) Psoriasis Treatment of the spine (hernia) Dental implant treatment Joint replacement surgery, arthritis Birth tourism and maternal health, infertility Treatment & care for diabetes Cerebral palsy Hepatitis treatment Epilepsia Sclerosis HIV Allergy Neurosurgery 906 733 652 643 799 696 437 333 316 265 210 174 171 167

Treatment in Germany: Top-15 Related Diseases Oncology 1,535 Average number of queries per month Treatment of the spine (including hernia surgery) Joint replacement surgery, arthritis Birth tourism and maternal health, infertility Dental implant treatment Cerebral palsy IVF (In Vitro Fertilization) Epilepsia Hepatitis treatment Treatment & care for diabetes Orthopaedics 520 481 444 368 287 268 253 866 1,077 1,022 HIV 180 Sclerosis 153 Neurology 153

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