NVESTOR DAY RAMSAY HEALTH CARE /GÉNÉRALE DE SANTÉ MARCH 2 th 205
NTRODUCTON PASCAL ROCHÉ Chief Executive Officer DENS CHARLES Group Head of Operations ARNAUD JEUDY Chief Financial Officer 2 nvestor day
ON A FACT-BASED APPROACH, FRANCE NEEDS TO ADAPT BUT HAS A HUGE POTENTAL 7,42 0,36 The 5 th World Economy (204) (in billion $) 28 95 3 French companies among the World top 500 global companies 4,77 3,82 2,90 2,85 2,24 2,3 2,06 2,03 57 3 28 28 7 3 3 0 8 8 8 8 8 Source MF Source Fortune 500 Quality of Education (number of Mathematical Fields Awards) 3 3 9 n 2050, with the UK, the largest country in Europe (in million of habitants) 73 73 72 5 6 2 France USA Russia UK Japan France UK Germany taly Source NSEE 3 nvestor day
MEDCAL SERVCES OF PRVATE CLNCS ARE FNANCED BY THE PUBLC HEALTH SYSTEM WTHN THE ONDAM BUDGET MEDCAL CONSUMPTON HAS NCREASED FASTER THAN GNP 20% 5% 0% 5% 0% MEDCAL SERVCES OF PRVATE CLNCS ARE FNANCED BY THE PUBLC HEALTH SYSTEM WTHN THE ONDAM BUDGET 245bn 30% 4.0% Medicines 35bn Others 35bn 8.4% 9.0% 0.% ONDAM 75bn.0%.7% 2.70% 945 960 990 995 2000 2005 200 205 2030 66% 75% 7% «ONDAM» 75bn 80% 70% 60% 50% 40% 30% 20% Share of chronical diseases in medical expenses in France (%) Medical consumption vs GNP in France (%) «Every year, the "Projet de loi de finances" (funding law project) voted by the Parliament sets a target for national funding dedicated to health expenses, expressed as a National Statutory Healthcare Spending Objective ("Objectifs National de Dépenses d'assurance Maladie" ONDAM) 4 nvestor day Source: OECD
ONDAM BUDGET WLL KEEP ON NCREASNG EVERY YEAR ONDAM is characterized by an amount and its evolution, both voted and achieved. t is expressed in 6 chapters regrouped in 4 categories 6 chapters in ONDAM Voted objective ONDAM in 203 bn 7bn 80bn 77bn Care for elderly people Care for disabled people Other care Ambulatory care Hospitals included in DRG Hospitals not included in DRG objective in common No objective No objective 2 objectives : ODMCO, MGAC 2 objectives : ODAM, OQN Non hospital treatments Hospitals Medico social sector Others ONDAM BUDGET (NDEX 00 N 200) 00 07 4 20 24 28 33 38 43 47 5 54 58 2% growth per year 70 200 2002 2003 2004 2005 2006 2007 2008 2009 200 20 202 203 207 5 nvestor day
AN NCREASNG FRENCH HEALTHCARE MARKET 90 85 80 75 70 65 60 HOSPTAL MARKET (N BN) 84 82 8 79 77 75 70 72 200 20 202 203 204 205 206 207 Forecast PRVATE ACTORS ARE MORE EFFCENT A MASSVE AND SECURE MARKET 79bn for healthcare facilities (MSO) A market split between 2 main categories : Non profit actors ; = 2,000 actors For profit actors. 2% annual growth expected up to 207 A MARKET WHCH S CALLNG FOR FURTHER CONSOLDATONS 00% 80% 60% 40% 20% 34% 0% 25% 7% Activity (sessions) Beds ONDAM budget shares Public Private 40,000 beds, 20% over capacity The number of MSO private clinics has decreased by 46% in the last 20 years A private sector key for the French health system, too big to fail Groups are increasing their market share within the private sector 6 nvestor day Source: FHP, 202
4% 2% 0% -2% WE ARE FACNG FLAT TARFFS BUT BY POSTONNG ON THE RGHT ACTVTES WE ARE STLL ABLE TO EXTRACT VALUE DRG EVOLUTON (PUT N PLACE N 2006) 4% % 0,47% 0% -0,05% 0,6% -0,2% -0,24% 2007 2008 2009 200 20 202 203 204-4% OUR EFFORTS ON CASE MX AND LENGTH OF STAY COUNTERACT FLAT TARFFS ( ) 00 090 080 070 060 050 076 086 38 352 20 202 203 204 MSO patient average revenue Patient day of stay average revenue 360 350 340 330 320 30 300 Besides, increasing subventions are currently put to place to favor : Quality outcomes ; Day surgery. which are at the heart of our strategy. 7 nvestor day
A GROWNG ACTVTY ON A MD TO LONG TERM PERSPECTVE MORE THAN 50% OF OUR CORE MARKET S ABOVE 60 YEARS OLD Age distribution in MSO Age distribution in FCR = 50% = 68% % 39% 35% 5% 6% 26% 34% 34% 0-9 20-59 60-79 >80 0-9 20-59 60-79 >80 Source: ATH, nsee & Roland Berger THE FRENCH POPULATON WLL NCREASE DURNG THE 5 COMNG YEARS 205 2030 French population in million 2 French population in million 2 63.3m 65.8m 8 nvestor day 2 Source: NSEE n 2050, Population including DOM-TOM will reach 73m
ENJOYNG STRONG AND SUSTANABLE DRVERS Age in million 205 OUR CORE MARKET S GETTNG BGGER Age in million 2030 = 5.7m 32,5 5 2 3,7 0-9 20-59 60-79 >80 = 9.6m 3,5 4,7 4,8 4,8 60-79 >80 60-79 >80 Age in % Age in % = 25% = 30% 5% 48% 24% 9% mprovement of diagnostic methods (endoscopy) Development of new treatments (new monoclonal antibodies, personalized medicine) and medical procedures (radiotherapy, non invasive procedures) 9 nvestor day 22% 23% 7% 0-9 20-59 60-79 >80 mprovement of treatments (ambulatory procedures, dosage form of drugs, local anesthesia) Generalization of key procedures (carpal tunnel, cataract, orthopedic prosthesis) New diagnostic methods: predictive tests 6% 0-9 20-59 60-79 >80 AND S SUPPORTED BY THERAPEUTC NNOVATONS : Source: ATH, nsee & Roland Berger Source: NSEE
GÉNÉRALE DE SANTÉ & RAMSAY SANTÉ COMBNED GROUP AT A GLANCE MAN FGURES 5 facilities.5m of entries 600 operating rooms COMBNED GEOGRAPHCAL DVERSTY Paris 3,000 beds 2,900 places 23 clinics with obstetric authorization 34,800 baby deliveries per year Legend MCO +SSR Psychiatry 445k emergencies entries in 24 clinics COMBNED REVENUES N 203 6 cancer institutes 2 076 389 5,000 practitioners 687 20,000 employees GdS Ramsay Sante 0 nvestor day
GENERALE DE SANTÉ : A LEADER OF A HGHLY FRAGMENTED MARKET 5-6% 2% ESTMATED MARKET SHARES (203) 3% 7% 6% 4% 4% 2% 2% (a) (a) Acquisition of Médi-Partenaires by Bridgepoint, current owner of Medipôle Sud Santé, announced in April 204. Source: Roland Berger, based on 202 revenues. GDS : EBTDA (% OF REVENUES) CONSTANT PERMETER.6% 2% 6.5% 3.5% 200 20 202 203 204 EBTDA National groups average (EBTDA) Private sector average (EBTDA) Consistent and stable profitability Higher profitability than competitors nvestor day
FOLLOWNG A CLEAR STRATGEY n this market performance is driven by four Key Success factors Générale de Santé Going further : Become the healthcare preference", switching from a B2B to a B2C model Footprint efficiency More than 95% of clinics in the most attractive quartiles Q and Q2 4 pillars Focused case mix Specialist clinics: over the 6 clinics, only 7 with a mixed model A high specialization Size : the 3 scale effects ~3% private market share 32% of market share on health territories covered 50 beds / clinic Quality & brand equity 20 clinics in national ranking 34% of clinics in national ranking Some strong clinic brand equity. e.g. Antony emergencies leadtime performance (9 minutes) Published by top general public magazines 2 nvestor day
CARE EXCELLENCE : SOME MEDALS OF HONOR 8 ranked in top 40 9 MSO ranked in top 50 4 ranked in top 25 Myocardial infarction General ranking Bariatric surgery 7 ranked in top 50 8 ranked in top 50 7 ranked in top 50 8 ranked in top 50 9 ranked in top 40 Cataract Pneumology Pacemakers Hip prothesis Spine surgery 3 nvestor day Source : Le Point, August 204
WE HAVE BEEN PREPARNG THE FUTURE BY KEEPNG A HGH NVESTMENT LEVEL Self financed CAPEX (in m) Most clusters are involved in brownfield projects of development 99 88 00 98 20 202 203 204 Cluster without recent major development project Major project opened in 203 Major project opened in 204 Major short term project (205) Major mid term project (> 205) These figures exclude the externalized CAPEX 3 main innovative projects Marseille: First French private operator to invest in a Cyberknife (radiotherapy) 2 Marseille: nnovative one day surgery facility (opening Sept. 6) 3 Dijon: regrouping 3 MSO in a clinic designed to simplify patient care 2 3 processes (opening Jan. 8) 205 206 207 208 4 nvestor day
WE ARE THE CLEAR LEADER N DAY SURGERY N FRANCE, WHCH S THE FUTURE OF HOSPTALSATON ANSWERS TO A NATONAL SURVEY FOCUSED ON ONE DAY SURGERY WHAT S ONE DAY SURGERY? 60% 28% 9% WOULD ACCEPT A ONE DAY SURGERY OPERATON? 85% 5% S T THE FUTURE OF SURGERY? 84% 6% DO YOU TRUST ONE DAY SURGERY? 78% 22% GÉNÉRALE DE SANTÉ S AHEAD TS COMPETTORS 2 47.6% 49.2% 44.0% 46.0% 39.3% 40.2% 37.0% 39.0% 5.8% 49.7% 42.7% 4.4% 54.6% GDS Private sector National average NA Public sector 20 202 203 204 5 nvestor day Source: FOP 2 Source : ATH
SWTCHNG FROM A B2B TO A B2C MODEL : OFFERNG NNOVATVE SERVCES TO OUR PATENTS Patient, Practitioner Relationship Management via a CRM tool adapted to our healthcare business PPRM Range of services proposed to our patients in order to enrich their experience : Better comfort ; Enternainement during their stay at hospital. SOLO ED Emergencies Department : Enhance the visibility of short waiting times in GDS services ; Develop services to meet patient expectations. Bring services in line with the expectations of future parents : Workshops and conferences Online registration process A personalized experience (monthly newsletter), NPS Net Promoter Score : Every patient is given the opportunity to rate his experience NPS is based on a direct question : «How likely would you recommend this hospital to a relative or a friend or a colleague?» 6 nvestor day
AN EXAMPLE OF NNOVATVE SERVCES: THE ED PROJECT What : The ED project Enhance the visibility of short waiting times in GDS services Develop a guide of high-quality standards for ED organization Develop services to meet patient expectations (eg. comfort in waiting area) Develop a health economics model for ED analysis How? Show waiting times (real time info refreshed every 5 min) on the web and in all relevant areas waiting rooms, hospital entrance and reception (first time in France) Workshops with professionals to evaluate and develop recommendations for organization standards Focus Groups with patients and definition of GDS promises regarding the service quality Data analysis based on activity and accountancy data 440000 420000 400000 380000 360000 # OF PATENTS N GDS EMERGENCY DEPARTMENT Cagr = 5% Results in our test ED mpact on Organization : 42% decrease of the avg. waiting time 25% decrease of the avg. length of stay mpact on Volumes +0% visits +40% traffic on the ED webpage 7 nvestor day 340000 320000 300000 200 20 202 203 204