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Healthcare Business Strategy Healthcare & Service Business Unit Koji Nagatomi Healthcare Business Strategy Healthcare & Service Business Unit Koji Nagatomi Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. Healthcare Market in Asia Growth of Asia’s* healthcare spending Accelerating growth *South East Asia + China + India （USD bil） unaffected by economic 3,100 conditions Changes in Population Income Aging Disease 710 Growth Growth Population Patterns 2016 2030 (Source) OECD, World Bank, Mitsui’s forecasts Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. 2 Healthcare Market in Asia Significant shortage of Number of hospital beds per 1,000 population （Number of beds） hospitals 4.8 (no. of beds) 2.8 2.8 2.3 1.9 Changes in 0.7 Population Income Aging Disease Growth Growth Population Patterns OECD Singapore Malaysia India China Turkey Average （Source） METI, Government of Singapore, World Bank, OECD Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. 3 Hospital Business Management in Asia Increased volume and quality of care Maximized value of medical services Management Structure Challenge／Lever ① Challenge／Lever ② Challenge／Lever ③ Increasing Revenue M&A・Increasing (unit price x no. Optimizing Cost No. of Beds of patients) Strategic problem solving from a management perspective Doctors Patients Problems can be solved utilizing business knowhow Trust and expectations Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. 4 Mitsui’s Resources in Hospital Business ■Progress in management participation and expansion of human resources Additional (Persons) Additional investment in IHH Investment in investment in Platform 60 ■Industry experts（MHM） Columbia Asia Columbia Asia Developing a large and strong platform ■ 50 MBK staff seconded DaVita and PHC 5 by participating in management of ■MBK staff at HQ 1 hospital businesses, such as IHH. 40 5 Investment 2 12 20 30 in IHH 5 20 2 Professionals 27 29 27 10 2 Expanding human resource including 12 industry experts and professional 0 2 managers. 2011 2016 2018 2019 Khazanah Khazanah Network Connection with industry experts, CPM KKR 3 increasing new business opportunities. DaVita Healthcare Partners ※Refer to appendix for company summaries Understand the key success factor of hospital business and acquire the position to proactively pull the lever to increase business value 5 IHH as Core Platform IHH (Fortis included) Data No.1 No.1 Presence in12 countries Turkey Malaysia, Turkey, Singapore, India, Brunei, Holland, Bulgaria, Macedonia, UAE, China (including HK), Mauritius, No.2 Sri Lanka India Total no. of hospital beds No.2 Malaysia No.1 beds No.1 15,000 Singapore ※Comparison between listed private hospitals in Asia (based on proprietary research） Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. 6 Track Record in Hospital Business ① 【Progress of IHH’s EBITDA】 【Our focus since initial investment in 2011】 （USD mil） 613 Formulating a growth strategy Supporting geographical expansion Formulating and executing capital strategies 218 Strengthening IHH’s management base 2011/12 2018/12 3,500 beds Over 15,000 beds EBITDA has increased 3X （16 Hospitals） （83 Hospitals） within 7 years after Equity Became the Largest joining the management of IHH Participation Shareholder Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. 7 Track Record in Hospital Business ② 【Progress of CLA’s EBITDA】 A hospital group 【Our focus since initial investment in 2016】 （USD mil） targeting middle- 55 income patients Developing a management structure Formulating strategy to increase revenue (unit price × no. of patients) Optimizing cost 18 Strengthening PDCA cycle management 2016/3 2019/3 2,300 beds 2,600 beds (27 Hospitals) (28 Hospitals) EBITDA increased 3X within 3 years of participation Participation Now Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. 8 Growth strategies centered on the hospital business Identify demand-driven business opportunities through participation in hospital business which is a “place” representing a miniature version of the healthcare industry Leverage neutrality as a trading company and take an active position in multiple businesses Regional expansion New business expansion China and India Leverage data Functional expansion Business spin-out 9 Growth Strategy 1. Expansion into China and India 【IHH’s geographical presence】 ■Growth of healthcare spending in China and India Bohai Bay Economic Rim Zone (Unit: US$ bn) （Beijing and others） China Central China Yangtze River Delta Expanding business through IHH （includes Chengdu） （includes Shanghai） 1,900 Entered into a MOU with China Resources Enterprise, one of Pearl River Delta China’s largest companies （includes Hong Kong） 【IHH’s geographical presence】 Northern region India （includes New Delhi） 560 New Asia Partner Eastern region Platform expansion through (includes Calcutta） 710 50 480 acquisition of Fortis and its PMI Western Region New partner strategy （includes Mumbai） 2016 2030 Southern region （includes Bengaluru） （Source）OECD, World Bank, Mitsui’s forecasts 10 Growth Strategy 2. Business spin-out Strengthening and expanding ancillary businesses of hospitals Promoting further growth through appropriately timed spin-outs Achieving further growth in external markets Specialty Diagnostic Clinic Imaging Spin-out Hospital Clinical Examination Ancillary Business 11 Growth Strategy 3. Leveraging medical data Build a medical data platform centered on IHH and leverage such data Strengths of IHH Value of Data Volume of Data Vision Approx. 600,000 inpatients and Enhance operational approx. 6 mil outpatients per efficiency and improve quality annum. of care Asia’s Largest Medical Data Platform Other related biz Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. 12 Quantitative goals and action plans 【Changes in Mitsui’s equity proportional EBITDA of hospitals and ancillary businesses】 (Not including new investments) (Unit: ¥bn) 59.0 CAGR 16% 38.0 22.0 FY19/3 Actual FY 20/3 Plan FY 23/3 estimate FY 28/3 estimate Expansion of business base （Asia） （China, India） Improving margin of existing businesses through business integration ・PMI Spin-out of ancillary businesses Business expansion through creation of data platforms Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. 13 Appendix IHH Healthcare Bhd. (IHH) PHC Columbia Asia DaVita Care Columbia Asia is a hospital group providing high quality DaVita Care operates dialysis clinics in China and South medical services to the middle-income population in Asia East Asia. The group aims to expand and improve the where rapid growth is anticipated. The group provides quality of medical services in Asia by applying what approx. 2,600 hospital beds to patients in 28 hospitals and 1 DaVita as the largest dialysis clinic group in the US clinic. Mitsui owns 26.1% as of FY 19/3 period end. learned through its operations. Mitsui owns 20.0% as of FY3/19 period end. Copyright © MITSUI & CO., LTD. ALL RIGHTS RESERVED. 15 .
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