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MENA Healthcare No Better Time to Be Overweight

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MENA Healthcare No Better Time to Be Overweight MENA Healthcare No Better Time to be Overweight MENA Healthcare Sector Report | 18 September, 2013 Sector Coverage September 18 2 0 1 3 Mohammad Kamal [email protected] +9714 507 1743 Dahlia Sabaayon, CFA Arqaam Capital Research Offshore s.a.l MENA Healthcare Summary of recommendations No better time to be overweight Bloomberg code MOUWASAT AB Lifestyle-related diseases are highly prevalent in MENA, and particularly in Company name Al Mouwasat Medical Services Company KSA and the UAE: sedentary lifestyles and poor dietary habits linked to Price target SAR 103 diabetes, cardiovascular diseases, and cancer have rendered KSA and UAE Rating 30% upside, Buy exposed to elevated incidence rates of key diseases. As a general data point, the obesity rate among Saudi adults, according to the WHO, is 3x the global Bloomberg code DALLAH AB rate, on par with the US (36%) and ahead of MENA (<30%). The UAE faces a Company name Dallah Healthcare Holding Company similar situation, with 36% of the population classified as obese. Perhaps Price target SAR 88 most striking is the incidence of diabetes among young (<39) residents in Rating 40% upside, Buy KSA, which stands at >2x the US rate at 32% of the overall diabetic population (14% US). Bloomberg code NMC LN Company name NMC Health Chronic underinvestment and over-expenditure: The KSA bed/1,000 ratio Price target GBp 440 of 2.2 (1.7 beds provided by the government, 0.5 by the private sector) is Rating 40% upside, Buy below the global average of 3.0, and far below the average of 5.5 in developed countries. The UAE is structurally similar, at 1.9 beds/1,000 in Bloomberg code CARE AB 2011. National spending on healthcare in KSA and UAE has been between Company name National Medical Care Company 4.0% and 2.5% of GDP over the past 5 years, roughly in-line with the MENA Price target SAR 48 average, but low by developed market standards (18% in the US, 11% in Rating 12% downside, Hold France and Germany, 8% in the UK). Conversely, the expenditure on medical treatments abroad for KSA and UAE nationals has cost both Bloomberg code ANH LN countries an average of USD 5bn in the past 10 years, as a consequence of Company name Al Noor Hospitals Group insufficient domestic healthcare infrastructure and a shortage of qualified Price target GBp 840 specialised doctors. Rating 0% upside, Hold Healthcare policy in both countries has stimulated private sector investment in capacity, while new regulation regarding insurance cover should prove a sizable catalyst. A combination of (i) reforms, (ii) public spending packages, and (iii) special lending terms targeting new medical facilities have spurred private sector participation. In the UAE, the introduction of mandatory health cover in Abu Dhabi in 2007 catalysed a 4x growth in inpatient claims, and 8x in outpatients. Dubai and the Northern Emirates are due to follow suit, releasing 50% in additional insured patients which to date have met treatment costs out-of-pocket. Discounted valuation despite superior quality: We are positive on NMC UH (Buy, GBp 440), MOUWASAT AB (Buy, SAR 103) and DALLAH AB (Buy, SAR 88). We find fundamentals priced in at current price for CARE AB (Hold, SAR 48) and ANH LN (Hold, GBp 840). KSA and UAE healthcare plays offer value in an EM context, as the sector trades at a 20% discount to EM peer fwd P/E, while generating stronger equity returns (1.5x), a 500bps EBITDA margin differential, and industry ROIC that is 6% higher on average. Risks: Geopolitics, sufficiency of government spending packages, and © Copyright 2013, Arqaam Capital Limited. All Rights Reserved. adoption of key regulation. See Important Notice. September 18 2013 MENA – Healthcare and Pharmaceuticals Contents Summary of recommendations ....................................................................................... 3 Key Performance Indicators ............................................................................................ 4 Valuation: ........................................................................................................................ 5 KSA and UAE Healthcare ................................................................................................. 6 The healthcare opportunity in KSA ................................................................................. 7 Key private healthcare groups in KSA ........................................................................... 13 The healthcare opportunity in the UAE ........................................................................ 14 Key UAE healthcare indicators ...................................................................................... 20 Al Mouwasat Medical Services Co................................................................................. 21 Dallah Healthcare Holding Co........................................................................................ 30 NMC Health ................................................................................................................... 39 National Medical Care Co. ............................................................................................. 50 Al Noor Hospitals Group ................................................................................................ 59 Healthcare and Pharmaceuticals © Copyright 2013, Arqaam Capital Limited. All Rights Reserved. See Important Notice. 2 September 18 2013 MENA – Healthcare and Pharmaceuticals Summary of recommendations Exhibit 1: Summary of recommendations Company Price target Rating Up (down) side ADTV, USDmn EV*, USDmn Index Free float Dallah Healthcare SAR 88 Buy 40% 11.7 707.1 SASEIDX 37.9% Mouwasat SAR 103 Buy 30% 3.4 1,099.4 SASEIDX 43.8% National Medical Care SAR 48 Hold (12%) 12.5 607.4 SASEIDX 38.3% NMC Health GBp 440 Buy 40% 0.6 983.4 ASX 33.0% Al Noor Hospitals Group Plc GBp 840 Hold 0% 0.8 1,012.8 ASX 29.1% Company EV/EBITDA FY 14e P/E FY 13e P/E FY 14e P/E FY 15e P/B FY 13e RoE Div yield Dallah Healthcare 14.0x 26.0x 19.3x 15.7x 2.5x 10% 1.7% Mouwasat 12.2x 18.1x 15.2x 14.2x 4.1x 23% 1.7% National Medical Care 15.7x 24.8x 23.4x 20.9x 2.9x 12% 2.2% NMC Health 9.8x 13.7x 12.7x 11.5x 2.4x 18% 1.5% Al Noor Hospitals Group Plc 10.0x 23.5x 17.5x 17.2x 8.8x 37% 1.7% Source: Company Data, Arqaam Capital Research *at recent market prices Dallah Healthcare (Buy, SAR 88): direct exposure to premium segment of KSA private healthcare sector. 2x expansion in bed capacity should translate into FY 13-18e EPS CAGR of 20%, which is further supported by double-digit growth in pharmaceuticals business (17% 5-yr revenue CAGR). Current market valuation implies 15% discount to EM peers on FY 14/15e EPS. We believe the market is overlooking the role of bed capacity growth on EPS at current multiples. We initiate with a Buy rating and SAR 88 FVE. Mouwasat (Buy, SAR 103): unique positioning vis-a-vis KSA oil industry communities. Key growth catalysts overlooked at current valuation: 85% bed capacity increase over 5 years, roll out of facilities in dense, underserviced urban centers (Riyadh), and upward re-pricing of agreements with insurers. Mouwasat currently trades at 15.2x FY 14e EPS vs. 17.6x and 19.3x for regional and local peers, implying discounts of 15% and 20%, respectively. We believe the stock should re-rate and trade in-line with sector multiples, at the very least. We initiate with a Buy rating and SAR 103 FVE. NMC Health (Buy, GBp 440): Well-positioned for mandatory health cover in Dubai & Northern Emirates, bed capacity in utilization should improve as a result. Bed capacity roll-out (+100%) should drive revenue CAGR of 16%. NMC holds the cheapest valuation profile within our healthcare coverage space (12.7x FY 14e EPS, 9.8x EV/EBITDA), despite superior healthcare EBITDA margins of 28% (vs. 25% regional peers, 20% EM). We value NMC at GBp 440/share, implying c. 40% in upside potential from current price, using DCF, and initiate with Buy. National Medical Care- CARE (Hold, SAR 48): Pure play on the middle income segment of the Saudi healthcare sector. 48% bed capacity additions to bolster market share, going forward, and support 5-yr revenue CAGR of 9% on a rise in inpatient as well as outpatient visitation. Valuation: We initiate with a Hold recommendation and SAR 48 FVE. At 23.4x FY 14e EPS, CARE trades at 35% and 20% premiums to regional and local peers. Valuations are stretched but tolerable, given the business’s strong domestic positioning (16% Riyadh market share in FY 14e). Al Noor Hospitals (Hold, GBp 840): Leading private healthcare provider in Abu Dhabi, dominant share of inpatient (39%) and outpatient (35%) market. Modest revenue growth outlook (5% CAGR 5-yr), medical staff costs to impact margins. Market valuation adequately captures fundamentals at c. 24x/18x FY 13e/14e P/E. We initiate coverage with Hold and GBp 840 FVE. Healthcare and Pharmaceuticals © Copyright 2013, Arqaam Capital Limited. All Rights Reserved. See Important Notice. 3 September 18 2013 MENA – Healthcare and Pharmaceuticals Key Performance Indicators Exhibit 2: Summary of key operating and performance indicators across the UAE and KSA healthcare coverage space NMC Dallah Mouwasat CARE Noor Operations Location- country UAE KSA KSA KSA UAE Location-city Abu Dhabi, Dubai, Sharjah Riyadh Eastern province, Riyadh (FY 13e) Riyadh Abu Dhabi, Oman Number of hospitals 7 2 6 2 3 Number of clinic centers na 284 376 175 na Number of other centers 3 na 2 dispensaries 4 dispensaries 12 medical centers Obstetrics Y Y N N N Paediatrics N Y N N N
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