HIRSLANDEN INVESTOR DAY PRESENTATION 18 FEBRUARY 2015 WELCOME & INTRODUCTION DANIE MEINTJES CEO MEDICLINIC INTERNATIONAL TIME LINE AND FINANCIAL OVERVIEW CRAIG TINGLE CFO MEDICLINIC INTERNATIONAL HIRSLANDEN TIME LINE 1990 2005 Merger of 5 clinics to form 1997 – 2002 2002 Takeover of Klinik St. Anna HIRSLANDEN Takeover of 7 clinics Takeover by BC Partners Introduction of Tarmed 2007 2010 2007 2007 Mediclinic International Acquisition of Klinik New management team at Opening of Garden Wing at acquires Hirslanden’s 13 Stephanshorn Hirslanden Klinik Hirslanden hospitals 2013 2012 2012 2012 Enzenbühltrakt project Successful listing of 13 Major debt refinancing of completed at Klinik KVG revision and hospitals on cantonal CHF2.9 billion successfully Hirslanden introduction of DRGs hospital lists completed Opening of outpatient clinic at Bern Station 2014 2014 2015 2014 ABO funding Commissioning of First bond issues totalling Opening of outpatient Acquisition of Clinique La Männedorf radiotherapy CHF200 million clinic in Belair “Urbahn” Colline and Swissana unit Clinic Hirslanden Analyst Presentation | February 2015 5 HIRSLANDEN KEY FINANCIAL INDICATORS Revenue and EBITDA CAGR = 6.2% 1 500 CAGR = 5.1% 1 200 900 CHF‘m 600 CHF 299 CHF 286 CHF 285 CHF 278 CHF 266 CHF 245 300 CHF 222 CHF 1 001 CHF 1 091 CHF 1 134 CHF 1 218 CHF 1 270 CHF 1 330 CHF 1 436 0 FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 Revenue EBITDA • Steady revenue and EBITDA growth • Normalised EBITDA shown • Major structural changes since early 2012 with listing, increase in generally insured patients and major long-term projects such as Lighthouse Hirslanden Analyst Presentation | February 2015 6 HIRSLANDEN GEARING Net debt : EBITDA 2,5 12,0 10,6 9,5 2,0 10,0 8,8 8,2 8,5 1,5 8,0 CHF’bn) 6,7 6,1 1,0 6,0 Net debt ( 0,5 4,0 CHF 2,34 CHF 2,34 CHF 2,33 CHF 2,34 CHF 2,37 CHF 1,91 CHF 1,83 0,0 2,0 FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 Net debt Net debt: EBITDA • Declining net debt to EBITDA ratio • Positive effect of debt refinancing in October 2012 clearly seen from FY2013 onward • After refinancing, average interest rate decreased from 5.62% to 2.3% • CHF 180 m amortised on senior loan as at 30 September 2014 Hirslanden Analyst Presentation | February 2015 7 HIRSLANDEN INAUGURAL DUAL TRANCHE BOND ISSUE • On 29 January 2015 Hirslanden accessed the CHF bond market • CHF 120 million at 1.625 % over 6 years, in combination with a CHF 80 million at 2.00 % with 10 year maturity • Final closing next week and further volume is possible • Aim of offering to refinance existing debt and diversify funding sources • Currently further refinancing options being evaluated • Rating of Baa- stable by Fedafin and Mid BB stable by Credit Suisse • Total transaction size the largest CHF new issue volume by a domestic health care sector issuer Hirslanden Analyst Presentation | February 2015 8 OPERATIONAL OVERVIEW OLE WIESINGER CEO HIRSLANDEN KEY FACTS SWITZERLAND Hirslanden Analyst Presentation | February 2015 10 KEY FACTS SWITZERLAND Official languages: Capital: Area: Government: German None 41,285 km² Federal Multi- French party directorial 133rd Italian (Berne) republic Romansh Population: GDP (PPP): Human GDP development (per capita): 8 million $ 385.333 index (HDI): Billion 0.917 $ 47,863 37th 3rd 8th Hirslanden Analyst Presentation | February 2015 11 KEY FACTS LIFE EXPECTANCY AT BIRTH 1970 AND 2011 (OR NEAREST YEAR) 90 80 70 60 50 40 30 20 10 0 Switzerland Germany OECD USA UAE India South Africa Data: OECD Health Statistics 2013. | Source UAE: indexmundi. United Arab Emirates - Life expectancy at birth Hirslanden Analyst Presentation | February 2015 12 KEY FACTS HEALTH EXPENDITURE PER CAPITA IN USD, 2011 (OR NEAREST YEAR) 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 Switzerland Germany OECD USA UAE India South Africa Data: OECD Health Statistics 2013. | Source UAE: The World Bank - Health expenditure per capita Hirslanden Analyst Presentation | February 2015 13 ENVIRONMENTAL CHALLENGES Hirslanden Analyst Presentation | February 2015 14 ENVIRONMENTAL CHALLENGES Outmigration of care Decreasing turnover per case Aging society From acute to chronical Regulatory environment Human resources Power of networks Increased transparency Limited market access Hirslanden Analyst Presentation | February 2015 15 REGULATORY ENVIRONMENT SWISS POLITICAL SYSTEM • Multi-party federal directorial democratic republic • Federal Council of Switzerland as head of government and executive power • Legislative power exercised by government and two chambers: Council of State and National Council • Direct representation • Healthcare: Steered by cantonal governments Hirslanden Analyst Presentation | February 2015 16 REGULATORY ENVIRONMENT SWISS FEDERAL STRUCTURE Hirslanden Analyst Presentation | February 2015 17 REGULATORY ENVIRONMENT THE CANTONS’ MULTIPLES ROLES Finance HSM Moratorium planning payer Tariff Healthcare Hospital determina- regulator operator tion Hirslanden Analyst Presentation | February 2015 18 HSM PLANNING THE APPROACH «Conference of Highly Specialized Medicine» (assigned by the 26 Health Ministers), organised by cantons Purpose: Centralisation of Highly Specialized Medicine in Switzerland Motivation criteria: • Small case load • Innovation potential • Need for specialized teams • Need for specialized infrastructures • Complexity of treatments • High costs Hirslanden Analyst Presentation | February 2015 19 HSM PLANNING THE CHALLENGE • Definition of HSM: What and who? • Distinction between specialised and highly-specialised medicine • Composition of decision making-body: Only representatives of public hospitals with multiple roles Hirslanden Analyst Presentation | February 2015 20 REGULATORY ENVIRONMENT THE CANTONS’ MULTIPLES ROLES Finance HSM Moratorium planning payer Tariff Healthcare Hospital determina- regulator operator tion Hirslanden Analyst Presentation | February 2015 21 HEALTHCARE REGULATOR HOSPITAL LIST - THE APPROACH • Cantonal hospital lists • Goal of list: Cover all medical services required by the inhabitants of canton • Billing of treatment costs to patient’s canton of residence and basic insurance (50:50) by listed hospitals • Listing made by cantonal government • Mandate dictates offered medical services, obligations and requirements to be met (most important: Quality and economic efficiency, patients access to treatment, within a reasonable time) Hirslanden Analyst Presentation | February 2015 22 HEALTHCARE REGULATOR HOSPITAL LIST – THE CHALLENGE • Public service mandates for 15 out of 16 Hirslanden hospitals: Klinik Im Park’s objection (Canton of Zurich) rejected; reapplication for 2016 • Extensive service mandates • Ongoing court cases (BE, SG) Hirslanden Analyst Presentation | February 2015 23 HEALTHCARE REGULATOR FURTHER REGULATORY CHALLENGES • Provisional DRG base rates • Outpatient tariff adjustment (shift of 200m Swiss francs from specialists to basic service providers) • Canton Vaud: Cantonal influence in acquisition of large medical equipment Hirslanden Analyst Presentation | February 2015 24 ENVIRONMENTAL CHALLENGES Outmigration of care Decreasing turnover per case Aging society From acute to chronical Regulatory environment Human resources Power of networks Increased transparency Limited market access Hirslanden Analyst Presentation | February 2015 25 OUTMIGRATION OF CARE AMBULATORY SURGERY VISITS UNITED STATES 1996 AND 2006 Ambulatory Inpatient 90 80 70 60 50 40 30 20 10 0 1996 2006 Data: CDC/NCHS, National Survey of Ambulatory Surgery, 2006 and National Hospital Discharge Survey. Hirslanden Analyst Presentation | February 2015 26 OUTMIGRATION OF CARE DEVELOPMENT IN OUTPATIENT BUSINESS IN SWITZERLAND Proportion of in- and outpatient cases in Swiss Hospitals 1996, 2004 and 2012 100 90 80 70 60 50 Outpatient 40 Inpatient 30 20 10 0 1996 2004 2012 Data: The Swiss Hospital Association H+, May 2014 Hirslanden Analyst Presentation | February 2015 27 BUSINESS OVERVIEW AND KEY STATISTICS Hirslanden Analyst Presentation | February 2015 28 THE SWISS HOSPITAL MARKET General Hospitals Employees (FTE) Beds 175 Hospitals 123'269 FTE 23'852 Acute beds 16% of privately held 32% of privately held 8% of total 35% of privately held 4% of total 6% of total 18% 82% Patient Care Days Cases Hirslanden Explanation 8.3m days 1.1m treated patients -Hirslanden's market share in % of private hospitals 31% of privately held 38% of privately held -Hirslanden's overall m/s 5% of total 7% of total 15% 18% Private Hospitals 85% 82% Public Hospitals Data: Swiss Federal Statistical Office (2012); Hirslanden. Hirslanden Analyst Presentation | February 2015 29 HIRSLANDEN OUR HOSPITALS Hirslanden Analyst Presentation | February 2015 30 HIRSLANDEN OUR AFFILIATED DOCTORS Hirslanden Analyst Presentation | February 2015 31 HIRSLANDEN OUR REFERRING DOCTORS Hirslanden Analyst Presentation | February 2015 32 OPERATIONAL OVERVIEW HOSPITALS BEDS 16 1 650 EMPLOYED VISITING EMPLOYEES SPECIALISTS SPECIALISTS 235 1 493 6 246 Hirslanden Analyst Presentation | February 2015 33 100 000 20000 40000 60000 80000 1 0001 0002 0003 0004 5 000 6 000 0007 GROWTH AT 0 Hirslanden 0 CAGR: CAGR: 2006 2004 CAGR: 4.4% CAGR: 3 607 29 016 3 628 56 719 2005 5.4% 2007 29 245 3 776 66 315 3 860 2006 Patients 08/09 34 062 4 107 67 019 4 166 2007 35 409 09/10 69 642 ( inpatient 4 288 08/09 4 343 FTE 35 178 73 448 10/11 09/10 HIRSLANDEN 4 419 34 553 cases 4 576 73 582 10/11 11/12 4 786 35 551 ) 4 871 77 643 11/12 12/13 37 808 5 016 80 588 Analyst Presentation | | 2015 Analyst February Presentation 5 065 12/13 38 898 13/14 82