healthy outlook for health investors - aljazira capital

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1 © All rights reserved Please read Disclaimer on the back Healthy Outlook for Health Investors Thematic Report July 2013 Executive Summary & Conclusion Aljazira capital initiated its coverage on KSA medical healthcare sector; which is (at present) considered one of the most promising growth avenues in the Kingdom; where, based on Economic Intelligence Unit, the sector is expected to witness (i) increase in healthcare spending at 2011-16CAGR of 9.4% and (ii) life expectancy is expected to reach 75.3yrs by 2016. In addition to these factors the sector, at present, is also witnessing scarcity in several medical support services (particularly high- end services). Hence, we believe it is essential to evaluate the local KSA sector on its strategic positioning along with financial analysis (which is a prime focus of our in-depth fundamental sector analysis) This will help the investor to; Understand the quality and suitability of the sector’s financial growth, Evaluate the direction of the sector; and Analyze the strategic alignment of future expansion plans of existing players. Our sector’s strategic analysis is mainly centered on the three widely accepted and recognized strategic models/approaches which are; Porter’s Five Forces Model; is applied to determine any industry’s attractiveness based on a) Intensity of competitive rivalry; nature & level of competition b) barriers to new entrants; high or low, c) substitution affect; level of similarities in products & services, d) buyers’ bargain power; ability of consumer to negotiate prices; and e) suppliers’ bargain power; industry players’ ability to negotiate the suppliers of key inputs. In this report (to analyze Porter’s five forces) we segregate the Kingdom’s local market into two broad segments i.e. Saudi residents and non-Saudi residents. Where, the demographic, spending pattern, preferences and economics are much differentiated from each other. However, we further segregate the two broad identified segments based on their income level and social status (into blue collar and white collar segment) to analyze the industry in a more appropriate manner. Porter’s Generic Competitive Analysis; focuses on the strategic positioning of a firm based on cost and differentiation scale which will help to identify whether a particular firm is cost effective or has a differentiation advantage over others. For generic competitive analysis, we classified the Kingdom’s healthcare service facilities into five broad categories; (i) Large size hospitals (>300 beds), (ii) Medium size hospitals (>100 beds; but <300 beds), (iii) Specialized clinics/medical facility (designed to treat specific disease), (iv) Small size hospitals (>50 beds; but < 100 bed) & polyclinics (daycare & mostly outpatients) and (v) Military and company-specific hospitals. Profit Pool Analysis; seeks to identify the industry’s sub-segments contribution in the industry’s overall profitability. For this analysis, we considered the profitability measures of two sub-segments of the Kingdom’s medical sector i.e. health care service provider (hospitals, specialized clinics and polyclinics) and pharmaceuticals. Our Porter’s five forces analysis concluded the industry as ‘Attractive’; whereas, generic competitive analysis indicated the medium size hospitals have better ‘cost and service payoff’ compared to large size hospital. But the increase in specialization could improve the cost & differentiation payoff for any particular hospital having broad market focus. Finally, our profit pool analysis indicated the expansion in medical healthcare services (hospitals and clinics) is more strategically aligned to avail the existing opportunities than other medical segments in the kingdom. We believe the factors identified in our strategic analysis will help the industry align itself to capitalize opportunities arising on account of local government support and also the factors of lifestyle health issues We believe the government’s financial assistance will continue to act as a growth stimulator for the expansion in industry and lead to increase the economies of scale. Hence, this indicates the existing players are well set to take the opportunity of expansion at low cost. The rising trend of non-communicable diseases in KSA will continue to suppress the patients’ negotiation power. On the other hand, the rising trend in mentioned disease is offering ample growth opportunities to develop the required infrastructure and medic services. Increase in the local medical training institutes (on government level) will translate into higher number of local physicians & doctors (as mentioned earlier). While, on the other hand, this will also support the government stance towards increasing local employment. Analyst Saleh AlQuati [email protected] +966-2-6618253 Senior Analyst Syed Taimure Akhtar [email protected] +966-2-6618271

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Page 1: Healthy Outlook for Health Investors - Aljazira Capital

1 © All rights reserved

Please read Disclaimer on the back

Healthy Outlook for Health InvestorsThematic Report

July 2013

Executive Summary & Conclusion

Aljazira capital initiated its coverage on KSA medical healthcare sector; which is (at present) considered one of the most promising growth avenues in the Kingdom; where, based on Economic Intelligence Unit, the sector is expected to witness (i) increase in healthcare spending at 2011-16CAGR of 9.4% and (ii) life expectancy is expected to reach 75.3yrs by 2016. In addition to these factors the sector, at present, is also witnessing scarcity in several medical support services (particularly high-end services). Hence, we believe it is essential to evaluate the local KSA sector on its strategic positioning along with financial analysis (which is a prime focus of our in-depth fundamental sector analysis) This will help the investor to;

• Understand the quality and suitability of the sector’s financial growth,

• Evaluate the direction of the sector; and

• Analyze the strategic alignment of future expansion plans of existing players.

Our sector’s strategic analysis is mainly centered on the three widely accepted and recognized strategic models/approaches which are;

• Porter’s Five Forces Model; is applied to determine any industry’s attractiveness based on a) Intensity of competitive rivalry; nature & level of competition b) barriers to new entrants; high or low, c) substitution affect; level of similarities in products & services, d) buyers’ bargain power; ability of consumer to negotiate prices; and e) suppliers’ bargain power; industry players’ ability to negotiate the suppliers of key inputs. In this report (to analyze Porter’s five forces) we segregate the Kingdom’s local market into two broad segments i.e. Saudi residents and non-Saudi residents. Where, the demographic, spending pattern, preferences and economics are much differentiated from each other. However, we further segregate the two broad identified segments based on their income level and social status (into blue collar and white collar segment) to analyze the industry in a more appropriate manner.

• Porter’s Generic Competitive Analysis; focuses on the strategic positioning of a firm based on cost and differentiation scale which will help to identify whether a particular firm is cost effective or has a differentiation advantage over others. For generic competitive analysis, we classified the Kingdom’s healthcare service facilities into five broad categories; (i) Large size hospitals (>300 beds), (ii) Medium size hospitals (>100 beds; but <300 beds), (iii) Specialized clinics/medical facility (designed to treat specific disease), (iv) Small size hospitals (>50 beds; but < 100 bed) & polyclinics (daycare & mostly outpatients) and (v) Military and company-specific hospitals.

• Profit Pool Analysis; seeks to identify the industry’s sub-segments contribution in the industry’s overall profitability. For this analysis, we considered the profitability measures of two sub-segments of the Kingdom’s medical sector i.e. health care service provider (hospitals, specialized clinics and polyclinics) and pharmaceuticals.

Our Porter’s five forces analysis concluded the industry as ‘Attractive’; whereas, generic competitive analysis indicated the medium size hospitals have better ‘cost and service payoff’ compared to large size hospital. But the increase in specialization could improve the cost & differentiation payoff for any particular hospital having broad market focus. Finally, our profit pool analysis indicated the expansion in medical healthcare services (hospitals and clinics) is more strategically aligned to avail the existing opportunities than other medical segments in the kingdom.

We believe the factors identified in our strategic analysis will help the industry align itself to capitalize opportunities arising on account of local government support and also the factors of lifestyle health issues

• We believe the government’s financial assistance will continue to act as a growth stimulator for the expansion in industry and lead to increase the economies of scale. Hence, this indicates the existing players are well set to take the opportunity of expansion at low cost.

• The rising trend of non-communicable diseases in KSA will continue to suppress the patients’ negotiation power. On the other hand, the rising trend in mentioned disease is offering ample growth opportunities to develop the required infrastructure and medic services.

• Increase in the local medical training institutes (on government level) will translate into higher number of local physicians & doctors (as mentioned earlier). While, on the other hand, this will also support the government stance towards increasing local employment.

Analyst

Saleh [email protected]+966-2-6618253

Senior Analyst

Syed Taimure [email protected]+966-2-6618271

Page 2: Healthy Outlook for Health Investors - Aljazira Capital

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Healthy Outlook for Health InvestorsThematic Report

July 2013

Introduction

The Kingdom’s healthcare is among the most promising investment avenues. Historically the growth in the sector was mainly associated with the increase in local population at a CAGR of 3.2% during 2000-10; which is expected to increase at a CAGR of 2.0% over 2010-20. On the other hand, according to Economic Intelligence Unit (EIU) estimates, the Kingdom’s spending on healthcare reached at 4.0% of GDP in 2011 as compared to 3.8% of GDP in 2010. It should be noted that the Kingdom’s healthcare spending to GDP ratio is almost similar to other GCC members but low in comparison with most developed countries.

Although the local government is increasing its spending on medical healthcare, the sector is still lagging with;

h 22 beds per 10,000 population 1 , h 9.4 physicians available per 10,000 population2 and h 21 nurses & midwives per 10,000 population.

The combination of these factors indicates the Kingdom has ample room to make further developments in these areas; while comparing with global and regional averages.

1. World Health Organization – World Health Statistic 20122. World Health Organization – World Health Statistic 2012

KSA Healthcare Expenditure - Global & Gcc Positioning

Source: World Health Organization – Word health statistics 2012

Saudi Arabia

Oman

Bahrain

Kuwait

Qatar UAE

Region of Americas

European region

Western Pacific Region

Global average

-

500

1,000

1,500

2,000

2,500

3,000

3,500

- 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0

Pe

r ca

pit

a e

xpe

nd

itu

re o

n h

ea

lth

care

(US

D)

Healthcare spending % GDP

Saudi Arabia Oman Bahrain Kuwait Qatar UAE Region of Americas European region Western Pacific Region Global average

Page 3: Healthy Outlook for Health Investors - Aljazira Capital

3 © All rights reserved

Please read Disclaimer on the back

Healthy Outlook for Health InvestorsThematic Report

July 2013

KSA Medical Healthcare Strategic Analysis

To make analysis easier, we segregate the Kingdom’s local market into two broad segments i.e. Saudi residents and non-Saudi residents. Where, the demographic, spending pattern, preferences and economics are much differentiated from each other. However, we further segregate the two broad identified segments based on their income level and social status (into blue collar and white collar segment) to analyze the industry in a more appropriate manner.

Based on our market segmentations, we applied three strategic models to analyze the sector attractiveness; and concluded that the local medical healthcare sector is attractive and offering ample growth opportunities.

Industry

Key target markets

Target market – Sub segment

KSA Healthcare Medical Services Sector - Global & Gcc Positioning

KSA Healthcare Market Segmentations Attractive

Source: World Health Organization – Word health statistics 2012

Source: Aljazira Capital Research

Saudi Arabia

UAE

OmanKuwait

Bahrain

Qatar

Region of Americas

European region

Western Pacific regionWorld average

-

5.0

10.0

15.0

20.0

25.0

30.0

35.0

0 10 20 30 40 50 60 70

Ph

ysi

cia

ns

pe

r 1

0,0

00

po

pu

lati

on

Beds per 10,000 population

Saudi Arabia UAE Oman Kuwait Bahrain Qatar Region of Americas European region Western Pacific region World average

This indicates a potential opportunity for KSA healthcare sector which is still below the global average. We believe the first phase should be to reach the world average. This could be done with increase in number of hospitals which will translate into increase in availability of beds and physicians.

Public sector employees

Low-Mid income, government insur-ance for public hos-pitals (i.e. free of cost) and limited ac-cess to private hos-pitals.

Private employee

Mid-High income, average-high class insurance facilities for private hospitals and access to gov-ernment hospitals.

White collar

Office workers, mid-high income, aver-age to high class in-surance as most of them are working in private sector.

Blue collar

Labor class, low in-come; low class in-surance just to fulfill the government re-quirement.

Non-Saudi residents Saudi residents

KSA Medical Healthcare sector

Page 4: Healthy Outlook for Health Investors - Aljazira Capital

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Healthy Outlook for Health InvestorsThematic Report

July 2013

Threatof New

Entrants

BargainingPower ofSuppliers

BargainingPower of

Buyers

RivalryAmongExisting

Competitors

Threat of SubsitituteProducts or Services

The Strategic Models We Used Are:

1. Porter’s 5 Forces Model

Porter’s 5 forces industry analysis is applied to determine any industry’s attractiveness based on a) Intensity of competitive rivalry; nature & level of competition b) barriers to new entrants; high or low, c) substitution effect; level of similarities in products & services, d) buyers’ bargain power; ability of consumer to negotiate prices; and e) suppliers’ bargain power; industry players’ ability to negotiate the suppliers of key inputs.

Porter’s 5 forces model

Source: Harvard Business Review

High barriers to new entrants - Favorable• Industry in mature stage.• High economies of scale.• Specializations• High capital incentive.

Low rivalry - Favorable• Few players.• Considerable market share.• Undersupply & specialized.• High-medium pricing power

High buyer power - Not favorable• Several options.• Availability of substitutes.• Products are highly commoditized.

Low buyer power – Favorable• Few options• Nature & use of end products/

services.• Highly specialized products.

High threat of substitute – Not favorable • Commoditized products/services.• High competition.• Several numbers of firms.

Low threat of substitute -Favorable• Low competition.• Few players.• Specialized products/services

Low supplier power – Favorable• Diversified sources of key input.• Inputs are commoditized; with low

specialization.• Unable to influence buyer.

High supplier power – Not favorable

• Limited source of key input.

• Key inputs are specialized.

• Dictate key input prices.

Low barriers to new entrants – Not favorable

• Threat for existing players. • Industry in growing stage.• Competition low• Low specializations• Low capital incentive.

High rivalry - Not favorable• Several players.• Limited market share.• Oversupply• Commoditized.• Low pricing power & profits

Page 5: Healthy Outlook for Health Investors - Aljazira Capital

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Healthy Outlook for Health InvestorsThematic Report

July 2013

Rivalry Intensity - Low

We consider the following key factors to evaluate the intensity of competitive rivalry among the Kingdom’s existing medical complexes;

• Pricing

• Brand name

• Medical facilities at the premises

• Geographical presence

We believe the pricing is a major concern for those customers who have mandatory health insurance or have no private health insurance (mainly Saudi citizen; who have only government insurance if not working in private sector). However, those customers having good health insurance coverage (whether Saudi citizen or non-Saudi citizen) are more focusing on brand name and other facilities (including quality of physicians). Hence, we believe the intensity of rivalry on prices is high on low-end medical complexes; whereas, the brand name & other facilities are more important for high-end (who have high medical expenditure power).

On the other hand, due to limited presence of big high class medical facilities (mainly concentrated in three big cities of KSA i.e. Riyadh, Dammam and Jeddah) the rivalry, at present, in high-end segment of sector is low. This could be capitalized by the new players through expansions. Furthermore, the intensity of rivalry based on geographical presence is high in small low-class medical facilities; since, the business of these small low-class medical facilities is mainly based on ease of access. It should be noted that the focus on medical services is limited at low-class small medical complexes; as people are using these facilities for the treatment of general diseases.

Our viewBased on our understanding, the limited availability of high-class and low-class specialized hospitals limits the intensity of rivalry. Whereas, the rivalry on pricing is not much effective on high-class (where the customers have good health insurance policy) and limited availability of quality physicians & medical staff left the customers with limited choices. We, therefore, concluded that overall the industry (at present) has low intensity of rivalry.

Implication On KSA Healthcare Sector

Threat To New Entrants - Medium To HighBased on our understanding, the entry barriers in the Kingdom’s healthcare industry vary depending on the nature of medical facilities.

• Specialized, large-to-medium hospitals have medium to high entry barriers due to the requirement of;

h Highly specialized physicians and medical staff.

h High capital investment (around SAR0.5bn on average) to accommodate all facilities.

h Ideal location; to optimize the coverage.

• Polyclinics & dispensaries have low to medium entry barriers due to the following reason;

h Average doctors and medical staff are available.

h Less capital incentive as compared to large-to-medium & specialized hospitals.

h Easy to find place and mostly located in nearby localities.

It should be noted that the approval for opening a new medical facility (whether specialized, general or small hospital) is not an easy task. Moreover, creating & maintaining a reputation is also a big challenge in medical healthcare field.

Beside these factors, the new regulation regarding ownership of hospital or medical complex by a local doctor increases the barrier to entry. Where, we believe the major impact will be on the private and small medical facilities (i.e. mostly polyclinics).

Our view Based on the above identified factors, we have concluded that

the KSA medical health care sector has medium-high entry barriers. This makes the industry more attractive for to existing players.

Substitution Effect - Low

The end services of the industry are unique in nature and have no substitutes; unless the local authority will allow alternative medics to penetrate in the market. However, inside the sector, we have identified the following factors which can make one medical complex a substitute to the other;

• Quality of physicians.

• Medical service differentiation.

• Proximity

• Wider health insurance policy

• Nature of illness.

h It should be noted that the quality physicians are scarce in the kingdom; hence, this factor makes a real difference among the existing players. The limited number of physicians limits the impact of substitution.

h Medical services are almost similar to each other and vary slightly from one medical complex to another. The main difference is perception & discounts due to insurance

policies. However, we can say (in case of general illness) that the polyclinics could be a good substitute of low-level hospitals; on cost & benefit analysis. We, therefore, believe the substitution effect is high on low end; while on high end the effect is limited.

h Proximity is the main issue associated with large-to-medium medical facilities rather than small & low-level medical complexes. Hence, this factor limits the substitution effect on wide scale.

h We believe health insurance policy in the kingdom is under evolution stage. Hence, this limits the substitution effect on the sector, for the time being; where, the widening of health insurance policy could accelerate the substituting effect. Seriousness of disease limits the options for customers (patients).

Our viewThe above analysis indicates that substitution effect inside the industry is low. Hence, make the industry more attractive for existing players to maximize their profitability.

Page 6: Healthy Outlook for Health Investors - Aljazira Capital

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Healthy Outlook for Health InvestorsThematic Report

July 2013

Buyer’s Negotiation Power - Low

It should be noted that the nature of disease and bargain power in healthcare industry has inverse relation i.e. higher the disease is serious; the lower will be the bargain power.

We believe, somehow (when the seriousness of disease is low) the customers’ negotiation power varies according to the insurance policies.

Beside the above mentioned factors, we believe the limited availability of physicians also put a limit to the buyers’ negotiation power.

Our viewHence, based on the nature of the industry’s business we believe the buyers (i.e. patients) have low bargain power. This makes the industry attractive to existing players.

Suppliers’ Negotiation Power - Low To Medium

We segregate the sector’s suppliers in two categories;

• Recruitment agencies providing physicians & medical staff

• Medical equipment & supplies manufacturers.

As per our understanding, the negotiation power of recruitment agencies is higher because they are recruiting talent; which is scarce in the kingdom.

On the other hand, the negotiation power of the manufacturer of medical supplies & equipment is low (except for highly sophisticated machines). Because, there products are highly commoditized and the medical facilities have number of supply sources.

Our viewWe expect the supplier power in medical healthcare industry ranges from low to medium. This makes the industry attractive to existing players.

• Increase medical coverage across the Kingdom; especially outside three big cities i.e. Riyadh, Dammam and Jeddah.

• Since the existing big players are well-equipped with expertise so we believe such move will be more beneficial for them to expand their coverage. Consequently, this will lead to increase the current market share of existing players and allow industry to optimize their marginal revenue i) per bed, ii) per physicians and iii) per locality.

• Increase in local talent will reduce the dependence on recruitment agencies which will translate into lower cost of hiring talents. On the other hand, these medical institutes will open new growth avenue for the industry.

• Wider the insurance policy more will be patients’ visit and spending power.

• Limited number of physicians.

• Insufficient medical coverage.

• I nadequate health insurance coverage.

• Scarcity of local talent.

• Inadequate medical infrastructure & facilities

Potential outcome of identified growth areas

Wider health insurance

Medical training

Infrastructure

development

Geographical

expansion

Outcome of Porter’s 5 forces analysis - Attractive

Source: Aljazira Capital

Source: Aljazira Capital

Ide

nt i

f ied

key

gro

wth

areas

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Healthy Outlook for Health InvestorsThematic Report

July 2013

2. Porter’s Generic Competitive Model

This analysis focuses on the strategic positioning of a firm based on cost and differentiation scale which will help to identify whether a particular firm is cost effective or have a differentiation advantage over others.

Here, the cost advantage could be due to i) natural undisrupted supply of key input, ii) low input cost like labor and utility and iii) government support through subsidies & other guarantees. While, on the other hand, differentiation advantage created through i) innovations, ii) effective utilization of available resources, iii) technological developments and iv) well-integrated supply chain. In short, these are the factors which will help the industry/business to sustain their competitiveness.

Based on the Porter’s generic competitive model we ranked the Kingdom’s key medical healthcare facilities according to their competitiveness. In this connection, we have identified that most of the hospitals and clinics are following a “differentiation” strategy because of specialization and quality of physicians; but not due to service differentiation. It should be noted that we consider military hospitals and company-specific clinics like Aramco and SABIC are targeting limited segment of the overall target market; hence, we believe they are following segmentation strategy and have narrow market scope and they are not operating for profit.

Segmentation Strategy

Useful when the industry/firm has narrow market scope i.e. facilitates selected segment of the target market. Where, the segmentation could be done on the back of several demographic, economic and socio economic factors including locations.

Example: The best example for such strategy is the international car industries; where the products are modified to satisfy the demand of consumers like; several variations in Toyota, Honda and Audi cars’ model found on country to country basis.

Cost Leadership The industry/firm competitiveness is measured on the back its ability to utilize the input cost advantage.

Example:High subsidies on gaseous feedstock make the industrial complexes in KSA more cost effective than the one using liquid feedstock (which is relatively expensive than gaseous feedstock)

Differentiation Strategy

The industry/firm competitiveness is measured on the back of its ability to create differentiation among the products/services.

Example:High tech processing equipment leads to increase quality and create differentiation.

Nar

row

mar

ket

scop

e

Uniqueness competency Low cost competency

Broa

d m

arke

t sc

ope

Source: Aljazira Capital

Page 8: Healthy Outlook for Health Investors - Aljazira Capital

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Healthy Outlook for Health InvestorsThematic Report

July 2013

Implication On KSA Healthcare Sector

In order to analyze the sector (based on Porter’s generic competitive model) we divide the Kingdom’s healthcare service facilities into five broad categories:

1. Large size hospitals (>300 beds)

2. Medium size hospitals (>100 beds; but <300 beds),

3. Specialized clinics/medical facility (designed to treat specific disease)

4. Small size hospitals (>50 beds; but < 100 bed) & polyclinics (day-care & mostly outpatients ); and

5. Military and company-specific hospitals (which will not be included in the comparison for the reasons stated above).

We cannot compare all of them due to the significant difference in their setup, but breaking them into two groups, we can identify the pros and cons of each group and come to the conclusion as to which segment is more attractive as a business model. We take two main criterion for comparison, Cost and Differentiation (as required by the approach we are using).

The large size and medium size hospitals are in one group. The main difference between both is the cost and differentiation (medical services), where the large size hospital is mainly a high cost with good service differentiation while a medium size hospital is a little lower on cost, hence a little less in quality of services. However, if we analyze the differences more deeply, we can come to a different outcome. A large size hospital is supposed to have top quality services to compensate for its high cost, but when it comes to the actual set up, the difference might not be worth the cost when compared to a medium size hospital, where cost is lower and services are at the minimal difference with a large size hospital. Location wise, there is not much difference between the two. However, there is one area where a large size hospital usually have a clear edge, which is the number of quality doctors, a medium size hospital might have a few quality doctors but the traffic/queue for them might be too long; whereas, a big size hospital will have more quality doctors for patients to choose from, which might result in a shift of patients to their hospitals.

Taking the second group comparison, a small size hospital and a polyclinic, we see that a small size hospital does have a bigger building and more services, but a polyclinic is significantly lower in cost and offers a good enough variety of services which compensate for the difference in comparison to small size low class hospitals.

It should be noted that standalone specialized clinics have a narrow scope; thus cannot be included when analyzing hospitals & medical set-ups which have broad market scope. However, increase in specialization will act as an additional factor which leads to improve the cost & differentiation payoff for any particular hospital having broad market focus. Therefore, this will translate into better profitability at the respective medical set-up.

Conclusion: Based on the brief analysis above, we arrive at the conclusion that although a large size hospital might seem to have an edge over medium size hospitals, but due to the little difference between the two, a medium size hospital can be a more attractive opportunity because it will cost lower and needs minor improvements in the services department to become competitive.

As to a polyclinic vs. small size hospital, the conclusion is easy to see, which indicates that a polyclinic is much more attractive business opportunity and has a competitive advantage over small size hospitals and can attract more patients, as it targets medium to low earning segment (mostly blue collar workers owing basic insurance), and is available in abundance in nearby locations.

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Healthy Outlook for Health InvestorsThematic Report

July 2013

3. Profit Pool Analysis

This approach seeks to identify the industry’s sub-segments contribution in the industry’s overall profitability.

Implication On KSA Medical Health Care Sector

Our industry-wide profit pool analysis is based on the following parameters;

• In the wake of certain constraints (listed below), we considered two sub-segments of the kingdom’s medical sectors i.e. health care service provider (hospitals, specialized clinics and polyclinics) and pharmaceuticals. These constraints are;

h The lack of local manufacturers/producers of medical equipment & supplies. However, several trading agencies are engaged to fill this gap (most of them are privately owned; where the data is an issue).

h No specific health insurance data exists inside the Kingdom.

• We used ‘operating profit’ of the listed pharmaceutical companies which is more suitable on the back of high variation in these companies profitability (due to high dependence on other non-operating income). Moreover, the limited data access to the other non-listed pharmaceutical company remained a key hurdle for us to expand our focus.

KSA medical healthcare profit pool analysis

Source: Aljazira Capital & companies’ annual reports

55.6%

44.4%

2011 2012

54.6%

45.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Hospitals, clinic and other medical care facilities Pharamceuticals company

Conclusion: Based on profit pool analysis, we believe the expansion in providing medical health care services is more attractive than pharmaceuticals.

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Healthy Outlook for Health Investors July 2013

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Disclaimer

AlJazira Capital, the investment arm of Bank AlJazira, is a Shariaa Compliant Saudi Closed Joint Stock company and operating under the regulatory supervision of the Capital Market Authority. AlJazira Capital is licensed to conduct securities business in all securities business as authorized by CMA, including dealing, managing, arranging, advisory, and custody. AlJazira Capital is the continuation of a long success story in the Saudi Tadawul market, having occupied the market leadership position for several years. With an objective to maintain its market leadership position, AlJazira Capital is expanding its brokerage capabilities to offer further value-added services, brokerage across MENA and International markets, as well as offering a full suite of securities business.

1. Overweight: This rating implies that the stock is currently trading at a discount to its 12 months price target. Stocks rated “Overweight” will typically provide an upside potential of over 10% from the current price levels over next twelve months.

2. Underweight: This rating implies that the stock is currently trading at a premium to its 12 months price target. Stocks rated “Underweight” would typically decline by over 10% from the current price levels over next twelve months.

3. Neutral: The rating implies that the stock is trading in the proximate range of its 12 months price target. Stocks rated “Neutral” is expected to stagnate within +/- 10% range from the current price levels over next twelve months.

4. Suspension of rating or rating on hold (SR/RH): This basically implies suspension of a rating pending further analysis of a material change in the fundamentals of the company.

The purpose of producing this report is to present a general view on the company/economic sector/economic subject under research, and not to recommend a buy/sell/hold for any security or any other assets. Based on that, this report does not take into consideration the specific financial position of every investor and/or his/her risk appetite in relation to investing in the security or any other assets, and hence, may not be suitable for all clients depending on their financial position and their ability and willingness to undertake risks. It is advised that every potential investor seek professional advice from several sources concerning investment decision and should study the impact of such decisions on his/her financial/legal/tax position and other concerns before getting into such investments or liquidate them partially or fully. The market of stocks, bonds, macroeconomic or microeconomic are of a volatile nature and could witness sudden changes without any prior warning, therefore, the investor in securities or other assets might face some unexpected risks and fluctuations. All the information, views and expectations and fair values or target prices contained in this report have been compiled or arrived at by AlJazira Capital from sources believed to be reliable, but AlJazira Capital has not independently verified the contents obtained from these sources and such information may be condensed or incomplete. Accordingly, no representation or warranty, express or implied, is made as to, and no reliance should be placed on the fairness, accuracy, completeness or correctness of the information and opinions contained in this report. AlJazira Capital shall not be liable for any loss as that may arise from the use of this report or its contents or otherwise arising in connection therewith. The past performance of any investment is not an indicator of future performance. Any financial projections, fair value estimates or price targets and statements regarding future prospects contained in this document may not be realized. The value of the security or any other assets or the return from them might increase or decrease. Any change in currency rates may have a positive or negative impact on the value/return on the stock or securities mentioned in the report. The investor might get an amount less than the amount invested in some cases. Some stocks or securities maybe, by nature, of low volume/trades or may become like that unexpectedly in special circumstances and this might increase the risk on the investor. Some fees might be levied on some investments in securities. This report has been written by professional employees in AlJazira Capital, and they undertake that neither them, nor their wives or children hold positions directly in any listed shares or securities contained in this report during the time of publication of this report. This report has been produced independently and separately and no party (in-house or outside) who might have interest whether direct or indirect have seen the contents of this report. It should be also noted that the Research Division of AlJazira Capital had no information at the time of issuing this report regarding any conflict of interest between the company/companies mentioned in this report and any members of the board / executives / employees of AlJazira Capital or any of Bank AlJazira Group companies. No part of this document may be reproduced whether inside or outside the Kingdom of Saudi Arabia without the written permission of AlJazira Capital. Persons who receive this document should make themselves aware, of and adhere to, any such restrictions. By accepting this document, the recipient agrees to be bound by the foregoing limitations.

AGM - Head of ResearchAbdullah Alawi+966 2 [email protected]

Senior Analyst Syed Taimure Akhtar +966 2 6618271 [email protected]

Senior Analyst

Talha Nazar +966 2 [email protected]

Analyst

Saleh Al-Quati+966 2 [email protected]

Analyst

Jassim Al-Jubran +966 2 [email protected]

General Manager - Brokerage DivisionAla’a Al-Yousef+966 1 [email protected]

AGM-Head of international

and institutional brokerageLuay Jawad Al-Motawa +966 1 [email protected]

Regional Manager - West and South Regions

Abdullah Al-Misbahi+966 2 [email protected]

Sales And Investment Centers Central Region

Manger

Sultan Ibrahim AL-Mutawa +966 1 [email protected]

Area Manager - Qassim & Eastern Province

Abdullah Al-Rahit+966 6 [email protected]

Asset Management Brokerage Corporate Finance Custody Advisory

Head Office: Madinah Road, Mosadia، P.O. Box: 6277, Jeddah 21442, Saudi Arabia، Tel: 02 6692669 - Fax: 02 669 7761