Estimated reading time: 8 minutes
The purchase of FVH as stated by TMG via their PR agency Motley Crew Consulting published “Singapore, 12th July 2023 – SGX Mainboard-listed healthcare group Thomson Medical Group
TMG, announced today that it has agreed to acquire Vietnam’s FV
Hospital for up to US$381.4 million, marking the country’s
biggest healthcare transaction to-date and Southeast Asia’s largest healthcare acquisition since 2020.”
The Wow effect comes after 4 years of depressing Healthcare sector and the stunning x16.8 Ebitda margin?
After Covid, the Viet A scandal for Covid supplies and winning all public hospital-related bids since 2019 and putting anything public Healthcare and Ministry of Health under investigation since reopening March 2022.
When it is too good to be true… TMG, a Singapore listed healthcare management group, is willing to buy high?
A x8 Ebitda in acquisition is a normal ratio, buying a few times more could be justified when looking into more details of the business potential and its market.
A quick insider look at the press release, and most healthcare figures are approximately… wrong or irrelevant?
The market grows +9% for Vietnamese people as they spend 89$/year in healthcare. Therefore the +9.2% growth y-o-y after 4 years reach à mere 89$ +51%= `137$/year expense, surely not enough to massively afford the FVH medical services.
Attracting medical tourism from Cambodia, Lao and Myanmar who spend respectively $75, $28 and $56 per person per year is not the best proof of attraction for medical excellence.
Medical tourism in Thailand is US$1.4Bn how can Vietnam be US$2Bn. The main cause for Vietnam not being on the map for international medical tourism is simply: there is NO MEDICAL TREATMENT VISA.
Expat stats by itour.com ‘reveals’ 83,500 expats before covid citing the min. of Labor, when it is well known not all expats hold a work permit the ratio being probably 1-of-3, therefore x3 is closer to the real figure for expats to include spouse, diplomats, charity and UN world NGO.
The ministry of Health strong hold and rampant envelope practices
During Covid, the Ministry of health ‘strongly required’ the private hospitals to take on Covid patients for free. After Covid the Viet A organized systematic win of all medical related bids over the 58 provinces put the whole sector to a halt and the effects are still being felt today
What are the consequences for the Vietnam healthcare system?
Vietnam’s healthcare system is largely based on the Ministry of Health decision making.
In the early 2000s a light of hope came with the Hanoi French Hospital then the Franco Vietnam Hospitals in HCMC getting 1000% foreign owned license. It was a great relief for the 2 capital cities of 10 Mio inhabitants without any international standards hospitals. Meanwhile Expats in Vietnam and wealthy Vietnamese were flying International SOS to use Thailand or Singapore as ‘centers of medical excellence’ to get their surgeries done.
Since 2000, no foreign license has been granted to newcomers to Vietnam. Is that a foreign investor business decision that Vietnam international hospital is not profitable or a politico economic monopolistic decision to keep the Market for the Vietnamese and the overwhelming state-owned and run hospitals.
The cosmetic of hospitals is attractive, the mentality inside has not changed much
In the past 20-years, there have been a few private Vietnamese hospital chains built since the last foreign invested hospital was granted a license.
The overwhelming majority are state owned and managed hospitals with low levels of service. Still today, food is brought from the family outside and some family members stay on the corridors providing improvised nursing services. The prices are regulated, the salaries limited so does the service level quality.
The private sector is developing with no particular incentive by the Ministry of Health, on the contrary as they favor the public hospitals as any investment is subject to some ‘favorable conditions’ to the officials in charge of purchasing or building. In the recent Covid pandemics, as the government decided that the people should receive free treatment, as the public hospitals ran out of hospital beds, the private hospitals were urged to help with Covid patients’ hospitalization… for free.
Otherwise there are very few other private hospitals developed as buildings can not be in the city center and a hospital can not be traded for the land appreciation as it remains a medical service to the public.
In face of low world-class competition, the old school mentality of self-employed doctors and ‘hide-your-trade’ of medical practitioners has not seen major improvement in the cure and service to patients.
Form General public hospitals to Private Vietnamese hospital is already a good move happening
The transition by addition of private hospitals is seen as good for the country’s improvement of medical treatment but it remains a threat to capture high-net worth patients and push the public sector to deliver better treatment without much salary increase to expect apart from tips or a source of ‘clients/patients’ in their moonlighting private practice.
The private sector has filled some vacuum with The Hoan My medium size hospital chains with 14 hospitals totalling 2900 beds. Their capital investments are limited based on the financial priorities of the shareholders.
The Vinmec 7 modern hospitals for a total of 1550 beds. The focus of Vingroup is on real estate development and recently a passion for cars and EV manufacturing since 2017. Hospital management has never been a priority, but perhaps capital appreciation of the network of hospitals fairly centrally located in their Vinhomes ‘city-in-the-city and a hospital business license resale for deep-pocket investors.
General hospitals to large specialty hospital will come and maybe TMG is starting this advanced model in healthcare
For patients in Vietnam, the grass of treatment is already greener with private hospitals of modest size. The cost is higher but the outcome is a cure with on-going personalized service.
The trend worldwide is for the replacement of general hospitals to specialized clinics with vertically integrated equipment and highly collaborative medical teams.
As TMG specializes in Mother and child care, they may mark a new dawn for the modern healthcare system. One can dream of ever greener grass in the whenever future.
What is TMG really buying to extract value from the FV hospital deal purchase?
The ‘winning’ strategy behind the deal is a typical Harvard professor Michael Porter 5 forces of competitive advantage, combined with a Albert Humphrey SWOT maturity analysis and a BCG Growth decision matrix. The rationale of Thomson Medical Group purchasing the FVH at a high premium will be developed in another article.
For now here are some of the main reasons for an opportunistic acquisition. A caveat of size may delay the deal as TMG mentions the financing is to be gathered as a mix of 4 sources: self financing, Capital increase, debts and capital markets fund raising. Meanwhile interests rates are high worldwide and the healthcare ministry and officials nationwide are still under investigation on the Viet A and AIC generalized bribery system on bid-offers rigged since 2018 across the 58 provinces of Vietnam.
The only foreign hospital license… ever since 2003. A strong brand.
As we cant see any foreseeable foreign license granted to any international hospital group. The capability to expand and scale is valuable in à country of 100 Mio inhabitants if you compare to Singapore with 5.4 Mio 22 hospitals JCI.
Whatever the world ranking, the Franco-Viet hospital name has an intrinsic aura with the Vietnamese and it is the only-foreign owned which gives more trust and credibility to the FVH. Moreover, it is JCI accredited since 2016.
A know-how to manage and the market needs for healthcare
Over the past 20-years, if the profits are not reflecting the huge progress, for sure the FVH and TMG will get 3 big values for the price they pay:
- The only foreign license (and no more since 2003), a strong intrinsic brand FVH JCI accredited. With 3 buildings (the F, V and H under construction to end-2024) very accessible.
- A strong team experience in patient treatments and health insurers claims refund worldwide.
- The knowledge Vietnamese healthcare market
A ready to milk the cow set-up for medical treatment income streams
The plan as per TMG Singapore exchange listing announcement dated 12-july 2023 is to establish 5 specialties:
- TMG strong focus on Woman and child Gynecology & Obstetrics
- IFV fertility center
- Oncology and Cancer
- Urology & dialysis
All 5 are in high and increasing demand for centers of excellence in Vietnam, and a shrewd financier can see that all 5 medical centers can generate high and repeat cash flows.
Conclusion: on healthcare and finance in Vietnam, we will adopt a wait and see stance.
Indeed, 2 caveats of size may delay the deal as TMG mentions:
- The financing is to be gathered as a mix of 4 sources: self financing, Capital increase, debts and capital markets fund raising.
- Current interest rates are high worldwide and the healthcare ministry and officials nationwide are still under investigation on the Viet A and AIC generalized bribery system on bid-offers rigged since 2018 across the 58 provinces of Vietnam, both could justify a pause by bankers and investors.
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