Investing in China Healthcare Sector Outlook 2014
By Teenie Fung
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The Healthcare industry in China Healthcare industry is expected to grow from $375bn in 2011 to $1 trillion in 2020. • Pharmaceutical market ($80.9 bn) – 35% of Asia Pacific, CAGR – 17%. • Medical equipment and supplies market ($26.6bn) - 35%, CARG – 16.5% • Medical biotechnology market ($13.3bn) – 17%, CARG – 16% 2
Overview & Key facts:
• The Chinese government has spent >$371bn today in healthcare reform, 3 times as planned in 2009. • A population of over 1.3 bn in China, will become the 2nd largest market in 6 years. • Increase in demand: Hospital bed utilization rate up from 36% to 88%. • Health insurance surged from 30% in 2003 to 95% in 2011. 3
Ample room for growth: Country’s spending on healthcare per capita is still half that of the developed market…
– expected to increase by 7% by 2020! 4
Drivers • 12th Five-Year Plan (FYP) – Policy support: 1) increase public funding, R&D and medical infrastructural investment. 2) expand medical insurance coverage 3) promote investment in private hospitals with favourable policies. • Favourable demographics: Rising disposable income, urbanization and aging population, shift of disease pattern from infectious to chronic disease which now accounts for 80% of deaths in China. …Increase in demand for healthcare services and quality of care. 5
ected to near $890 average rate of 13.8
profile of disease in China.
Demand in healthcare is much higher in China when compared to developed countries‌ vs. global comparison group Comparison of population 65+ Number in Million (2012) 12.40
40
9.60
26
129
13
10.10
171
Population aged 65 and over
120.9
136
China’s elderly population exceeds the combined elderly population in this comparison group.
42.4 30.1 10.7 2014
2015
Deloitte Analysis
2020
China
US
Japan
UK
16.9 1.5
6.0
Malaysia S. Korea Germany
Source: Economist Intelligence Unit Monitor Deloitte Analysis
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Players in the market: • Chinese prescription market is dominated by MNC – >60% of top 20 pharma companies in China are global MNC. • Most domestic companies are generic drug manufacturers.
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Challenges
• Slower consumption due to anti- corruption actions and reduced disposable income due to slower economic growth. • Profit margin squeezed: Costs in raw material rise and competition stiffens, followed by price-cut policy reform. • Fragmented logistic market: the three largest Chinese distributors including Sinopharm, comprise less than 30% of the domestic Chinese market. (e.g. UPS and Sinopharm)
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Chinese pharmaceutical market: Strong growth amid slower economic growth and government crackdown… • • • •
•
Largest emerging drugs market and is set to be the global number two overall within three years, according to consultancy IMS Health. Outperformed Indian and Japanese market by about 13% and 4% respectively. 50% expected growth in the next 5 years to over $100bn. EDL Tendering will favour local companies, rather than MNCs, to supply the bulk of generic drugs in China. Demand surged in outsourcing activities due to appealing factors of cost, market opportunity and higher international standard commitment. Increasing exports of Chinese pharmaceutical contract manufacturing with 23% annual growth. E.g. AstraZeneca alone spent US$9bn per year on purchasing. Leading multinational companies in China such as AstraZeneca PLC (LON:AZN) and Pifzer Inc (NYSE:PFE). 9
Rising China’s expenditure per capita, but still lower than the world’s expenditure. Reforms will be boosting the market through improved affordability and accessibility… Health expenditure per capita (US$)
Source: World Bank 10
2009
15.5
97.6
12.0
7.1%
2010
19.0
120.0
14.8
23.0%
2011
22.2
139.9
17.3
16.6%
2012
26.6
167.8
20.7
20.0%
Health Care equipment & Supplies in China: Slow but growing - $52bn by 2017. Imports lead the high-end market Increasing wealth in China supports market shift…
CAGR: 2008–12
16.5%
G L O B A L W E A LT H RE P ORT 2 0 1 3 _48
SOURCE: MARKETLINE
M AR KE TL IN E
China
Figure 1: China health care equipment & supplie s market value: $ billion, 2008–12
Figure 1
Wealth per adult over time USD 25,000
Tenacious growth
USD 20,000 USD 15,000 USD 10,000
Wealth per adult in China has grown robustly since 2000, USD 5,000 almost quadrupling from USD 5,700 to USD 22,230 in 2013. Wealth fell by approximately 20% as a result of the financial USD 0 crisis, but soon recovered and despite recent uncertainties is 2000 2002 2004 2006 2008 Wealth per adult well above its pre-crisis peak. The level has increased more in SOURCE: MARKETLINE M AR KE TL IN E Wealth per adult at constant exchange rate US dollars than in yuan, due to the appreciation of China’s Source: Credit Suisse AG, Research Institute currency since 2009; but most of the rise in wealth reflects real growth. Total household wealth in China is the third highest in the world, just 2% behind Japan and 56% ahead of France (in Figure 2 fourth place). Due to a high savings rate and relatively well Composition of wealth per adult developed financial institutions, a high proportion (46%) of Chinese household assets are in financial form compared with USD 25,000 other major developing or transition countries. At the 0099 same China - Health Care Equipment & Supplies - 2067 - 2012 time, housing, new construction and rural land arePage | 8 © MARKETLINE THIS PROFILE IS A LICENSED PRODUCT ANDprivatized IS NOT TO BE PHOTOCOPIED USD 20,000 very important forms of wealth in China, accounting for much of USD 15,000 the USD 12,900 in real assets per adult. Debt averages USD 1,400, equivalent to 6% of gross assets. While this is USD 10,000 relatively low, personal debt has been rising at a fast rate in
•
•
2010
2012
Increasing competitiveness - Migration from Mass-market to high-end market: Domestic manufacturers are upgrading their equipment by substantial R&D investment, less high-tech imports are expected over time.
Greater affordability in high-priced treatments as the population becomes wealthier despite slower economic growth.
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1.4
cording to a report jointly author by GSMA and PricewaterhouseCoopers (PwC), the 1.0 0.8 0.8 0.7 Chinese medical monitoring services market will reach $1.2 0.6 0.6 0.5billion by 2017, with over 90 percent of the revenues coming from chronic disease management solutions.54
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Ita ly
In di a
Ca na da
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Br az i
a
Ru ss i
Fr an ce
an y
rm
Ja pa n
na
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(US dollars). The next two largest market sub-sectors are diagnosis and treatment (see Figure 29).55
China and US are predicted to be the largest mHealth markets in 2017. Figure 27 Figure 28 mHealth Market in China
Market Scale of Wearable Mobile Medical Equipment in China
80
30
60
20
40
10
0
47.7 80%
48.9% 42.9% 33.3% 20.0% 3.5
0
15.8 2011
2011
8.0
2012
2013E 22.1
18.6
28.4 2014E
71.8
23.7
28.5%
5.6
4.2
60%
48.8%
18.8%
17.7%
80% 70%
100% 125.3
GrowthRate Rate Growth 40
74.5% 120%
99.2%
50
100
20
69.7% 101.2%
Market MarketScale Scale
40% 20%
11.9
42.3
50% 40% 30% 20%
0 2015E
60%
2016E
GROWTH RATE
MARKET SCALE (100 million RMB)
120
60
GROWTH RATE
140
MARKET SCALE (100 million RMB)
•
Un ite
d
St at es
Market opportunity especially inThey mobile health care devices, due to rapid growth also predicts that monitoring services will dominate the worldwide mHealth in the number of mobile users… market. They predict that by 2017 monitoring services will reach about 15 billion
10%
2017E
0 2012
2013E
2014E
2015E
2016E
2017E
Figure 29
Global mHealth Market Opportunity by Service Categories, US$ billion, 2017
Monitoring | $15 billion | 65% Emergency Response | $0 | 0% Health Practitioner Support | $1.1 billion | 5%
Chronic Disease Management and Post Acute Care 29%
Health Surveillance Support | $0.1 billion | 0% Administration | $0.1 billion | 1% Wellness | $0.7 billion | 3% Prevention | $0.2 billion | 1% Diagnosis | $3.4 billion | 15% Treatment | $2.3 billion | 10%
71%
Independent Aging Note: Total worldwide market size (2017E): US$ 23 billion Source: PwC analysis
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Biotechnology market: Increased regulatory uncertainty and pressure on drug pricing lead to hold back in investment…
• Greater impact on profit reduction on High-tech drugs than generics.
…but obtain better financial position through M&A activities in LR in search of discovering ‘Biotech Blockbuster’ - costly and lengthy with high risk R&D investment.
• In 2017, the market is forecast to have a value of $27.5 bn, an increase of 106.8% since 2012.
Healthcare accounts for 95%, largest segment of the biotechnology market in China. 13
North America and Europe continue to lead investment activity within healthcare private equity, with North Am
Trend: Growing foreign investors’ confidence in FDI reforms. Deal accounting for seven out of the top 10 deals in 2013. However, growth in activity in Asia-Pacific and the rest activities in underperforming healthcare sector increase gradually over outpaced these regions (see Figure 4). While the number of buyout deals grew at a compound annual rate of 5 years,America and 3% in Europe over the last five years, it has grown by more than 45% in the Asia-Pacific region predominately in China and India… world. Asia-Pacific also saw a rare billion-dollar deal via Panasonic’s carve-out of 80% of its healthcare busin • Thedeal list followed historical patterns, with the majority of deals occurring in the US and Europe;; however, in 20 Chinese state built over 100 life science parks that employ 55.8mn scientific and •
some geographic diversity by way of deals in Japan and Canada. By sector, provider and services was the m technological personnel. all of the regions, while medtech shrank a bit in each of the regions compared with 2012 (see Figure 5). Leading China-originated companies in China such as Shanghai Kehua Bio-engineering Co., Ltd (002022:CH) and Sinovac Biotech Ltd. (SVA:NASDAQ GS)
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I d a M c
Investment Strategy • Healthcare is still a defensive sector. However, the sector is overvalued (22x MSCI Healthcare PE) compared to 9.7x MSCI PE. 5/26/2014
T China stocks leap higher on reform euphoria - FT.comp
One popular stock pick is Biostime, a Hong Kon its share price rise 5.9 per cent on Monday, taki cent. It now trades on a price to book ratio of al earnings ratio of about 32, compared with an av share market.
In the healthcare sector, shares in Shandong We devices such as syringes – have leapt by more th also aided by better-than-expected third-quarte MSCI’s China healthcare index now trades on a compared with just 9.7 for the index provider’s
Those “excessive valuations” have prompted Mr popular sectors including healthcare, internet a
RELATED TOPICS China, China - Politics & Policy, China So 15
•
Focus on industry leaders with strong M&A capabilities: M&A activities outstripped 2013 – look for drugmakers with advantages of scale, low-cost production or unique, in-demand products. Competition will drive out small companies that cannot sustain their products at low price. Focus on quality companies with 1) limited negative exposure to policy e.g. pricecut 2) strong product portfolio (branding and exclusive price) 3) high earnings visibility E.g. Hutchison China MediTech (HCM: LSE, TP 8.45) due to their minimal exposure to government cost controls and potential negative investor sentiment. Recently, it formed new joint venture with Sinopharm in April.
•
Focus on the non-EDL drugs, which account for 80% of the market: The long-term value creators such as Sino Biopharm (1177.HK, TP 6.65) and China Medical Systems (0867.HK, TP 9.36) could still grow faster than peers because they are best positioned for the industry evolution (e.g. relying more on R&D) and will likely have minimal impact from current drug policy changes due to their exclusive rich non-EDL product portfolio. 16
Conclusion • Strong and persistent growth in Healthcare sector remains attractive. • Growth of all 3 sectors – pharmaceutical, medical equipment/ supplies and biotechnology will decelerate in the near-term but is expected to rebound and continue to grow faster than developed countries. • Strategic investment focus on market leaders with M&A capabilities and limited negative exposure to policy.
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