British Utd Provident Assoc (BUPA)
05 March 2015
Bupa
Preliminary results announcement for the year ended 31 December
2014
BUPA DELIVERS GOOD RESULTS WITH CONTINUED GLOBAL GROWTH
HIGHLIGHTS
o Revenue GBP9.8bn, up 8%; up 15% at constant exchange rates
(CER). Excluding recently acquired businesses(1) , revenue up 6% at
CER.
o Underlying profit before taxation(2) flat at GBP637.8m; up 8%
at CER. Excluding recently acquired businesses and related
financing costs(3) , underlying profit up 6% at CER.
o Statutory profit before taxation up 18% to GBP609.2m.
o Customer numbers up 31% to 28.7m, including 6.2m from joint
ventures and associates(4) and 2.4m added through acquisitions.
o Cash flow from operations up 69% to GBP984.0m (2013:
GBP582.9m).
Good performance delivered globally, despite challenging
conditions in the UK, Spain and Australia
o Good growth delivered globally, despite challenging economic
and regulatory circumstances in the UK, Spain and Australia.
o Strong performance in Australia and New Zealand, as we focused
on differentiating ourselves through the quality and breadth of our
service.
o Second year of growth in the UK, supported by a focus on
operational efficiency. Cost savings of GBP30m realised from
efficiencies made in key back office processes, procurement and
sales.
o Strong customer growth in International Development Markets,
notably in Poland, Saudi Arabia and India.
o Good growth delivered by recently acquired businesses with
integration progressing well in Chile, Poland, Hong Kong and
Australia.
Strong financial position
o Strongly capitalised with 319% (Dec 2013: 309%) coverage of
Insurance Groups
Directive (IGD) capital requirement.
o Successful GBP350m seven-year senior bond issue in June,
secured with a coupon of
3.375%, with strong investor demand.
o Reaffirmation of Bupa's key credit ratings during the year (A-
from Fitch and Baa2 from Moody's).
o Full repayment of drawings under our GBP800m bank facility
following bond issue and strong cash repatriations to the
centre.
o Leverage reduced to 27.6% in the second half of the year (2014
H1: 31.5%, 2013 FY: 28.9%) following strong cash generation.
Building a platform for future growth, supported by investment
in new products and services
o Capital investment of GBP391.8m (2013: GBP330.9m).
o Launch of Bupa Medical Visa Services and Bupa GP Clinics in
Australia, expanding our provision footprint and capability.
o Dental expansion well underway in Australia, Spain, Chile and
the UK.
o Major corporate health insurance wins in the UK in the second
half of the year, expected to drive customer growth in 2015.
o New range of individual and corporate products and services
launched by Bupa Hong Kong and Bupa Global, as a part of our new
10-year distribution agreement with Hang Seng Bank.
o Developing new and innovative facilities to care for the
growing ageing population in Australia, New Zealand, the UK and
Spain.
Making quality healthcare more affordable and accessible to more
people
o In the UK, we signed a new long-term agreement with Spire
Hospitals, with prices agreed for six years and a framework to
further improve quality of care. This provides a solid basis to
address the affordability of private healthcare and we will look to
work with other hospital providers in a similar way going
forward.
o Reduced the price of co-payment health insurance products in
Spain.
o Partnering with the public sector in Australia, UK, Spain and
Saudi Arabia to deliver healthcare, information and advice, helping
millions more people with their health and wellbeing.
Stuart Fletcher, CEO of Bupa, commented:
"2014 was a good year for Bupa in which we delivered growth
across our business, building momentum behind our strategic vision,
Bupa 2020. We focused on integrating acquired businesses and
improving operational effectiveness, resulting in good financial
growth. Revenue increased to GBP9.8bn and underlying profit before
taxation was GBP637.8m, up 15% and 8% respectively at constant
exchange rates (CER). Excluding recently acquired businesses and
associated financing costs, revenue and underlying profit were both
up 6% at CER. We are committed to ensuring millions of people enjoy
better health because of Bupa and customer numbers increased 31% to
28.7m, including 6.2m customers of our joint ventures and
associates and 2.4m customers added through acquisitions.
"We have seen good growth in our established markets with a
particularly strong performance from Australia and New Zealand,
while the UK delivered a second year of growth. All Market Units
benefitted from our focus on efficiency and close management of
operating costs. We are also pleased with the contribution our
recently acquired businesses have made to our performance with
their integration well progressed and on track. During the year we
developed strategic partnerships including a 10-year distribution
agreement with Hang Seng Bank, which further strengthens our market
position in Hong Kong.
"In 2014 we strengthened our organisational platform and built
good momentum for future growth, supported by our investment in new
products, services and operations. We are well positioned to build
on this through 2015 due to our diversified international
footprint, the strength of our business model and our international
expertise in healthcare, enabling us to tackle some of healthcare's
biggest challenges and reach millions more people in fulfilment of
our purpose: longer, healthier, happier lives."
Enquiries:
Evelyn Bourke - CFO 020 7656 2576
Gareth Evans - Treasurer 020 7656 2316
Bupa Corporate Affairs 020 7656 2646
CEO Review
Bupa 2020 is our strategic vision for how we will deliver our
purpose: longer, healthier, happier lives, and help millions of
people enjoy better health. We have three strategic goals: being a
healthcare partner to millions more, delivering extraordinary
business performance and being an organisation where our people
love to work.
Performance
2014 was a year in which our focus on growing all our
businesses, while improving operational effectiveness across Bupa,
yielded positive results with good momentum built in the year. We
delivered good revenue growth, up 8% to GBP9.8bn and grew customer
numbers strongly by 31% to 28.7m, with 11% of the growth through
the acquisition of Cruz Blanca Salud (now rebranded Bupa Chile), 6%
from joint ventures and associates, 2% from our micro health
insurance initiatives in India and Ghana and 12% from the rest of
the business. We maintained underlying profit at GBP637.8m and
continued to invest in new products, services and operations to
support future growth, with capital investment of GBP391.8m. At
constant exchange rates, revenue grew 15% and underlying profit was
up 8%. Excluding recently acquired businesses and associated
financing costs, revenue was up 6% and underlying profit was up 6%
at CER. Statutory profits rose 18% to GBP609.2m.
We took significant steps to transform the business to enable us
to deliver sustainable financial performance and fulfil Bupa 2020.
This included increasing operational effectiveness across all
Market Units, including delivering GBP30m of cost savings in the UK
by improving efficiency in key back office processes and
procurement, and by streamlining the sales organisation. We also
began to restructure and regionalise operations in Bupa Global to
better serve our customers in their own language, culture and time
zone. In Australia, we significantly expanded our healthcare
provision footprint, with the launch of Bupa Medical Visa Services
in July and Bupa GP Clinics in October.
In our established markets, we saw a particularly strong
performance from Australia and New Zealand, where we are
differentiating our business through the quality and breadth of our
service. In the UK, we delivered a second year of growth,
benefitting in particular from our focus on efficiency and
management of operating costs. We also continue to lead reform in
the UK private healthcare market through our on-going drive to
reduce healthcare costs, including those charged by private
hospitals, to deliver better value for customers. In November, we
signed a ground-breaking contract with Spire Healthcare, commencing
in 2015, agreeing prices until 2021.
We have swiftly embedded recent acquisitions and these
businesses made a strong contribution to our performance in 2014.
Bupa Chile, formerly Cruz Blanca Salud, is performing well and
during the final quarter of 2014, we began to migrate the branding
of parts of the business to the Bupa brand. In Australia, we began
promoting Bupa Dental Corporation's clinics to our health insurance
customers and vice versa. We also increased the number of Bupa
Dental Corporation practices that are part of our health insurance
customer network to over 110. In Poland, we are focused on
developing LUX MED's integrated healthcare funding and provision
offering, as we believe this model brings better oversight of the
patient journey and supports more affordable and accessible
healthcare. We are investing in the development of the business,
completing several local acquisitions during the year and launching
a new specialist dental centre in Wroclaw, one of Poland's biggest
cities. In Hong Kong, we are embedding the Quality HealthCare
clinic business into the organisation and in August opened a new
premium medical centre.
We have a target to reduce absolute carbon emissions by 20% by
the end of 2015 with 2009 being the base line, and measured in line
with the Greenhouse Gas Protocol Standard. Year-on-year carbon
emissions are down 1%, and currently stand 14% down on 2009,
despite our business growth, and we have made strong improvements
in our direct and indirect emissions through energy efficiency,
clean energy generation on our sites and sourcing certified green
tariff electricity, particularly in Spain. We have established a
dedicated GBP50m Energy Saver Fund to invest in projects over 2014
and 2015 to reduce our operating costs, energy use and carbon
emissions. Hundreds of projects are underway around the world, from
solar panels to the installation of more energy efficient lighting.
We expect to meet our target by the end of 2015.
A healthcare partner to millions more people
We continue to develop strategic partnerships so we can support
millions of people to improve their health and wellbeing.
We are committed to partnering with the public sector where our
expertise can benefit patients and public health systems. The
successful launch of Bupa Medical Visa Services, which provides
health checks on behalf of the Australian Government to an
estimated 275,000 visa applicants a year, is an example of this in
practice. In the UK, we have developed a pioneering intermediate
care service with Central Manchester University Hospital Foundation
Trust, helping over 300 people back to good health without the need
for a long hospital stay. We have also published an independently
verified report on our Public Private Partnership (PPP) in
Valencia, Spain.
In April, we entered into an exclusive 10-year distribution
agreement in Hong Kong with Hang Seng Bank to offer its three
million customers a new range of health insurance products and
services. We also announced our intention to increase our stake in
Max Bupa, our joint venture in India with Max India, to 49%, as
soon as legislative approval is granted for an increase in the
foreign direct investment limit for the insurance sector.
We continued our partnership with the World Health Organization
and the International Telecommunication Union on the global mobile
health initiative, Be He@lthy, Be Mobile, to help address
non-communicable diseases. We also cemented our partnership with
Alzheimer's Disease International, as we continued to lobby for
governments to adopt our joint Dementia Charter and develop
National Dementia Plans. In December, we jointly published Cancer -
it's everyone's business with the Union for International Cancer
Control (UICC). This report calls for new PPPs to combat cancer and
achieve long-term change through workplace health initiatives. We
also established a new Chief Medical Officers' network to explore
how we can combine the experience of a global network of clinicians
in corporations to improve health and wellbeing.
A place where our people love to work
We want each and every one of our people to love working at
Bupa. Being a great place to work is an essential part of our Bupa
2020 vision and is key to ensuring we deliver excellent care and
service for our customers. In 2014, 83% of our people completed our
Global People Survey (GPS), our biggest response to date, with an
increase of 6,077 employees compared with 2013. Part of the GPS
measures pride, satisfaction, advocacy and commitment from which we
reach our employee engagement index. In 2014, engagement grew
year-on-year, demonstrating the understanding and connection our
people have to our purpose and their continued commitment to
achieving our ambitious goals.
We place great emphasis on leadership and we have strengthened
our executive team over the course of the year both with a number
of new appointments and by continued investment in the development
of our leaders. Bupa Leaders Are is the expression of the
leadership we believe is needed to deliver Bupa 2020 and
extraordinary business performance every year. We have expanded our
Bupa Leaders Are development programme to include 1,000 of our
leaders around the world. It is also becoming part of the fabric of
Bupa through leadership events, performance management, development
and recruitment.
Outlook
In 2014 we strengthened our platform to continue our progress
towards Bupa 2020. In 2015, we will continue to focus on
integrating and delivering performance from our acquired
businesses, growing and developing all our businesses and driving
operating efficiencies across Bupa. We will continue to innovate
and develop products and services to best meet the changing needs
of our customers, with a focus on making healthcare more affordable
and accessible. We will remain disciplined with our finances,
particularly given on-going trading conditions in the UK, Spain and
Australia. Overall, we are well positioned to drive growth and
financial returns over the next year, reaching millions more people
in fulfilment of our purpose: longer, healthier, happier lives.
Australia and New Zealand
Customers Revenue Underlying Profit
---------------- ---------- ------------ ------------------
2014 5.7m GBP3,759.6m GBP309.2m
---------------- ---------- ------------ ------------------
2013 4.9m GBP3,791.8m GBP284.1m
---------------- ---------- ------------ ------------------
% growth 16% -1% 9%
---------------- ---------- ------------ ------------------
% growth (CER) 11% 24%
---------------- ---------- ------------ ------------------
The Australia and New Zealand Market Unit comprises four
business units:
-- Bupa Health Insurance, a leading health insurance provider in
Australia, which also offers health related services and
international health cover;
-- Bupa Health Services, our health provision business, which
comprises Bupa Dental Corporation, Bupa Optical, Bupa Medical Visa
Services, Bupa Health Dialog and Bupa Medical GP Clinics;
-- Bupa Aged Care Australia, the largest privately-owned
residential aged care provider in Australia, which cares for almost
10,000 residents across 65 homes; and
-- Bupa Care Services New Zealand, New Zealand's largest aged
care provider, caring for around 25,000 people in 58 homes, 29
retirement villages, seven rehabilitation sites and through its
personal medical alarm network.
Market context
-- The Australian economy remains stable but tight budgetary and
fiscal conditions at a national level continue to make consumers
cautious about discretionary spending.
-- In Australia there are a number of government incentives to
encourage the take up of health insurance, including the Private
Health Insurance Rebate, which acts as a government subsidy towards
the cost of health insurance. Changes to the Rebate in recent
years, including the introduction of means testing and a freeze on
rebate income tiers, are adding to affordability pressures for
people with health insurance. Consequently, there is a trend
towards downgrading and switching between providers based on lowest
price.
-- From 1 July 2015, responsibility for the regulation of
Australia's Private Health Insurance Industry is moving from the
Private Health Insurance Administration Council (PHIAC) to the
Australian Prudential Regulation Authority (APRA). Bupa expects
minimal short-term impact from this change, however, we have asked
the Australian Government to consider a delayed implementation date
to provide the industry with more time to understand the full scope
of the proposed changes and give relevant government bodies more
ability to mitigate any potential unintended consequences.
-- 2014 saw the most comprehensive aged care reforms in
Australia for decades, designed to give consumers greater choice
and control over how they pay for residential aged care. We are
focused on helping our customers to understand the personal impacts
of the reforms, ensuring our pricing is competitive and exploring
opportunities to develop new services made possible by the
reforms.
-- In New Zealand, consumer spending trends are generally more
favourable and the economy continues to grow. The government is
focused on managing the economy to stimulate growth and building
better public services. We are seeing a shift towards an
investment-funding mindset, which may provide further opportunities
for the business.
Performance
Australia and New Zealand performed strongly, delivering growth
in revenue (at CER), customers and underlying profit, despite the
increasingly competitive market and challenging political, economic
and regulatory environment in Australia. We focused on integrating
acquisitions made in 2013, launching our new Bupa Medical Visa
Services business, and delivering an industry-leading customer
experience.
-- Revenue down 1%, up 11% at CER
o Revenue growth in all businesses, with strong growth in Bupa
Health Services, supported by the full-year contribution of Dental
Corporation, acquired in 2013, the launch of Bupa Medical Visa
Services, and Bupa Aged Care Australia, supported by the Innovative
Care acquisition in 2013.
-- Customers up 16%
o Growth driven by our 2013 acquisitions as well as the launch
of Bupa Medical Visa Services. Good growth in our health insurance
business and Care Services businesses, supported by the opening of
five new care homes.
-- Underlying profit up 9%; up 24% at CER
o Growth positively impacted by our 2013 acquisitions, as well
as a good performance by our health insurance business and aged
care businesses. Profit also benefited from a change in regulation,
which enabled us to reassess the amount of money held as a risk
margin against the provision for claims.
-- Our Australian and New Zealand aged care businesses
maintained strong occupancy levels above 90%, in a year of growth
and expansion for both businesses.
Integration, acquisition and new business update
The integration of our 2013 acquisitions is progressing well. We
began promoting Bupa Dental Corporation's clinics as "part of Bupa"
to our health insurance customers and increased the number of Bupa
Dental Corporation practices that are part of our health insurance
customer network to over 110.
New care homes acquired as part of our 2013 purchase of
Innovative Care are making a significant contribution to the
performance of the Australian aged care business with all key
performance metrics ahead of expectations. We also opened aged care
homes in Runaway Bay (Queensland) and Templestowe (Victoria).
We completed the purchase of the Cargill Aged Care facility in
Invercargill, New Zealand in June. This is the fourth and final
site in the group that was acquired in 2013 from Oceania. The new
home adds 40 beds and a retirement village to our New Zealand aged
care portfolio, reinforcing our position as the largest provider of
aged care beds in New Zealand and the fourth largest retirement
village provider. The New Zealand business was also well supported
by the opening of the Ballarat Village and care home in Rangiora,
which opened with strong village sales.
In July, we established Bupa Medical Visa Services, which
provides health checks and a range of other medical assessment
services on behalf of the Australian Government. The new business
is part of a three year agreement, which has seen Bupa open six
purpose-built medical centres in major Australian cities and manage
a network of approved clinics to provide health checks to an
estimated 275,000 visa applicants each year. The new business made
a strong contribution to growth in both customer numbers and
revenue in its first six months of operation.
In October, we began operating GP services in Australia for the
first time through our newly established Bupa Medical business. We
now offer GP services from a Bupa-branded clinic in Sydney's
Central Business District with plans to roll out an additional five
clinics across the broader Sydney metropolitan area over the next
12 months.
In January, the Australian aged care business entered into an
agreement for the development and operation of six new care homes,
consolidating its position as Australia's largest privately owned
aged care provider. Two new homes in Echuca (Victoria) and Tugun
(Queensland) commenced operations in 2014 with the remaining four
to be developed and opened progressively in 2015 and 2016.
Healthcare partner to millions more people
The launch of new businesses and operations across Australia and
New Zealand in 2014 has significantly expanded Bupa's provision
capability in the market and support our purpose of longer,
healthier, happier lives. In addition, growth in existing business
and the expansion of our care home footprint has grown the number
of people with a direct customer relationship with Bupa.
We continue to lead the development of the health insurance
sector with our 'Pay for Quality' initiative to improve quality and
deliver better value for customers. Our partnership with
Healthscope Hospitals is working to shift the focus in health
insurance from cost to value-for-money, helping to drive quality
improvement by creating a funding platform that rewards better
healthcare outcomes in clinical quality and safety. During 2014, we
also agreed new contracts with a number of hospital networks,
assisting improved claims management, while delivering value and
quality for customers.
Bupa Health Insurance has embarked on a major transformational
agenda by stepping up efforts to retain customers, improving
processes to proactively approach customers and providing enhanced
training so we can resolve customer concerns the first time they
call. We are simplifying all interactions with customers, including
our claims processing, and are focused on differentiating ourselves
in the market through the quality and breadth of our service.
By partnering with the public sector, we can help millions more
people with their health and wellbeing and the launch of Bupa
Medical Visa Services is an example of how this can work in
practice. In Australia, we are also the primary service provider
for the Coordinated Veterans' Care programme, a contract with the
Department of Veterans' Affairs, which was extended in 2014 for a
further two years.
Bupa's Integrated Healthcare Program continues to represent a
significant innovation for the aged care sector. By integrating
medical care into our homes through the recruitment of GPs we have
refocused the roles of all our care givers to deliver better
clinical management. For our residents, this means greater
continuity of care and better access to personalised services,
improving health outcomes and quality of life. At the end of 2014,
22 care homes in Australia were operating under this new model.
A place where our people love to work
We aim to have an extraordinary culture and organisation, with
people healthier because they work at Bupa and with our people
making a positive impact on the environment and the health of their
communities.
Our annual Global People Survey (GPS) in Australia and New
Zealand showed an increase in employee engagement (up 1% to 76%).
Following the rollout of our company-wide leadership programme,
'Bupa Leaders Are', we achieved a Leadership Index(5) score of 75%,
showing the high level of connection and affinity between our
people and our leaders.
We are committed to helping our people to be healthier because
they work for Bupa and in 2014 over 80% of our people participated
in at least one employee wellbeing activity over the year,
including heart health checks, mental wellbeing seminars,
relaxation sessions and our quit smoking programme.
Outlook
We expect the economic, political and regulatory environment in
Australia and New Zealand to remain stable and anticipate
challenges around affordability and consumer sentiment in Australia
will continue in 2015. Despite this, we expect to continue to grow
our customers, revenue and profit over the course of the year.
Greater public and private collaboration will assist in tackling
the challenge of rising healthcare expenditure and we believe the
government's appetite for collaboration with the private sector
continues to improve in both Australia and New Zealand.
UK
Customers Revenue Underlying Profit
---------------- ---------- ------------ ------------------
FY 2014 4.0m GBP2,711.2m GBP175.0m
---------------- ---------- ------------ ------------------
FY 2013 3.9m GBP2,573.5m GBP139.5m
---------------- ---------- ------------ ------------------
% growth 3% 5% 25%
---------------- ---------- ------------ ------------------
% growth (CER) 5% 25%
---------------- ---------- ------------ ------------------
The UK Market Unit comprises five business units:
-- Bupa Health Funding, offering health insurance and health funding products;
-- Bupa Care Services, caring for around 39,700 people in 280 homes;
-- Bupa Health Clinics, which runs wellness centres, clinics, occupational health
services and dental clinics;
-- Bupa Home Healthcare, providing out-of-hospital healthcare services to around 35,500
patients; and
-- Bupa Cromwell Hospital, Bupa's complex care hospital based in London, providing care
for insured, self-pay and international patients.
Market context
-- The UK health insurance sector remains challenging. However,
early signs of growth are being seen in the Small and Medium-sized
Enterprises (SME) and Corporate sector, with major new contract
wins in the second half of 2014, while cost remains a key concern
for individual consumers(6) .
-- Over 70% of the 39,700 people we look after each year in our
care homes are publicly funded by local authorities or the NHS.
Public funding pressures continue to mean that local authority fee
rates have risen below inflation or, in many cases, have not risen
at all for four years, while running costs including staffing,
utilities and catering are increasing. This is having an adverse
sector wide impact.
-- The Care Act became law in May, introducing major reforms to
residential and nursing care, including a cap on the amount
individuals will have to pay towards the cost of care during their
lifetime, new bands for means tested support and new
responsibilities for local authorities to arrange care. Detailed
regulations are currently being drafted by the Department of Health
and major funding changes are not due to come into effect until
April 2016.
Performance
2014 was the second year of growth in the UK, despite tough
trading conditions, as management action to improve operational
efficiency, innovate to meet the changing healthcare needs of our
customers and make healthcare more affordable and accessible both
yielded results in the year and created momentum for 2015.
-- Revenue up 5%
o Revenue growth driven in particular by Bupa Health Clinics,
benefiting from the opening of 13 new dental centres, Bupa Care
Services, as a consequence of the full-year contribution of
Richmond Care Villages, acquired in August 2013, and Bupa Home
Healthcare, driven by new contracts won in the latter part of
2013.
o In Bupa Health Funding we saw revenue growth in our SME
business, but this was offset by a decline in Individual health
insurance sales, as experienced across the whole sector.
-- Customer numbers up 3%
o Growth mainly driven by Bupa Health Clinics, due to the
expansion of our dental clinics and Bupa Cromwell Hospital, which
saw good growth in patient numbers, particularly from overseas.
o In Bupa Health Funding, we saw customer growth in our SME
business and early signs of growth in our Corporate business. This
was offset by continued tough market conditions in the Individual
health insurance sector.
-- Underlying profit up 25% year-on-year - our second consecutive year of growth.
o Supported by our focus on improving operational efficiency.
Cost savings of GBP30m delivered by improving efficiency in key
back office processes and procurement and by streamlining the sales
function.
o Profitability was also positively impacted by the results of
Bupa Health Clinics, Bupa Home Healthcare and Bupa Cromwell
Hospital. Growth in Care Services due to the impact of the
full-year contribution of Richmond Care Villages, was partly offset
by higher care home running costs and continued pressure on care
homes fee rates.
-- Bupa Care Services occupancy levels increased slightly to 87.4%.
-- We saved more than GBP1.5m in energy costs as a part of our
drive to reduce our carbon footprint. In 2014 we invested GBP13.2m
in low carbon technologies. We have more Combined Heat and Power
units (CHPs) in our portfolio than any other company in the UK and
have installed over 24,000 LED fittings.
Healthcare partner to millions more people
We are focused on meeting the changing healthcare needs and
concerns of our customers and society. We are developing innovative
products and services and campaigning to make healthcare more
affordable and accessible to deliver better value for money.
In 2014, Bupa Health Funding corporate customers experienced
some of the lowest premium increases on record. Because of our
success in healthcare cost containment, we were able to reduce or
hold premiums level for over half our renewing corporate customers.
We continue to lead reform of the UK private healthcare market
through our on-going drive to reduce healthcare costs, including
those charged by private hospitals. In November, we signed a
ground-breaking long-term agreement with Spire Healthcare on prices
for all Spire's hospitals until 2021, commencing on 1 April 2015.
We look forward to passing the benefits of this deal through to our
customers over the course of the contract. We intend to work with
other hospital providers in a similar way and are urging the whole
sector - funders, consultants and hospitals - to work together to
drive better value and transparency for customers.
We are committed to partnering with the NHS where our expertise
can benefit patients and the public health system. We havedeveloped
a pioneering intermediate care service with Central Manchester
University Hospital Foundation Trust at our Gorton Parks care home
in Eccles. In 2014, the service had over 300 admissions, helping
people back to good health without the need for a long hospital
stay. This service frees up NHS resources and provides individuals
with the opportunity to choose the care setting that is right for
them.
We are investing to address the health and care needs of the
UK's growing ageing population. In 2014, we invested GBP54m in
developing new and innovative facilities for older people, opening
two new care homes in Tunbridge Wells and Cardiff and starting work
on two new Richmond Care Villages in Witney and Aston-on-Trent, as
well as refurbishing existing homes.
A place where our people love to work
We aim to have an extraordinary culture and organisation, with
people healthier because they work at Bupa and with our people
making a positive impact in their communities.
The number of employees taking part in our annual Global People
Survey (GPS) increased by 1,547 to 78% (up from 76% in 2013). It
showed our employee engagement to be 59%. Following the roll out of
our company-wide leadership programme, 'Bupa Leaders Are', we
achieved a Leadership Index(7) score of 62%.
We provide all our people with Business Fit, as part of our
commitment to helping them feel healthier because they work at
Bupa. Business Fit offers early intervention services to speed up
access to diagnosis and treatment and physiotherapy for muscle,
bone and joint conditions. It also provides fast, direct
self-referral for mental health conditions and access to Bupa
Anytime Healthline for round-the-clock medical advice from a nurse
or GP.
Outlook
Our focus in 2015 is on growth through making private healthcare
more accessible and affordable for more people in the UK. We will
do this by focusing on operational efficiency, leading sector
reform to deliver better value and innovating to meet changing
customer needs. We will launch a three year investment programme to
address some of the UK's toughest healthcare challenges. This will
include investing in our Care Services business, with a focus on
dementia care, developing our care villages and intermediate care;
the development of new products, services and online tools to
respond to our customers' changing needs and engage more people in
their health and wellbeing and funding projects to reduce our
carbon footprint, as we recognise that good health and the
environment are interdependent. We will also continue to progress
towards our ambition of owning and operating 75 dental centres by
the end of 2015.
We will work with the government and other key parties to
clarify and enable the implementation of the Care Act to ensure it
results in improved care outcomes for residents. In 2015 we will be
launching The Bupa UK Foundation. This will be a company limited by
guarantee and a charity registered by the Charity Commission. The
Bupa UK Foundation will be entirely funded by Bupa UK, and will
provide funding for practical projects and initiatives which aim to
tackle critical challenges in health and social care, and improve
people's health and wellbeing.
Spain and Latin America
Customers Revenue Underlying Profit
---------------- ---------- ------------ ------------------
2014 4.9m GBP1,842.5m GBP130.6m
---------------- ---------- ------------ ------------------
2013 2.4m GBP1,363.5m GBP126.5m
---------------- ---------- ------------ ------------------
% growth 104% 35% 3%
---------------- ---------- ------------ ------------------
% growth (CER) 42% 9%
---------------- ---------- ------------ ------------------
The Spain and Latin America Domestic Market Unit comprises five
business units:
-- Sanitas Seguros, providing health insurance services in Spain;
-- Sanitas Hospitales and New Services, operating four private
hospitals, 19 private medical clinics, health and wellbeing
services through 19 centres and two public-private partnerships
(PPPs) in Spain;
-- Sanitas Dental, providing dental insurance services through
173 centres (109 owned and 64 franchises) and third-party networks
in Spain;
-- Sanitas Residencial, caring for around 4,700 Spanish people in 40 care homes; and
-- Bupa Chile, formerly Cruz Blanca Salud acquired in February
2014, a leading health insurer and provider in Chile with three
hospitals and 29 medical clinics, which has recently expanded its
provision operations into Peru.
Market context
-- Economic conditions in Spain remain challenging and while GDP
growth of 1.6% in 2014 suggests early signs of recovery,
unemployment levels remain very high at 24%(8) .
-- Government budget cuts are continuing to affect the Spanish
health system and satisfaction with public healthcare is
declining(9) . While this is increasing pressure on our medical
costs, as health insurance customers move more of their treatment
to the private sector, it should drive uptake of health insurance
in the medium-term.
-- In the Chilean market, despite GDP growth falling to 1.7% in
2014, the economic fundamentals and growth outlook for the market
are positive. Real GDP growth is forecast to rebound, rising to
2.7% in 2015 and 2016 and 4.3% in 2017(10) .
-- Health is a high growth sector in Chile, driven by
year-on-year growth in healthcare expenditure for more than a
decade (9.5% CAGR 2000-2012). The private health insurance market
grew by 10% in revenue in 2014, supported by an expanding number of
people taking out health insurance and increasing premiums(11)
.
Performance
Spain and Latin America delivered a resilient performance in
2014, despite tough economic conditions in Spain, delivering growth
in revenue, customers and underlying profit. We focused on
operational efficiency and innovating to respond to customer needs,
as well as integrating Cruz Blanca Salud (now rebranded Bupa
Chile).
-- Revenue up 35%, 42% at CER
o Growth primarily driven by the contribution of Bupa Chile, and
supported by strong growth in Sanitas Dental, benefiting from new
dental centres opened during the year, and good growth in Sanitas
Residencial.
-- Customer numbers up 104%
o Growth mainly due to the acquisition of Bupa Chile, but also
supported by Sanitas Dental and Sanitas Hospitales and New
Services.
o This was partially offset by challenging conditions in the
Spanish health insurance market.
-- Underlying profit up 3%, with 9% CER growth,
o Underlying profit benefited from the contribution of Bupa
Chile, as well as a strong performance by Sanitas Residencial.
o Profit was impacted by low growth rates in private health
insurance, a trend seen across the sector(12) and lower inflation
rates which have negatively affected revenue for our PPPs.
-- Sanitas Residencial achieved record occupancy, which
increased to 92%. We maintained our sales focus on the private
market to offset the impact of cuts in public expenditure on social
services, driven by Spain's challenging macro-economic
environment.
Integration and acquisition update
The integration of Bupa Chile is progressing as planned and the
business is performing ahead of expectations. During the final
quarter of 2014, we began to migrate parts of the business to the
Bupa brand, commencing with the hospitals business. The brand of
the health funding business, Isapre Cruz Blanca, will remain
unchanged for regulatory and economic reasons.
In Spain, we acquired the Virgen del Mar hospital in Madrid in
September, following our work with the hospital as a private
provision partner. The hospital includes 68 beds and provides more
than 58,000 consultations and 5,000 surgeries a year. We are now
fully integrating Virgen del Mar into the business.
Healthcare partner to millions more people
We are working with hospitals and other healthcare providers to
identify opportunities to reduce and manage medical costs. In
Spain, we have reviewed our product portfolio to help reduce the
cost of our co-payment health insurance products, which require
contributions from our customers at the point of treatment. In the
current economic climate, this move has been well received with
strong sales of co-payment products.
We are also looking closely at our own costs, and have made our
sales channels more efficient by reviewing our distribution
arrangements, signing new agreements with leading insurance brokers
to boost productivity and renewing our co-insurance partnership
with BBVA, Spain's second largest bank. This partnership provides
Sanitas with a major distribution channel to reach potential new
customers, through BBVA's 3,400 retail offices in Spain.
We continue to invest in developing market leading products,
services and facilities for our customers as a key point of
differentiation. We opened 25 new dental centres across Spain,
bringing our total number of clinics to 173 and further openings
are planned for 2015. In our Spanish health insurance business, we
focused on strengthening sales channels for independent dental
insurance products and now have over ,91,000 members. In
particular, we saw a significant increase in sales made in dental
centres.
In our hospitals and PPPs we are investing in services and
focusing on quality to attract patients to our facilities. In our
CIMA hospital in Barcelona, we opened a new Obstetrics Unit,
including a neonatal Intensive Care Unit, to provide specialist
advice and care to women during pregnancy, childbirth and the
post-natal period. Our PPP hospitals in Manises and Torrejón have
also added new services, including a new radiotherapy unit in
Torrejón. Both PPPs continue to attract patients from outside their
catchment areas, which is testament to the quality of service
patients receive in our hospitals.
As a result of our sustained focus on quality in our hospitals,
our Torrejón hospital was named the number one hospital in Spain
for digestive system surgery and management in the IASIST(13)
hospital index, in the large general hospital category, which
assesses and ranks over 150 hospitals in Spain against quality,
operational and efficiency indicators. Our Manises hospital was
also awarded a prize in the hospital management category.
In Sanitas Residencial, our care services business, we have
developed a day care service to respond to the needs of customers -
and their families - for more flexible care options. This service,
which has been rolled out to 15 care homes, is increasing our
customer reach as part of our strategy of creating 'care hubs' in
the communities in which we operate.
A place where our people love to work
We aim to have an extraordinary culture and organisation, with
our people healthier because they work at Bupa and making a
positive impact in their communities.
In our annual Global People Survey (GPS), we maintained
excellent levels of employee engagement (81%). Following the roll
out of our company-wide leadership programme, 'Bupa Leaders Are',
we achieved a Leadership Index(14) score of 73%.
We are committed to helping our people to be healthier because
they work for Bupa. Sanitas' 'Smile' programme is focused on
providing employees with health and wellbeing support for
themselves and their families, including nutritional advice, online
personal training plans, smoking cessation guidance and stress
management workshops. In 2014, 2,685 employees participated in the
programme, with independent research by Universidad Europea showing
that their health indicators improved within six months of
enrolment, while productivity also increased by 43.3%. Due to the
success of the programme for our own people, Sanitas has now
developed 'Smile' as a new product offering for corporate
customers.
Outlook
We will continue to focus on the integration ofBupa Chile,
driving operational efficiency, developing products and services to
respond to our customers' needs and exploring entry into further
markets in Latin America where we see strong growth potential. In
our Spanish health insurance business we expect tough trading
conditions to persist in 2015. We will continue to manage medical
costs carefully to ensure that our products are affordable and we
deliver sustainable growth. We expect an improved performance from
our hospitals, PPPs and New Services as established facilities grow
and new facilities become fully operational, particularly the CIMA
and Virgen del Mar hospitals.
International Development Markets
Customers Revenue Underlying Profit
---------------- ---------- ---------- ------------------
2014 12.1m GBP506.7m GBP17.1m
---------------- ---------- ---------- ------------------
2013 8.7m GBP377.3m GBP5.9m
---------------- ---------- ---------- ------------------
% growth 39% 34% 190%
---------------- ---------- ---------- ------------------
% growth (CER) 42% 235%
---------------- ---------- ---------- ------------------
International Development Markets (IDM) comprises:
-- Domestic health insurance businesses in Hong Kong, Thailand,
India and Saudi Arabia, as well as a representative office in
China;
-- LUX MED, the largest private healthcare business in Poland; and
-- Quality HealthCare, the largest private clinic network in Hong Kong.
-- Health Dialog, a health analytics business in the USA, sold
to Rite Aid in March 2014, as previously reported at the half year
2014.
Market context
-- In 2014 there was a general slowdown in emerging market
economies and a weakening of exchange rates, while political and
social changes in the markets in which IDM operates have presented
opportunities and challenges.
-- In India, as soon as legislative approval is granted for an
increase in the foreign direct investment limit for the insurance
sector, we intend to submit a formal application to the relevant
authorities in India to increase our stake in our joint venture,
Max Bupa, to the proposed new maximum limit of 49%.
Performance
IDM performed strongly in 2014 growing revenue, customers and
underlying profit, as we continued to deliver our strategy of
growing and developing our existing markets, while exploring
opportunities to enter new territories where we see potential to
deliver strong growth and increase standards of healthcare for
millions more people.
-- Revenue up 34%; up 42% at CER
o Growth driven by the full-year contribution of our LUX MED and
Quality HealthCare acquisitions made in 2013 and supported by
strong sales in Thailand and Hong Kong. Revenues from our Bupa
Arabia associate and our Max Bupa joint venture are not included in
our revenue figures(15) .
o This growth was partly offset by the sale of the US operations
of Health Dialog to Rite Aid in March.
-- Strong customer growth of 39%
o 18.4% of customer growth was delivered by our 2013
acquisitions and 13.8% by Bupa Arabia and Max Bupa(16) . Bupa
Arabia performed particularly strongly due to significant corporate
wins including a contract to provide health insurance to Saudi
Basic Industries Corporation, Bupa's largest ever corporate win in
terms of customers. Our micro health insurance initiatives in India
and Ghana contributed a further 5.7% to customer growth.
-- Underlying profit up 190%, up 235% at CER, an improvement of GBP11.2m on 2013.
o This was largely due to the strong performance of Bupa Arabia,
the impact of earnings from our 2013 acquisitions and the
divestment of the US operations of Health Dialog.
Integration and acquisition update
In Poland, we are focused on developing LUX MED's integrated
healthcare funding and provision offering, as we believe the
integrated model brings better oversight of the patient journey and
makes healthcare more affordable and accessible. We are investing
in the development of the business, completing several local
acquisitions during the year and launching a new specialist dental
centre in Wroclaw, one of Poland's biggest cities. In Hong Kong, we
are embedding the Quality HealthCare clinic business into the
organisation and in August opened a new premium medical centre.
Healthcare partner to millions more people
In April, together with Bupa Global, we significantly increased
our reach to millions more people in Hong Kong, when we launched a
10-year distribution partnership with Hang Seng Bank, part of HSBC
and one of Hong Kong's leading retail banks with three million
customers. The partnership, coupled with our acquisition of Quality
HealthCare in 2013, further strengthens Bupa's market position in
Hong Kong. Alongside our well established health insurance
business, we now have an extensive footprint in healthcare
provision and a major new distribution channel through which to
reach potential customers with quality, affordable healthcare.
In India, Max Bupa launched Bancassurance partnerships with
Deutsche Bank, Standard Chartered, Ratnakar Bank and Federal Bank,
significantly increasing our distribution network in the market and
enabling us to access up to 14m potential new customers.
During 2014, Bupa Arabia and LUX MED both developed high-profile
sporting partnerships providing a platform to extend the reach and
impact of our brand beyond our customers and to engage more people
in their health and wellbeing. Bupa Arabia formed a strategic
partnership with Saudi Arabia's largest and most successful
football club, Riyadh's Al-Hilal FC. The partnership provides
Al-Hilal FC with health insurance and healthcare services for the
club. LUX MED became the first private healthcare provider to
partner with the Polish Olympic Committee. This partnership
provides LUX MED with a platform to engage with sportspeople and
fans alike in Poland about improving their health and wellbeing
through sport and physical activity.
In India, Max Bupa hosted its Walk for Health event in Delhi and
Mumbai for the third consecutive year, involving more than 15,000
families, 5,000 school children and numerous businesses. All
participants walked 5km and pledged to incorporate more walking
into their daily routine. The event aims to educate the public
about the benefits of walking to bring about positive and
sustainable behaviour change.
We are focused on developing new products and services that
answer our customers' needs. In July, Max Bupa launched an enhanced
version of its popular Heartbeat Health Insurance plan to respond
to India's strong family-focus. The enhanced product offers
individuals the opportunity to insure many members and generations
of their family on one policy.
A place where our people love to work
We aim to have an extraordinary culture and organisation, with
people healthier because they work at Bupa and with our people
making a positive impact in their communities.
Our annual Global People Survey (GPS) in IDM showed a
significant increase in employee engagement (up 17% to 75%) and
following the rollout of our company-wide leadership programme,
'Bupa Leaders Are', we achieved an overall Leadership Index(17)
score of 77%.
As a healthcare leader, the continuous learning and development
of our medical personnel is a focus area and in 2014 over 1,400
doctors and nurses took part in LUX MED's 'Academy' medical
training lectures on Family Medicine, Surgery, Lifesaving and
Midwifery.
Following investment in employee wellbeing initiatives, we saw a
significant increase in GPS scores with our people saying they are
healthier because they work at Bupa (up 54% to 60%). In Bupa
Arabia, we introduced a business-wide initiative to increase
employee fitness levels, reduce body fat and increase muscle mass
through tailored fitness and nutritional programmes.
Outlook
Building on the momentum of 2014, our focus is on consolidating
and growing existing markets and exploring opportunities to enter
emerging territories where we see strong, sustainable growth
potential with significant opportunities to increase standards of
healthcare for millions more people. We are confident in the
long-term economic outlook in all of IDM's markets. We anticipate
Bupa Arabia will continue to demonstrate strong growth and we will
continue the integration of our 2013 acquisitions, LUX MED and
Quality HealthCare.
Bupa Global
Customers Revenue Underlying Profit
---------------- ---------- ---------- ------------------
2014 2.1m GBP958.7m GBP97.9m
---------------- ---------- ---------- ------------------
2013 1.9m GBP953.0m GBP114.0m
---------------- ---------- ---------- ------------------
% growth 11% 1% -14%
---------------- ---------- ---------- ------------------
% growth (CER) 4% -12%
---------------- ---------- ---------- ------------------
The Bupa Global Market Unit provides products and services
worldwide to people who want access to premium healthcare at home
or as they study, live, travel or work abroad. Bupa Global provides
international health insurance, travel insurance and medical
assistance to individuals, small businesses and global corporate
customers all around the world. Bupa Global is comprised of three
operating units:
-- Bupa Global Latin America, the largest provider of
international health insurance in the Latin America region;
-- Bupa Global North America, responsible for Bupa's significant
(49%) investment in Highway to Health, Inc. in the US and the
strategic global partnership with the Blue Cross and Blue Shield(R)
(BCBS) system, the largest US-based health insurance group; and
-- Bupa Global Business Unit, which oversees Bupa Global's new
regional operations in Greater China and the Middle East, as well
as retaining responsibility for the remaining regions of Africa,
South East Asia and Europe.
Market Context
-- Bupa Global operates across multiple regions and economies,
with a number of common themes and trends influencing demand for
Bupa Global's products and services.
-- There are over 232 million international migrants in the
world today(18) and an increasing trend for global mobility with
assignments abroad expected to double over the decade(19) . We
anticipate these trends will fuel demand for both corporate and
individual international private health insurance.
-- During 2014, we saw a continued trend towards mandatory
health cover regimes in a number of countries in which we operate.
While these changes primarily impact domestic health insurance
products, we continue to monitor such developments closely to
ensure that our products remain a distinctive, premium and
international alternative, addressing more than minimum local cover
requirements and providing competitive advantage.
Performance
2014 was a year in which we began the transformation of our Bupa
Global Market Unit, as we regionalised our operations to better
serve our customers, delivered operational efficiencies, focused on
strategic partnerships and developed new tiered products in key
markets to provide access to high quality healthcare anytime,
anywhere.
-- Revenue up 1%, up 4% at CER, supported by several major corporate account wins.
-- Customer numbers up 11%, with growth in all segments, a
significant contribution by Highway to Health, Inc. and continued
growth in key markets such as the United Arab Emirates and Hong
Kong, combined with a year-on-year improvement in individual
customer retention rates.
-- Underlying profit decreased by 14%, down 12% at CER, due to
higher claims costs on certain large corporate accounts. We
reviewed, re-priced and in some cases decided to discontinue these
accounts, while strengthening our claims provision. Profitability
was also impacted by our investment in transformation (see below).
This transformation will enable our continued move to a regional
operating model, bringing our resources closer to our
customers.
Transformation and Regionalisation
We are streamlining our business to integrate previously
separate Bupa businesses into a single Market Unit, delivering
operational efficiencies, removing duplication and reducing the
number of managerial layers.
To support our integration, in July, we completed our global
brand migration from legacy trading names to our new trading name,
Bupa Global, which is now used in all customer communications. Our
new name better reflects our customer base and our products and
services, and enables a more consistent customer experience
globally.
We are also ensuring our customer service, sales and marketing
capabilities are closer to our customers. To better serve our
customers in their own language, culture and time zone, we
continued to regionalise our operations in 2014. We established
three new regions - Bupa Global North America, Bupa Global Greater
China and Bupa Global Middle East to oversee our expansion in those
regions. The new regions complement the existing Bupa Global Latin
America region and Bupa Global Business Unit, which retains
responsibility for remaining geographies.
Healthcare partner to millions more people
We will engage millions more people with their health and
wellbeing through our strategic partnerships. In 2014, we began a
strategic global partnership with the Blue Cross Blue Shield
Association, an association of 37 independent local Blue Cross and
Blue Shield Plans which collectively constitutes the largest
US-based health insurance group. As a result of the partnership,
our customers in all but a few countries worldwide, will benefit by
accessing the Blue Cross and Blue Shield network of over 5,700
hospitals and 800,000 providers when travelling or working in the
US. Blue Cross and Blue Shield members of 'Geo Blue',a product
offered to Americans leaving the US to study, live or work abroad,
now also benefit from an expanded international network.
In partnership with IDM's domestic health insurance business in
Hong Kong, we launched a range of individual and corporate products
and services, as a part of our new 10-year distribution agreement
with Hang Seng Bank. These products and services are now available
to the Bank's three million customers. Services include support for
those with, or at risk of developing, a chronic condition, such as
heart disease or diabetes, helping to address Hong Kong's
escalating incidence of chronic disease(20) . Services are designed
to empower people to better understand and manage their condition.
Other services include a stand-alone medical concierge service,
which provides professional healthcare support and assistance,
including a 24/7 health line, and a second expert medical opinion
service. Our partnership with Hang Seng Bank will be extended to
mainland China in 2015 with the launch of a similar product
offering. Early sales figures in Hong Kong are currently exceeding
expectations.
In the UK we launched our first range of tiered products in
December - Bupa Global Select, Premier, Elite and Ultimate Health
Plans. These products allow customers to tailor their level of
cover to their healthcare needs and expectations, with similar
propositions to be rolled out in a number of our priority markets
in 2015.
A place where our people love to work
We aim to have an extraordinary culture and organisation, with
people healthier because they work at Bupa and with our people
making a positive impact in their communities.
Our annual Global People Survey (GPS) showed an overall decrease
in employee engagement (down 14% to 63%). This is the result of an
average decrease across the entire Global Market Unit as we
launched our change programme, but we saw some strong areas of
performance including a score of 87% for Bupa Global Latin America,
ranking it above other peer organisations of similar sizes. Through
our change programme, we maintained our focus on employee
engagement with a series of internal events and communication
campaigns to help our people grow their understanding of our
strategy and engage in how their functions and roles are
contributing to our success. Following the rollout of our
company-wide leadership programme, 'Bupa Leaders Are', we achieved
a Leadership Index(21) score of 68%.
We also created opportunities for our people to have a positive
impact in their communities. For example, in September, we held our
first 'Wellbeing in my Community Day' for Brighton-based employees
with over 300 of our people learning about Bupa health benefits and
services available to them and other health and wellbeing services
provided in the local community. The event was run in partnership
with MIND, a UK-based mental health charity. In October, our
Miami-based employees participated in a number of events for Cancer
Awareness Week, including fundraising activities and a "Bupa Pink
Friday Walk" in which the majority of our employees took part in a
walk to raise breast cancer awareness in the local community.
Outlook
In 2015, the transformation of Bupa Global will continue. We
will maintain our focus on our regionalisation strategy, in
particular on building our new regions - Bupa Global North America,
Bupa Global Greater China and Bupa Global Middle East. We will
launch tiered products in a number of priority markets, including
Hong Kong and Mexico, to offer customers greater choice and access
to quality healthcare. The integration of our global provider
network will continue to give customers access to leading hospitals
and healthcare professionals wherever they are in the world, as it
has done in the past. Lastly, sustained collaboration with other
parts of Bupa will ensure that we all benefit from our joint scale
and expertise.
BUPA 1025Z LN
(1) Businesses acquired in 2013 and 2014, most notably
Innovative Care, LUX MED, Dental Corporation, Quality HealthCare
and Cruz Blanca Salud.
(2) See Financial Review (p22) for definition of underlying
profit before taxation.
(3) Adjusted for the impact on our net financial expense for the
cost of additional borrowings used to finance acquisitions.
(4) While revenues from our associate and joint ventures, Bupa
Arabia, Max Bupa and Highway to Health Inc., are excluded in our
reported figures, customer numbers and the appropriate share of
profit from these businesses are included in our reported
numbers.
(5) The Leadership Index brings together all questions in Bupa's
Global People Survey aligned to our leadership profile. It measures
the experience our people are having of our leaders including
perceptions of the leaders' commitment to their own leadership
growth, their commitment to growing and developing others, their
ability to help our people understand and connect to Bupa's overall
strategic vision and purpose, as well as the overall quality of
their management.
(6) Bupa's Generation X research, conducted by YouGov, found
that 50% of those born between 1959 and 1980 say the main barrier
to having private healthcare is that they can't afford it, with 37%
saying that would be more likely to have it if it was more
affordable. Research undertaken in July 2014 with a sample size of
2,005.
(7) See footnote 4.
(8) Source: INE, the Spanish National Statistics Institute.
(9) Source: Annual Health System Survey, Spanish Ministry of
Health
(10) Source: Central Bank of Chile (Monetary Policy Report
December 2014)
(11) Source: National Public Health Fund (Fonasa),
Superintendence of Health, Chile
(12) Source: ICEA, the institute for statistics and studies of
the insurance sector in Spain, a part of UNESPA, the Spanish trade
association for insurance companies.
(13) IASIST is an expert in providing management information on
clinical and economic performance of healthcare providers in Spain.
It has the largest, most detailed and up-to-date clinical databases
in Spain.
(14) See footnote 4.
(15) While revenues from our associate and joint venture are
excluded from our reported figures, customer numbers and the
appropriate share of profit from these businesses are included in
our reported numbers.
(16) Excluding Max Bupa's micro health insurance customers,
which are included in the growth from micro health insurance
initiatives below.
(17) See footnote 4.
(18) United Nations Department for Economic and Social Affairs
Population Division - September 2013.
(19) PriceWaterhouseCoopers' Talent Mobility 2020 report
spanning 2010 to 2020.
(20) Source:
http://www.statistics.gov.hk/pub/B11301622014XXXXB0100.pdf
(21) See footnote 4.
This information is provided by RNS
The company news service from the London Stock Exchange
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