Shining star of the global healthcare sector

Annual Report 2019

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Great Success in Foreign Medical Tourism

We have an important role in increasing Turkey’s share in global health tourism. With our expertise, service quality and treatment technology, we have reached a position that accepts patients not only from the nearby regions but from all around the world.

Medical Park and Liv Hospital brands are now in Turquality Program


Contributing to increase Turkey’s share from Foreign Medical Tourism (FMT) with foreign currency inflow of over 76 million USD generated from more than 70 thousand patients from approximately 180 countries each year, MLP Care admitted to Turquality with its two brands. Thus, MLP Care became the first company in the service sector to be admitted to this program with two different brands in Turkey.

Reliable Technological Steps

In line with our long-term strategy, we increased the use of technology in our operations with our work in digitalization, automation and artificial intelligence. We aim to develop an ecosystem that will benefit not only our company, but also our country and the region we are in, by implementing technologies that will shape the future of the health sector.

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Şans Ver (Give a Chance)
Social Responsibility Project

More than 28,000 patients in Turkey are struggling to hold on to life in difficult conditions due to organ failure. In order to increase the number of organ donations, we raise awareness on this issue with our campaign which based on our www.sansver.org website, and carry out an exemplary social responsibility project. 

MLP Care is Turkey’s largest multidisciplinary hospital group.

MLP Care in Brief


More than 12 thousand permanent employees

MLP Care leads the Turkish healthcare sector with its hospital facilities, affiliates and more than 12 thousand permanent employees.

Originally founded in 1993 as Medical Park, MLP Sağlık Hizmetleri A.Ş. (MLP Care) continues to extend its reach with the Liv Hospital brand and the VM Medical Park concept. As the largest healthcare group in the industry, MLP Care currently operates 29 hospitals in 16 cities across the country – from Bursa and Elazığ to Trabzon and Antalya. MLP Care leads the Turkish healthcare sector with its hospital facilities, affiliates and more than 12 thousand permanent employees.

Boasting a powerful brand and a broad portfolio of services aimed at diversified customer segments, MLP Care is Turkey’s largest multidisciplinary hospital group. The Company’s highly centralized business model supports hospital field operations and central management. MLP Care has a nationwide network that spans the most populated cities in Turkey.

Maintaining strong and profitable growth, MLP Care’s business model is supported by a balanced payer profile. The Company’s executive management team consists of senior professionals who have extensive industry knowledge and experience gained at Turkey’s leading healthcare institutions and enterprises.

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Premium Mass

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2 BRANDS AND 1 CONCEPT TARGETING DIFFERENT SEGMENTS

BALANCED REVENUE SOURCES

MLP Care has a unique approach that allows the Company to target diverse segments in the population. The Company provides services in Turkey under two brands and one concept, featuring three pricing strategies: These are the Medical Park and Liv Hospital brands, and the VM Medical Park concept, respectively.

OUR STRENGTHS

  1. Operates in the attractive Turkish healthcare market
  2. Leader in private hospital provision
  3. Strong brand recognition and unique business model addressing all price points
  4. Clinical excellence and world-class service offering
  5. Superior operational and financial performance
  6. Outstanding platform for further growth
  7. Visionary leadership supported by an exceptional management team

Vision, Mission and Values

Vision

We aim to become a reference institution abroad and the most preferred private healthcare service provider in Turkey.

We are going to reach our vision by;

  1. Keeping our patients as the top priority, 
  2. Achieving measurable and high-quality clinical results, 
  3. Investing in human, infrastructure and technology, 
  4. Being the most attractive institution in which physicians and other medical personnel are willing to work.

Mission

We work to ensure that all people live healthy lives.

Values

  • We value people – reliability is our core indispensable principle.  
  • We make a difference with our services.  
  • We are committed to scientific methods and continuous improvement.  
  • We are an agile, goal- and success-oriented team.  
  • We serve as a model institution with our ethical principles and professional ethics. 

Certifications and Awards

  • JCI (Joint Commission International) Accreditation Standards 
  • Ministry of Health Quality Standards 
  • SRC Center of Excellence Certification  
  • Surgical Review Corporation Center of Excellence Award 
  • Bond and Loans 2019 “IPO/Equity Capital Markets Deal of the Year” Award 
  • Runner-up Award in the Healthcare Services category in Turkey’s Top 500 Service Exporters Survey organized by the Turkish Exporters Assembly (TIM) 
  • Medical Park and Liv Hospital brands were accepted to the Turquality Support Program 
  • MLP Care’s Investor Relations practices ranked at the top of the list in the EMEA for all sectors according to a survey by Institutional Investor. 

2019 Highlights

MLP Care completed a strong 2019, performing above expectations due to balanced and efficiency-oriented growth.


TL 3,7 Billion

MLP Care continued its strong growth trend in 2019, increasing its revenue and EBITDA above expectations to TL 3.7 billion, up by 18%, and TL 560 million, up by 33%, respectively.

  • MLP Care continued its strong growth trend in 2019, increasing its revenue and EBITDA above expectations to TL 3.7 billion, up by 18%, and TL 560 million, up by 33%, respectively.
  • MLP Care expanded its hospital network by adding VM Medical Park Maltepe Hospital in December 2019.
  • MLP Care completed the year with operational success, exiting from three of its non-contributing small-scale hospitals to tighten portfolio efficiency, in line with its strategy to focus growth in metropolitan areas with large-scale hospitals and smart cost management. The Company mitigated its FX exposure by hedging the principal and interest payments of the EUR-denominated syndicated loan for the 2019-2020 period in 2018.

Extel Survey 2019

MLP Sağlık Hizmetleri A.Ş. (MLP Care), the leading hospital group of Turkey with the Medical Park and Liv Hospital brands, achieved notable success in its investor relations practices. MLP Care ranked 8th for “Best Corporate IR” in the Extel Survey 2019 MedTech & Services category. In addition, MLP Care ranked 1st in the MedTech & Services category for:

  • “Quality of Website/Webcasting,” 
  • “Most Improved Service (Quality of Service),” 
  • “Quality of One-to-One Meetings,” 
  • “Quality of Non-Deal Roadshows/Visits,” 
  • “Quality of Annual Reports/Formal Disclosure,” 

and ranked 2nd for

  • “Business Knowledge/Insights,” 
  • “Proactivity of Senior Executives.” 

Institutional Investor 2019

MLP Care has been listed among the “Most Honored Companies” by Institutional Investor, one of the world’s leading corporate investment magazines, for its investor relations practices. As one of two companies awarded in the MedTech & Services category, MLP Care was also included in the “The Best CEOs,” “The Best CFOs,” “The Best IR Professionals,” and “The Best IR Program” lists. Thus, having received the highest score, MLP Care ranked at the top of the list for all sectors, sharing the first place with two other companies. 

MLP Care has been listed among the “Most Honored Companies” by Institutional Investor, one of the world’s leading corporate investment magazines, for its investor relations practices.

As a result of Institutional Investor’s “Emerging EMEA Executive Team 2019” survey, which evaluated nearly 400 companies and executives from more than 20 sectors in the region covering Europe, Middle East and Africa (EMEA), with the participation of more than 12,000 investment professionals, MLP Care was awarded the special designation of “Most Honored Company,” along with just 43 companies from the region.

Optimization in the Hospital Portfolio in 2019

In line with its strategy of expanding in metropolitan areas through large-scale hospitals, MLP Care performed two notable transactions. 

Maltepe

MLP Care’s 80%-owned subsidiary, Samsun Medikal Grup Özel Sağlık Hizmetleri A.Ş., signed a contract to acquire Özel Mehmet Toprak Hospital in Maltepe, Istanbul, on December 6, 2019. The agreement consists of the acquisition of the hospital license and the long-term leasing of the hospital building and medical equipment. 

The hospital is currently operational, and no additional capital expenditure is foreseen. MLP Care intends to bring the hospital to its full potential via leveraging the Company’s brand strength, operational know-how, and experienced physicians and management staff.

The acquired hospital has 125 beds, 60 policlinic rooms, seven operating rooms, and a total closed area of 20 thousand m². It is located in Maltepe, among the top ten most populous districts in Istanbul, with 500 thousand people.

Arkaz

As part of its strategy to focus growth in metropolitan areas with large-scale hospitals, MLP Care decided to exit from some of its non-contributing small-scale hospitals to increase portfolio efficiency. In 9M 2019, the share of the exited hospitals in consolidated revenues was 3.4% and -1.0% in consolidated EBITDA.

In this context, MLP Care sold its 57% stake in Arkaz Sağlık Hizmetleri A.Ş. (Arkaz), which includes Avcılar, Ereğli and Silivri hospitals, to the minority shareholder Hayati Arkaz for cash proceeds. As part of the transaction, Çanakkale Hospital was spun off from Arkaz and MLP Care acquired the remaining 43% stake in Çanakkale Hospital, increasing the Company’s ownership to 100%. In 9M 2019, the share of the Çanakkale hospital in consolidated revenues was 0.9% and 1.3% in consolidated EBITDA.

The regulatory approvals for both the Maltepe and Arkaz transactions were completed as of December 17, 2019.   

Key Indicators

In 2019, MLP Care’s EBITDA** increased by 32.8% to TL 560 million compared to last year.

Main Income Statement Items


2018

2019*

Change

Revenue (TL million)

3,132

3,704

18%

Operating Income (TL million)

301

450

49%

Operating Income Margin

9.6%

12.1%

251 bps

Net Profit/(Loss) (TL million)

(104)

18

n.m.

Adjusted EBITDA*** (TL million)

505

579

15%

Adjusted EBITDA*** Margin

16.1%

15.6%

(48) bps

Adjusted EBITDA** (TL million)

421

560

33%

Adjusted EBITDA** Margin

13.5%

15.1%

166 bps

Free Cash Flow (TL million)

50

236

373%

Main Balance Sheet Items


2018

2019*

Change

Cash and Cash Equivalents (TL million)

223

306

37%

Total Assets (TL million)

3,239

3,606

11%

Equity Attributable to the Owner of the Company (TL million)

474

451

(5%)

Net Financial Debt (TL million)

1,243

1,465

18%

Net Financial Debt/Adjusted EBITDA

2.5

2.5

3%


*Excluding obligations under operational leases related to IFRS 16

**Adjusted (excluding FX effect of other income/expenses from operating activities)

***Adjusted (Excluding obligations under operational leases related to IFRS 16)

Message from
the Chairman and CEO

“In order for both our Company and our country to achieve their goals, we must produce high value-added services: To accomplish this, we need to produce technologies that will shape this transformation.

Armed with this awareness, we have been conducting digital transformation studies comprehensively for two years, as well as structuring our clinical artificial intelligence studies.”

Dr. Muharrem Usta
Chairman of the Board of Directors and CEO

Esteemed Shareholders, Business Partners and Employees,

While needs and expectations in terms of healthcare vary worldwide, the rapid development of technology is deepening the great transformation in healthcare services. There is no doubt that the countries and institutions driving this evolution will play a strong role on the global stage.

Thanks to competitive advantages such as specialist physicians and healthcare personnel, advanced medical devices and success in complex operations, Turkey has become one of the most important healthcare destinations in the world. I would like to acknowledge our pride and satisfaction in contributing to this success of our country with our Medical Park and Liv Hospital brands.

In 2019, as a Group, we provided foreign currency inflow of more than USD 76 million to our country by about 32% compared to the previous year, through increasing revenue generated from the services we offer to foreign patients. At the same time, the share of Foreign Medical Tourism (FMT) in our total revenue expanded from 5% to 12% between 2016 and 2019.  


32% increase

In 2019, as a Group, we provided foreign currency inflow of more than USD 76 million to our country by about 32% compared to the previous year, through increasing revenue generated from the services we offer to foreign patients.

We have impressive goals in foreign medical tourism. As you know, our Medical Park and Liv Hospital brands were accepted to the Turquality Support Program towards the end of 2019. We are well aware that being the first company in the service sector to receive Turquality for two brands at the same time presents us with great responsibility, along with great joy and satisfaction. While continuing to work at full strength to become a world brand in healthcare, I believe that being supported as a Turquality brand will add significant momentum to our Company.

In order for both our Company and our country to achieve their goals, we must produce high value-added services: To accomplish this, we need to produce technologies that will shape this transformation. Armed with this awareness, we have been conducting digital transformation studies comprehensively for two years, as well as structuring our clinical artificial intelligence studies.

We recently signed a multi-faceted strategic partnership with the American artificial intelligence software developer, Enlitic, in the field of clinical artificial intelligence. Enlitic, our partner, develops artificial intelligence software that works as a decision support system for physicians and helps them to diagnose patients’ conditions faster and more accurately. Within the scope of our cooperation, deep learning models will be developed, trained and validated by using Enlitic’s artificial intelligence software technology for many foreign patients applying to our hospitals for advanced healthcare services, as well as for domestic patients. With the integration of the developed artificial intelligence models, the imaging and diagnostic stages will be accelerated, and processes will be comprehensive and achieved with minimum error. We plan to present clinical artificial intelligence models to healthcare institutions operating in Eastern Europe and Central Asia, as well as to those in our country.


As MLP Care, while focusing on sustainable growth, we will continue to take bold steps towards the digitalization of healthcare.

We have also reached one of our goals by establishing the first of its kind Medical Artificial Intelligence Center in Turkey with İstinye University, to develop artificial intelligence models and facilitate learning processes. In this center, we are working hard to become leader not only in Turkey but also in Eastern Europe and Central Asia through data processing and artificial intelligence algorithms by launching one of the best supercomputers in our country. At the same time, this Center will mark a significant step to use and to integrate AI into a global healthcare system through developed models. I believe this cooperation will be the beginning of a project that will create great value for Turkey.

In 2019, while we were working on these exciting projects, we also continued our efficiency studies. We focused on cost management and, as a result of these efforts, we achieved growth of 18% in revenue and 33% in EBITDA.

In line with our strategy of expanding in metropolitan areas through large-scale hospitals, we exited from three small-scale hospitals to increase portfolio efficiency, and we added another important hospital in İstanbul (22 thousand sqm) to our network.

As MLP Care, while focusing on sustainable growth, we will continue to take bold steps towards the digitalization of healthcare. Rather than merely keeping pace with the digital world, we seek to be one of the leading companies of this transformation process in the world and to undertake projects that will set an example, not only in our country but also in all around the world. I express my thanks to our employees and our valuable stakeholders, whom I believe will be our greatest strength in this journey to shape the future of the healthcare sector.

Respectfully yours,
Dr. Muharrem USTA 
Chairman of the Board of Directors and CEO

MLP Care Activity Map

HOSPITALS OPENED IN 2019

VM Medical Park Maltepe Hospital

Opening: December 2019
Location: Istanbul 

TL 3.7 BILLION

Revenue

TL 560 MILLION

EBITDA*

*Adjusted (excluding FX effect of other income/expenses from operating activities and obligations under operational leases related to IFRS 16)

16 CITIES

29 HOSPITALS

around

20,000

employees